三维造影增强能量多普勒超声在卵巢肿瘤诊断中的应用

Application of three-dimensional contrast-enhanced power Doppler ultrasound for ovarian masses

目的探讨三维造影增强能量多普勒(3D-CEPD)在卵巢良恶性肿瘤鉴别诊断中的价值。方法对50例卵巢肿瘤患者分别于造影前、造影中及造影后进行三维能量多普勒(3D-PD)检查。采用3D-PD直方图计算肿瘤血管形成指数(Ⅵ)、血流指数(FI)和血管形成-血流指数(VFI),比较卵巢良性与恶性肿瘤各血管参数的差异及各血管参数在造影前、造影中、造影后的差异,并评价3个参数的诊断效能。结果 50例患者中,18例为恶性肿瘤,32例为良性肿瘤。造影前、中、后卵巢恶性肿瘤的血管参数均明显高于良性肿瘤(P均<0.01),良恶性肿瘤的各血管参数在造影前、造影中、造影后的差异有统计学意义(P均<0.01)。3个不同检查时段血管参数鉴别卵巢良恶性肿瘤的ROC曲线下面积均为Ⅵ最大,FI最小。造影前、中、后三个不同检查时段Ⅵ诊断卵巢恶性肿瘤的ROC曲线下面积分别为0.83、0.87、0.89。造影前以Ⅵ=2.2%为界值,鉴别卵巢良恶性肿瘤的敏感度、特异度、阳性预测值、阴性预测值及准确率为77.77%、87.50%、77.77%、87.50%、84.00%;造影中以Ⅵ=23.2%为界值,各诊断效能分别为94.44%、90.62%、85.00%、96.66%、92.00%;而造影后以Ⅵ=12.4%为界值,各诊断效能分别为94.44%、93.75%、89.47%、96.77%、94.00%,造影中及造影后的诊断效能较造影前明显增高(P<0.01),而造影后的特异度、阳性预测值优于造影中(P<0.01)。结论 3D-CEPD可提高鉴别卵巢肿瘤良恶性的能力,血管参数Ⅵ最有诊断价值,其诊断效能以造影后更佳。

Objective To investigate the diagnostic value of three-dimensional contrast-enhanced power Doppler （3D- CEPD） in differentiating benign and malignant ovarian masses. Methods Fifty patients with ovarian masses were evaluated by 3D-PD before contrast-enhanced, contrast-enhanced medium and after contrast-enhanced. Vascularization index （VI）, flow index （FI） and vascularization-flow index （VFI） were calculated using 3D-PD histogram which were compared be- tween the benign and malignant tumors and among three different inspection periods. The diagnostic efficacy of three pa- rameters was evaluated. Results Of the 50 cases, 18 cases were malignant, and 32 cases were benign. In three different inspection periods, the vascular parameters of malignant tumors were significantly higher than those of benign tumors （all P〈0.01）. The differences of the vascular parameters in three different periods were also statistically significant （all P〈 0.01）. The area under the ROC curve （AUC） of VI was the highest, and of FI was the lowest. AUCs of VI in three different periods was 0.83, 0.87 and 0.89, respectively. Before contrast-enhanced, with VI=2.2% as cut-off value, the sensitivity, specificity, positive predictive value, negative predictive value and accuracy rate in diagnosing malignant tumors was 77.77%, 87.51%, 77.77%, 87. 50%, 84.00%, respectively. In contrast-enhanced medium, with VI= 23.2% as cut-off value, the diagnostic performance was 94.44%, 90.62%, 85.00%, 96.66%, 92.00%. And after contrast-en- hanced, with VI= 12.4% as cut-off value, the diagnostic performance were 94.44%, 93.75%, 89.47%, 96. 77%, 94.00%, respectively. The diagnostic efficacy in contrast-enhanced medium and after contrast-enhanced were better than those in before contrast-enhanced （P〈0.01）. Conclusion 3D-CEPD can improve the ability of differential diagnosis of be- nign and malignant ovarian tumors. VI has high diagnostic value in the three vascular parameters. After contrast-enhanced, the diagnostic efficiency is higher than the others.