妇科超声影像报告和数据系统联合三维超声造影鉴别诊断卵巢良恶性肿块

Gynecologic imaging reporting and data system combined with three-dimensional contrast-enhanced ultrasonography for differential diagnosis of benign and malignant ovarian masses

目的探讨妇科超声影像报告和数据系统(GI-RADS)联合三维超声造影(3D-CEUS)鉴别诊断卵巢良恶性肿块的价值。方法对102例卵巢肿块患者行二维超声及3D-CEUS检查,观察3D-CEUS灌注特征,并采用GI-RADS评估二维声像图表现。通过单因素χ~2检验及多因素Logistic回归分析,获得卵巢恶性肿块的独立预测因子,构建GI-RADS与3D-CEUS联合评分系统。绘制ROC曲线,评价GI-RADS联合3D-CEUS与单纯应用GI-RADS诊断卵巢恶性肿块的效能,并进行比较。结果单因素及多因素分析结果显示,卵巢恶性肿块的独立预测因子包括大乳头状突起物(≥7mm)、分隔或囊壁厚度≥3mm、有中心性血流、病灶实性成分≥50%,合并腹腔积液、高增强、造影剂分布不均匀以及血管密集、走行纡曲、杂乱。GI-RADS与3D-CEUS联合评分系统诊断卵巢恶性肿块的最佳临界值为4分,GI-RADS联合3D-CEUS的ROC曲线下面积大于单纯应用GI-RADS(0.969vs 0.839,Z=1.64,P=0.029),且敏感度、特异度、阳性预测值、阴性预测值及准确率均高于单纯应用GI-RADS(P均<0.001)。结论与单纯应用GI-RADS相比,GI-RADS联合3D-CEUS可更有效地鉴别卵巢良恶性肿块。

Objective To evaluate the efficacy of the combination of gynecologic imaging reporting and data system（GIRADS）ultrasonographic stratification and 3D contrast-enhanced ultrasonography（3D-CEUS）in identifying malignant lesions from benign ovarian masses.Methods Both of 2D ultrasound（2D-US）and 3D-CEUS were performed on 102 patients with ovarian masses.The perfusion characteristics of ovarian masses were observed with 3D-CEUS,and the 2D-US features of ovarian masses were analyzed based on GI-RADS.Simple and multiple Logistic regression analysis were used to investigate whether the independent risk predictors in differential diagnosis of benign and malignant ovarian could be confirmed.In addition,ROC curves were drawn.The diagnostic efficacy of GI-RADS combined with 3D-CEUS scoring system was evaluated and compared with that of only GI-RADS.Results Simple and multiple Logistic regression analysis confirmed that there were 8 independent predictors of malignant masses,including large papillary projections（≥7 mm）,separated or wall thickness≥3 mm,central blood flow,the proportion of solid part≥50%,combination of ascites,high level enhancement,uneven distribution of contrast media in enhanced solid part and the vascular with characteristics as dense,tortuous and anfractuous.When using 4 points as the cut-off,the area under the curve（AUC）of GI-RADS combined with 3D-CEUS scoring system in identifying malignant ovarian masses was 0.969,higher than that of only GIRADS（0.839;Z=1.64,P=0.029）.Furthermore,the scoring system showed higher sensitivity,specificity,positive predictive value,negative predictive value and accuracy（all P〈0.001）.Conclusion The combination of GI-RADS with 3D-CEUS can be more effective to distinguish malignant lesions from benign ovarian masses.