彩色多普勒超声在获得性子宫动静脉瘘的诊断及疗效评估中的应用

Application of color Doppler ultrasound in acquired arteriovenous malformations

目的探讨获得性子宫动静脉瘘(AVM)的二维及多普勒超声特征,分析二维及彩色多普勒超声在经子宫动脉栓塞治疗后疗效观察中的价值。方法选择11例获得性子宫AVM患者为研究对象。回顾性分析其子宫及病灶区二维声像图、彩色多普勒血流(CDFI)表现,量化分析多普勒流速曲线特点,包括收缩期峰值速率(PSV)和阻力指数(RI),结合临床症状对经子宫动脉栓塞术(UAE)治疗后病灶的声像图变化,进行分析。结果11例患者均经彩色多普勒超声诊断为子宫AVM,二维超声图像显示为子宫肌层内见单发类圆形无回声区和(或)多个小无回声区伴低回声呈"蜂窝状",彩色多普勒显示无回声区内有丰富红蓝镶嵌血流信号充填,呈"马赛克"或"湖泊样"改变;脉冲多普勒呈高速低阻血流流速曲线,典型者表现出静脉血流动脉化表现,11例超声检查结果与子宫动脉造影结果基本一致。患者均接受了UAE治疗,10例栓塞术后1周~6个月复查,二维超声见病灶均有明显减小或逐渐消失,彩色多普勒超声表现为低速静脉血流信号或异常血流信号消失;1例随访1周~11个月表现为病灶减小但低速低阻动脉流速曲线持续存在,再次栓塞后仍复发出血,患者因无生育需求最终切除子宫。结论彩色多普勒超声对获得性子宫动静脉瘘的诊断及UAE后对其治疗效果的评估监测有重要价值。

Objective To investigate the characteristics of two dimensional ultrasound and Doppler ultrasound in acquired uterine arteriovenous malformations (AVM), and to analyze their value in the observation of curative effect after uterine artery embolization. Methods Eleven patients with acquired uterine AVM were selected as the study subjects. Retrospective analysis was made on the two-dimensional sonographic and color Doppler flow imaging (CDFI) performance of the uterus and lesion area, and quantitative analysis was made on its Doppler waveform characteristics, including peak systolic velocity (PSV) and resistance index (RI), combined with clinical symptoms and the changes in the sonogram of the lesion after uterine artery embolization. Results All 11 patients were diagnosed as uterine AVM by color Doppler ultrasound. Two-dimensional ultrasound images showed a single rounded anechoic area and/or multiple small anechoic areas with hypoechoic honeycomb-like area in the myometrium, while their color Doppler showed that there was a rich red-blue mosaic blood flow signal filling in the anechoic zone, showing a mosaic or lake-like change;Doppler waveform showed a high-speed, low-impedance blood flow spectrum, and 11 cases of ultrasound examination results and uterine artery angiography results were basically consistent. All patients underwent UAE treatment. Ten patients were re-examined at 1 week to 6 months after embolization. Two-dimensional ultrasound showed significant reduction or gradual disappearance. The color Doppler ultrasound showed low-velocity venous blood flow signal or abnormal blood flow signal disappearance compared with before treatment. One case followed up at 1 week to 11 months after embolization showed lesions reduced but low-speed and low-resistance arterial spectrum persisted, and recurrent bleeding occurred after re-embolization. The patient eventually had her uterus removed due to no fertility requirements. Conclusions Color Doppler ultrasound has significant importance in the diagnosis of acquired AVMs and in monitoring the efficacy of embolotherapy in patients with acquired uterine AVMs.