经阴道二维超声、三维容积超声及血流显像在脱出型黏膜下肌瘤诊断中应用价值

Application value of two-dimensional transvaginal ultrasonography,three-dimensional ultrasonography volumetric imaging and three-dimensional Doppler ultrasound in the diagnosis of prolapsed submucosal myoma

目的:探讨经阴道二维超声(2D-TVS)、三维超声(3D-TVS)容积成像及血流显像(3D-DUS)在脱出型黏膜下肌瘤诊断及起始部定位中的价值。方法:临床可疑脱出型黏膜下肌瘤并决定手术治疗病人57例,均行2D-TVS检查,术前再行3D-TVS检查。以手术病理结果为金标准,比较2种方法的诊断准确率。并根据手术结果,将脱出型黏膜下肌瘤病人作为确诊组,非肌瘤性病变病人作为疑似组,比较2组病人的“低回声为主”“Ⅰ形蒂部结构”等声像图特点。结果:经手术病理确诊脱出型黏膜下肌瘤34例,宫颈息肉20例,宫颈癌、子宫内膜癌、宫颈肌瘤各1例。2D-TVS和3D-TVS诊断灵敏度分别为88.2%、94.1%,差异无统计学意义(P>0.05);特异度分别为54.5%、86.4%,3D-TVS特异度高于2D-TVS(P<0.05);一致性百分率分别为75%、91%。在2D-TVS的低回声为主、“Ⅰ”形蒂部结构、丰富条状血流和3D-TVS的“梨形”团块及3D-DUS的蒂部条束状血流方面,确诊组病人检出率均高于疑似组(P<0.05~P<0.01)。结论:2D-TVS与3D-TVS均能检查脱出型黏膜下肌瘤,但后者诊断特异度高于前者;2D-TVS、3D-TVS及3D-DUS显示的瘤体形态及血流的声像图特征可以作为诊断及鉴别诊断指标,提高诊断准确率,减少误诊及漏诊。

Objective:To evaluate the application value of two-dimensional transvaginal ultrasonography(2D-TVS),three-dimensional transvaginal ultrasonography(3D-TVS)volumetric imaging and three-dimensional Doppler ultrasound(3D-DUS)in the diagnosis and initial location of submucous myoma of prolapsed type.Methods:Fifty-seven patients with suspected prolapsed submucosal myoma deciding on surgical treatment were detected using 2D-TVS and 3D-TVS before operation.Taking the surgery results as golden standard,the diagnostic accuracy was compared between the two methods.According to the surgical results,the patients with protuberant submucosal myoma and patients with non-myomatous disease were divided into the confirmed group and suspected group,respectively.The ultrasonographic characteristics of"low echo"and"Ⅰshaped pedicle structure"were compared between two groups.Results:There were 34 cases of prolapsive submucosal myoma,20 cases of cervical polyp,1 case of cervical cancer,1 case of endometrial cancer and 1 case of cervical myom according to the results of the surgery and pathology.The diagnostic sensitivity of 2D-TVS and 3D-TVS was 88.2%and 94.1%,respectively,and the difference of which was not statistically significant(P>0.05).The specificity of 2D-TVS and 3D-TVS was 54.5%and 86.4%,respectively,and which of 3D-TVS was higher than that of 2D-TVS(P<0.05).The percentage of consistency in 2D-TVS and 3D-TVS was 75%and 91%,respectively.In terms of the low echo,"Ⅰshaped"pedicle structure and rich strip blood flow in 2D-TVS,and pear-shaped"mass of 3D-TVS and strip bundle blood flow of 3D-DUS,the detection rate of which in confirmed group was higher than that in suspected group(P<0.05 to P<0.01).Conclusions:2D-TVS and 3D-TVS can be used to diagnose the submucous myoma of prolapsed type,and the diagnostic specificity of the 3D-TVS is higher than that of the 2D-TVS.The sonographic characteristics of tumor morphology and blood flow displayed by 2D-TVS,3D-TVS and 3D-DUS can be used as the diagnostic and differential diagnostic indicators,which can improve the diagnostic accuracy and reduce misdiagnosis and missed diagnosis.