子宫腺肌病局限型与弥漫型超声造影图像特点分析

Analysis on the characteristics of CEUS images of localized type and diffuse type of adenomyosis

目的:分析子宫腺肌病局限型与弥漫型超声造影(CEUS)图像特点。方法:选取医院收治的100例子宫腺肌病患者,根据患者病理分型将其分为局限型组(42例)和弥漫型组(58例),同期选取医院体检的40名育龄期妇女纳入健康对照组。所有受检者均进行超声造影检查,观察及分析3组受检者超声造影图像,比较3组造影剂时间-强度曲线(TIC)中的始增时间(AT)、峰值时间(TTP)及最大峰值强度(IMAX)投影(projection)水平。采用受试者工作特征(ROC)曲线下面积(AUC)分析超声造影在子宫腺肌病局限型与弥漫型鉴别中的价值。结果:局限型组和弥漫型组患者孕产史、流产史及宫内节育器比例明显高于健康对照组,差异有统计学意义(x^(2)=25.299,x^(2)=30.159,x^(2)=50.173;P<0.05)。局限型组患者超声造影以环状增强为主,弥漫型组患者以向心性增强为主;局限型组和弥漫型组患者超声造影增强方式及不均匀增强比例明显高于健康对照组,差异有统计学意义(x^(2)=34.551,x^(2)=61.468;P<0.05)。局限型组和弥漫型组患者超声造影高增强及低增强比例明显高于健康对照组,其中局限型组以高增强为主,弥漫型组以低增强为主,差异具有统计学意义(x^(2)=12.741,P<0.05)。局限型组和弥漫型组患者TIC中的TTP、IMAX水平明显低于健康对照组,AT水平明显高于健康对照组,局限型组TTP、IMAX及AT水平明显高于弥漫型组,3组比较差异均有统计学意义(F=82.620,F=53.340,F=202.470;P<0.05)。超声造影鉴别子宫腺肌病局限型的AUC为0.815。结论:子宫腺肌病局限型与弥漫型CEUS增强方式、增强水平及TIC相关指标变化差异明显,CEUS在鉴别局限型与弥漫型方面具有一定应用价值。

Objective:To analyze the image characteristics of contrast-enhanced ultrasound(CEUS) of localized type and diffuse type of adenomyosis.Methods:100 patients with adenomyosis in hospital were selected and they were divided into localized type group and diffuse type group according to the pathological type of patients.At the same time,40 women who were at childbearing age and underwent physical examination in hospital were divided into health control group.All of subjects underwent CEUS examination,and CEUS images of 3 groups were observed and analyzed.And the arrival time(AT),time to peak(TTP) and maximum intensity(IMAX) in time-intensity curve(TIC)of contrast agent among 3 groups were compared.The area under curve(AUC) of receiver operating characteristics(ROC) curve was used to analyze the CEUS value in the differential diagnosis of localized type and diffuse type of adenomyosis.Results:The proportions of pregnancy and birth history,abortion history and intrauterine device in localized type group and diffuse type group were significantly higher than those of health control group(x^(2)=25.299,x^(2)=30.159,x^(2)=50.173,P<0.05).The enhancement with ring shape was main in the CEUS of localized type group,and the enhancement with centrality was main in the CEUS of diffuse type group.The proportions of CEUS mode and uneven enhancement of localized type group and diffuse type group were significantly higher than those of health control group(x^(2)=34.551,x^(2)=61.468,P<0.05).The proportions of high enhancement and low enhancement of CEUS in localized type group and diffuse type group were significantly higher than those in health control group,in which the localized type group was mainly high enhancement and the diffuse type group was mainly low enhancement,the difference of that among three groups was statistically significant(x^(2)=12.741,P<0.05).The levels of TTP and IMAX in TIC of localized type group and diffuse type group were significantly lower than those in health control group,and the AT level of the former was significantly higher than that of the latter,and the TTP,IMAX and AT levels of localized type group were significantly higher than those of diffuse type group(F=82.620,F=53.340,F=202.470,P<0.05).The AUC of CEUS was 0.815 in differentiating localized type of adenomyosis.Conclusion:The differences of the changes of the enhancement mode and enhancement level of CEUS,and the related indicators of TIC between localized type and diffuse type of adenomyosis are significant,and CEUS has a certain of value in differentiating localized type and diffuse type.