常规超声与超声造影对宫腔病变的诊断价值

Diagnostic value of conventional ultrasound and contrast-enhanced ultrasound for intrauterine lesions

目的探讨常规超声与超声造影对宫腔病变的诊断价值。方法选取自2018年12月14日至2020年12月10日在北京大学人民医院妇科超声检查室就诊并提示宫腔病变的患者55例。常规二维超声根据宫腔病灶回声、大小及血流信号初步判断病变性质,再于宫腔镜手术前行超声造影检查,以正常宫壁做对照,根据病变区造影剂到达时间、峰值强度及消退时间对病变做出良恶性判断。以病理结果为金标准,分析比较常规超声与超声造影对宫腔病变的诊断效能,以及宫腔良、恶性病变超声造影模式差异。结果宫腔镜术后病理诊断良性病变36例;恶性病变19例。以术后病理为金标准,常规二维超声诊断病变良恶性的准确性为47.3%,敏感度63.2%、特异度73.7%、阳性预测值70.6%、阴性预测值93.3%;超声造影诊断病变良恶性的准确性为89.1%,敏感度89.5%、特异度88.9%、阳性预测值81.0%、阴性预测值94.1%。常规超声诊断结果与病理诊断不符合的6例患者中,5例超声造影诊断结果与病理相符合。常规二维超声无法明确诊断的23例患者中,20例超声造影诊断结果与病理相符合,超声造影对该23例的诊断敏感度为83.3%(5/6),特异度为88.2%(15/17)。恶性病变以早增强(84.2%,16/19)、高增强(78.9%,15/19)和早消退(89.5%,17/19)为主,早-高-早及早-高-同造影模式均为恶性病例,占比73.7%(14/19)。良性病变以同步增强及晚增强为主,占94.4%(34/36),其中晚-低-同模式分布最多,为13例。结论超声造影可弥补单一采用常规二维超声的不足,二者联合应用可提高宫腔病变诊断准确性。

Objective To assess the diagnostic value of conventional two dimensional ultrasound and contrast-enhanced ultrasound(CEUS)for intrauterine lesions before surgery.Methods Fifty-five patients with intrauterine lesions who were admitted to the gynecological ultrasound department of Peking University People's Hospital from December 14,2018 to December 10,2020 were recruited.The malignancy of the lesions was first judged by conventional two dimensional ultrasound according to the echo,size,and blood flow signal,and then by CEUS according to the arrival time of contrast agent in the lesion area,the peak intensity,and the time of regression(contrast pattern),with the normal human uterine wall as the control.Using post endoscopic resection pathological results as the gold standard,the accuracy,sensitivity,specificity,positive predictive value,and negative predictive value of conventional two dimensional ultrasound and CEUS were calculated,and the contrast patterns of malignant and benign lesion were compared.Results In total,36 patients with malignant and 19 with benign intrauterine lesions were verified by post endoscopic resection pathological examination.Using the pathological result as the golden standard,the accuracy,sensitivity,specificity,positive predictive value,and negative predictive value of conventional two dimensional ultrasound were 47.3%, 63.2%, 73.7%, 70.6%, and 93.3%, respectively;the correspondingpercentages for CEUS were 89.1%, 89.5%, 88.9%, 81.0%, and 94.1%. Of the six misclassified cases byconventional two dimensional ultrasound, five were correctly diagnosed by CEUS (one false positive).Regarding the 23 intrauterine lesions for which conventional two dimensional ultrasound could not predict,20 were correctly diagnosed by CEUS, with a sensitivity of 83.3% (5/6) and specificity of 88.2% (15/17).The contrast imaging patterns of malignant intrauterine lesions were mainly characterized by earlyenhancement (84.2%, 16/19), high peak intensity (78.9%, 15/19), and early regression (89.5%, 17/19). Boththe imaging patterns of early enhancement-high peak intensity-early regression and early enhancement-highpeak intensity-synchronous regression suggested malignant lesions, and these two patterns togetherconstituted 73.7% (14/19) of all malignant patterns. Benign lesions were mainly associated with synchronousenhancement or late enhancement (94.4%, 34/36). The pattern of late enhancement-low peak intensitysynchronousregression occurred in 13 of 36 benign intrauterine lesions. Conclusion CEUS and conventionaltwo dimensional ultrasound are mutually complementary, and the former may make up for the deficiencies of thelatter. Combined use of the two techniques can improve the accuracy of intrauterine lesion diagnosis.