灰阶超声造影在子宫肌瘤和子宫腺肌瘤鉴别诊断中的应用

目的探讨灰阶超声造影在子宫肌瘤和子宫腺肌瘤鉴别诊断中的应用价值.方法选取住院手术切除子宫肿瘤的患者31例(34个子宫占位性病灶),其中子宫肌瘤23例(25个病灶),子宫腺肌瘤8例(9个病灶).采用实时造影匹配成像技术(CnTI)和声学定量时间强度分析软件,术前经阴道先行子宫常规超声检查,然后经左侧肘静脉以快速团注法注入声诺维(SonoVue)混悬液2.4～4.8 ml行子宫灰阶超声造影及声学定量时间-强度曲线分析检查.检查结果与术前常规超声及手术病理相对照.结果34个病灶超声造影增强方式可分为周边网状型、同步型和缓慢向心型.子宫肌瘤以周边网状型为主,子宫腺肌瘤以同步型或缓慢向心型为主;子宫腺肌瘤组的增强峰值时间、峰值强度、150 s强度及增强幅度均比子宫肌瘤组高;子宫肌瘤组以速升速降型曲线为特征,子宫腺肌瘤以缓升缓降型或速升缓降型为特征,灰阶超声造影对子宫肌瘤和子宫腺肌瘤的鉴别诊断准确率(94.1%)高于常规超声(82.4%).结论子宫灰阶超声造影能实时、动态、连续地反映子宫肌瘤和子宫腺肌瘤的微循环灌注特点,与常规超声结合使用可提高超声对子宫肌瘤和子宫腺肌瘤的鉴别诊断准确率,有较好的临床应用前景.

Differentiation of uterine myoma and adenomyoma by gray-scale contrast-enhanced ultrasonography

Objective To investigate the value of gray-scale contrast-enhanced ultrasonography in differential diagnosis of uterine myoma and adenomyoma.Methods Thirty-one hospitalized patients with 34 space-occupying lesions in the uterus were examined by gray-scale contrast-enhanced ultrasonograpby (CEUS),including 23 cases of 25 uterine myoma and 8 cases of 9 adenomyoma.Esacte Du8 color Doppler sonography system,Contrast Tuned Imaging(CnTI)and Wash-in/Wash-out software were used in this study.Conventional transvaginal ultrasonography was performed preoperatively and then Sono Vue was injec- ted rapidly and agglomerately into left antecubital vein at 2.4-4.8 ml.Gray-scale contrast-enhanced ultra- sonograpby of uterus and analysis of acoustic quantitative time-intensity curve were performed.The results of CEUS were compared with those of conventional ultrasound and pathology.Student t test and Fisher exact test were performed by SPSS 11.0 software.Results After injection of SonoVue,all lesions were enhanced on harmonic ultrasonogram.Three patterns of enhancement were observed according to dynamic enhanced model:peripheral net pattern,synchronous enhanced pattern and slow-moving to centripetal pattern.The pe- ripheral net pattern was mostly shown in uterine myoma;synchronous or slow-moving to centripetal enhanced pattern was mostly shown in adenomyoma.Time to peak intensity,peak signal intensity,150-second signal intensity and enhanced range of adenomyoma were significantly higher than those of uterine myoma.The curve of uterine myoma ascended and descended quickly,while that of adenomyoma ascended and descended slowly or ascended quickly and descended slowly.The accuracy rate of differentiation was higher(94.1%) by gray-scale CEUS than that(82.4%)by conventional ultrasound.Conclusions Gray-scale contrast-en- hanced ultrasonngraphy combined with conventional ultrasonography is very useful in the differential diagnosis of uterine myoma and adenomyoma.