静脉超声造影对子宫腺肌症和子宫肌瘤的鉴别诊断价值

马菊香; 马永红; 高姗姗; 吴珏; 朱珉; 段振玲

doi:10.12259/j.issn.2095-610X.S20201109

静脉超声造影对子宫腺肌症和子宫肌瘤的鉴别诊断价值

doi: 10.12259/j.issn.2095-610X.S20201109

昆明医科大学第一附属医院妇产科，云南昆明　650032

基金项目: 云南省教育厅科学研究基金资助项目（2018JS200）

详细信息

作者简介:
马菊香（1980～），女，云南玉溪人，医学硕士，主治医师，主要从事妇产科超声工作

通讯作者:
马永红，E-mail：myhdoctor@126.com

中图分类号: R445.1
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出版历程
- 收稿日期: 2020-09-03
- 网络出版日期: 2020-12-03
- 刊出日期: 2020-11-25

Value of Intravenous Contrast-enhanced Ultrasound in Differential Diagnosis of Adenomyosis and Uterine Fibroids

Dept. of Obstetrics and Gynecology，The 1st Affiliated Hospital of Kunming Medical University，Kunming Yunnan 650032，China

摘要

摘要: 目的探讨静脉超声造影对子宫腺肌症和子宫肌瘤的鉴别诊断价值。方法对2017年12月至2019年12月就诊于昆明医科大学第一附属医院妇产科133例子宫肌瘤和子宫腺肌症的患者实施常规超声检查及静脉超声造影检查；与术后病理检查结果对照，对比常规超声与静脉超声造影检查之间的准确性差异，分析子宫肌瘤与子宫腺肌病之间的超声影像学特点。结果（1）常规超声、超声造影诊断子宫肌瘤的准确率分别为92%，98%，二者差异有统计学意义（P < 0.05）；诊断子宫腺肌症的准确率分别为91%，100%，二者差异有统计学意义（P < 0.05）；（2）静脉超声造影检查，子宫腺肌症患者开始时间早于子宫腺肌瘤患者，达峰时间早于子宫肌瘤患者，峰值强度低于子宫肌瘤患者，差异有统计学意义（P < 0.05）。结论（1）静脉超声造影在子宫腺肌症与子宫肌瘤的诊断中优于常规超声检查；（2）子宫腺肌症与子宫肌瘤在超声造影检查中有各自不同特征性改变，可作为鉴别两者的要点。
- 超声造影 /
- 子宫腺肌症 /
- 子宫肌瘤
Abstract: Objective To evaluate the differential diagnosis of uterine adenomyosis and uterine fibroids by intravenous contrast-enhanced ultrasound（CEUS）. Methods Routine ultrasonography and intravenous CEUS were performed in patients with uterine fibroids and adenomyosis in the department of obstetrics and gynecology, the First Affiliated Hospital of Kunming Medical University from December 2017 to December 2019. The results of postoperative pathological examination were compared, the accuracy of conventional ultrasound and intravenous CEUS was analyzed, and the characteristics of CEUS for uterine fibroids and adenomyosis were also analyzed. Results 1. The accuracy rates of conventional ultrasound and CEUS in the diagnosis of uterine fibroids were 92% and 98%, respectively, with statistically significant differences（P < 0.05）. The accuracy of adenomyosis diagnosis was 91% and 100%, respectively, with statistically significant difference（P < 0.05）. 2. According to intravenous contrast-enhanced ultrasonography, the onset time of adenomyosis was earlier than that of adenomyoma, and the peak time was earlier than that of uterine fibroids, and the peak intensity was lower than that of uterine fibroids, with statistically significant difference（P < 0.05）. Conclusions 1. Intravenous CEUS is superior to conventional ultrasonography in the diagnosis of adenomyosis and uterine fibroids. 2. Adenomyosis and hysteromyoma have different characteristic changes in contrast-enhanced ultrasonography, which can be used as the key point to differentiate them.
- Contrast-enhanced ultrasound /
- Adenomyosis /
- Uterine fibroids

HTML全文

图 1 超声造影显示包块早于子宫肌壁灌注，周边呈典型的环状增强，造影剂呈放射状向包块内部填充

Figure 1. Contrast-enhanced ultrasound showed that the mass appeared earlier than the myometrium wall perfusion，with a typical annular enhancement around the periphery，and contrast agent radially filling the mass

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图 2 超声造影显示带蒂浆膜下子宫肌瘤，血供来自于子宫动脉

Figure 2. Contrast-enhanced ultrasound showed a subserosal uterine fibroid with blood supply from the uterine artery

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图 3 超声造影显示典型子宫腺肌症包块与子宫肌壁呈同进同退等增强，无周边环状增强

Figure 3. Contrast-enhanced ultrasound showed that the typical adenomyosis mass and the uterine muscle wall were enhanced synchronically，without circumferential enhancement

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图 4 超声造影显示子宫腺肌症患者，内部无造影剂灌注，为异位子宫内膜在肌壁间周期性出血液化坏死区域

Figure 4. Contrast-enhanced ultrasonography showed that in adenomyosis，there was no contrast perfusion inside，and the ectopic endometrium was in the area of periodic bleeding and liquefactive necrosis between muscle walls

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表 1 诊断结果（%）

Table 1. Diagnostic results（%）

诊断方法	子宫肌瘤	子宫腺肌症
常规阴道超声检查	59/67（92）	60/66（91）
静脉超声造影	66/67（98）	66/66（100）
χ²	12.0	23.0
P	0.001	0.011

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表 2 子宫肌瘤与子宫腺肌症超声造影参数对比（$\bar x \pm s$）

Table 2. Comparison of CEUS parameters between uterine fibroids and adenomyosis（$\bar x \pm s$）

TIC参数	子宫肌瘤组（n = 67）	子宫腺肌病（n = 66）	P
开始时间（s）	17.39 ± 2.45	14.05 ± 2.98	0.000
达峰时间（s）	27.35 ± 3.78	23.59 ± 4.36	0.000
峰值强度（db）	36.23 ± 4.97	28.66 ± 4.67	0.000

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参考文献(18)

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