超声造影和时间-强度曲线对子宫内膜良恶性病变的鉴别诊断价值

摘要

目的：探讨超声造影（ CEUS）和时间-强度曲线（ TIC）对子宫内膜良恶性病变的鉴别诊断价值。方法选取2010年12月-2013年10月在三峡大学仁和医院行CEUS检查并经手术病理检查证实为子宫内膜病变患者40例，其中子宫内膜癌患者23例（恶性组），子宫内膜良性病变患者17例（良性组），分析两组CEUS模式、TIC形态及相关参数〔峰值强度（Peak）、达峰时间（TTP）、造影剂平均渡越时间（MTT）、曲线下面积（AUC）〕。结果与良性组比较，恶性组充盈模式较快速，充盈时间较早，多高增强，消退早于周围肌层。恶性组TIC呈“速升速降”型，形成“小尖波”，且23例患者中有15例TIC下穿至肌层以下，形成“下穿支”；良性组TIC呈“速升缓降”型，波峰圆钝。子宫内膜癌、子宫内膜癌周边正常肌层、良性病灶与良性病灶周边正常肌层AUC、MTT比较，差异均无统计学意义（P>0.05）；子宫内膜癌、子宫内膜癌周边正常肌层、良性病灶与良性病灶周边正常肌层Peak、TTP比较，差异均有统计学意义（P<0.05）；其中子宫内膜癌Peak高于良性病灶及良性病灶周边正常肌层（P<0.05）。结论子宫内膜良恶性病变的CEUS模式与TIC形态和相关参数具有一定特征性，特别是TIC的下穿支对恶性病变的诊断具有一定特征性，因此联合应用二者有助于鉴别子宫内膜良恶性病变。%Objective To explore the values of contrast-enhanced ultrasound( CEUS) and time-intensity curve ( TIC) in differential diagnosis of benign and malignant endometrial lesions( EL). Methods Forty patients who had CEUS and surgical pathological examinations and were diagnosed as EL in Renhe Hospital of Three Gorges University from December 2010 to October 2013 were divided into groups malignant EL(MEL group,n =23),benign EL(BEL group,n =17). The CEUS models,TIC morphology and related parameters including peak intensity( Peak),time to peak( TTP),mean transit time of contrast agent( MTT),area under the curve( AUC)were analyzed. Results Compared with BEL group,MEL group had rapid filling model,early filling time,with a lot of high reinforcement,degrade preceding surrounding myometrium. In MEL group,TIC assumed a " rapidly-up-and-down" form,becoming a " sharp wave",and in 15 patients TIC passed down through myometrium,forming a " down-perforating branch". In BEL group,TIC assumed a " rapidly-up-and-slowly-down" form with round and blunt wave peak. There was no difference in AUC,MTT between endometrial cancer( EC),its surrounding normal myometrium,benign lesion and its surrounding normal myometrium(P >0. 05),there was difference in Peak,TTP(P<0. 05),and peak of EC was higher than that of benign lesion and its surrounding normal myometrium(P<0. 05). Conclusion In MEL,CEUS model,TIC type and related parameters are of a certain mark for malignant lesions,espe-cially the " down-perforating branch" of TIC. So their combination helps distinguish BEL from MEL.