子宫输卵管超声造影中负性造影剂对宫腔病变的诊断价值  

Diagnosis value of negative contrast media in hysterosalpingo-contrast-sonograghyuterine on uterine cavity lesions

作　　者：范丽[1,2] 王莎莎[2] 程琦[2] 朱贤胜[2] 王泓[2] 凌茵[2] 

机构地区：[1]南方医科大学,广东广州510515 [2]广州军区广州总医院超声影像科,广东广州510010

出　　处：《中国医学物理学杂志》2015年第3期347-351,共5页Chinese Journal of Medical Physics

基　　金：中国健康促进基金会&医学数字影像专项基金(MID20130002)

摘　　要：目的:探讨经阴道子宫输卵管超声造影中联合负性造影剂对宫腔病变的诊断价值。方法:对407例不孕症患者采用微泡型造影剂进行经阴道子宫输卵管超声造影后联合负性造影剂再次进行宫腔造影,观察宫腔整体形态有无异常、宫腔内膜面光整程度及有无病变并记录病变的位置、大小、形态、回声、与内膜的关系等。其中对59例造影结果与宫腔镜进行对照。结果:从407例微泡型造影剂造影中发现宫腔病变71例,阳性率17.4%,其中子宫畸形17例,内膜息肉33例,粘膜下肌瘤1例,宫腔粘连38例,子宫切口憩室7例。从407例负性造影剂造影中发现宫腔病变166例,阳性率40.8%。其中子宫畸形15例,内膜息肉33例,粘膜下肌瘤2例,宫腔粘连109例,子宫切口憩室7例。两种造影剂对内膜息肉和宫腔粘连的发现率比较,差异具有统计学意义(P<0.001),而对子宫畸形、粘膜下肌瘤及切口憩室的发现率诊断比较,差异无统计学意义(P>0.05)。与宫腔镜对照(Kappa值=0.781),负性造影剂造影诊断宫腔内病变的敏感性、特异性、阳性预测值、阴性预测值分别为98.1%、80.0%、98.1%、80.0%。结论:负性造影剂可清晰显示宫腔内病变,尤其对体积较小的内膜息肉及宫腔粘连的诊断优于正性造影剂,经阴道子宫输卵管超声造影中联合负性造影剂可提高宫腔病变的诊断符合率。Objective To assess the diagnosis value of negative contrast media in transvaginal hysterosalpingo-contrast- sonograghyuterine （TVS HyCoSy） on uterine cavity lesions. Methods The 407 women with infertility were detected by hysterosonography with negative contrast media after TVS HyCoSy with microbubbles contrast media, to observe the morphology of uterine cavity, the smoothness and complete degree of endometrium surface and any pathological changes, and to record the location, size, morphology, echo and the relationship with endometrium. And the hysterosonography results of 59 patients were compared with the hysteroscopy results. Results Among 407 women with infertile, 71 presented uterine cavity lesions detected by TVS HyCoSy with microbubbles contrast media, with 17.4% of positive rate, including 17 uterine malformation, 33 endometrial polyps, 1 submucous myoma, 38 intrauterine adhesions and 7 uterine incision diverticulum. While uterine cavity lesions were found in 166 patient by hysterosonography with negative contrast media, with 40.8% of positive rate, including 15 uterine malformation, 33 endometrial polyps, 2 submucous myoma, 109 intrauterine adhesions and 7 uterine incision diverticulum. The difference in the detection of endometrial polyps and intrauterine adhesions between these two types of contrast medias was statistically significant （P〈0.001）, while no statistically difference was found in uterine malformation, submucous myoma and uterine incision diverticulum （P〉0.05）. Compared to the hysteroscopy, with a Cohen＇s kappa of 0.781, the sensitivity, specificity and positive predictive value of uterine cavity lesions diagnosed by hysterosonography with negative contrast media were 98.1%, 80.0%, 98.1% and 80.0%, respectively. Conclusion Sonohystero- graphy with negative contrast media can clearly present uterine cavity lesions, and its diagnosis of small endometrial polyps and uterine membrane adhesion are better than the diagnosis by positive contrast agent. TVS HyCoSy with negative c

关 键 词：子宫输卵管超声造影 负性造影剂 宫腔造影 宫腔病变 不孕症 

分 类 号：R445.1[医药卫生—影像医学与核医学]