超声造影评价子宫剖宫产瘢痕妊娠的诊断价值  

The Diagnostic Value of Contrast-Enhanced Ultrasound in Cesarean Scar Pregnancy

作　　者：刘冬梅 刘勇 顾小宁 刘芳 石富文 杨敏 Liu Dongmei;Liu Yong;Gu Xiaoning;Liu Fang;Shi Fuwen;Yang Min(Department of Ultrasound,Beijing Shijitan Hospital,Capital Medical University,Beijing 100038,China)

机构地区：[1]首都医科大学附属北京世纪坛医院超声科

出　　处：《中国超声医学杂志》2019年第11期1019-1022,共4页Chinese Journal of Ultrasound in Medicine

摘　　要：目的通过分析超声造影(CEUS)在子宫剖宫产瘢痕妊娠中的特异度表现及CEUS参数,探讨CEUS在瘢痕妊娠诊断中的价值。方法60例怀疑瘢痕妊娠并决定终止妊娠的患者行经阴道超声,其中35例同时行CEUS,以手术为金标准,对比两种检查方法的诊断准确率,将CEUS患者分为瘢痕妊娠组与非瘢痕妊娠组,对比分析两组患者的CEUS参数。结果CEUS及经阴道超声诊断瘢痕妊娠的灵敏度、特异度、阳性预测值、阴性预测值、Youden指数、诊断准确率、Kappa值及ROC曲线下面积分别为95.8%、81.8%、92.0%、90.0%、77.6%、91.4%、0.888;83.9%、72.4%、76.5%、80.8%、56.3%、78.3%、0.781。瘢痕妊娠组与非瘢痕妊娠组的CEUS参数对比,开始增强时间、达峰时间、峰值强度、增强速率均存在显著差异(P<0.05)。结论CEUS在瘢痕妊娠的诊断中具有特征性表现,其诊断效能高于经阴道超声,CEUS参数(开始增强时间、达峰时间、峰值强度、增强速率)可以作为辅助诊断指标,提高瘢痕妊娠的诊断准确率,减少临床过度治疗。Objective To investigate the features of contrast-enhanced ultrasound(CEUS)for cesarean scar pregnancy(CSP)and the CEUS parameters,and to evaluate the value of CEUS in the diagnosis of CSP.Methods Transvaginal ultrasound was performed in 60 patients with clinically suspected CSP who decided to terminate the pregnancy,and CEUS was performed in 35 patients.Taken surgery result as golden standard,the diagnostic accuracy were calculated.Patients were divided into two groups according to surgery result,CSP group and non-CSP group,CEUS parameters were analyzed.Results The sensitivity,specificity,positive predictive value,negative predictive value,Youden index,diagnostic accuracy,Kappa value,and the area under the ROC curves of CEUS and transvaginal ultrasound were 95.8%,81.8%,92.0%,90.0%,77.6%,91.4%,0.888;83.9%,72.4%,76.5%,80.8%,56.3%,78.3%,0.781,respectively.CEUS parameters of CSP group showed faster arrival time,time to peak,higher peak intensity and greater enhancement rate than that of non-CSP group(P<0.05).Conclusions There are some features of CEUS for CSP,CEUS has an advantage over transvaginal ultrasound in CSP diagnosis,CEUS parameters(arrival time,time to peak,peak intensity and enhancement rate)can be used as a supplementary diagnostic indicator to improve diagnostic accuracy of CSP,and reduce clinical over-treatment.

关 键 词：瘢痕妊娠 超声造影 异位妊娠 造影剂 子宫 

分 类 号：R44[医药卫生—诊断学]