经阴道超声造影对附件包块良恶性的定性、定量诊断  

Qualitative and quantitative diagnosis of benign and malignant adnexal masses by transvaginal contrast-enhanced ultrasonography

作　　者：王佳佳 余彩茶 胡明子 Wang Jiajia;Yu Caicha;Hu Mingzi(Department of Obstetrics and Gynecology Ultrasound,Wenzhou People's Hospital,Wenzhou 325000,Zhejiang Province,China)

机构地区：[1]温州市人民医院妇产超声科,温州325000

出　　处：《中国基层医药》2024年第3期333-337,共5页Chinese Journal of Primary Medicine and Pharmacy

基　　金：浙江省温州市基础性医疗卫生科技项目(Y202110456)。

摘　　要：目的评估经阴道超声造影对附件包块良恶性的定性、定量诊断价值。方法选取温州市人民医院2021年1月至2022年12月常规超声检查发现的附件包块患者49例,分别对其进行经阴道二维超声、二维超声联合彩色多普勒和超声造影检测,判定包块良恶性。以术后病理检查结果为金标准,比较各种检测方式的定性诊断效能。采用受试者工作特征曲线(ROC曲线)分析经阴道超声造影相关参数对附件包块良恶性鉴别诊断的能力。结果49例患者中,恶性肿瘤10例。超声造影诊断准确率为93.88%(46/49),其灵敏度、特异度、阳性预测值、阴性预测值分别为90.00%(9/10)、94.87%(37/39)、81.82%(9/11)、97.37%(37/38)。McNemar检验结果显示,二维超声(χ^(2)=0.37,P=0.546)、二维超声联合彩色多普勒(χ^(2)=0.17,P=0.683)、超声造影(χ^(2)=0.00,P=1.000)三种诊断方式与金标准检测结果差异均无统计学意义;一致性评估(Kappa检验)结果显示,超声造影诊断结果与金标准一致性最高(Kappa值=0.82,P<0.001)。ROC曲线分析提示,超声造影中的始增时间、峰值强度、平均渡越时间表现出了较高的量化诊断效能,曲线下面积分别为0.83、0.82、0.84,诊断临界值分别为17.30 s、21.65 dB和92.60 s。结论超声造影对附件包块良恶性鉴别具有一定的定性、定量诊断价值,可为进一步的治疗提供更多依据。Objective To evaluate the qualitative and quantitative diagnostic value of transvaginal contrast-enhanced ultrasonography for benign and malignant adnexal masses.Methods Forty-nine patients with adnexal masses detected by routine ultrasound examination at Wenzhou People's Hospital from January 2021 to December 2022 were included in this study.Initially,transvaginal two-dimensional ultrasound,two-dimensional ultrasound integrated with color Doppler,and contrast-enhanced ultrasonography were used to accurately classify the masses as benign or malignant.Using postoperative pathology as the gold standard,the qualitative diagnostic accuracy of various detection methods was compared.Subsequently,the receiver operating characteristic curve analysis was performed to assess the quantitative diagnostic accuracy of transvaginal contrast-enhanced ultrasonography-related parameters in distinguishing between benign and malignant adnexal masses.Results Among the 49 patients,10 were diagnosed with malignant tumors.The diagnostic accuracy of contrast-enhanced ultrasonography was 93.88%(46/49),with a sensitivity of 90.00%(9/10),a specificity of 94.87%(37/39),a positive predictive value of 81.82%(9/11),and a negative predictive value of 97.37%(37/38).The results of the diagnostic difference assessment(McNemar test)revealed that there was no significant difference between two-dimensional ultrasound(χ^(2)=0.37,P=0.546),two-dimensional ultrasound combined with color Doppler(χ^(2)=0.17,P=0.683),and contrast-enhanced ultrasonography(χ^(2)=0.00,P=1.000),and the gold standard test results.The consistency assessment(Kappa test)revealed that the diagnostic results of contrast-enhanced ultrasonography exhibited the highest concordance with the gold standard,with a Kappa value of 0.82(P<0.001).Furthermore,the receiver operating characteristic curve analysis indicated that the initial increase time,peak intensity,and mean transit time in contrast-enhanced ultrasonography demonstrated high quantitative diagnostic accuracy.The areas under the

关 键 词：腔内超声检查 超声检查 多普勒 彩色 子宫附件疾病 诊断 鉴别 敏感性与特异性 ROC曲线 

分 类 号：R711[医药卫生—妇产科学]