O-RADS超声风险分层联合超声造影诊断卵巢-附件肿块的价值  

Value of O-RADS ultrasound risk stratification plus contrast-enhanced ultrasound to the diagnosis of ovarian-adnexal masses

作　　者：武莉娜 谢苗苗 孙园园 朱兆领 邵黎阳 王子怡 王睿丽 WU Lina;XIE Miaomiao;SUN Yuanyuan;ZHU Zhaoling;SHAO Liyang;WANG Ziyi;WANG Ruili(Department of Ultrasound,Henan University People's Hospital,Henan Provincial People's Hospital,Zhengzhou,Henan 450003,China)

机构地区：[1]河南大学人民医院河南省人民医院超声科,河南郑州450003

出　　处：《中华实用诊断与治疗杂志》2024年第4期396-401,共6页Journal of Chinese Practical Diagnosis and Therapy

基　　金：河南省医学科技攻关计划联合共建项目(LHGJ20200043)。

摘　　要：目的探讨O-RADS超声风险分层联合超声造影(CEUS)在卵巢-附件肿块良恶性鉴别诊断中的应用价值。方法2021年11月—2023年4月河南省人民医院诊治卵巢-附件肿块患者44例,均行常规经腹部或阴道超声及CEUS检查,对肿块超声资料采用3种方法进行良恶性诊断:(1)O-RADS超声风险分层由2名高年资超声科医师分别评估,结果不一致时经共同讨论后确定最终结果;(2)CEUS评估采用时间-强度曲线分析,根据肿块增强特征判定良性和恶性;(3)O-RADS超声风险分层与CEUS联合评估:根据CEUS良恶性评估结果调整O-RADS超声风险分层。CEUS检查后3个月内行手术或穿刺活检组织病理检查。采用Kappa检验评价2名医师评估肿块O-RADS超声风险分层结果的一致性;绘制ROC曲线,评估O-RADS超声风险分层、CEUS及二者联合诊断卵巢-附件肿块恶性的效能。结果44例患者共51个肿块,组织病理结果为良性肿块36个,恶性(含交界性)肿块15个。51个肿块O-RADS超声风险分层最终结果为1级0个,2级5个,3级5个,4级22个,5级19个;2名医师评估肿块O-RADS超声风险分层的一致性较高(Kappa=0.878,P<0.001)。51个肿块CEUS评估结果为良性34个,恶性17个。O-RADS超声风险分层与CEUS联合评估后,肿块O-RADS超声风险分层不变33个,2级升至3级1个,3级升至4级4个,4级降至3级3个,4级升至5级3个,5级降至4级7个。O-RADS超声风险分层、CEUS及二者联合诊断卵巢-附件肿块恶性的AUC分别为0.768(95%CI:0.628~0.874,P<0.001)、0.831(95%CI:0.699~0.921,P<0.001)、0.853(95%CI:0.726~0.936,P<0.001),灵敏度分别为73.33%、80.00%、86.67%,特异度分别为77.78%、86.11%、91.67%,准确率分别为76.47%、84.31%、90.20%。O-RADS超声风险分层与CEUS联合诊断卵巢-附件肿块恶性的AUC高于O-RADS超声风险分层(Z=2.234,P=0.025),与CEUS比较差异无统计学意义(Z=1.585,P=0.113),O-RADS超声风险分层与CEUS比较差异无统计学意义(Z=1.000,P=0.317)。结论O-RADS�Objective To explore the value of O-RADS ultrasound risk stratification combined with contrast-enhanced ultrasound(CEUS)to the differential diagnosis of benign and malignant ovarian-adnexal masses.Methods Forty-four patients with ovarian-adnexal masses underwent routine transabdominal or transvaginal ultrasound and CEUS in Henan Provincial People's Hospital from November 2021 to April 2023.The ultrasound data of the masses were analyzed by three methods as O-RADS ultrasound risk stratification(the masses were evaluated by two senior sonographers,and the final results were determined after discussion when their results were inconsistent),CEUS(with time-intensity curve analysis,the benign and malignant masses were determined according to the enhancement characteristics of the masses),and combined evaluation of O-RADS ultrasound risk stratification and CEUS(O-RADS ultrasound risk stratifications of the masses were adjusted according to the evaluation results of CEUS).Surgical or puncture biopsy histopathological examination were performed within 3 months after CEUS.Kappa test was used to evaluate the consistency of the results of O-RADS ultrasound risk stratification by two sonographers.The ROC curves were plotted to evaluate the efficiencies of O-R ADS ultrasound risk stratification,CEUS and their combination on the diagnosis of malignant ovarian-adnexal masses.Results In 44 patients(51 masses),there were 36 benign masses and 15 malignant(including borderline)masses.The final O-R ADS ultrasound risk stratification results of 51 masses were no grade 1 mass,5 grade 2 masses,5 grade 3 masses,22 grade 4 masses,and 19 grade 5 masses.The consistency of two sonographers in evaluating the O-RADS ultrasound risk stratification of masses was high(Kappa=0.878,P<0.001).CEUS found 34 benign masses and 17 malignant masses.After the combined evaluation of O-RADS ultrasound risk stratification and CEUS,33 masses remained the same O-RADS ultrasound risk stratification,1 mass was upgraded from grade 2 to grade 3,4 masses were upgrad

关 键 词：卵巢-附件肿块 O-RADS超声风险分层 超声造影 组织病理检查 

分 类 号：R445.1[医药卫生—影像医学与核医学] R737.31[医药卫生—诊断学]