超声造影在识别Ⅰ期子宫静脉内平滑肌瘤病中的诊断价值  

CEUS in Identification of Uterine Intravenous Leiomyomatosis at StageⅠ

作　　者：陈琦 张超[2] 顾小宁 石富文 刘芳 成珍珍 杨敏 刘冬梅 Chen Qi;Zhang Chao;Gu Xiaoning;Shi Fuwen;Liu Fang;Cheng Zhenzhen;Yang Min;Liu Dongmei(Department of Ultrasonography,Beijing Shijitan Hospital,Capital Medical University,Beijing 100038,China;Department of Ultrasound,Beijing Chaoyang Hospital,Capital Medical University,Beijing 100020,China)

机构地区：[1]首都医科大学附属北京世纪坛医院超声科,北京市100038 [2]首都医科大学附属北京朝阳医院超声科,北京市100020

出　　处：《中国超声医学杂志》2024年第11期1293-1296,共4页Chinese Journal of Ultrasound in Medicine

基　　金：北京市属医院科研培育计划项目(No.PX2023027)。

摘　　要：目的分析Ⅰ期子宫静脉内平滑肌瘤病(IVL)的超声造影特征,探讨超声造影识别Ⅰ期IVL的应用价值。方法回顾性收集经手术病理证实为Ⅰ期IVL的16例患者的临床病历、常规超声与超声造影资料,总结Ⅰ期IVL的常规超声及超声造影特征。结果①常规超声和超声造影的诊断准确度分别为25%(4/16)、62.5%(10/16),两者差异有统计学意义(χ^(2)=4.571,P<0.05)。②常规超声诊断正确的4例均为宫旁病灶,1例表现为混合回声肿块,内见迂曲无回声;3例表现为静脉内低回声。③超声造影表现为增强早期肿块内部血管先显影,横切面显示多个斑点状增强区;达峰期不均匀低增强,并呈“蠕虫样”沿静脉延伸;增强晚期无明显的“血管环征”,静脉内IVL表现为低增强的病灶被周围持续高增强的静脉血流环绕的特点,呈“夹心饼干”征。结论超声造影在Ⅰ期IVL的诊断中具有重要意义,能够弥补常规超声的不足,提高诊断准确度。Objective To analyze the contrast-enhanced ultrasound(CEUS)characteristics of uterine intravenous leiomyomatosis(IVL)at stageⅠand explore the diagnostic value of CEUS of IVL at stageⅠ.Methods The clinical records,ultrasound and CEUS data of 16 patients with surgical pathological confirmation of IVL at stageⅠwere collected retrospectively.The features of the conventional ultrasound and CEUS of IVL at Stage I were summarized.Results①The preoperative diagnostic accuracy of conventional ultrasound and CEUS was 25%(4/16)and 62.5%(10/16),respectively,and the difference was statistically significant(χ^(2)=4.571,P<0.05).②All 4 cases with correct diagnosis by conventional ultrasound were parauterus lesions,including a case of mass-type IVL showing an large mixed echogenic mass with visible tortuous and echoless extension inside.3 cases of IVL showed a hypoechoic mass in the parauterine veins.③CEUS showed that the blood vessels within the mass were visualized firstly and multiple spotted punctate enhancement areas were shown in cross-section in the early stages of enhancement.The peak stage showed inhomogeneous hypoenhancement and“worm-like”extension along the vein.There was no obvious“vascular ring sign”around the periphery in the late stage of enhancement,while IVL showed the characteristic of low enhancement lesions surrounded by continuous high enhancement venous blood flow around the periphery,with a“sandwich biscuit”sign.Conclusions CEUS is of great significance in identifying the early diagnosis of IVL at stageⅠ,which can make up for the deficiency of conventional ultrasound,and improve the diagnostic accuracy.

关 键 词：子宫静脉内平滑肌瘤病 超声 超声造影 

分 类 号：R737.33[医药卫生—肿瘤] R445.1[医药卫生—临床医学]