超声造影在子宫病变诊断中的应用研究
发布时间：2018-08-15 15:43
【摘要】：[目的]运用超声造影技术对常规超声难以诊断的子宫病变患者进行造影检查,旨在探讨该技术在子宫病变诊断中的价值。[方法]选取2015年2月至2016年12月就诊于昆明医科大学第一附属医院,在妇产科超声室常规经腹部超声或经阴道超声检查疑为子宫肌瘤、子宫腺肌病、宫颈癌、子宫内膜癌和剖宫产瘢痕部位妊娠的67例患者为研究对象。以声诺维为造影剂,运用脉冲反相谐波成像技术对患者进行静脉超声造影检查,观察子宫病变区造影剂的灌注过程,分析灌注模式及时间强度曲线,其诊断结果与清宫、诊断性刮宫、宫腔镜及手术病理结果对照。[结果](1)典型的子宫肌瘤表现为周边呈环状或半环状增强,达峰后有明显边界,消退时肌瘤中央早于子宫肌层消退;子宫腺肌病病灶的增强和消退与子宫肌层同步,边界显示不清;子宫肌瘤组的达峰时间(TP)晚于子宫腺肌病组(P0.05),半洗出时间(HWOT)早于腺肌病组(P0.05),差异有统计学意义,两者的上升时间(RT)和峰值强度(PI)差异无统计学意义(P0.05);(2)宫颈癌和子宫内膜癌表现为增强及消退均早于肌层,峰值强度高于肌层;宫颈上皮内瘤变和子宫内膜增生病变区内的造影剂与宫体肌层同步灌注,同步消退;宫颈癌和子宫内膜癌组的上升时间(RT)、达峰时间(TP)、半洗出时间(HWOT)早于宫颈上皮内瘤变和子宫内膜增生组(P0.05),峰值强度(PI)则大于宫颈上皮内瘤变和子宫内膜增生组(P0.05),差异有统计学意义;(3)孕囊型瘢痕妊娠患者的病灶区早于子宫肌层灌注,孕囊周边呈环状高增强似“面包圈”,包块型瘢痕妊娠患者的病灶内部分区域表现为快速灌注,快速消退,呈不均匀性高增强,部分区域无增强;难免流产的高回声团块晚于肌层灌注,晚于肌层消退;瘢痕妊娠组的上升时间(RT)早于难免流产组(P0.05),峰值强度(PI)大于难免流产组(P0.05),差异有统计学意义;两者的达峰时间(TP)和半洗出时间(HWOT)差异无统计学意义(P0.05)。[结论]超声造影从微循环的层面观察子宫病变区的血流灌注特点。通过分析不同子宫病变的造影增强模式及时间强度曲线,进一步提高诊断子宫病变的准确性,为术前鉴别诊断及选择合适的治疗方案提供了一种新的影像学检查方法。
[Abstract]:[objective] to evaluate the value of contrast-enhanced ultrasonography in the diagnosis of uterine lesions. [methods] from February 2015 to December 2016, we selected the first affiliated Hospital of Kunming Medical University to examine the suspected uterine leiomyoma, adenomyosis and cervical cancer by transabdominal ultrasound or transvaginal ultrasound in the Department of Obstetrics and Gynecology. 67 cases of endometrial carcinoma and cesarean scar pregnancy were studied. Using sonovir as contrast agent, the patients were examined by pulse inverse harmonic imaging (PRT), the perfusion process of contrast agent in uterine lesion area was observed, the perfusion mode and time intensity curve were analyzed, the diagnostic results and the clear palace were analyzed. Diagnostic curettage, hysteroscopy and surgical and pathological results were compared. [results] (1) the typical hysteromyoma showed circumferential or semi-annular enhancement with obvious boundary after peak, the central myoma subsided earlier than the myometrium, and the enhancement and regression of adenomyosis were synchronized with the myometrium. The peak time of uterine myoma group (TP) was later than that of adenomyosis group (P0.05), and the half-washing time (HWOT) was earlier than that of adenomyosis group (P0.05), the difference was statistically significant. There was no significant difference in the rising time (RT) and peak intensity (PI) between the two groups (P0.05); (2) the enhancement and regression of cervical carcinoma and endometrial carcinoma were earlier than that of muscular layer, and the peak intensity was higher than that of muscular layer. The contrast agent in the area of cervical intraepithelial neoplasia and endometrial hyperplasia was perfused synchronously with the myometrium of the uterine body and subsided simultaneously. The rising time of (RT), peak time in cervical cancer and endometrial carcinoma group was earlier than that in cervical intraepithelial neoplasia and endometrial hyperplasia group (P0.05), and the peak intensity (PI) was higher than that in cervical intraepithelial neoplasia and endometrial hyperplasia group (P0.05), which was lower than that in cervical intraepithelial neoplasia and endometrial hyperplasia group (P0.05). (3) the focus area of pregnant women with gestational cystic scar was earlier than that of uterine myometrium perfusion. The circumference of the gestational sac was annular high enhancement like "bread circle", and some of the lesions in the pregnant women with cicatricial scar showed rapid perfusion, fast regression, uneven enhancement, and no enhancement in some areas. The hyperechoic mass of inevitable abortion was later than the myometrial perfusion later than the myometrium regression; the rising time of scar pregnancy group was earlier than that of inevitable abortion group (P0.05) the peak intensity of (PI) was larger than that of unavoidable abortion group (P0.05) the difference was statistically significant. There was no significant difference in peak time (TP) and half washing time (HWOT) between the two groups (P0.05). [conclusion] Contrast-enhanced ultrasonography is used to observe the perfusion characteristics of uterine lesion from the microcirculation level. By analyzing the contrast enhancement mode and time intensity curve of different uterine lesions, the accuracy of diagnosis of uterine lesions was further improved, and a new imaging examination method was provided for differential diagnosis and selection of appropriate treatment schemes before operation.
【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R445.1;R711.74
本文编号：2184661
[Abstract]:[objective] to evaluate the value of contrast-enhanced ultrasonography in the diagnosis of uterine lesions. [methods] from February 2015 to December 2016, we selected the first affiliated Hospital of Kunming Medical University to examine the suspected uterine leiomyoma, adenomyosis and cervical cancer by transabdominal ultrasound or transvaginal ultrasound in the Department of Obstetrics and Gynecology. 67 cases of endometrial carcinoma and cesarean scar pregnancy were studied. Using sonovir as contrast agent, the patients were examined by pulse inverse harmonic imaging (PRT), the perfusion process of contrast agent in uterine lesion area was observed, the perfusion mode and time intensity curve were analyzed, the diagnostic results and the clear palace were analyzed. Diagnostic curettage, hysteroscopy and surgical and pathological results were compared. [results] (1) the typical hysteromyoma showed circumferential or semi-annular enhancement with obvious boundary after peak, the central myoma subsided earlier than the myometrium, and the enhancement and regression of adenomyosis were synchronized with the myometrium. The peak time of uterine myoma group (TP) was later than that of adenomyosis group (P0.05), and the half-washing time (HWOT) was earlier than that of adenomyosis group (P0.05), the difference was statistically significant. There was no significant difference in the rising time (RT) and peak intensity (PI) between the two groups (P0.05); (2) the enhancement and regression of cervical carcinoma and endometrial carcinoma were earlier than that of muscular layer, and the peak intensity was higher than that of muscular layer. The contrast agent in the area of cervical intraepithelial neoplasia and endometrial hyperplasia was perfused synchronously with the myometrium of the uterine body and subsided simultaneously. The rising time of (RT), peak time in cervical cancer and endometrial carcinoma group was earlier than that in cervical intraepithelial neoplasia and endometrial hyperplasia group (P0.05), and the peak intensity (PI) was higher than that in cervical intraepithelial neoplasia and endometrial hyperplasia group (P0.05), which was lower than that in cervical intraepithelial neoplasia and endometrial hyperplasia group (P0.05). (3) the focus area of pregnant women with gestational cystic scar was earlier than that of uterine myometrium perfusion. The circumference of the gestational sac was annular high enhancement like "bread circle", and some of the lesions in the pregnant women with cicatricial scar showed rapid perfusion, fast regression, uneven enhancement, and no enhancement in some areas. The hyperechoic mass of inevitable abortion was later than the myometrial perfusion later than the myometrium regression; the rising time of scar pregnancy group was earlier than that of inevitable abortion group (P0.05) the peak intensity of (PI) was larger than that of unavoidable abortion group (P0.05) the difference was statistically significant. There was no significant difference in peak time (TP) and half washing time (HWOT) between the two groups (P0.05). [conclusion] Contrast-enhanced ultrasonography is used to observe the perfusion characteristics of uterine lesion from the microcirculation level. By analyzing the contrast enhancement mode and time intensity curve of different uterine lesions, the accuracy of diagnosis of uterine lesions was further improved, and a new imaging examination method was provided for differential diagnosis and selection of appropriate treatment schemes before operation.
【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R445.1;R711.74
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