Transabdominal combined with transvaginal color Doppler ultrasound can improve the accuracy in the differential diagnosis of hysteromyoma
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摘要:
目的研究经腹部联合经阴道彩色多普勒超声检查鉴别诊断子宫肌瘤的价值。 方法选择2015年5月~2018年9月本院收治的子宫肌瘤患者(n=245)和子宫腺肌瘤患者(n=105)，均在本院进行经腹部超声（TAS)和经阴道超声（TVS)检查，扫查子宫以及肿块的形态、大小、回声等情况，并观察肌层、内膜血流分布情况。以手术病理学为金标准，分析TAS、TVS以及两者联合鉴别诊断子宫肌瘤的准确度，并分析两者声图像表现，比较两者子宫动脉血流参数。 结果TAS联合TVS诊断的准确度为96.57%、敏感度为96.19%、特异度为96.73%，均高于单纯TAS或TVS诊断（P < 0.05)；子宫肌瘤大部分病灶较为清晰，且有假包膜，病灶回声以低回声为主，病灶部位血流较为丰富，呈环形或半环形；子宫腺肌瘤子宫形态较为正常，病灶部位模糊不清，且无假包膜，内部回声多见强回声，病灶部位周围血流不丰富；子宫肌瘤患者阻力指数、血流搏动指数等血流动力学参数指标水平均低于子宫腺肌瘤患者（P < 0.05)。 结论TVS联合TAS检查可提高子宫肌瘤鉴别诊断的准确率，降低误诊、漏诊现象，有较好的临床诊断价值。 Abstract:ObjectiveTo explore the value of transabdominal combined with transvaginal color Doppler ultrasound in the differential diagnosis of hysteromyoma. MethodsA total of 245 patients with hysteromyoma and 105 patients with uterine adenomyoma in the hospital between May 2015 and September 2018 were enrolled. All of them completed transabdominal sonography (TAS) and transvaginal sonography (TVS). Shapes, sizes and echo of the uterus and masses, blood flow distribution in the muscular layer and endometrium were observed. With operation and pathology as the golden standard, accuracy rates of TAS, TVS and combination of the two in the differential diagnosis of hysteromyoma were analyzed. The images and uterine artery blood flow parameters were analyzed. ResultsThe diagnostic accuracy, sensitivity and specificity of TAS combined with TVS (96.57%, 96.19% and 96.73%) were significantly higher than those of TAS or TVS alone (P < 0.05). Most of the hysteromyomas were clear, with pseudocapsules. The echoes mainly were low echoes, and blood flow in lesions was rich, which was ring-shaped or semi-ring-shaped. The shape of uterus with uterine adenomyoma was normal, but the lesion was unclear, without pseudocapsule. Most internal echoes were strong, and blood flow around the lesion was not rich. The hemodynamic parameters such as Resistance index and pulsatility index in patients with hysteromyoma were significantly lower than those with uterine adenomyoma (P < 0.05). ConclusionTVS combined with TAS can improve the accuracy in the differential diagnosis of hysteromyoma, and reduce misdiagnosis and missed diagnosis. -
图 1 经腹部及阴道超声检查
A:经腹部超声检查, 子宫宫体局限性隆起, 病灶结构清晰; B:经阴道超声检查, 病灶部位血流丰富, 呈现半环形, 前后壁肌间和宫底部查见多个弱回声肌瘤.
Figure 1. Trans-abdominal and transvaginal sonography.
表 1 TVS和TAS诊断效能对比
Table 1. Comparison of diagnostic efficiency between TVS and TAS[n(%)]
金标准 TAS TVS 联合诊断 阳性 阴性 阳性 阴性 阳性 阴性 子宫肌瘤(n=245) 213 (86.94) 32 (13.06) 227 (92.65) 18 (7.35) 237 (96.73)ab 8 (3.27) 子宫腺肌瘤(n=105) 89 (84.76) 16 (15.24) 93 (88.57) 12 (11.43) 101 (96.19)ab 4 (3.81) 合计 302 (86.29) 48 (13.71) 320 (91.43) 30 (8.57) 338 (96.57)ab 12 (3.43) aP < 0.05 vs TAS; bP < 0.05 vs TVS; 阳性表示正确检出, 阴性表示误诊或漏诊. TAS: Transabdominal sonography; TVS: Transvaginal sonography 
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表 2 两种疾病患者血流参数比较
Table 2. Comparison of blood flow parameters between patients with the two diseases (Mean±SD)
组别 RI PI Vs Vd 子宫肌瘤(n=245) 0.56±0.15 1.21±0.16 61.23±2.43 4.62±1.03 子宫腺肌瘤(n=105) 0.73±0.12 1.39±0.13 70.47±2.21 5.70±0.86 t 10.285 10.175 33.476 9.426 P 0.000 0.000 0.000 0.000
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