经阴道超声造影对卵巢肿瘤鉴别诊断的初步应用研究王全民(通讯作者)陈谊(第三军医大学大坪医院野战外科研究所妇产科重庆400042)【摘要】目的采用经阴道超声造影观察不同性质和类型的卵巢肿瘤的影像学特点和造影增强模式，初步探讨经阴道超声造影在卵巢良恶性肿瘤诊断及鉴别诊断中的应用价值。方法对我院妇科收治的经阴道多普勒超声提示卵巢肿瘤且良恶性鉴别难度较大的患者50例，行经阴道超声造影检查，结合术后病理结果分析、对比不同性质和类型的卵巢肿瘤患者病灶IX的多普勒血流信号和超声造影剂的灌注特征，并比较其时间一强度曲线上造影增强的开始时间、达峰时间、峰值强度和曲线下面积等相应参数。结果①经阴道超声造影对卵巢肿瘤性质鉴别的准确率(96%)显著高于经阴道多普勒超声检查(72%)(P<0.01)。②良性肿瘤超声造影后主要表现为囊壁结构的环形增强、实性结构整体或分散的点状、树枝状增强，肿瘤形态规则、边界清楚，而恶性肿瘤主要是瘤体实性结构快速、非均质地增强。③恶性卵巢肿瘤超声造影剂增强的开始时间和达峰时间均显著早于良性肿瘤(分别为P<0.01和P<0.05),且峰值强度和曲线下面积显著高于良性肿瘤(P<0.01)。结论卵巢良恶性肿瘤在超声造影剂注射后的增强模式不同，经阴道超声造影可以敏感地显示病灶局部的血流灌注情况；分析良恶性卵巢肿瘤时间一强度曲线参数的差异可提高对卵巢肿瘤性质和类型鉴别的准确率，其有良好的应用前景。【关键词】经阴道超声造影卵巢肿瘤彩色多普勒血流成像时间一强度曲线【中图分类号】R730.4【文献标识码】A【文章编号】2095-1752(2014)18-0021-03PrimaryapplicationoftransvaginalultrasoundcontrastindifferentialdiagnosisofabenignandmalignantovariantumorWangQuanmin*(Correspondentauthor)，ChenYi(DepartmentofObstetricsandGynecology,InstituteofSurgeryResearch,DapingHospital,ThirdMilitaryMedicalUniversity,Chongqing400042)【Abstract】Toobservetheimagingfeaturesandcontrast-enhancedpatternsofovariantumorindifferentpropertiesandtypesthroughtransvaginalultrasoundangiography,andtoexploretheapplicationoftransvaginalultrasoundangiographyinthediagnosisanddifferentialdiagnosisofbenignandmalignantovarytumors.MethodTherewere50patientsadmittedtothedepartmentofgynecologyinourhospitalandtakenonthetransvaginalultrasoundangiography,whowereconsideredassuspiciousovariantumorsaftertransvaginalultrasoundexamination,withgreatdifficultyindifferentiatingbenignfrommalignantCombinedwithpathologicalresultsafteroperations,analysisandcomparisonwerecarriedontheDopplerultrasoundimagingfeaturesandperfusioncharacteristicsofultrasoundcontrastagentsinthelesionsofpatientswithovariantumorsofdifferentpropertiesandtypes.Wealsocomparedtheparametersofthetime-intensitycurve,includingstarttime,peaktime,peakintensityandareaunderthecurve.Results①Theaccuracyofidentificationoftheovarytumorfeatureswas96%throughtransvaginalultrasoundangiography,significantlyhigherthan72%throughtransvaginalultrasoundDoppler(P<0.01).②Themainperformanceofbenigntumorafterultrasoundangiographywereannularenhancementofcystwall,overallenhancementofsolidmassorpunctateenhancementofpapillarystructures,withregularmorphologyandclearboundary.Whiletheperfusioncharacteristicsofmalignanttumorwerefastandinhomogeneousenhancementofthetumorsolidstructure.③Inthetime-intensitycurveofmalignanttumors,thestarttimeandpeaktimeofcontrastenhancementweresignificantlyearlierthanbenigntumors(P<0.01andP<0.05,respectively);andthepeakintensityandareaunderthecurveweresignificantlyhigherthanbenigntumors(P<0.01).ConclusionsBenignandmalignantovariantumorshoweddifferentenhancedmodeafterinjectionofultrasoundcontrastagents.Transvaginalultrasoundangiographyc...