CAJ | 학술논문

目的：观察Ⅰ期子宫内膜癌的超声造影增强特点，分析Ⅰ期子宫内膜癌超声造影的时间-强度曲线特征，探讨超声造影技术对Ⅰ期子宫内膜癌的诊断价值。方法选择哈尔滨医科大学附属肿瘤医院自2009年10月至2010年12月经诊断性刮宫确诊为子宫内膜癌患者，行超声造影检查，选择经手术病理证实Ⅰ期的47例患者为研究对象，进行回顾性分析。观察病变部位对比剂的灌注特点，应用ACQ软件分别以病灶和未受累肌层为感兴趣区做时间-强度曲线，配对比较曲线形态和定量参数变化特征。结果（1）病灶部位开始增强时间、开始消退时间均早于子宫肌层，差异有统计学意义（ P＜0.05）。82.9％（39/47）病灶增强早于未受累肌层，68.1％（32/47）病灶早于肌层消退。（2）子宫内膜癌超声造影灌注强度特点：病灶在动脉期呈现不均匀增强为63.8％（30/47），呈现高增强为80.9％（38/47），时间-强度曲线参数显示病灶与未受累肌层相比，AT（s）到达时间早、TTP（S）达峰时间早、PI（dB）峰值强度大，差异有显著性（P＜0.05）。（3）子宫内膜癌肌层浸润深度的结果比较，超声造影检查的总符合率为74.5％（35/47），经一致性检验， Kappa＝0.516（ P＜0.01），提示超声造影检查与病理结果之间存在中等程度一致性。结论经阴道超声造影对Ⅰ期子宫内膜癌生长部位、形态和范围能够显示得更加清晰，且对比剂灌注增强和消退有显著特点，为病变的诊断和鉴别诊断提供了帮助。
목적：관찰Ⅰ기자궁내막암적초성조영증강특점，분석Ⅰ기자궁내막암초성조영적시간-강도곡선특정，탐토초성조영기술대Ⅰ기자궁내막암적진단개치。방법선택합이빈의과대학부속종류의원자2009년10월지2010년12월경진단성괄궁학진위자궁내막암환자，행초성조영검사，선택경수술병리증실Ⅰ기적47례환자위연구대상，진행회고성분석。관찰병변부위대비제적관주특점，응용ACQ연건분별이병조화미수루기층위감흥취구주시간-강도곡선，배대비교곡선형태화정량삼수변화특정。결과（1）병조부위개시증강시간、개시소퇴시간균조우자궁기층，차이유통계학의의（ P＜0.05）。82.9％（39/47）병조증강조우미수루기층，68.1％（32/47）병조조우기층소퇴。（2）자궁내막암초성조영관주강도특점：병조재동맥기정현불균균증강위63.8％（30/47），정현고증강위80.9％（38/47），시간-강도곡선삼수현시병조여미수루기층상비，AT（s）도체시간조、TTP（S）체봉시간조、PI（dB）봉치강도대，차이유현저성（P＜0.05）。（3）자궁내막암기층침윤심도적결과비교，초성조영검사적총부합솔위74.5％（35/47），경일치성검험， Kappa＝0.516（ P＜0.01），제시초성조영검사여병리결과지간존재중등정도일치성。결론경음도초성조영대Ⅰ기자궁내막암생장부위、형태화범위능구현시득경가청석，차대비제관주증강화소퇴유현저특점，위병변적진단화감별진단제공료방조。
Objective To observe the features and analyze the time-intensity curves ( TIC) of transvaginal contrast-enhanced ultrasound for endometrial cracinoma ,and to further explore the clinical role of transvaginal CEUS in the diagnosis of the stageⅠendometrial carcinoma .Methods Forty-seven patients with the stageⅠendometrial carcinoma were examined by the CEUS with SonoVue from October 2009 to December 2010 in the third affiliated hospital of Harbin Medical University .In all patients , endometrium diseases were diagnosed by biopsy under hysteroscope and CEUS examinations .The enhancement patterns and TIC of lesions and normal myometrium were analyzed.ACQ with the ultrasound image software was used to analyze the contrast enhancement ,match makde the curve form and quantitative analysed the changing characteristics of the parameters .Results ( 1 ) In the early and late enhanced stages ,the arrivel time and the wash out time were always sooner than the normal myometrium .82.9%(39/47)lesions were enhanced earlier than the normal myometrium ,and 68.1%(32/47) lesions were washer out earlier than the normal myometrium.(2)The enhancement features of lesions of endometrial carcinoma lesions during the arterial phase were as follows.A total of 63.8%(30/47)of lesions presented with inhomogeneous enhancement , 80.9%(38/47)presented with hyperechoic enhancement .The analytical results of the parameters for the TIC among lesions normal endometrium,the average AT,TTP were shorter than of normal endometrium(P<0.05),the average PI was higher than of normal endometrium (P<0.05).(3)In the qualitative diagnosis and the grade of endometrial carcinoma,contrast-enhanced ultrasound examination of the total coincidence was 74.5%(35/47).The consistency ( Kappa=0.516 ) of diagnose of endometrial carcinoma was general between CEUS and pathology results ( P<0.01 ) .Conclusion CEUS shows lesions more clearly among the position , shape, and range.The enhancement and resolution of agent possess markable characteristics ,which is an help advantage in evaluating the encroachment of the stageⅠendometrial carcinoma .