CAJ | 학술논문

目的：探讨经阴道超声造影（ TVS-CEUS）技术在宫颈癌术前诊断中的临床应用价值。方法回顾性分析31例宫颈癌患者的TVS-CEUS术前检查图像，未受累的宫颈、肌层及内膜作为对照，分析宫颈癌瘤体的造影声像图，评估局部病灶的性质、大小范围及术前分期，与术后病理结果进行比较。与正常肌层对比分析宫颈癌病灶TVS-CEUS的时间-增强曲线（ TIC）形态及参数。结果 TVS-CEUS较常规TVS更能清晰显示病灶的边界，获得的病灶大小的测值更接近病理结果。正常子宫肌层与宫颈造影增强模式相同， TIC曲线参数差异无统计学意义（ P＞0.05），内膜的增强时间稍短，差异有统计学意义（ P＜0.05）。宫颈癌造影增强及消退早于正常肌层，增强强度高于正常肌层，其增强模式为“早进早退”，不同分期的宫颈癌造影增强模式不同。宫颈癌病灶的TIC曲线参数造影剂显影时间（AT）、达峰时间（TTP）、增强时间（ET）、增强强度（EI）、上升斜率（RSR）、半洗出时间（HWOT）、下降早期斜率（HWSR）与对照组比较差异有统计学意义（P＜0.05），对各参数进行ROC曲线分析得出对宫颈癌诊断能力较强的参数为RSR，界值为1.96 dB/s，灵敏度为100％，特异度为97.6％，Youden指数为97.6％。结论 TVS-CEUS在宫颈癌术前诊断中有较高的临床应用价值。
목적：탐토경음도초성조영（ TVS-CEUS）기술재궁경암술전진단중적림상응용개치。방법회고성분석31례궁경암환자적TVS-CEUS술전검사도상，미수루적궁경、기층급내막작위대조，분석궁경암류체적조영성상도，평고국부병조적성질、대소범위급술전분기，여술후병리결과진행비교。여정상기층대비분석궁경암병조TVS-CEUS적시간-증강곡선（ TIC）형태급삼수。결과 TVS-CEUS교상규TVS경능청석현시병조적변계，획득적병조대소적측치경접근병리결과。정상자궁기층여궁경조영증강모식상동， TIC곡선삼수차이무통계학의의（ P＞0.05），내막적증강시간초단，차이유통계학의의（ P＜0.05）。궁경암조영증강급소퇴조우정상기층，증강강도고우정상기층，기증강모식위“조진조퇴”，불동분기적궁경암조영증강모식불동。궁경암병조적TIC곡선삼수조영제현영시간（AT）、체봉시간（TTP）、증강시간（ET）、증강강도（EI）、상승사솔（RSR）、반세출시간（HWOT）、하강조기사솔（HWSR）여대조조비교차이유통계학의의（P＜0.05），대각삼수진행ROC곡선분석득출대궁경암진단능력교강적삼수위RSR，계치위1.96 dB/s，령민도위100％，특이도위97.6％，Youden지수위97.6％。결론 TVS-CEUS재궁경암술전진단중유교고적림상응용개치。
Objective To explore the clinical value of TVS-CEUS in preoperative diagnosis of cervical cancer.Methods Preoperative TVS-CEUS imaging of 27 cases for cervical cancer were analyzed retrospectively , comparing with normal cervix, myometrium, endometrium.Contrast enhancement ultrasonography was analyzed to evaluate the quality,size,scope and preoperative staging for cervical lesion ,comparing the result of pathologic .The difference of lesions and normal myometrium enhancement patterns , and the time-intensity curves were analyzed . Results The boundary and the size of the lesion was more clearly displayed and more closed to the pathology results by TVS-CEUS than conventional TVS .The normal cervical and myometrium had the same contrast enhancement pattern,the difference of parameter TIC curve had not statistically significant ( P >0.05 ) except the shorter of relatively rise time in endometrium ( P<0.05 ) .The cervical carcinoma had the early enhanced time and relatively rise in intensity than normal endometrium , discripted ‘early perfusion and wash-out′, various stages of cervical cancers had different enhancement pattern .In contrast parameters,contrast media arriving time,time to peak,relative rise time,relative rise in intensity,rising-slope rate,half wash-out time,half washed slope rate all have significant difference between cervical cancer and normal group ( P <0.05 ) .Rising-slope rate was the best parameter for diagnosing cervical cancer , ROC curve showed the cut off values as 1.96 dB/s, the sensitivity was 100%, the specificity was 97.6%,Youden index was 97.6%.Conclusion TVS-CEUS has considerable value in preoperative diagnosis of cervical cancer .