CAJ | 학술논문

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，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。方法对广元市中心医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区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‐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％），差异有统计学意义（P＜0．05）。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。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（均 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‐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，具有良好的应用前景。
목적：채용경음도초성조영관찰불동성질화류형적란소종류적영상학특점화조영증강모식，탐토경음도초성조영재란소량악성종류진단급감별진단중적응용개치。방법대엄원시중심의원부과수치적경음도다보륵초성제시란소종류차량악성감별난도교대적환자50례，행경음도초성조영검사，결합술후병리결과분석，대비불동성질화류형적란소종류환자병조구적다보륵혈류신호화초성조영제적관주특정，병비교기시간‐강도곡선상조영증강적개시시간、체봉시간、봉치강도화곡선하면적등상응삼수。결과경음도초성조영대란소종류성질감별적준학솔（96％）현저고우경음도다보륵초성검사（72％），차이유통계학의의（P＜0．05）。량성종류초성조영후주요표현위낭벽결구적배형증강、실성결구정체혹분산적점상、수지상증강，종류형태규칙、변계청초，이악성종류주요시류체실성결구쾌속、비균질지증강。악성란소종류초성조영제증강적개시시간화체봉시간균현저조우량성종류（균 P＜0．05），차봉치강도화곡선하면적현저고우량성종류（P＜0．01）。결론란소량악성종류재초성조영제주사후적증강모식불동，경음도초성조영가이민감지현시병조국부적혈류관주정황；분석량악성란소종류시간‐강도곡선삼수적차이가제고대란소종류성질화류형감별적준학솔，구유량호적응용전경。
Objective To observe the imaging features and contrast enhanced patterns of ovarian tumor in different properties and types through transvaginal ultrasound angiography ,and to explore the application of transvaginal ultrasound angiography in the diagnosis and differential diagnosis of benign and malignant ovary tumors .Methods There were 50 patients admitted to the depart‐ment of gynecology in Guangyuan Central Hospital and taken on the transvaginal ultrasound angiography who were considered as suspicious ovarian tumors after transvaginal ultrasound examination ,with great difficulty in differentiating benign from malignant . Combined with pathological results after operations ,analysis and comparison were carried on the Doppler ultrasound imaging fea‐tures and perfusion characteristics of ultrasound contrast agents in the lesions of patients with ovarian tumors of different properties and types .We also compared the parameters of the time intensity curve ,including start time ,peak time ,peak intensity and area un‐der the curve .Results The accuracy of identification of the ovary tumor features was 96% through transvaginal ultrasound angiog‐raphy ,significantly higher than 72% through transvaginal ultrasound Doppler(P<0 .05) .The main performance of benign tumor after ultrasound angiography were annular enhancement of cyst wall ,overall enhancement of solid mass or punctate enhancement of papillary structures ,with regular morphology and clear boundary .While the perfusion characteristics of malignant tumor were fast and inhomogeneous enhancement of the tumor solid structure .In the time intensity curve of malignant tumors ,the start time and peak time of contrast enhancement were significantly earlier than benign tumors (P<0 .05);and the peak intensity and area under the curve were significantly higher than benign tumors (P<0 .01) .Conclusion Benign and malignant ovarian tumor showed different enhanced mode after injection of ultrasound contrast agents .Transvaginal ultrasound angiography can display the perfusion of local lesions sensitively .Analysis of the difference of the parameters in time intensity curve between benign and malignant ovarian tumors can improve the accuracy of identification of the feature and type of ovarian tumor ,thus this method has a good application prospects .