【作者】 苏娜；

【导师】 姜玉新； 戴晴；

【作者基本信息】 北京协和医学院 ， 影像医学与核医学， 2010， 博士

【摘要】 目的1.观察良恶性妊娠相关子宫疾病的超声造影增强特点及时间-强度曲线特征。2.探讨超声造影在鉴别良恶性妊娠相关子宫疾病中的应用价值。资料和方法采用低机械指数反相脉冲谐波(PIH)超声造影技术,对73例妊娠相关子宫病变(恶性48例,良性25例)进行超声造影观察,超声造影剂为SonoVue,观察病灶的常规超声及超声造影表现。从5个方面观察病灶超声造影特征,包括增强顺序、增强大小、增强边界、增强模式、无增强面积。将病灶的超声造影增强模式分为弥漫增强、区域增强、网状增强及环状增强型。以病灶和未受累肌层为感兴趣区,应用QLAB软件分别生成时间-强度曲线。结果73例患者包括48例子宫妊娠滋养细胞肿瘤(侵蚀性葡萄胎26例,绒毛膜癌21例,胎盘部位滋养细胞肿瘤1例)和25例良性妊娠相关子宫疾病(包块型宫角妊娠11例,包块型瘢痕妊娠5例,肌壁间妊娠2例,妊娠物残留7例)。1、侵蚀性葡萄胎：初治病灶以弥漫增强型为主(80.0%)；化疗后病灶以区域增强型为主(64.7%)。2、绒毛膜癌：初治病灶表现为弥漫增强(50.0%)和环状增强(50.0%),病灶增强模式与病灶大小有关系。化疗后病灶以环状增强为主(73.3%)。3、包块型宫角妊娠和瘢痕妊娠均表现为环状增强型(100%)；肌壁间妊娠表现为弥漫增强(50.0%)和环状增强(50.0%)；妊娠物残留以区域增强为主(85.7%)。4、良恶性妊娠相关子宫疾病的增强模式有显著性差异(P<0.05)。5、良恶性妊娠相关子宫疾病的病灶区同正常肌层区的时间-强度曲线各参数比较均有显著性差异(P<0.05),表现为病灶的增强开始时间及达峰时间均早于正常肌层,增强速率及峰值强度大于正常肌层。6、子宫妊娠滋养细胞肿瘤与良性妊娠相关子宫疾病的病灶区时间-强度曲线参数无显著性差异(P>0.05)。7、良恶性妊娠相关子宫疾病造影后病灶范围较灰阶超声增大,恶性病灶增大更显著。结论1、良恶性妊娠相关子宫疾病超声造影具有不同的增强特点,在造影增强模式上存在一定差异,超声造影有助于两者鉴别。2、良恶性妊娠相关子宫疾病的病灶与周围肌层的灌注存在明显差异,超声造影有助于病灶边界范围的识别。更多还原

【Abstract】 ObjectiveTo (1) observe the characteristics of gestational trophoblastic neoplasia (GTN) and benign pregnancy-associated uterine disease by contrast-enhanced ultrasound (CEUS); (2) assess the clinical value of CEUS in differentiating the benign and malignant pregnancy-associated uterine disease.Material and methodsSeventy-three pregnancy-associated uterine disease cases (malignant:n=48; benign: n=25) were evaluated by contrast-enhanced ultrasound using the microbubble contrast agent SonoVue under a low mechanical index. The characteristics of enhancement were observed from five aspects including orientation, size, margin, enhancement pattern and the proportion of unenhanced area. The enhancement patterns were divided into four types:diffuse enhancement, regional enhancement, reticular enhancement and ring-like enhancement.The time-intensity curves (TIC) were created from the lesion and the normal myometrium in the same patient.ResultsSeventy-three cases include 48 gestational trophoblastic neoplasia(invasive mole: n=26; choriocarcinoma:n=21; placental site trophoblastic tumor, n=1) and 25 benign pregnancy-associated uterine disease cases (mass-type cornual pregnancy:n=11; mass-type cesarean scar pregnancy:n=5; intramural pregnancy:n=2; residual trophoblastic tissue:n=7).(1) Invasive mole:80.0% of the untreated lesions showed diffuse enhancement, 64.7% of the lesions after chemotherapy showed regional enhancement.(2) Choriocarcinoma:untreated lesions showed diffuse enhancement (50.0%) and ring-like enhancement (50.0%), the enhancement patterns had a relationship with the size of lesion. After chemotherapy,73.3% of the lesions showed ring-like enhancement. (3) Mass-type cornual pregnancy and mass-type scar pregnancy showed the ring-like enhancement (100%); intramural pregnancy showed the diffuse enhancement (50.0%) and the ring-like enhancement (50.0%); 85.7% of the residual trophoblastic tissue showed regional enhancement.(4) There are significant differences of the enhancement patterns between the benign and malignant pregnancy-associated uterine disease (P<0.05).(5) There are significant differences of the perfusion dynamic between the lesion and the normal myometrium in both of the benign and malignant pregnancy-associated uterine disease (P<0.05). The start time and the peak time of the lesions are earlier than the normal myometrium, the enhancement rate and peak intensity are greater than the normal myometrium.(6) There are not significant differences of the parameters of TIC between the benign and the malignant pregnancy-associated uterine disease (P> 0.05).(7) The size of the lesion in the CEUS is greater than the gray-scale ultrasound, especially in the malignant lesions.Conclusion(1) The enhancement patterns are different between the benign and malignant pregnancy-associated uterine diseases. CEUS is valuable for diagnosis and differentiation of these diseases.(2) There are significant differences of the perfusion dynamic between the lesion and surrounding normal myomerium, so it is helpful to distinguish the margin of the lesion.更多还原