二维及彩色多普勒超声对良、恶性卵巢肿瘤的诊断价值

目的 探讨经腹二维及彩色多普勒超声对良、恶性卵巢肿瘤的诊断价值。方法 对58例卵巢肿瘤进行二维及彩色多普勒超声检测，并对其良、恶性卵巢肿瘤的形态、包膜、内部结构及内部血流阻力指数(RI)进行对比分析。结果 良、恶性肿瘤的形态、包膜、内部结构及内部血流RI有明显差异。结论 超声形态学和彩色多普勒检测卵巢肿瘤的血流RI，能够提高良、恶性卵巢肿瘤的诊断准确率。     

彩色多普勒超声鉴别良恶性乳腺肿物的应用

目的 探讨彩色多普勒超声鉴别良恶性乳腺肿物的应用。 方法 95例乳腺病变住院患者，首先用二维超声明确肿块部位、形态、大小等一般情况，然后用彩色多普勒血流成像（CDFI）观察，记录血流分级，用频谱多普勒测量病灶内多处血管并记录最高的搏动指数（PI）、阻力指数（RI）和峰值流速等参数。 结果 （1）临床怀疑乳腺肿块95例，超声检出乳腺肿物93例；（2）良性组与恶性组肿物在Adle，分级存在显著性差异（P〈0.05）；（3）频谱分析显示两组间峰值流速、平均流速、PI、RI之间均存在显著性差异（P〈0．05），恶性组均高于良性组。 结论 （1）彩色多普勒超声检出乳腺肿物准确，简便；（2）综合分析和评价CDFI血流Adler分级、肿物内血流速度、PI、RI等指标有助于对乳腺良恶性肿物的鉴别。     

经阴道超声诊断卵巢肿瘤的价值

目的探讨经阴道超声（TVCD）结合彩色多普勒超声在卵巢良恶性肿瘤诊断中的价值。方法经阴道超声对63例（78个）卵巢良恶性肿瘤的形态学进行评分，同时加用彩色多普勒超声血流检查。根据彩色血流分布分为Ⅰ、Ⅱ、Ⅲ三型，并检测肿块收缩期峰值流速（PSV）及阻力指数（RI）值，将诊断结果与手术病理相对照。结果以B超积分≥5诊断卵巢恶性肿瘤的特异性、敏感性及准确性分别为86．5％、83．9％、85．5％；以RI〈0．45诊断卵巢恶性肿瘤的特异性、敏感性、准确性分别为85．3％、37．9％、63．5％。良性肿瘤血管多分布于肿瘤周边或隔上，以Ⅰ、Ⅱ型为主，而恶性肿瘤血供丰富，血管主要分布于肿瘤实质区，以Ⅲ型为主，两组间差异有极显著性。良恶性卵巢肿瘤的PSV之间有显著性差异。结论不能单独用RI或PSV等某一指标来评价肿瘤的性质，联合应用二维超声、CDFI及动力学指标，综合分析，可最大限度地提高对卵巢肿瘤的诊断准确性。     

彩色多普勒超声血流阻力指数联合糖链抗原125对卵巢肿瘤的诊断价值

目的探讨彩色多普勒超声血流阻力指数（resistance index,RI）联合血清糖链抗原125（carbohydrate antigen 125,CA125）检测在卵巢良、恶性肿瘤鉴别诊断中的价值。方法检测60例卵巢肿瘤患者血清CA125水平,并行彩色多普勒超声检查记录RI,与手术组织病理结果进行对照,比较RI及RI联合CA125诊断卵巢肿瘤的效能。结果手术组织病理诊断卵巢良性肿瘤45例,恶性肿瘤15例;RI联合CA125诊断良性、恶性卵巢肿瘤的准确率（93.33%、86.67%）高于RI（66.67%、53.33%）（P〈0.05）。结论彩色多普勒超声RI联合血清CA125检测鉴别诊断良、恶性卵巢肿瘤优于单独应用彩色多普勒超声RI。     

CDFI对卵巢肿瘤良恶性的鉴别诊断价值

目的：探讨彩色多普勒血流显像鉴别卵巢良恶性肿瘤的临床价值。方法;对127例卵巢肿瘤患者术前进行彩色多普勒检查并与术后病理对照。结果：恶性肿瘤的彩色血流显示率明显高于良性组（P＜0．01）,RI明显低于良性组（P＜0．01）。恶性肿瘤的血管分布较良性组高亦有显著差异（P＜0．01）。结论：彩色多普勒血流显像对卵巢肿瘤良恶性的鉴别具有较大的临床诊断价值。     

三维多普勒能量成像在卵巢肿瘤中的应用

目的评价三维多普勒能量成像在诊断卵巢肿瘤中的应用价值。方法65例患者76个卵巢占位性病变，进行三维能量多普勒重建，观察肿瘤形态、肿瘤内的细微结构及血管形态，且计算肿瘤内血管指数（VI），对比其术前诊断与术后病理结果。结果三维多普勒能量图所观测卵巢癌的血管形态及血管分级与卵巢良性肿瘤之间存在显著差异，以Ⅱ级血管分型诊断卵巢癌的敏感性为65％，特异性为100％；卵巢肿瘤内VI在良恶性之间存在显著差异，以VI≥0．02条／cm^3诊断卵巢癌敏感性为75．0％，特异性为80．9％。结论三维能量成像在术前能客观地反映卵巢肿瘤的血流情况，可为临床鉴别良恶性提供有意义的指标。     

彩色多普勒超声在乳腺小肿块鉴别诊断中的价值

目的 探讨彩色多普勒超声在乳腺良恶性小肿块(≤2 cm)鉴别诊断中的价值.方法 对71个乳腺小肿块,用脉冲多普勒检测肿块的血流动力学指标,应用三维能量多普勒血流成像(three-dimensional color power angiography,3D-CPA)观察肿块的血流形态学改变并计算肿块的血管指数.结果 良性组以环绕型血流为主,占87.5%(21/24),恶性组以穿入型血流为主,占70.3%(26/37).以穿入型血流诊断小乳腺癌的敏感性70.3%,特异性87.5%.乳腺肿块的血管指数作为乳腺癌的诊断依据,敏感性较低,但特异性高,以血管指数≥1.65条/cm~3为界值,其鉴别乳腺良恶性肿块的敏感性和特异性分别为75.7%和91.7%.结论 依据彩色多普勒超声表现特点有助于乳腺小肿块良恶性的鉴别.     

阴道彩色多普勒超声技术观察卵巢肿瘤内血流指数预测良恶性

目的：卵巢肿瘤是女性生殖器官的恶性肿瘤之一．为评价经阴道彩色多普勒超声技术(TVS-CD)对卵巢肿瘤(排除单纯性卵巢囊肿)内部血流的情况预测其良恶性程度。方法：使用美国GE公司LOGIQ7的阴道探头E8C对137位卵巢肿瘤妇女进行TVS-CD检查，观察肿瘤内部的RI、PI值，再结合血清CA-125。结果：TVS-CD测卵巢肿瘤内部血流动脉频谱RI≤0．4，PI≤1．0支持恶性肿瘤，良恶性肿瘤的动脉频谱RI、PI有显著性差异。结论：阴道彩色多普勒超声技术可以对卵巢形态结构有直观性，再测其肿瘤内部血流RI及PI值，并结合血清CA-125，对临床有一定指导作用。对早期卵巢恶性肿瘤可作为首选筛查方法。     

三维彩色血管能量成像鉴别乳腺肿块良恶性的价值

目的　探讨三维彩色血管能量成像 (3D- CPA)在鉴别乳腺肿块良、恶性中的作用。方法　对 30例乳腺肿块的患者术前 1周内行超声检查 ,记录其彩色多普勒血流显像 (CDFI)及 3D- CPA的特点 ,与术后病理结果对照。结果　良、恶性肿块血流分布的差异有非常显著性意义 (P<0 .0 1) ;良、恶性肿块的血流阻力指数(RI)的差异有非常显著性意义 (P<0 .0 1) ;用 3D- CPA观察良、恶性肿块的血管形态有显著不同 ,血管内径的差异有非常显著性意义 (P<0 .0 1)。结论　用 3D- CPA有助于鉴别乳腺肿块的良恶性 ,可弥补 CDFI的不足。     

彩色多普勒超声在骨肿瘤诊断中的应用价值

目的：探讨彩色多普勒超声在诊断骨肿瘤中的价值。方法：应用二维及彩色多普勒超声显像对22例恶性和27例良性骨肿瘤进行检查，观察分析病变的声像图特征、血流分布和血流动力学变化。结果：良、恶性组问血流分级有显著差异（P＜0．01），组间收缩期峰值流速（PSV）及舒张末期流速（EDV）的差异不明显（P〉0．05），阻力指数（RI）差异显著（P＜0．01）。Pearson线性相关分析显示骨肿瘤的声像图特征和血流情况与良、恶性均有良好的相关性。结论：超声对骨肿瘤病变周围软组织浸润的判断具有独特的优势，CDFI对良、恶性的鉴别诊断有一定的意义。     

Receiver operating characteristic curves of transvaginal Doppler blood flow measurements in benign and malignant adnexal tumors.

The role of receiver operating characteristic curves of transvaginal Doppler velocimetry in predicting malignancy was evaluated in 80 patients with benign and 40 patients with malignant adnexal tumors. The mean values of peak systolic velocity did not differ significantly. Malignant tumors had a significantly higher end diastolic velocity and mean flow velocity than benign tumors. Benign tumors had a significantly higher ratio of peak systolic to end diastolic velocity, pulsatility index, and resistive index than malignant tumors. The diagnostic accuracies in predicting malignancy were as follows: peak systolic velocity, 62%; end diastolic velocity, 79%; ratio of peak systolic to end diastolic velocity, 63%; mean flow velocity, 73%; pulsatility index, 91%; resistive index, RI 92%. Doppler velocimetry analysis allows us to predict the presence of malignancy with limited reliability.     

Early ovarian cancer: 3-D power Doppler

Transvaginal sonography plays an important role in the assessment of the morphology of ovarian lesions. However, the accuracy of the technique is limited due to the significant number of false-positive results. Color Doppler imaging and pulsed Doppler spectral analysis enable evaluation of ovarian tumor blood flow, analysis of the distribution of blood vessels, and quantitative measurement of blood flow velocity waveforms. These parameters increase the sensitivity and specificity of ultrasound evaluation of ovarian tumors. Unfortunately, there is no consensus as to which Doppler parameters and cutoff values are the most predictive of malignancy. Three-dimensional (3-D) power Doppler ultrasound provides a new tool to evaluate features of tumor vascularity. Three-dimensional ultrasound and 3-D power Doppler imaging in patients with “positive” findings on standard ultrasound tests, which encompass annual gray-scale transvaginal sonography followed by transvaginal color Doppler ultrasound in selected cases, represent a novel approach for early and accurate detection of ovarian cancer through screening. Combined evaluations of morphology and neovascularity by 3-D power Doppler ultrasound may improve early detection of ovarian carcinoma. Contrast-enhanced 3-D power Doppler sonography facilitates visualization of adnexal tumor vessels, which may aid in differentiating benign from malignant adnexal lesions.     

二维及彩色多普勒超声对良性、交界性、恶性卵巢肿瘤的诊断价值

目的　探讨经腹二维及彩色多普勒超声对良性、交界性、恶性卵巢肿瘤的诊断价值。方法　对 118例卵巢肿瘤进行二维及彩色多普勒超声检测 ,并对其良性、交界性、恶性卵巢肿瘤的形态、包膜、内部结构、实性回声面积、周边、腹水及内部血流阻力指数进行对比分析。结果　良性、交界性、恶性卵巢肿瘤的形态、包膜、内部结构及实性回声面积有明显差异 (P <0 .0 1)。 61%的恶性肿瘤出现腹水 ,而良性肿瘤不足 2 % ,交界性卵巢肿瘤 44 %出现腹水。三者周边和内部血流的检出无差异 (P >0 .0 5 ) ,而内部血流的阻力指数有明显差异 (P <0 .0 1)。结论　超声形态学和彩色多普勒检测卵巢肿瘤的血流阻力指数 ,能够提高良性、交界性、恶性卵巢肿瘤的诊断价值     

恶性危险指数结合超声频谱参数对卵巢肿瘤良、恶性的诊断价值

目的探讨在判断卵巢肿瘤良、恶性的诊断中,恶性危险指数（RMI4）分别与彩色多普勒超声血流阻力指数（RI）、搏动指数（PI）、时间平均最大速度（TAMXV）联合应用,判断其中最佳联合方式,并分析其诊断价值。 方法回顾150例卵巢肿瘤患者（92例良性病例,58例恶性病例）术前超声检查结果,包括二维声像图特征和频谱多普勒RI、PI、TAMXV测值;根据患者超声二维声像图像特征、绝经状态、血清CA125进行RMI4评分。记录单一变量以及双变量（RMI4分别与RI、PI、TAMXV以两种诊断标准结合）判断肿瘤为良恶性的结果与术后病理进行对照,计算各组的敏感度、假阳性率、阳性预测值、阴性预测值。 结果RMI4单独诊断时具有91%敏感性及22%假阳性率,多普勒变量中,TAMXV具有100%敏感性与49%假阳性率。而当RMI4与TAMXV的组合（同时符合二者恶性标准既判断肿瘤为恶性）具有敏感性91%与假阳性率11%。 结论彩色多普勒超声RMI4评分与TAMXV同时符合恶性标准时诊断卵巢肿瘤为恶性的判断方法,优于单一变量及其他双变量联合方式。      

Resistance to blood flow in ovarian tumors: correlation between resistance index and histological pattern of vascularization.

OBJECTIVE: To investigate the correlation between the histological patterns of vascularization and the resistance index (RI) in ovarian tumors. DESIGN: In a retrospective study, the histological sections of the ovarian tumors with known preoperative RI values were reviewed and the pattern of vascularization was studied. SUBJECTS: Twenty-two women underwent B-mode sonography and color Doppler ultrasound within 3 days prior to explorative laparotomy for ovarian masses in the years 1992-93. METHODS: The RI of the ovarian tumors was calculated as the mean of three consecutive waveforms with the lowest RI. The representative histological sections were evaluated for quantity of arterioles and venules, after staining by Masson trichrome and Elastic Van Gieson. The arteriolar fraction (defined as the number of arterioles divided by the sum of the arterioles plus venules) and the density of vessels (defined as the number of arterioles and venules per microscopic field) were calculated in each histological section and correlated with the preoperative RI values. RESULTS: The mean RI was 0.36 +/- 0.07 for malignant tumors and 0.57 +/- 0.03 for benign tumors. Ovaries with malignancies showed significantly lower arteriolar fraction values (0.30 +/- 0.12) than those with benign tumors (0.56 +/- 0.05) and those with metastatic tumors (0.43 +/- 0.2) (p < 0.002 and p < 0.001, respectively). The density of vessels was higher in malignant tumors (8.0 +/- 3.8) than in benign lesions (2.7 +/- 1.5) (p < 0.01). RI values showed a strong positive correlation (r = +0.85, p < 0.0005) with the arteriolar fraction and a negative and weaker correlation (r = -0.69, p < 0.001) with the density of vessels. CONCLUSIONS: RI values are predominantly determined by the proportion of arterioles. The correlation between the histological pattern of vascularization and RI values reflects tumor angiogenesis and increases understanding of the advantages and limitations of measuring vascular resistance by color Doppler ultrasound.     

A sensitive new indicator for diagnostics of ovarian malignancy, based on the Doppler velocity spectrum

Ovarian cancer is the most deadly gynecological malignancy, with an overall survival rate of about 35%. Approximately 60% of the cases of ovarian cancer are lethal. Ultrasonic examination, including Doppler imaging, is a commonly used technique for the diagnosis of ovarian masses. Two major clinical parameters, currently derived from the Doppler flow waveform, are the resistance index (RI) and the pulsatility index (PI). The decay constant of the Doppler waveform, which characterizes its decrease from systole to diastole as an exponential decay, has recently been presented as an additional measure of tumor malignancy. In this paper, we have analyzed the velocity spectrum of the Doppler flow signal to determine if it reveals differences that might contribute to the diagnosis of malignancy. We designed a new parameter characterizing the slope of the mean velocity spectrum at end-diastole ("End Diastolic Velocity Distribution Slope," referred to as DVD_S). Additional indices, related to various approaches for the analysis of the Doppler image, were also derived. However, they proved to be inferior to the DVD_S. The DVD_S was tested on 20 benign and 33 malignant ovarian images. This new parameter seems to provide a good ability to discriminate between the two types of tumor. Its mean value is 1.90 +/- 1.33 for malignant tumors, compared to 9.21 +/- 5.34 for benign masses (area under ROC curve: 0.983), yielding a detection rate of about 94%. In fact, this parameter provides much better results than the previously used variables, and has the potential to significantly improve the detection of malignancy.     

Transvaginal Doppler examination for the differential diagnosis of solid pelvic tumors.

To evaluate the ability of transvaginal Doppler examination to discriminate between different types of solid pelvic tumors, 55 women scheduled for laparotomy because of a solid pelvic mass underwent transvaginal sonographic examination, including color and spectral Doppler techniques. Arteries in the wall and core of each mass were examined. The histological diagnoses were as follows: uterine myoma (n = 28), malignant ovarian tumor (n = 19), and benign ovarian tumor (n = 8). Pulsatility index values tended to be highest in the malignant ovarian tumors, albeit with considerable overlap with respect to the other tumor types. The respective median pulsatility index values for arteries in the wall and core of the malignant ovarian tumors were 0.93 and 0.87, versus 0.65 and 0.51 in the benign ovarian tumors and 0.80 and 0.67 in the myomas. Time-averaged maximum velocity did not differ significantly among the three types of tumor. We conclude that Doppler measurement of blood flow velocity in tumor arteries does not add substantial information to the differential diagnosis between myomas and benign or malignant solid ovarian tumors.     

Complex adnexal mass in pregnancy: predictive value of color Doppler sonography.

We sought to establish color Doppler sonographic criteria specific to benign and malignant neoplasms in pregnant patients for parameters already reported for complex adnexal masses in nongravid patients. Thirty-four patients with complex adnexal masses were evaluated during the second trimester with transabdominal sonography and transvaginal color Doppler sonography. The lowest pulsatility index obtained was chosen to be indicative of histologic type. A pulsatility index of less than 1.0 in a morphologically suspect area was taken to be suggestive of malignancy. Prospective diagnoses made by color Doppler sonography were compared with actual histologic diagnosis. Three malignant ovarian lesions and five tumors of low malignant potential were identified correctly, with a sensitivity of 0.89 and a mean pulsatility index of 0.71 (range, 0.44 to 1.3). The mean pulsatility index for benign masses was 1.21 (range, 0.4 to 2.8) (P = 0.03). The negative predictive value of a pulsatility index greater than 1.0 was 0.93. The positive predictive value and false-positive rate for a pulsatility index less than 1.0, however, were 0.42 and 0.48, respectively. Low impedance was associated with malignant ovarian masses detected during pregnancy. A considerable overlap in blood flow patterns, however, may cause incorrect assignment of malignant potential to some benign lesions.