三维超声造影诊断附件小肿块的初步研究

目的 探讨三维超声造影诊断附件小肿块的价值。方法 对47枚附件小肿块进行二维及三维超声造影检查，对比分析附件良恶性小肿块二维及三维超声造影的图像表现，所有病例均经手术病理或长期随访证实。结果 良性小肿块40枚，二维超声造影多表现由周边向实质内、分隔或乳头状增强;恶性小肿块7枚，二维超声造影呈现为多中心由实质内向周边增强。良恶性小肿块三维超声造影的包膜血管、分隔及内部增强间差异有统计学意义(P＜0.05)。良性实性小肿块内部血管稀疏平直，囊性小肿块的囊壁可见增强，囊内无增强;恶性小肿块表现为实质内血管分布无序扭曲、密集杂乱，形成血管球，呈显著增强,6枚周边可见粗大的供养血管进入。结论三维超声造影显示复杂血管空间结构具有优势，有望成为一种研究附件良恶性小肿块血管真实构筑的新方法。

Value of three-dimensional contrast-enhanced ultrasonography in diagnosis of small adnexal masses: a preliminary study

Objective To evaluate the value of three-dimensional contrast-enhanced ultrasonography (3D-CEUS) in diagnosis of small adnexal masses.Methods Forty-three patients with 47 adnexal masses were examined by both two-dimensional contrast-enhanced ultrasound (2D-CEUS) and 3D-CEUS.Sonographic features of adnexal masses with 3D-CEUS were analyzed and compared with 2D-CEUS.All patients with adnexal masses were proved by operational pathology and long-term follow-up results.Results Enhancement from the periphery to the parenchyma, septa or papillae was shown by 2D-CEUS among 40 benign adnexal masses, and multicenter enhancement from parenchyma to the periphery among 7 malignant ones.There were significant differences in blood vessels of envelope and septa, and the enhancement of parenchyma between benign and malignant adnexal masses by 3D-CEUS (P ＜0.05).Straight and sparse blood vessels were seen inside benign solid masses.Enhancement was observed in the wall of cystic masses,but not in intracapsular structures.Dense and distorted vascularity was found inside malignant adnexal masses forming a ball in the parenchyma, which was significantly enhanced.Thick vasa vasorum was also visible in 6 out of 7 malignant ones.Conclusions 3D-CEUS has an advantage in displaying complex spatial vascular structures,and might be a new tool to study real vascular structures in small adnexal masses.