Transvaginal sonography in the diagnosis of adenomyosis: which findings are most accurate?

OBJECTIVES: To evaluate the accuracy of various transvaginal sonographic findings in adenomyosis by comparing them with histopathological results and to determine the most valuable sonographic feature in the diagnosis of adenomyosis. METHODS: In this prospective study, 70 consecutive patients scheduled for hysterectomy underwent preoperative transvaginal sonography. If at least one of the following sonographic features was present, a diagnosis of adenomyosis was made: heterogeneous myometrial echotexture, globular-appearing uterus, asymmetrical thickness of the anteroposterior wall of the myometrium, subendometrial myometrial cysts, subendometrial echogenic linear striations or poor definition of the endometrial-myometrial junction. The sonographic features were compared with the histopathological results. RESULTS: The prevalence of adenomyosis was 37.1% (26/70 patients). The sensitivity, specificity, positive (PPV) and negative (NPV) predictive values and accuracy of transvaginal ultrasound for the diagnosis of adenomyosis were 80.8%, 61.4%, 55.3%, 84.4% and 68.6%, respectively. We found that a regularly enlarged uterus with a globular appearance, subendometrial echogenic linear striations and myometrial cysts had the highest accuracy for the diagnosis of adenomyosis. Of all findings evaluated, heterogeneous myometrium was the most common in patients with adenomyosis (21/26 patients), but it had a poor specificity. The presence of subendometrial linear striations was the most specific sonographic feature (95.5%) and it had the highest PPV (80.0%) for the diagnosis of adenomyosis. CONCLUSIONS: The presence of subendometrial echogenic linear striations, a globular configuration and myometrial cysts on transvaginal ultrasound supports the diagnosis of adenomyosis. Among the transvaginal ultrasound diagnostic findings of adenomyosis, subendometrial linear striations have the highest diagnostic accuracy.     

Limitations of transvaginal sonography for the diagnosis of adenomyosis, with histopathological correlation.

OBJECTIVES: To evaluate the accuracy of transabdominal sonography (TAS) and transvaginal sonography (TVS) for the diagnosis of adenomyosis, and to determine the diagnostic relevance of various sonographic criteria. SUBJECTS AND METHODS: A total of 129 women scheduled for hysterectomy were enrolled into this prospective study. Group 1 (n = 23) consisted of patients with menometrorrhagia who were free of myoma and endometrial disorders on TAS. Group 2 consisted of all the other patients (n = 106). TAS and TVS findings were compared to histopathological results. RESULTS: The prevalence of adenomyosis in Groups 1 and 2 was 91.3% and 24.5%, respectively. TAS had limited value for the diagnosis of adenomyosis in both groups. The sensitivity, specificity, and positive and negative predictive values of TVS in Groups 1 and 2 were 80.9% and 38.4%, 100% and 97.5%, 100% and 83.3%, and 40% and 82.9%, respectively. The accuracy of combined TAS and TVS in Groups 1 and 2 was 91.3% and 83%, respectively. The presence of myometrial cysts was the most specific ultrasound diagnostic criterion for adenomyosis. Hypoechoic linear myometrial striations related to the presence of myometrial hypertrophy correlated to hormonal status with a sensitivity of 66.6% and a specificity of 100% in Group 1. CONCLUSIONS: Our results show that TAS has a limited diagnostic capacity for adenomyosis but also that TVS alone was poor in patients with an enlarged uterus. In these cases a combination of TVS and TAS should be used.     

对阴道超声诊断卵巢巧克力囊肿声像图特征的认识

目的　通过阴道超声观察卵巢巧克力囊肿声像图特征 ,确定其声像图诊断要点 ,以提高卵巢巧克力囊肿的诊断准确性。方法　采用HPImagePoint多特色超声系统 ,阴道探头频率 75MHZ ,观察 93例卵巢巧克力囊肿的阴道超声声像图直接 /间接征象 ,确定其声像图诊断要点。全部病例经开腹或腹腔镜手术并行病理检查证实。结果　术前阴道超声诊断卵巢巧克力囊肿 98例 ,正确者 93例 ,误诊 5例 ,诊断准确率 94 8%。结论　阴道超声对卵巢巧克力囊肿诊断具有实用价值 ,正确认识其声像图诊断要点 ,提高其诊断准确性     

经腹与经阴道超声对输卵管妊娠诊断价值的比较研究

目的　研究经腹超声 (TAS)与经阴道超声 (TVS)对输卵管妊娠的诊断价值。方法　 44例输卵管妊娠患者行TAS与TVS ,并与手术结果进行对比分析。结果　输卵管妊娠直接声像图表现为环状回声与附件区非特异性包块 ;TAS对附件包块的诊断敏感性与包块大小相关 ;TAS与TVS对破裂型输卵管妊娠诊断的敏感性无差异 ;TVS对早期未破裂型输卵管妊娠的诊断明显优于TAS。结论　TVS对输卵管妊娠的早期诊断具有重要的临床应用价值。     

经阴道超声对子宫肌腺病的诊断价值探讨

目的　探讨经阴道超声检查在子宫肌腺病诊断中的应用价值。方法　 5 0例子宫肌腺病患者行经腹超声 (TAS)检查 ,2 3例行经阴道超声 (TVS)及彩色多普勒能量图 (CDE)检查 ,其中 5 0例加行血CA12 5检查。TAS及TVS两组对照并与手术及病理诊断对照分析。结果　TVS组与病理诊断符合 2 0例 ,TAS组与病理诊断符合 2 3例 ,两者敏感性分别为 86.9% ,46% ,特异性分别为 92 .9% ,95 .6%。 3 1例血CA12 5 >3 5IU/ml,占 63 %。结论　经阴道超声检查是诊断子宫肌腺病的主要依据之一 ,联合血CA12 5检查可提高子宫肌腺病的诊断率。彩色多普勒能量图的诊断价值有待进一步探讨。     

不同类型胎儿泌尿系发育不良的超声声像图特征及诊断价值

目的分析不同类型胎儿泌尿系发育不良的超声声像图特征及诊断价值。方法随机抽取在我院接受产前超声诊断并确诊为泌尿系统发育不良的84例胎儿作为研究对象,所有胎儿接受病理诊断。比较产前超声诊断符合率,总结超声声像图特征,探究其临床价值。结果经病理学诊断,84例胎儿中有82例确诊为泌尿系发育不良,产前超声诊断符合率为97.62%;产前超声诊断84例泌尿系发育不良胎儿中单纯肾积水占比最高,为65.48%,其次为肾盂积水合并输尿管扩张,占10.71%;声像图特征分析发现单纯肾积水主要表现为肾盂扩张;肾发育不全声像图可见肾脏表面粗糙,肾脏较正常小,存在较强实质回声。结论产前超声诊断具有较高分辨率、图像清晰、诊断符合率高及操作简单等优势,能够有效检出不同类型胎儿泌尿系发育不良。     

异位妊娠以急腹症就诊的超声诊断价值

目的探讨异位妊娠以急腹症就诊的超声声像图特点与超声诊断价值。方法超声诊断结果与手术及病理结果对照。结果本组30例,超声诊断与手术符合率为100%,提示异位部位准确率为93.3%。结论超声诊断在本类型病例中有重要的临床价值,本类型的病例具有一定的声像图特点,认识这些特点能够降低漏诊和误诊率。     

超声检查在肺癌锁骨上淋巴结转移中的诊断价值

目的：探讨超声诊断肺癌锁骨上淋巴结转移的准确性。方法：对疑似或确诊肺癌并检出肿大锁骨上淋巴结的患者135例行彩色多普勒超声检查,并将判断结果和超声引导下细针穿刺细胞学检查（FNAC）的结果相比较,评价超声鉴别诊断肺癌锁骨上淋巴结转移的准确性。结果：135例中,共85例患者符合4项恶性转移性淋巴结的超声标准,其中62例经FNAC确诊为恶性（准确率为74.1%）,包括22例临床疑似肺癌并初次确诊的患者;符合3项标准的98例患者中64例确诊为恶性（准确率67.4%）。结论：超声是一种有效且可靠的判断锁骨上淋巴结转移的方法,可用于常规筛查。     

肾静脉栓塞的彩色多普勒超声征象及其诊断价值

目的通过与增强CT对比分析,探讨彩色多普勒超声在肾静脉栓塞疾病中的诊断价值。 方法选取2014年1月至2017年9月在北京协和医院就诊的经手术病理或随访证实的40例45侧肾静脉栓塞患者,其中,15例20侧肾静脉血栓及25例25侧肾静脉癌栓,均行彩色多普勒超声及增强CT检查,总结肾静脉栓塞的超声表现,包括栓塞病灶的位置、受累静脉管腔及管壁特点、侧支形成情况及彩色多普勒表现。超声与增强CT诊断肾静脉血栓及癌栓的准确率比较采用χ²检验。 结果彩色多普勒超声对肾静脉血栓及癌栓的诊断准确性分别为85%、84%,CT增强扫描的诊断准确性依次分别为100%、96%,差异均无统计学意义（P均>0.05）。肾静脉栓塞的主要超声征象有：（1）肾静脉管腔扩张伴实性成分填充;（2）主干内血流中断或充盈缺损;（3）肾内无明显静脉血流信号或血流信号分布稀疏。 结论彩色多普勒超声与增强CT在诊断肾静脉栓塞上有较好的一致性,超声可作为评估肾静脉栓塞的重要影像学方式,结合病史能为肾静脉栓塞提供较为可靠的诊断依据。     

Accuracy and Reproducibility of Sonoelastography for the Assessment of Fibroids and Adenomyosis,with Magnetic Resonance Imaging as Reference Standard

The aims of this prospective diagnostic evaluation study were (i) to estimate the inter-observer agreement and reproducibility of real-time sonoelastography and real-time gray-scale ultrasound in the measurement of uterine and fibroid volumes; (ii) to evaluate the agreement between real-time gray-scale ultrasound, sonoelastography and magnetic resonance imaging with respect to these outcomes; and (iii) to evaluate the diagnostic accuracy of sonoelastography in the diagnosis of uterine pathology on stored sonoelastography and gray-scale cine loops. Women without a history of uterine pathology and with the diagnosis intrauterine fibroids or adenomyosis were included. All participants underwent gray-scale ultrasound, sonoelastography and magnetic resonance imaging. Compression sonoelastography was found to have high inter-observer and inter-method agreement for the measurement of uterine and fibroid volumes. The addition of sonoelastography to gray-scale ultrasound seems to be useful in the differentiation between fibroids, adenomyosis and normal uteri as reflected by an increase in accuracy and diagnostic agreement.     

经阴道超声诊断胚胎移植术后宫内外复合妊娠:60例分析

目的 评估经阴道超声诊断胚胎移植后宫内外复合妊娠的价值。方法 回顾性分析60例经手术证实的宫内外复合妊娠患者的经阴道超声资料,观察声像图特点,分析延迟诊断的原因,对比宫内胚芽及宫外胚芽长度。结果 经阴道超声诊断宫内外复合妊娠准确率为100%（60/60）。延迟诊断4例（4/60,6.67%）,其中3例存在卵巢过度刺激综合征,1例为漏诊。宫外异位妊娠表现为混合回声包块25例（25/60,41.67%）,不均质稍高回声包块17例（17/60,28.33%）,不均质中等回声包块1例（1/60,1.67%）,孕囊样回声17例（17/60,28.33%）。宫内妊娠表现为类孕囊1例（1/60,1.67%）,孕囊仅见卵黄囊10例（10/60,16.67%）,孕囊见卵黄囊及胚芽49例（49/60,81.67%）。宫内胚芽长（0.42±0.39）cm,宫外胚芽长（0.31±0.26）cm,差异有统计学意义（t=2.35,P=0.03）。结论 经阴道超声在诊断胚胎移植术后宫内外复合妊娠中具有重要意义。     

阴道超声对子宫内膜增殖症的鉴别诊断价值

目的:探讨阴道超声扫描对子宫内膜增殖症的鉴别诊断价值.方法:对58例患者进行阴道超声检查,检查结果与临床对照,观察各种病因引起子宫内膜增殖的特征性改变.结果:阴道超声扫描正常分泌期内膜增厚、早期妊娠、子宫内膜增生过长及子宫内膜癌有其各自声像图特征.与临床或病理学诊断比较有较好的一致性.结论:作为新的超声扫描技术,阴道内超声扫描对子宫内膜增殖症的鉴别诊断有较高的应用价值.     

乳腺黏液癌超声图像特征及误诊分析

目的探讨乳腺黏液癌的超声图像特点及超声误诊原因,以提高超声检查准确率。 方法对2010年1月至2017年1月在常州第二人民医院乳腺外科经手术病理证实的58例乳腺黏液癌患者,共60个病灶(单纯型36例,共36个病灶;混合型22例,共24个病灶)的声像图做回顾性分析,超声表现包括肿块数量、大小、边界、形态、内部回声、后方回声及肿块内部是否伴微钙化灶、肿块内部血流情况及腋下淋巴结受累情况。 结果58例乳腺黏液癌患者中有44例术前超声诊断与术后病理诊断符合,超声诊断准确率为75.9%(44/58);9例单纯型乳腺黏液癌术前超声参照乳腺影像报告和数据系统(BI-RADS)分级2～3级,其中1例误诊为脂肪瘤,2例误诊为囊肿,5例误诊为纤维腺瘤或腺病,1例误诊为导管内乳头状瘤;另外5例混合型乳腺黏液癌术前超声BI-RADS分级为5级,误诊为浸润性导管癌。 结论超声检查对乳腺黏液癌具有较高的诊断准确率。单纯型黏液癌具有良性乳腺肿块的一些声像图特征,应特别注意与乳腺良性肿块鉴别;混合型黏液癌具有浸润性导管癌的部分声像图特征,应特别注意鉴别。     

剖宫产切口疤痕妊娠与宫颈妊娠的超声监测

目的:分析剖宫产切口疤痕妊娠与宫颈妊娠的超声声像变化特征,评价经阴道彩色多普勒超声在子宫下部异位妊娠诊治中的监测价值。方法:总结1995~2005年6月本院住院诊治的子宫下段剖宫产切口疤痕妊娠和宫颈妊娠病例,分析其彩色多普勒超声声像特征,追踪其临床转归及手术、病理结果。结果:剖宫产切口疤痕妊娠9例,宫颈妊娠5例,均由临床手术病理证实,根据经阴道彩色多普勒超声声像学特征分为4型:I型为胚胎存活型(5例),II型为胚胎停育有孕囊型(2例),III型为类滋养细胞疾病型(4例),IV型为绒毛退变型(3例)。I型全宫切除3例,保守治疗2例,II型2例均行全宫切除;III型全宫切除1例,经腹宫颈切开取绒毛术1例,余2例保守治疗;IV型均为保守治疗。结论:经阴道彩色多普勒超声对子宫下部异位妊娠能够提供较准确的定位定性诊断,正确的超声分型有助于临床选择合适的治疗方案,估计病程及转归。     

输卵管炎性疾病超声诊断方法学研究

目的探讨输卵管炎性疾病的超声诊断方法。方法回顾性分析本院228例输卵管炎性疾病的超声诊断结果,总结输卵管结构超声显示的方法以及不同阶段输卵管炎性疾病的声像图特征,并对经腹部超声(TAS)与经阴道超声(TVS)检查结果进行对比研究。结果急性单纯性输卵管炎、急性输卵管炎伴输卵管积脓、输卵管积液分别为42例、45例、131例,TVS诊断符合率分别为100%、93.8%、98.4%,TAS诊断符合率分别为23.1%、73.4%、93.1%,诊断符合率差异均有统计学意义(P<0.05)。结论 TVS能清晰显示急性输卵管炎输卵管壁水肿、增厚、管腔轻微扩张等细微变化及丰富血供。TVS、TAS均能良好显示输卵管积液、输卵管积脓内部特征性结构,具有重要临床应用价值,但TVS优于TAS。     

Role of transvaginal sonography in the detection of endometriomata

Endometriosis is a common cause of pelvic pain and infertility in young women. Transvaginal sonography is major means for diagnosing ovarian masses. In our study, we scanned 60 patients with endometriomata who underwent laparotomy or laparoscopy. We compared preoperative ultrasonographic diagnosis with histological reports. The sonographic criteria for the diagnosis of endometriomata were (1) cystic structure with low, homogeneous echogenicity and (2) thick cystic wall with regular margins. In 50 patients, sonography suggested an endometrioma. In 47 cases, the diagnosis was correct. The false-positive cases were all caused by cystic teratomas with a homogeneous sonographic pattern. Ten false-negative cases were diagnosed by ultrasonography as functional ovarian cysts (5), teratomas (3), and benign ovarian cystoma (1). Only 1 case of a 5-mm endometrioma was demonstrated by laparoscopy but not by TVS. The sensitivity of TVS for diagnosing endometriomata was 82.4% and specificity 97.7%; the positive and negative predictive values were 94% and 92.8%, respectively. The diagnostic accuracy of TVS was 93%. In our experience, TVS is a very specific means for diagnosing endometriomata when the typical pattern is detected; however, the sensitivity of the technique needs to be improved. © 1995 John Wiley & Sons, Inc.     

Transvaginal power Doppler findings in laparoscopically proven acute pelvic inflammatory disease.

OBJECTIVES: To evaluate the usefulness of power Doppler transvaginal sonography (TVS) in the diagnosis of pelvic inflammatory disease (PID) and to assess the diagnostic reliability of specific sonographic findings. POPULATION: The study population consisted of 30 women admitted for suspected acute PID. The reference group consisted of 20 women with proven hydrosalpinx formation. METHODS: Both conventional TVS and power Doppler TVS were performed. All patients with suspected acute PID underwent laparoscopy in order to confirm the diagnosis. Sonographic criteria described earlier were used for the diagnosis of acute PID. Power Doppler was used to assess the vascularity of any adnexal mass. RESULTS: Laparoscopy confirmed the diagnosis of PID in 20 (67%) of the 30 women with clinically suspected acute PID. Specific TVS findings, including wall thickness > 5 mm, cog-wheel sign, incomplete septa, and the presence of cul-de-sac fluid, discriminated women with acute PID from the control women with hydrosalpinx formation. Power Doppler TVS revealed hyperemia in all women with acute PID, but in only two women with hydrosalpinx (P = 0.01). Pulsatility indices were significantly lower in the acute PID group than in the control group (pulsatility index 0.84 +/- 0.04 vs. 1.50 +/- 0.10; P < 0.01). CONCLUSION: Power Doppler TVS was 100% sensitive and 80% specific in the diagnosis of PID (overall accuracy 93%). Specific sonographic landmark findings and power Doppler findings augment the clinical diagnosis of PID and allow simple classification of the severity of the disease.     

Early determination of fetal sex using transvaginal sonography: technique and pitfalls

Transvaginal sonography (TVS) enables sex determination at an early stage of pregnancy. The morphologic features of fetal external genitalia at 13 weeks to 16 weeks, menstrual age, are different from those seen later in pregnancy; therefore an attempt to determine fetal gender at this early stage by the same criteria as those used later is hazardous, especially for determining the male sex. The main diagnostic criteria for male gender determination by TVS are the "dome" sign representing the sonographic visualization of the fetal scrotum, the cranially directed phallus, and the longitudinal raphe at the base of the penis. The diagnostic criteria for female gender are the 2 or 4 parallel lines representing the labial folds and the caudally directed phallus (clitoris). The length of the fetal phallus at this early stage is not diagnostic and may be the main pitfall to the unexperienced sonographer. Between weeks 13 and 14 sex diagnosis was possible in 130/171 pregnancies (76%) in our first 2 years and 188/235 (80%) in our last 2 years of experience. Between weeks 15 and 16 sex diagnosis was possible in 122/139 pregnancies (88%) during our first 2 years and 96.7% (528/546) during the last 2 years of experience. The accuracy rate for fetal male gender identification increased from 91.7% during the first 2 years of TVS experience to 99.7% during the last 2 years of TVS experience, and the accuracy rate for female gender identification, increased from 93.3% to 100%, respectively, applying the above criteria and based on acquired experience of early fetal sex identification by TVS early in gestation. Early and precise determination of fetal sex is possible and might avoid invasive procedures such as amniocentesis.     

三维容积成像在甲状腺实性结节诊断中的应用

目的 探讨三维容积成像在甲状腺实性结节良恶性鉴别中的应用价值。方法 对119例甲状腺实性结节手术患者共144个结节行二维及三维超声检查,利用三维容积及断层技术行三维重建,分析良恶性结节的冠状面成像特征,评价其诊断价值。结果 144个结节中,良性结节75例,恶性结节69例。冠状面成像特征中,良恶性结节的形态、边界、边缘有无成角或毛刺、内部回声及有无微钙化差异均有统计学意义(P均<0.05)。建立Logistic回归模型,最终进入模型的甲状腺恶性结节冠状面成像特征包括形态不规则、边缘成角或毛刺、低回声。三维超声诊断甲状腺恶性实性结节的敏感度为92.75%(64/69),特异度为85.33%(64/75),准确率为88.89%(128/144),均高于二维超声[89.86%(62/69),80.00%(60/75),84.72%(122/144)],但两者的诊断效能差异均无统计学意义(P均>0.05)。结论 在三维冠状面成像中,甲状腺良恶性结节的特征差异显著。三维容积成像在甲状腺实性结节的良恶性鉴别诊断中具有重要的价值。     

阴道超声联合MRI诊断剖宫产切口瘢痕妊娠残余子宫肌层厚度的价值

目的分析经阴道彩色多普勒超声（TVS）检查联合MRI诊断剖宫产切口瘢痕妊娠残余子宫肌层厚度的价值。方法连续收集2019年1月~2020年6月本院收治的80例超声检查剖宫产切口瘢痕妊娠（CSP）疑似切口处残余子宫肌层小于3 mm患者的临床资料,80例患者均要求终止妊娠,所有患者入院后均完善阴道超声检查和MRI检查,并与手术、病理学检查结果进行对比,分析两种诊断方法的影像学特点,探讨其临床诊断价值。结果经手术、病理学证实80例疑似CSP切口处残余子宫肌层小于3 mm患者有71例,阴道超声联合MRI诊断阳性72例,阴性8例,诊断准确率为96.25%,特异度77.78%,灵敏度98.59%,阳性预测值为97.22%,阴性预测值87.50%,Kappa值0.803;阴道超声观察到卵黄囊结构40例、胚芽结构25例,原始心管搏动15例,MRI在对孕囊内部结构观察方面远不如超声,其优势在于孕囊周边的比邻结构的观察。结论阴道超声检查与MRI对CSP切口处残余子宫肌层厚度的诊断准确率均较高,两者联合大大提高了诊断准确率,超声在切口肌层血流信号观察、阻力指数、孕囊内卵黄囊、胚芽及胎心搏动诊断方面有优势,实时、价廉,可重复性强,MRI能够更好的评估切口处剩余肌层的厚度以及与周围组织的关系,二者联合检测可更好的评估切口处残余子宫肌层的厚度,为患者和手术医生选择手术方式提供更有力的依据。