骨肉瘤的三维彩色血管能量成像研究

Objective To evaluate the value of three-dimensional color power angiography(3D-CPA,) in osteosarcoma diagnosis. Methods Forty-three cases with osteosarcoma were detected with 3D-CPA to assess the vascular classification(3D-CPA Ⅰ to Ⅲ) and measure the vascular parameters including vascularization index(VI), flow index(FI) and vascularization-flow index(VFI). Results All of the 43 cases were classified into 3D-CPA Ⅲ type. The space structure shape of blood vessels and the origin of nutrient vessels was clear. The quantitative measurement showed that VI was 25.84±6.87,FI was 34, 18±2.93, VFI was 9.02±4.04. Conclnsions It is a new method to analyze and diagnose osteosarcoma with 3D-CPA because it can show the nutrient vessels and the embranchments of blood vessels clearly, tridimensionally and integrally and Bake quantitative or partial-quantitative analysis.     

三维能量多普勒血管成像在亚甲减中的定量研究

Objective To quantify Doppler signal in subclinical hypothyroidism (SHT)patients and provide quantitative parameters with three-dimensional caor power angiography(3D-PDA) and color Doppler flow imaging(CDFI). Then analysis the relationship between the above indices and TSH, TPOAb and TGAb. Methods Thirty two patients with SHT(case group)and thirty two normal controls(control group)were examined by 3D-CPA and CDFI. Under the CDFI condition to exam Peak Systolic Velocity of Superior Thyroid Artery(PSV)and Resistive Index(RI) and Acceleration Time(AT). Meanwhile region of interested(ROI) were defined to obtain histogram and the quantification index: Mean Gray (MG) , Vascularization Index (VI) , Flow Index (FI) ,Vascularization Flow Index(VFI). Then analysis the relationship between the above indices and thyroid function parameters. Such as TSH and TPOAb. Results The difference between images of case group and control group was much significant. The quantification index MG (42 ± 4. 15), VI (18. 29 ± 1.86), FI (32 ± 2.1), VFI (9.6±0. 80) ,PSV(69. 2 ± 10. 1 cm/s) and AT(0. 072 ±0. 18 s) of case group were much higher than that of control group MG(37 ±2.65) ,VI(11. 7 ±0. 102) ,FI(24. 05 ± 1.56) and VFI(0. 33 ±0. 02) ,PSV(69.2 ± 10. 1 cm/s)and AT(0. 030 ±0. 01 s) (P ＜0. 05) ,PSV VI, Fl and VFI have positive correlation with TSH TPOAb and TGAb except RI. Conclusion 3D Color power angiography is a new good tool to assess the level of echo and blood flow quantitatively. It can provide important evidence for diagnosis and treatment of SHT.     

MMP-9和TIMP-1在不明原因不孕症患者子宫内膜的表达

Objective To study the expression situation of matrix metalloproteinase-9(MMP-9) and tissue inhibitor of metalloproteinase-1 (TIMP-1) in the endometrium of women with unexplained infertility and normal endometrium, and to explore the relationship between MMP-9/TIMP-1 expres-sion and unexplained infertility. Methods Immunohistochemieal assay(SP method) was employed to deteet the expression of MMP-9/TIMP-1 in 20 cases of impaired endometrium(unexplained infertility group,endometrial plantation window phase)and 20 cases of normal endometrium(heahhy control group). Results There were different levels of MMP-9/TIMP-1 expression in kytoplasms of glandular epicytes and stromal cells of all endometrial samples. The expression of MMP-9/TIMP-1 was signifi-cantly weaker in unexplained infertility group than that in healthy control group(P＜0.05). Conclusion Low expression of MMP-9/TIMP-1 in the endometrial plantation window phase may be one of impor-tant factors for unexplained infertility.     

实时组织弹性成像在评价肝肿瘤中的应用价值

Objective To explore the imaging features of liver tumors with real-time tissue elastography.Methods Eighty-five liver lesions in 67 cases were scanned with conventional ultrasonography and elastography using HI-Vision900 system and then assessed with grade scores.Results on ultrasound were compared with those on pathology.Results Majority of lesions with grade a-b on elastography were identified as benign on pathology, while most of masses with grade c-e on elastography were confirmed as malignant on pathology.The sensitivity, specificity and accuracy were 93.5%, 87.0% and 91.8% for elastography to detect malignant lesions,74.2% ,73.4% and 74.1% for conventional ultrasound.The Kappa value of two doctors on elastography in group Ⅰ (the depth of the lesion ≤10cm) was significantly higher than group Ⅱ (the depth of the lesion ＞10cm).Conclusions Real-time tissue elastography of liver tumors provides a new convenient,non-invasive diagnostic methods,contribute to identify the benign and malignant live tumors.     

实时组织弹性成像在评价肝肿瘤中的应用价值

Objective To explore the imaging features of liver tumors with real-time tissue elastography.Methods Eighty-five liver lesions in 67 cases were scanned with conventional ultrasonography and elastography using HI-Vision900 system and then assessed with grade scores.Results on ultrasound were compared with those on pathology.Results Majority of lesions with grade a-b on elastography were identified as benign on pathology, while most of masses with grade c-e on elastography were confirmed as malignant on pathology.The sensitivity, specificity and accuracy were 93.5%, 87.0% and 91.8% for elastography to detect malignant lesions,74.2% ,73.4% and 74.1% for conventional ultrasound.The Kappa value of two doctors on elastography in group Ⅰ (the depth of the lesion ≤10cm) was significantly higher than group Ⅱ (the depth of the lesion ＞10cm).Conclusions Real-time tissue elastography of liver tumors provides a new convenient,non-invasive diagnostic methods,contribute to identify the benign and malignant live tumors.     

提高乳腺钙化灶超声显示率的临床研究

Objective To evaluate the value of MicroPure software system in the display of calcification and diagnostic accuracy of breast carcinoma.Methods Sixty-three patients with 68 breast lesions were checked by conventional ultrasound,X-ray and MicroPure software technique.The calcification was described and the lesions were classified with BI-RADS.All cases were pathologically confirmed by biopsy or operation.Results ①Compared to the detection rate for calcification of X-ray,the display rate of conventional ultrasound was 80.6% ,and the display rate of MicroPure software technique was 100%.②The area under the curve of diagnosing benign and malignant of breast lesions was 0.916,0.857 and 0.970 respectively with ultrasound,X-ray and MicroPure software technique.③Three lesions was classified Ⅲ in BI-RADS with conventional ultrasound,and Ⅳ in BI-RADS with MicroPure software.The pathologic results were malignant.Conclusions MicroPure software system obviously raised the ultrasonic display rate of calcification,meanwhile,it raised the diagnostic accurate rate of breast cancer.It especially raised the tendency rate for the patients who were classified between Ⅲ and Ⅳ in BI-RADS.     

Breast non-mass-like lesions on contrast-enhanced ultrasonography: Feature analysis,breast image reporting and data system classification assessment

BACKGROUND Breast non-mass-like lesions(NMLs)account for 9.2%of all breast lesions.The specificity of the ultrasound diagnosis of NMLs is low,and it cannot be objectively classified according to the 5th Edition of the Breast Imaging Reporting and Data System(BI-RADS).Contrast-enhanced ultrasound(CEUS)can help to differentiate and classify breast lesions but there are few studies on NMLs alone.AIM To analyze the features of benign and malignant breast NMLs in grayscale ultrasonography(US),color Doppler flow imaging(CDFI)and CEUS,and to explore the efficacy of the combined diagnosis of NMLs and the effect of CEUS on the BI-RADS classification of NMLs.METHODS A total of 51 breast NMLs verified by pathology were analyzed in our hospital from January 2017 to April 2019.All lesions were examined by US,CDFI and CEUS,and their features from those examinations were analyzed.With pathology as the gold standard,binary logic regression was used to analyze the independent risk factors for malignant breast NMLs,and a regression equation was established to calculate the efficiency of combined diagnosis.Based on the regression equation,the combined diagnostic efficiency of US combined with CEUS(US+CEUS)was determined.The initial BI-RADS-US classification of NMLs was adjusted according to the independent risk factors identified by CEUS,and the diagnostic efficiency of CEUS combined with BI-RADS(CEUS+BI-RADS)was calculated based on the results.ROC curves were drawn to compare the diagnostic values of the three methods,including US,US+CEUS,and CEUS+BI-RADS,for benign and malignant NMLs.RESULTS Microcalcification,enhancement time,enhancement intensity,lesion scope,and peripheral blood vessels were significantly different between benign and malignant NMLs.Among these features,microcalcification,higher enhancement,and lesion scope were identified as independent risk factors for malignant breast NMLs.When US,US+CEUS,and CEUS+BI-RADS were used to identify the benign and malignant breast NMLs,their sensitivity rates were 82.6%,91.3%,and 87.0%,respectively;their specificity rates were 71.4%,89.2%,and 92.9%,respectively;their positive predictive values were 70.4%,87.5%,and 90.9%,respectively;their negative predictive values were 83.3%,92.6%,and 89.7%,respectively;their accuracy rates were 76.5%,90.2%,and 90.2%,respectively;and their corresponding areas under ROC curves were 0.752,0.877 and 0.903,respectively.Z tests showed that the area under the ROC curve of US was statistically smaller than that of US+CEUS and CEUS+BI-RADS,and there was no statistical difference between US+CEUS and CEUS+BI-RADS.CONCLUSION US combined with CEUS can improve diagnostic efficiency for NMLs.The adjustment of the BI-RADS classification according to the features of contrastenhanced US of NMLs enables the diagnostic results to be simple and intuitive,facilitates the management of NMLs,and effectively reduces the incidence of unnecessary biopsy.     

人工智能计算机辅助系统联合超声造影在甲状腺TI-RADS 5类结节中的应用价值

Objective : To investigate the differential diagnostic value of Artificial Intelligence Computer Aided system with Contrast-Enhanced Ultrasonography for thyroid TI‐RADS 5 nodules．Methods：93cases with thyroid nodules diagnosed by AI-CAD and CEUS had been treated in our hospital,All cases are confirmed by pathology,compare the sensitivity,specificity,positive predictive value,negative predictive value and diagnostic coincidence rate of AI-CAD diagnosis,CEUS diagnosis and combined application.Results:Ninety-three patients with 141 thyroid nodules(including 87 benign nodules and 54 malignant nodules),The sensitivity and specificity of AI-CAD diagnosis were 78.2% and 85.2%,and for CEUS diagnosis were 89.7% and 63.0%,while for combined application were 94.3% and 63%.Conclusion: AI-CAD and CEUS is very helpful in differential diagnosis of thyroid TI‐RADS 5 nodules.Combined using both methods can significantly increase the diagnostic coincidence rate of thyroid TI‐RADS 5 nodules.     

IVF-ET患者鲜胚移植周期子宫内膜容受性超声参数与妊娠结局的关联性研究

目的 探究体外受精-胚胎移植(IVF-ET)患者鲜胚移植周期子宫内膜容受性超声参数与妊娠结局的关联性。方法 选择2020年7月至2023年1月在邯郸市中心医院就诊的98例IVF-ET患者,根据患者移植术后12~14d妊娠结局将研究对象分为妊娠组59例和非妊娠组39例。比较两组患者一般资料;在移植当天通过三维重建技术比较两组患者子宫内膜容积、血管指数(VI)、血流指数(FI)、血管血流指数(VFI)以及子宫内膜下血流参数;受试者操作特性曲线(ROC)分析各子宫内膜容受性超声参数对妊娠结局的预测价值。结果 两组患者子宫内膜厚度、容积及子宫内膜形态分型无显著差异(P>0.05);妊娠组患者子宫内膜下S/D、PI、RI显著低于非妊娠组(P<0.05),而子宫内膜和子宫内膜下FI、VI、VFI均显著高于非妊娠组(P<0.05);患者子宫内膜下PI、S/D、RI、FI、VI、VFI和子宫内膜FI、VI、VFI以及联合检测的ROC曲线下面积(AUC)分别为0.796、0.736、0.617、0.735、0.711、0.717、0.780、0.611、0.725和0.978(P<0.05)。结论 IVF-ET患者子宫内膜下S/D、PI、VI、FI、VFI与子宫内膜VI、VFI均可预测患者妊娠结局,其中联合检测对患者妊娠结局的预测价值最高。     

三维超声检测子宫内膜及内膜下血流评估体外受精-胚胎移植中子宫内膜容受性的价值

目的 探讨经阴道三维能量多普勒超声检测子宫内膜及内膜下血流对体外受精与胚胎移植(IVF-ET)中子宫内膜容受性的预测价值.方法 应用经阴道三维能量多普勒超声,对120例接受IVFET的不孕患者,于控制性超排卵(COH)周期人绒毛膜促性腺激素(HCG)注射日进行子宫内膜厚度、内膜容积、内膜及内膜下区域的血管化指数(VI)、血流指数(FI)、血管化血流指数(VFI)测定,根据妊娠结果分为妊娠组与未妊娠组,比较两组间各参数的差异.结果 120例患者中有2例未检测到内膜血流,2例未检测到内膜下血流,1例未检测到内膜及内膜下血流,其余115例内膜和内膜下血流均显示.120例患者临床妊娠39例,妊娠率32.5%,妊娠组内膜及内膜下VI、FI、VFI均高于未妊娠组,两组间VI、FI、VFI比较差异有统计学意义(P＜0.05).内膜及内膜下VI、FI、VFI预测妊娠的ROC曲线下面积分别为0.729、0.670、0.655及0.720、0.715、0.617.结论 经阴道三维能量多普勒超声检测子宫内膜及内膜下血流可以预测子宫内膜容受性,评估IVF-ET结局.     

内膜体积和三维能量多普勒对子宫内膜息肉和子宫内膜增生的鉴别诊断价值

目的 评价内膜体积和三维能量多普勒分析对子宫内膜息肉和子官内膜增生的鉴别诊断价值.方法 选择二维超声拟诊宫腔占位或内膜不均匀增厚并行官腔镜或诊刮手术的患者156例(其中增生期的内膜息肉50例,子宫内膜增生51例,其他55例),于手术前24 h内行三维超声检查,术后均取材送病理检查.比较子宫内膜息肉组和子宫内膜增生组的内膜体积和三维能量多普勒测量的血管指数(VI)、血流指数(FI)、血管-血流指数(VFI).结果 子宫内膜息肉组和子宫内膜增生组的内膜体积、VI、FI和VFI比较差异均具有统计学意义.结论 内膜体积和三维能量多普勒分析对子宫内膜息肉和子宫内膜增生有较高的鉴别诊断价值.     

三维能量多普勒检测体外授精-胚胎移植患者子宫内膜血流参数与妊娠结局的关系

目的 探讨体外授精-胚胎移植患者子宫动脉血流和子宫内膜血流参数与妊娠结局的关系.方法 行体外授精-胚胎移植的不孕症患者90例,均于注射绒毛膜促性腺激素(HCG)日应用三维能量多普勒超声测量子宫内膜厚度、内膜容积以及内膜血流参数.根据其妊娠与否分为妊娠组(43例,包括生化妊娠和临床妊娠)和非妊娠组(47例),比较两组之间参数的差异.结果 两组间子宫动脉搏动指数(PI)、阻力指数(RI)值及内膜体积比较差异无统计学意义(P＞0.05);内膜血管指数(VI)、血流指数(FI)和血管-血流指数(VFI)比较差异有统计学意义(P＜0.05).VI、FI、VFI的曲线下面积分别为0.880、0.713和0.646.其中VI的曲线下面积最大,VI的截断值为0.733％时,敏感性为84.2％,特异性为88.9％.结论 在注射HCG日经阴道三维能量多普勒测量子宫内膜血流参数能较好地评价子宫内膜血流,预测妊娠结局.     

三维能量多普勒超声对子宫内膜癌的诊断价值

目的探讨三维能量多普勒超声对子宫内膜癌的诊断价值。方法应用三维能量多普勒超声观察199例阴道流血患者(根据病理结果分为良性病变组162例、子宫内膜癌组12例、月经紊乱组25例)和30例绝经期子宫内膜患者(绝经组),对比分析各组子宫内膜血流动力学参数:收缩期峰值流速(Vmax)、阻力指数(RI)、搏动指数(PI)、血管形成指数(VI)、血流指数(FI)、血管形成-血流指数(VFI)。结果良性病变组、子宫内膜癌组和月经紊乱组Vmax比较差异无统计学意义;子宫内膜癌组RI、PI与良性病变组和月经紊乱组比较差异均有统计学意义(均P0.01);子宫内膜癌组VI、FI、VFI值均高于良性病变组、月经紊乱组和绝经组,差异均有统计学意义(均P0.01);良性病变组VI、FI、VFI值均高于月经紊乱组和绝经组,差异均有统计学意义(均P0.05);月经紊乱组VI、FI、VFI值均高于绝经组,差异均有统计学意义(均P0.05)。结论三维能量多普勒超声能有效鉴别子宫内膜癌、内膜良性病变和正常内膜,对早期检出子宫内膜癌有重要临床应用价值。     

经阴道3D-PDI联合2D-SWE定量参数评估备孕女性ER及预测受孕结局的价值

目的 探讨经阴道三维能量多普勒血流显像超声(3D-PDI)联合二维实时剪切波弹性成像(2D-SWE)评估备孕女性子宫内膜容受性(ER)及预测受孕结局的价值。方法 选取2020年1月~2022年3月本院接受卵泡检测的87例备孕女性,均于排卵第7~8天(种植窗期)进行经阴道3D-PDI、2D-SWE检查和生殖激素水平检测。随访6周,根据受孕结局将其分为受孕组31例和未受孕组56例,比较两组种植窗期的血清雌二醇(E₂)、睾酮(T)、孕酮(P)、促黄体生成素(LH)、促卵泡生成素(FSH)水平和子宫内膜厚度、容积、内膜回声类型、内膜血流分型及子宫螺旋动脉搏动指数(PI)、阻力指数(RI)、收缩期峰值流速/舒张末期流速(S/D)值、血管化指数(VI)、血流指数(FI)、血管化血流指数(VFI)及增殖期弹性模量值等参数;受试者操作特征曲线(ROC)分析经阴道3D-PDI联合2D-SWE定量参数对备孕女性受孕结局的预测价值。结果 受孕组和未受孕组年龄、BMI、生育史、备孕时间和E₂、P、T、LH、FSH水平无显著差异(P＞0.05);受孕组子宫内膜厚度显著高于未受孕组(P＜0.05);两组子宫容积、子宫内膜回声类型和子宫内膜血流分型无显著差异(P＞0.05);受孕组S/D和增殖期弹性模量值均显著低于未受孕组,FI显著高于未受孕组(P＜0.05);两组PI、RI、VI和VFI无显著差异(P＞0.05);ROC分析,子宫内膜厚度、S/D、FI和增殖期弹性模量值预测备孕女性受孕结局的ROC分别为0.789、0.851、0.853和0.840,联合检测预测备孕女性受孕结局的ROC为0.895(P＜0.05)。结论 经阴道3D-PDI联合2D-SWE定量参数可客观全面的评估备孕女性ER,临床可用于预测备孕女性受孕结局。     

三维彩色血管能量成像对乳腺肿物血管的定量研究

目的探讨三维彩色血管能量成像（3D—CPA）定量检测乳腺肿物内血管参数对鉴别诊断肿物良恶性的临床价值。方法61例乳腺肿瘤患者,良性组31例,恶性组30例,对其行3D—CPA重建。采用Vocal分析软件,选择三维能量直方图获得血管形成指数（vI）、血流指数（FI）和血管形成一血流指数（VFI）;并对乳腺肿物进行3D—CPA血流分级,比较乳腺良恶性肿物vI、FI、VFI及其与乳腺肿物内血流分级的关系。结果3D—CPA血流Ⅲ级患者的VI、FI、VFI高于Ⅱ级（P〈0．05）,以Ⅲ级作为诊断乳腺良恶性标准,敏感性、特异性、准确性分别为91．3％、76．3％、82．0％。恶性组VI、FI、VFI均高于良性组（P〈0．05）。以vI≥1．157诊断乳腺恶性肿瘤的敏感性分别为87％,准确性为77％,特异性为68％;以FI≥32．397诊断乳腺恶性肿瘤的敏感性为83％,准确性为67％,特异性为52％;以VFI／〉0．426诊断乳腺恶性肿瘤的敏感性为83％,准确性为73％,特异性为61％。结论乳腺肿物3D—CPA血管定量参数VI、FI、VFI与乳腺肿物血流分级结果一致,可用来判断乳腺肿物内部血管丰富程度,恶性肿物参数均高于良性肿物,有助于乳腺良恶性肿瘤的鉴别。     

Endometrial volume and vascularity measurements by transvaginal 3-dimensional ultrasonography and power Doppler angiography in stimulated and tumoral endometria: an interobserver reproducibility study.

OBJECTIVE: The purpose of this study was to evaluate interobserver reproducibility of endometrial volume and vascular indices of the endometrium and subendometrial area estimated by 3-dimensional power Doppler angiography (3D-PDA) using the Virtual Organ Computer-Aided Analysis program, determining the influence of the endometrial growth etiology on measurements. METHODS: Forty women underwent 3D-PDA ultrasonography. Group A comprised 25 women scanned on the day after controlled ovarian stimulation with human chorionic gonadotropin. Group B comprised 15 patients who had uterine bleeding and questionable endometrial thickening. (Histologic evaluation revealed 10 endometrial cancers and 5 endometrial hyperplasias.) A single observer examined all patients and acquired all volume data sets. Forty volume data sets were then analyzed with the Virtual Organ Computer-Aided Analysis program by 2 different observers. Endometrial volume and vascularity indices (vascularization index [VI], flow index [FI], and vascularization flow index [VFI]) of the endometrium and subendometrium were manually calculated in the coronal plane with a 9 degrees rotation step. An intraclass correlation coefficient (ICC) was used to assess interobserver reliability. RESULTS: Endometrial volume was more reproducible in group A (ICC = 0.98) than in group B (ICC = 0.58) (P < .05). Endometrial and subendometrial VI, FI, and VFI also presented good reproducibility with ICC greater than 0.84. The ICC was not statistically different for endometrial and subendometrial VI, FI, and VFI according to patient group, although subendometrial VFI was less reproducible in group B (ICC = 0.53) than in group A (ICC = 0.88). CONCLUSIONS: Endometrial volume and endometrial and subendometrial 3D power Doppler indices have acceptable reproducibility. The interobserver reproducibility in tumoral endometrium was more similar than in stimulated endometrium. Our results indicate that 3D-PDA is a reliable method to evaluate physiologic and pathologic endometrial changes.     

三维超声造影诊断宫腔镜分离术后合并重度宫腔粘连的价值

目的探讨三维超声造影（3D-CEUS）诊断宫腔镜下宫腔粘连分解术（TCRA）后重度宫腔粘连（SIUA）的价值。方法回顾性分析83例TCRA术后IUA患者临床资料,所有患者均行宫腔镜、经阴道二维三维超声检查、3D-CEUS检查,获得子宫内膜相关参数:子宫内膜厚度、容积、血管指数、血流指数、血管化血流指数。以宫腔镜检查结果为准,分析3D-CEUS诊断TCRA术后SIUA的价值。结果本组TCRA术后确诊SIUA 36例,SIUA三维成像表现为宫腔形态异常、狭小、边缘不规则,内膜回声不连续等。经阴道三维超声诊断TCRA术后IUA分级准确率90.36%,与宫腔镜检查结果一致性较好（Kappa=0.795,P<0.05）。SIUA患者子宫内膜厚度、容积、血管指数、血流指数、血管化血流指数低于中度组和轻度组（P<0.05）,二元Logistic回归分析子宫内膜厚度、容积、血管指数、血流指数、血管化血流指数与TCRA术后SIUA发生显著相关（P<0.05）。ROC结果显示,子宫内膜厚度、血管化血流指数鉴别SIUA的效能较高,曲线下面积分别为0.794、0.856,灵敏度为80.56%、74.47%,特异度为88.89%、82.98%。结论经阴道三维超声可清晰显示TCRA术后宫腔粘连程度和累及范围,为IUA分级提供可靠参考。3D-CEUS测量相关子宫内膜参数可作为SIUA诊断的定量指标。      

三维能量多普勒直方图鉴别诊断卵巢肿物良恶性的价值

目的应用三维能量多普勒直方图定量测量卵巢肿物血管参数,并评价其鉴别诊断卵巢肿物良恶性的价值及与临床分期的关系。方法应用三维能量多普勒超声在术前1周内对57例卵巢肿物患者进行检查,测量肿物内实性部分的血管参数,包括血管形成指数(VI)、血流指数(FI)、血管形成-血流指数(VFI)。比较卵巢良性与恶性肿物之间血管参数的差异及其与临床分期的关系。结果 57例患者中共检出卵巢肿物62个(双侧卵巢肿物5例),经病理证实为良性肿物22个(良性组),恶性肿物40个(恶性组,包括交界性肿瘤8个)。恶性组肿瘤VI(6.3±5.9)%、FI(32.0±8.6)和VFI(2.4±2.7)测值均明显高于良性组肿物VI(2.1±3.3)%、FI(21.0±12.5)和VFI(0.7±1.1),差异有统计学意义(P均<0.01)。以VI>2.1%为界值鉴别卵巢肿瘤良恶性的灵敏度和特异度分别为80.0%、73.0%;卵巢癌FIGO分期Ⅰ、Ⅱ期肿瘤与Ⅲ、Ⅳ期肿瘤VI、FI和VFI测值比较差异均无统计学意义。结论三维能量多普勒直方图是术前评估卵巢肿物良恶性的新方法,可为其提供有价值的信息,但不能术前评估卵巢癌分期情况。     

三维造影增强能量多普勒超声在卵巢肿瘤诊断中的应用

目的 探讨三维造影增强能量多普勒（3D-CEPD）在卵巢良恶性肿瘤鉴别诊断中的价值。方法 对50例卵巢肿瘤患者分别于造影前、造影中及造影后进行三维能量多普勒（3D-PD）检查。采用3D-PD直方图计算肿瘤血管形成指数（VI）、血流指数（FI）和血管形成-血流指数（VFI）,比较卵巢良性与恶性肿瘤各血管参数的差异及各血管参数在造影前、造影中、造影后的差异,并评价3个参数的诊断效能。结果 50例患者中,18例为恶性肿瘤,32例为良性肿瘤。造影前、中、后卵巢恶性肿瘤的血管参数均明显高于良性肿瘤（P均<0.01）,良恶性肿瘤的各血管参数在造影前、造影中、造影后的差异有统计学意义（P均<0.01）。3个不同检查时段血管参数鉴别卵巢良恶性肿瘤的ROC曲线下面积均为VI最大,FI最小。造影前、中、后三个不同检查时段VI诊断卵巢恶性肿瘤的ROC曲线下面积分别为0.83、0.87、0.89。造影前以VI=2.2%为界值,鉴别卵巢良恶性肿瘤的敏感度、特异度、阳性预测值、阴性预测值及准确率为77.77%、87.50%、77.77%、87.50%、84.00%;造影中以VI=23.2%为界值,各诊断效能分别为94.44%、90.62%、85.00%、96.66%、92.00%;而造影后以VI=12.4%为界值,各诊断效能分别为94.44%、93.75%、89.47%、96.77%、94.00%,造影中及造影后的诊断效能较造影前明显增高（P<0.01）,而造影后的特异度、阳性预测值优于造影中（P<0.01）。结论 3D-CEPD可提高鉴别卵巢肿瘤良恶性的能力,血管参数VI最有诊断价值,其诊断效能以造影后更佳。