彩色多普勒超声诊断睾丸附件扭转的价值

目的探讨彩色多普勒超声诊断睾丸附件扭转的价值。方法对37例经彩色多普勒超声检查并经临床确诊为睾丸附件扭转患者的超声声像图表现进行回顾性分析。结果37例患者中,超声诊断为睾丸附件扭转者35例,超声误诊2例,诊断准确率为94.6%（35/37）。彩色多普勒超声显示睾丸上极或附睾头旁大小不等的不均质高回声结节,内无血流;25例患侧睾丸呈不同程度增大,血流增多;29例显示睾丸鞘膜腔内积液;30例显示阴囊壁不同程度增厚。结论睾丸上极或附睾头旁无血流的高回声结节是睾丸附件扭转的特征性声像图表现。彩色多普勒超声对睾丸附件扭转诊断准确性高,可作为诊断睾丸附件扭转的最佳检查方法。     

卵巢肿物蒂扭转的彩色多普勒超声诊断——血管蒂的超声表现

目的 应用彩色多普勒超声观察扭转血管蒂的声像图表现，评价无血流的血管蒂对附件组织的活性的超声诊断价值。方法 用频谱多普勒超声探查有无动静脉血流频谱。如有血流，定为无扭转。如血管蒂是弯曲或螺旋状，而且无血流信号，则认为有扭转存在。结果 42例中有33例术前超声确诊有扭转，28例经手术证实。预测准确率为84．8％。结论 通过声像图对血管蒂的观察来预测附件肿物有无蒂扭转比根据卵巢有包块和子宫直肠凹处见游离液准确率要高。     

彩色多普勒超声在睾丸扭转和睾丸附件扭转诊断及鉴别诊断中的应用

目的：探讨彩色多普勒超声在睾丸扭转和睾丸附件扭转诊断及鉴别诊断中的应用价值。方法：分析44例睾丸扭转和37例睾丸附件扭转彩色多普勒超声声像图特点, 总结二者鉴别诊断要点。结果：睾丸扭转特异性表现为睾丸内血运减少或消失以及睾丸上方无血运高回声团块。睾丸附件扭转超声表现为睾丸与附睾头之间或睾丸旁不均质高回声结节及睾丸、附睾内血运轻度增多。结论：彩色多普勒超声在睾丸扭转和睾丸附件扭转诊断及鉴别诊断中具有重要诊断价值。     

单纯性输卵管扭转的超声诊断

目的结合临床总结单纯性输卵管扭转的超声声像图特征.方法采用经腔内超声或经腹部超声对12例单纯性输卵管扭转患者进行检查,并按照输卵管扭转后的形态改变进行超声分型.结果12例单纯性输卵管扭转患者均以腹痛就诊,4例伴恶心呕吐.其临床及超声声像图表现:(1)输卵管扭转部位:12例患者患侧输卵管扭转部位均为输卵管峡部,右侧输卵管扭转4例,左侧输卵管扭转8例,输卵管扭转处管径增粗,最大直径为3~7 cm.(2)输卵管扭转圈数:12例中3例患侧输卵管扭转1圈,4例输卵管扭转2圈,3例输卵管扭转3圈,1例输卵管扭转4圈,1例输卵管扭转6圈.(3)超声直接征象:二维动态超声声像图示5例输卵管扭转处呈漩涡征.(4)超声间接征象:二维超声声像图示囊肿型10例(10/12,轻型4例,输卵管迂曲扩张,壁厚不光滑,输卵管黏膜皱襞较长,且清晰易辨认;重型6例,表现为圆形或椭圆形无回声区,壁较厚,多不光滑,输卵管黏膜皱襞呈小突起样不易辨认或黏膜皱襞消失);混合回声型2例(2/12),表现为附件区高回声、低回声和无回声混杂的团块,输卵管的结构不清晰.(5)内部血流显示情况:彩色多普勒血流成像示10例(囊肿型9例,混合回声型1例)患侧输卵管内部血流信号减少或消失,2例血流信号正常.(6)6例(6/12)伴少量盆腔积液(囊肿型5例,混合回声型1例).12例患者卵巢均正常.与手术病理诊断结果对照显示术前超声正确诊断单纯性输卵管扭转6例(6/12),误诊6例(6/12,2例误诊为卵巢扭转,2例误诊为卵巢囊肿蒂扭转,2例误诊为炎性包块).结论漩涡征是诊断单纯性输卵管扭转的直接征象;患侧卵巢正常而附件区输卵管扩张形成的囊肿或混合回声团块是诊断单纯性输卵管扭转重要的间接征象,认识并观察到这些超声征象有助于提高术前超声诊断准确性.     

原发性输卵管癌的超声声像图表现及误诊原因分析

目的探讨原发性输卵管癌(PFTC)的超声特征,分析误诊原因,以提高对该病的超声诊断水平。方法对2008年8月至2016年11月解放军总医院收治并经手术病理证实的41例原发性输卵管癌患者的临床、病理资料及超声声像图分型表现进行分析。结果 41例原发性输卵管癌声像图表现:(1)Ⅰ型6例,显示附件区迂曲管状囊性结构,囊壁见单发或多发乳头样突起,彩色多普勒示乳头上见较丰富的血流信号。(2)Ⅱ型2例,显示附件区囊实性肿块,呈腊肠形改变,边界清楚,在实性部分周边或一侧沿输卵管走行方向见囊性区,彩色多普勒示实性部分见较丰富或丰富的血流信号。(3)Ⅲ型13例,显示附件区低回声肿块,呈腊肠形改变,边界清楚,彩色多普勒示其内见较丰富或丰富的血流信号。(4)Ⅳ型14例,附件区单发或多发实性为主低回声肿块,形态欠规则,彩色多普勒示实性部分见较丰富或丰富的血流信号,一侧或双侧未显示正常卵巢结构,伴膀胱子宫陷窝腹膜增厚、子宫直肠陷窝腹膜增厚、大网膜增厚、远处其他脏器转移等1项或多项恶性征象。(5)Ⅴ型6例,仅表现输卵管积液或超声显示附件区无异常改变。术前超声提示原发性输卵管癌19例(46.3%,19/41)、误诊及漏诊22例(53.7%,22/41)。结论原发性输卵管癌超声声像图有一定特征性,但病变较小时超声易漏误诊。超声检查可显示输卵管病变位置、大小、内部回声、血流及其他脏器转移情况,可作为原发性输卵管癌术前诊断及术后随访的首选影像学方法。     

睾丸附件扭转的彩色多普勒超声诊断价值

目的：探讨彩色多普勒超声对睾丸附件扭转的诊断价值。方法对58例急性阴囊肿瘤的患儿进行灰阶及彩色多普勒超声检查，诊断睾丸附件扭转48例（49侧）；并对手术和保守治疗证实的48例患者的声像图进行回顾分析。结果：49例睾丸附件扭转中，超声显示睾丸附睾头间，睾丸上极和附睾头旁结节（扭转的睾丸附件）45例，结节多呈不均质高回声；42例结节内未显示血流信号，睾丸，附睾肿大及其血流信号增多41例；阴囊壁增厚39例，睾丸鞘膜积液31例，48例中，超声诊断正确45例，误诊3例，诊断符合为93．5％，结论：睾丸附睾头间及睾丸附睾旁高回声结节是睾丸附件扭转的特征性声像表现，彩色多普勒超声对本病诊断准确性高，可作为诊断睾丸附件扭转的最佳检查方法。     

彩色多普勒超声诊断卵巢扭转的价值

目的探讨彩色多普勒超声(CDFI)对卵巢扭转的诊断价值。方法应用CDFI对经手术后病理证实的11例卵巢扭转的声像图进行综合分析。结果3例为单纯性卵巢扭转,超声均准确诊断。8例为卵巢肿物伴扭转,超声准确提示扭转6例,2例分别误诊为右卵巢囊肿伴感染及左黄体血肿伴感染。诊断符合率81.8%。结论彩色多普超声诊断卵巢扭转实用有效,寻找并识别扭转的血管蒂是诊断本病的关键。     

睾丸附睾附件扭转的高频超声研究

目的 研究睾丸附伯和附睾附件扭转的高频彩色多普勒超声表现及其临床意义。方法 应用高频彩色多普勒超声检查、分析17例睾丸附件或附睾附件扭转的声像图改变，并与正常附件的超声表现、手术及随访结果进行对照。结果 睾丸附件或附睾附件扭转的超声表现为其体积膨大，呈卵圆形，回声不均匀，多呈高回声。扭转的附件多位于附睾头与睾丸上极之间，位置固定，并有触痛。附件内无血流信号显示、而附着处组织血供增多。患侧睾丸鞘膜积液。结论 高频彩色多普勒超声能发现睾丸附件或附睾附件扭转，并可判断其程度，有助于附件扭转治疗方案的选择。     

超声诊断睾丸或附睾附件扭转31例分析

目的探讨睾丸或附睾附件扭转的超声诊断价值。方法回顾性分析31例小儿睾丸或附睾附件扭转的声像图表现。结果睾丸或附睾附件扭转有特征性的声像图表现。结论彩色多普勒超声检查为诊断睾丸或附睾附件扭转的最佳检查方法。     

小儿睾丸附件扭转彩色多普勒超声诊断价值

目的：总结小儿睾丸附件扭转彩色多普勒超声表现及诊断价值。方法：回顾性分析82例睾丸附件扭转手术患儿的彩色多普勒超声表现。结果：82例患儿经手术证实睾丸附件扭转,归纳超声表现为睾丸上极与附睾头部附近可见类圆形结节,呈不均质强回声43例,等低回声者39例,伴不同程度附睾肿大80例（98%）,阴囊壁增厚74例（90%）,鞘膜积液56例（68%）,精索增粗52例（63%）,睾丸肿大21例（26%）,诊断符合率为93%（76/82）。结论：睾丸附件扭转声像图有较明显的特异性改变,高频探头结合彩色多普勒观察准确性高,能够快速明确诊断以利于临床治疗。     

Adnexal torsion: new clinical and imaging observations by sonography, computed tomography, and magnetic resonance imaging.

OBJECTIVE: The purpose of this study was to review the clinical, imaging, and pathologic findings associated with adnexal torsion. METHODS: A review of surgically proven cases of torsion between 1990 and 2006 included clinical, surgical, and pathologic data and preoperative sonographic, computed tomographic (CT), and magnetic resonance imaging (MRI) studies. Imaging reports were assessed to determine whether a correct preoperative diagnosis was made. Factors related to failure to make a correct diagnosis were evaluated. RESULTS: Fifty-eight cases of torsion were evaluated (patient ages, 12-85 years; 14 postmenopausal). There was a slight right-sided predominance (55%); in most cases (72%), both the ovary and fallopian tube were involved. Common symptoms/signs were pain (91%), leukocytosis (64%), nausea/vomiting (62%), and a palpable mass (41%). Twenty-eight patients (48%) had previous abdominal surgery; in 12 (46%) of these 28, pelvic adhesions were noted. At pathologic examination, underlying adnexal masses were found in 30 cases (52%); they were benign in 26 (87%) of 30 cases. Common imaging findings were an adnexal mass (65% on sonography, 87% on CT, and 75% on MRI), a displaced adnexal mass/enlarged ovary (53% on sonography, 87% on CT, and 75% on MRI), and ascites (53% on sonography, 73% on CT, and 50% on MRI). A correct preoperative diagnosis was made by initial sonography in 15 (71%) of 21 cases versus initial CT in 5 (38%) of 13. A correct imaging diagnosis was made more frequently in premenopausal than in menopausal patients (P = .02) and in patients without an underlying adnexal mass compared with those with a mass (P = .05). CONCLUSIONS: Although CT shows features suggestive of torsion, in our study, the diagnostic value of initial CT was less than that of initial sonography. A correct preoperative diagnosis was made less often with an underlying adnexal mass and in postmenopausal women. Previous surgery and adhesions may be predisposing factors for adnexal torsion.     

超声包裹征预测附件囊性包块蒂扭转的价值

目的探讨超声"包裹征"预测附件囊性包块蒂扭转的应用价值。方法回顾性分析193例因急性下腹痛就诊且超声检查存在附件囊性包块女性患者的超声图像,以手术结果为金标准确定附件扭转组131例,非扭转组62例,比较两组间超声包裹征的出现率,计算包裹征预测附件囊性包块蒂扭转的诊断效能。结果 (1)包裹征对应病理表现为扭转后输卵管及囊壁组织的广泛梗死水肿,半包绕扭转蒂部远端的囊肿;(2)扭转组131例中,出现包裹征共36例(27.5%),非扭转组中62例中出现1例(1.6%)包裹征,两组间差异具有统计学意义(P<0.001)。包裹征诊断附件囊性包块蒂扭转灵敏度、特异度和准确度分别为27.5%、98.4%、50.3%。当囊性包块最大长径<75.5mm时,包裹征诊断附件囊肿蒂扭转灵敏度、特异度和准确度分别为51.9%、97.6%、71.6%。结论超声包裹征预测附件囊性包块蒂扭转中具有高特异度。对于因下腹痛来诊女性患者,当合并包裹征时,应敢于提出疑似扭转的诊断。     

Sonography of ovarian fibromas/thecomas

The sonographic findings in 14 patients with ovarian fibromas/thecomas are described. A broad spectrum of sonographic features are presented and include hypoechoic mass with posterior shadowing (two cases); anechoic mass with good through transmission (with septations, two cases; without septations, four cases), echogenic mass with well-defined posterior wall (three cases); calcified mass (two cases); mixed echogenicity mass (one case). The pattern of a hypoechoic adnexal mass with acoustic shadowing should still suggest a fibroma/thecoma, but in most cases the appearance is nonspecific.     

Emergent complication of assisted reproductive technology: Clinical analysis of 17 pregnant women with adnexal torsion

BackgroundThe purpose of this study was to evaluate the clinical symptoms, surgical management, and outcomes of pregnant women with adnexal torsion due to assisted reproductive technology.MethodsIt was a retrospective study that include 17 pregnant women with adnexal torsion, in which the maternal age, type of fertilization, gestational age, clinical symptoms, ultrasonic findings, side affected by the disease, surgical method, and pregnancy outcomes were evaluated.ResultsA total of 17 patients with adnexal torsion were included in this study, of which 8 patients conceived by in vitro fertilization-embryo transfer (IVF-ET), 1 by artificial insemination (AIH), and the other 8 conceived naturally after ovulation induction. About 14 were reported to have occurred in the first trimester of pregnancy, 1 case in the second trimester, and the other 2 in the third trimester. Clinical symptoms were abdominal pain with or without nausea and vomiting. 14 cases occurred in the right adnexa and the other 3 in the left. 5 of the patients underwent laparoscopy, and the other 12 underwent laparotomy. 8 cases were of full- term delivery, 6 twins gave birth prematurely, and 3 patients had inevitable abortion.ConclusionsAdnexal torsion is an acute onset of lower abdominal pain in women, which seldom occurs during pregnancy. However, because of the wide application of assisted reproductive technology (ART), its incidence has increased. Early diagnosis and treatment can lead to better results.     

Contribution of color Doppler flow to the ultrasonographic diagnosis of tubal abnormalities.

Our objective was to characterize tubal abnormalities with color Doppler ultrasonography. We evaluated 25 women with adnexal masses suggestive of tubal masses using gray scale sonography. Color Doppler flow was added to further characterize the adnexal lesion. Of 18 women diagnosed as having hydrosalpinx, in 6 cases the diagnosis was tuboovarian abscess and in 1 case the diagnosis was tubal torsion. In the periphery of the hydrosalpinx, color Doppler flow revealed a mean resistive index of 0.752 +/- 0.04. In the periphery of the tuboovarian abscess, an abundant flow with reduced resistance to flow (mean resistive index = 0.448 +/- 0.04) was seen. The difference was statistically significant (P < 0.0001). In the case of adnexal torsion, no blood flow was detected in the lesion. All cases but one were confirmed in either laparoscopy or laparotomy or during colpotomy and drainage of the abscess. For adnexal masses suggestive of tubal lesions, color Doppler flow can further characterize the masses by detecting a significantly richer and low resistant blood flow in cases of tuboovarian abscess in comparison to hydrosalpinx.     

Sonographic and MRI findings in prepubertal adnexal hemorrhagic cyst with torsion

Adnexal torsion is rare before menarche. We report the case of a 10-year-old girl with persistent left lower quadrant pain proven by surgery to be caused by adnexal torsion due to a hemorrhagic cyst. Sonography showed a well-defined, complex, predominantly solid mass with some sound through-transmission and a small amount of fluid. The left ovary could not be distinguished from the mass; the right ovary appeared normal. Doppler sonography demonstrated no blood flow within the mass. MRI revealed a circumferential region of high signal intensity in the periphery of the mass and multiple hyperintense foci in the left ovary.     

Echogenic adnexal masses associated with first-trimester pregnancy: sonographic appearance and clinical significance

In a retrospective survey of a large obstetrical ultrasound experience, 10 echogenic adnexal masses in nine patients with a coexistent intrauterine pregnancy were detected and analyzed. Definitive follow-up data available for seven of the nine patients disclosed three ovarian teratomas, two hemorrhagic corpus luteum cysts, one endometrioma, one inflammatory mass, and one colonic pseudomass. In one additional patient, an echogenic ectopic pregnancy with an intrauterine pseudogestational sac simulated the above entities. Conservative management with follow-up sonography is generally indicated for echogenic masses coexistent with first-trimester intrauterine pregnancies.     

Comparison of tubal ring and corpus luteum echogenicities: a useful differentiating characteristic.

The purpose of this report is to compare the echogenicity of the tubal ring of an ectopic pregnancy and the corpus luteum with that of the ovary for improved detection of early ectopic pregnancy. In patients with ectopic pregnancy diagnosed at sonography on the basis of the presence of an adnexal tubal ring, echogenicity of the ring was compared with the echogenicity of the ovarian parenchyma. Twenty-six patients with tubal rings containing either a yolk sac or cardiac activity were included. Twenty-three (88%) of the 26 tubal rings had echogenicity equal to or greater than that of ovarian parenchyma. In 13 patients with ectopic pregnancy diagnosed on the basis of an empty tubal ring, 10 rings (77%) were more echogenic than the ovary. In 45 control patients with intrauterine pregnancy, the corpus luteum was more echogenic than the ovary in only 3 (7%). The tubal ring of an ectopic pregnancy is usually more echogenic than ovarian parenchyma, and the corpus luteum is usually equal to or less echogenic than the ovary. Echogenicity of an adnexal mass may help distinguish the tubal ring of an ectopic pregnancy from a corpus luteum.     

Ovarian and adnexal torsion: spectrum of sonographic findings with pathologic correlation.

OBJECTIVE: To determine the spectrum of sonographic findings on gray scale and color Doppler sonography in a series of pathologically proven cases of ovarian and adnexal torsion. METHODS: The study population included 15 patients with surgical confirmation of ovarian or adnexal torsion, or both, who underwent sonographic examination before surgery. All sonograms were reviewed retrospectively. RESULTS: Gray scale abnormalities included the following: complex masses in 11 (73%) of 15 patients, cystic masses in 3 (20%), and a solid mass in 1 (7%). Cul-de-sac fluid was present in 13 (87%) of 15 patients. Adnexal neoplasms were present in 4 (27%) of 15 (1 granulosa cell tumor and 3 dermoid cysts) on pathologic examination. Doppler findings were abnormal in 14 (93%) of 15 patients and normal in 1 (7%). Abnormal Doppler findings included no arterial and no venous flow in 6 (40%) of 15, decreased venous flow with no arterial flow in 5 (33%), decreased venous flow and decreased arterial flow in 2 (13%), and decreased arterial flow with no venous flow in 1 (7%). Small amounts of cul-de-sac fluid were present in 13 (87%) of 15 patients. CONCLUSIONS: The diagnosis of ovarian and adnexal torsion remains challenging. It cannot be based solely on the absence or presence of flow on color Doppler sonography, because the presence of arterial or venous flow does not exclude the diagnosis of adnexal torsion. Comparison with the morphologic appearance and flow patterns of the contralateral ovary will aid in diagnosis.     

妊娠合并附件扭转：临床及超声表现

目的 观察妊娠合并附件扭转(AT)的临床及超声表现。方法 回顾性分析20例经超声诊断并经手术证实AT孕妇的临床资料及声像图特征,并记录其随访结局。结果 20例中,8例左侧AT、12例右侧AT,均表现为腹痛伴患侧下腹部压痛,5例伴恶心呕吐、2例伴恶心无呕吐。超声于18例见卵巢肿物、2例卵巢均匀性增大,15例患侧卵巢内见点条状血流信号;15例附件区探及扭转的蒂样结构,即"漩涡征";1例卵巢周围皮质内见放射状排列的窦卵泡,即"滤泡环征";3例见卵巢间质水肿;16例伴腹盆腔积液。11例接受经腹腔镜手术,9例接受开腹探查术(5例联合剖宫产术);术中见AT扭转90°~1 800°。对18例卵巢肿物中的9例行附件切除术、7例行囊肿剥离术,2例仅予复位卵巢及输卵管。15例接受随访,9例妊娠至足月后7例顺产、2例接受剖宫产,6例继续妊娠未见明显异常。结论 妊娠合并AT以腹痛为主要临床表现,可伴恶心呕吐;超声常见卵巢肿物较大或卵巢增大和特征性的卵巢旁扭转蒂样结构。