超声造影与MRI增强扫描对不确定性盆腔肿块良恶性判断的比较研究

目的 比较超声造影（CEUS）与MRI增强扫描对不确定性盆腔肿块良恶性的诊断价值。方法 对46例常规超声检查发现不确定性（使用国际卵巢肿瘤分析中的简易准则判断）盆腔肿块行实时CEUS以及MRI增强扫描检查,2名超声科医师及2名放射科医师在结合患者病史以及血清肿瘤标志物前后分别对检查结果独立作出诊断,以术后病理结果（n = 43）或临床治疗后的最终随访诊断结果（n = 3）作为金标准,对比结合病史及肿瘤标志物前后2种影像技术的诊断价值。结果 结合患者病史及肿瘤标志物前,CEUS对不确定性盆腔肿块的诊断准确度为67.4%,低于MRI增强扫描的80.4%,两者比较结果差异有统计学意义（P < 0.05）;结合病史和（或）结合肿瘤标志物后,2种影像技术对不确定性盆腔肿块的诊断准确度比较差异均无统计学意义（P均> 0.05）。CEUS结合患者病史和肿瘤标志物对不确定性盆腔肿块诊断准确度为91.3%,与不结合任何病史资料的CEUS比较差异有统计学意义（P < 0.05）。结论 在结合患者病史和血清肿瘤标志物的情况下,CEUS与MRI增强扫描对不确定性盆腔肿块的诊断准确度相当,CEUS对不确定性盆腔肿块的良恶性判断具有良好的临床应用价值。

Comparison between contrast-enhanced ultrasound and enhanced MRI in indeterminate pelvic masses

Objective To compare the diagnostic value of contrast-enhanced ultrasound （CEUS） and enhanced magnetic resonance imaging （MRI） in indeterminate pelvic masses. Methods CEUS and MRI were performed on 46 cases of sonographically indeterminate pelvic masses according to International Ovarian Tumor Analysis （IOTA） simple rules. Two independent sonographers and two radiologists reviewed the images before and after combining with medical history and serum tumor markers, respectively. The results of CEUS and MRI were compared with pathologic findings （n = 43） or follow-up data after clinical treatment （n = 3） as gold standard. The diagnostic values of CEUS and MRI before and after combining with medical history and tumor markers were compared. Results The diagnostic accuracy of CEUS in indeterminate pelvic masses was 67.4% without combining with medical history and tumor markers, which was lower than 80.4% of MRI. There was a statistical significance （P < 0.05）. However, there was no statistical significance between them after combining with tumor markers and/or medical history （both P > 0.05）. The accuracy of CEUS combined with medical history and tumor markers in diagnosing pelvic masses was 91.3%, which was statistically different from CEUS without considering any medical histories （P < 0.05）. Conclusion When combining with medical history and tumor markers, CEUS yields an equivalent diagnostic accuracy in differentiating malignant from benign pelvic masses compared with MRI. CEUS has high clinical value for diagnosing indeterminate pelvic masses.