输卵管妊娠的超声造影表现及与手术病理的对照分析

目的了解输卵管妊娠的超声造影表现，探讨超声造影技术的临床应用价值。方法采用CnTI技术及SonoVue，对43例疑似输卵管妊娠病例进行二维超声及超声造影检查，总结其声像表现并与手术病理对照分析。结果43例患者中24例行手术治疗，超声确诊输卵管妊娠21例，3例误诊，另19例接受保守治疗或失访。与手术病理对照，二维超声在14例患者附件区发现Donut环，其中7例造影时环壁均匀强化，术中腹腔内无出血或仅有少量出血；7例环壁不均匀强化，术中示输卵管积血。4例二维超声示附件区Donut环及其周围不规则形混合回声，造影时仅见Donut环强化，术中可见输卵管伞端有血块包绕。3例二维超声示附件区不规则混合回声肿块，造影时肿块内见长圆形或“腊肠形”薄壁样强化，术中可见输卵管内及盆腔血块，病理于血块中发现绒毛组织。结论不同类型的输卵管妊娠超声造影表现不同，超声造影可在一定程度上反映其病理改变，有利于输卵管妊娠诊断和鉴别诊断。

Contrast-enhanced ultrasonography of tube pregnancy-comparison with operational and pathologic results

Objective To depict the characteristics of different types of tube pregnancy by contrast-enhanced ultrasound and to evaluate the clinical value of contrast-enhanced ultrasound in the diagnosis of tube pregnancy.Methods Forty-three patients suspected of tube pregnancy underwent contrast-enhanced ultrasound by utilizing SonoVue with contrast tune imaging (CnTI) technology.Contrast-enhanced sonographic features were analyzed and compared with operational and pathologic results.Results Twenty-four patients received operation.Twenty-one of them were confirmed as tube pregnancy,the other three patients were misdiagnosed.Nineteen patients failed to be followed up or received conservative treatment.Among the confirmed cases,fourteen patients displayed Donut sign on B-mode ultrasound,seven of which showed a ring-like homogeneous enhancement of the mass after injection of SonoVue,no blood or little blood was found in abdominal cavity in operation and un-ruptured tube pregnancy was diagnosed.While the other seven patients showed inhomogeneous enhancement of the lesion in contrast-enhanced ultrasound,hemosalpinx was detected in these patients in operation with the diagnosis of aborted tube pregnancy.On B-mode ultrasound,four patients showed Donut sign along with irregular and inhomogeneous masses,but enhancement were only seen within the Donut and no blood perfusion into the irregular masses on contrast-enhanced imaging.Clots around the tube were found in these patients in operation.In the other three patients,irregular adnexal masses with no Donut sign were found on baseline scan.After injection of SonoVue,sausage-shaped thin-wall enhancement was detected.All the three patients had hemosalpinx and chorionic tissue was found within the clot by pathologic examination.Conclusions Different types of tube pregnancy had different manifestations in contrast-enhanced sonography,which can reflect the pathologic features of tube pregnancy to some extent,and may contribute to the diagnosis and the differential diagnosis of the disease.