摘要目的 探讨超声静脉造影(CEUS)和腔内造影在鉴别诊断绝经后子宫内膜良恶性病变中的价值.方法 对2016年3月至2018年3月间确诊的90例绝经后子宫内膜病变患者的超声资料进行回顾性分析,根据病理学结果分为良性组(55例)和恶性组(35例),比较两组患者腔内造影子宫内膜厚度,CEUS的上升时间(RT)、达峰时间(TTP)、基础强度(BI)和峰值强度(PI)等超声参数,以病理学诊断为“金标准”,应用受试者工作曲线(ROC)比较不同超声参数在子宫内膜良恶性中的诊断效能.结果 恶性组患者的子宫内膜厚度和PI明显高于良性组(P＜0.05),RT和TTP显著低于良性组(P＜0.05),而BI组间差异无统计学意义(P＞0.05).ROC曲线显示,PI鉴别子宫内膜病变良恶性的AUC最高(AUC=0.983),其次为RT和TTP(AUC=0.889,0.872)、子宫内膜厚度(AUC =0.766),PI的AUC明显高于RT、TTP和子宫内膜厚度(P＜0.05),其最佳截点为PI≥20.23dB.PI、RT和TTP的鉴别子宫内膜良恶性病变的灵敏度均明显高于子宫内膜厚度(P＜0.05),而PI的特异度和阳性似然比(+LR)均显著高于RT、TTP和子宫内膜厚度(P＜0.05).结论 与腔内造影相比,超声静脉造影在鉴别绝经后子宫内膜良恶性肿瘤中具有更好的诊断价值,其中PI≥20.23dB下的诊断灵敏度、特异度较高.

abstractsObjective To explore the value of contrast-enhanced ultrasound (CEUS) and intraluminal contrast in the differential diagnosis of postmenopausal endometrial benign and malignant lesions.Methods The ultrasound data of 90 patients with postmenopausal endometrial lesions diagnosed in our hospital between March 2016 and March 2018 were retrospectively analyzed.According to pathological findings,they were divided into benign group (55 cases) and malignant group (35 cases).The endometrial thickness of endovascular contrast,rise time (RT),time to peak (TTP),base intensity (BI),and peak intensity (PI) of CEUS in two groups were compared.Receiver operating characteristic curves (ROC) were used to compare the efficacy of different ultrasound parameters in benign and malignant endometrial by using pathology diagnosis as "gold standard".Results The endometrial thickness and PI were significantly higher in the malignant group than those in the benign group (P ＜ 0.05),while the RT and TTP were significantly lower than benign group (P ＜ 0.05),with no statistical difference in BI (P ＞ 0.05).The ROC curve showed that PI has the highest area under curve (AUC) in the differential diagnosis of benign and malignant endometrial lesions (AUC =0.983),followed by RT and TTP (AUC =0.889,0.872),and intimal thickness (AUC =0.766).AUC of PI was significantly higher than RT,TTP and intimal thickness (P ＜ 0.05),and the best cut-off point for PI ≥20.23 dB.The sensitivity of PI,RT,and TTP in differentiating benign and malignant endometrial lesions was significantly higher than that in intimal thickness (P ＜ 0.05),whereas the specificity and positive likelihood ratio (+ LR) of PI were significantly higher than those of RT,TTP,and intimal thickness (P ＜ 0.05).Conclusions Compared with intracavitary ultrasound,CEUS has better diagnostic value in differentiating benign and malignant endometrial tumors.Among them,the diagnostic sensitivity and specificity of PI≥20.23 dB are higher.