摘要目的 分析比较超声造影和国际卵巢肿瘤分析组织(International Ovarian Tumor Analysis ,IOTA)简单评价法鉴别诊断附件区肿瘤良恶性的临床价值.方法 对常规超声发现的101个可疑恶性的附件区肿瘤术前进行IO T A简单评价法分类,将肿瘤分为良性、不确定性、恶性;再进行超声造影检查,根据包膜完整性、包膜厚度均匀程度、增强强度(无增强、低增强、等增强、高增强)、增强表现(均匀、不均匀) 、分隔样增强对其进行评分,绘制ROC曲线,获得最佳评分界值,以病理结果作为金标准,分析比较二者诊断效能.结果 ①IO T A简单评价法鉴别诊断附件区肿瘤的ROC曲线下面积为 0 .757 ( P ＝ 0 .000 ) ,将不确定类型归为良性时登指数为 0 .41 ,敏感性 61 .54%,特异性79 .59%;将不确定类型归为恶性时登指数为0 .31 ,敏感性96 .15%,特异性34 .69%;排除不确定类型时,约登指数0 .77 ,敏感性76 .19%,特异性89 .47%.②超声造影评分指标:包膜不连续、包膜厚薄不均、分隔样增强、增强强度、增强表现在良恶性肿瘤中的差异具有统计学意义( P ＜0 .01) .③超声造影评分鉴别诊断附件区肿瘤的ROC曲线下面积0 .914 ( P ＝0 .000) ,将评分＞3分的肿物归为恶性时约登指数最大,为 0 .80 ,敏感性 78 .85%,特异性 91 .84%.④ IO T A 简单评价法联合超声造影:将IO T A简单评价法评价为良性的归为良性,评价为恶性的归为恶性,评价为不确定性且超声造影评分≤3分的归为良性,评价为不确定性且超声造影评分＞ 3分的归为恶性.二者联合鉴别诊断附件区肿瘤的ROC曲线下面积0 .831 ( P ＝0 .000) ,约登指数为0 .66 ,敏感性86 .54%,特异性 79 .59%.结论 超声造影相比IO T A简单评价法和二者联合在鉴别诊断附件区肿物良恶性方面具有较高的诊断效能.

abstractsObjective To campare the diagnostic value of contrast-enhanced ultrasound(CEUS) and International Ovarian Tumor Analysis (IOTA) simple rules in the differential diagnosis of adnexal tumors . Methods For the 101 suspicious malignant adnexal tumors discovered by conventional ultrasound ,IOTA simple rules and CEUS were performed before operation . Tumors were divided into benign ,uncertain and malignant according to IOTA simple rules . Tumors were scored by CEUS according to the membrane integrity ,coating thickness uniformity ,separation enhancement ,enhance strength ( no enhancement ,low enhancement ,equal or high enhancement) ,and enhanced performance( uniform and non-uniform) . The ROC curve was drawn with the pathological results as the gold standard ,and the best boundary value was obtained . Finally ,the diagnostic efficiency of the diagnostic methods were analyzed . Results ①According to the ROC curve analysis ,the area under the curve of IOTA simple rules was 0 .757( P ＝0 .000) . When the uncertainty type was classified as benign ,the random index was 0 .41 ,the sensitivity was 61 .54% ,and the specificity was 79 .59% . When the uncertainty type was classified as malignant ,the random index was 0 .31 ,the sensitivity was 96 .15% ,and the specificity was 34 .69% . When the uncertain types were excluded the Youden index was 0 .77 ,the sensitivity was 76 .19% ,and the specificity was 89 .47% . ②The differences in the membrane integrity , coating thickness uniformity , separation enhancement , enhance strength , enhanced performance between benign and malignant tumors were statistically significant( P ＜ 0 .01) . ③According to the ROC curve analysis ,the area under the curve of CEUS was 0 .914( P ＝ 0 .000) ,cut-off value was 3 score . The Youden index ,sensitivity and specificity of evaluating benign and malignant adnexal tumors were 0 .80 ,78 .85% and 91 .84% respectively . ④ The tumors evaluated as benign by IOTA simple rules was classified as benign . The tumors evaluated as malignant by IOTA simple rules were classified as malignant . The tumors evaluated as uncertain by IOTA simple rules and scored less than or equal to 3 points according to CEUS were classified as benign . The tumors evaluated as uncertain by IOTA simple rules and scored more than 3 points according to CEUS were classified as malignant . According to the ROC curve analysis ,the area under the curve of CEUS combined with IOTA simple rules was 0 .831 ( P ＝0 .000) . The Youden index ,sensitivity and specificity in evaluating benign and malignant adnexal tumors were respectively 0 .66 ,86 .54% and 79 .59% respectively . Conclusions CEUS has a higher diagnostic efficiency than IOTA Simple Rules and the two combined in the diagnosis of adnexal tumors .