Ultrasound Imaging In The Diagnosis Of Gynecological Diseases

Part One Contrast-enhanced Ultrasound of uterus diseases and a Correlation Study in PathologyPurposeObserve the contrast enhancement appearances of uterine diseases and assess the clinical value of contrast-enhanced ultrasound(CEUS) for these diseases.Analyze the characters of time-intensity curve(TIC) of endometrial cancers and the pathological basis of endometrial cancer TIC characteristics.Materials and methodsThe technique was low medical index pulse inversion harmonics and the contrast agent was SonoVue.Take 6 normal uterus CEUS as comparison cases.The enhancement phases and patterns were observed.The enhancement phases of lesions were campared to the uterus myometrium.The enhancement patterns were divided into four types: centripetal enhancement,centrifugal enhancement,diffuse enhancement and ring-like enhancement.In 18 cases,the time-intensity curves were given and the curve parameters were compared between the endometrial lesions and un-involved myometrium.Divide the cases into two groups by anterior-posterior width of lesions with value of 2cm.The curve parameters were compared between the two groups.In pathological study,efforts were paid on finding the relations between the grades or stages and tumor TIC parameters. Through immuno-histochemical staining for CD31 in 14 cases,the micro-vessel densities (MVD) were obtained.The relationships between TIC characters and MVDs were analyzed.Results1.Altogether 61 lesions were enrolled in this study,observed for their enhancement appearances during CEUS,including 30 endometrial carcinomas(confirmed by dilation and curettage,D&C),17 myomas,4 endometrial polyps,7 atypical trophoblastic tumors, 2 adenometriosis lesions and 1 uterus corner pregnancy remnant.(1) 80%endometrial cancer lesions and their feeding vessels enhanced earlier than the un-involved myometrium.The enhancement pattern was mainly diffuse type(92.3%, 28/30).53.3%(16/30) of cases wash-out earlier than the myometrium.The remain cases (46.7%) wash-out as the same pace as the myometrium.76.7%(23/30) cases showed the feeding vessels through CEUS.36.7%(11/30) of cases showed clearer tumors in growth positions,shapes and boundaries.(2) Submucous myomas and intra-myometrium myomas enhanced as the same pace as the myometrium(80%,8/10).The enhancement patterns were mainly diffuse enhancement(58.8%,10/17) and centripetal enhancement(35.3%,6/17).86.7% (13/15) of cases washed out earlier than the myometrium.(3) 75%(3/4) of polyps enhanced in a centrifugal enhancement and washed out later than the myometrium.(4) 71.4%(5/7) of atypical trophoblastic tumors lesions enhanced as the same pace as the myometrium but washed out later than myometrium.85.7%(6/7) were in ring-like pattern.(5) The one uterus corner pregnancy remnant enhanced earlier and washed out later than the myometrium in a diffuse type.The size became larger in enhancement state for about 1 cm diameter.2.The curve parameters analysis showed that the start time and peak time of lesions were earlier,the peak intensity and the rising of intensity were bigger,the rate of rising of intensity was faster in tumors than un-involved myometrium with significant differences. The curve parameters between＜1.9cm group lesion and≥1.9cm group lesion have no significant difference,neither in different grade groups and in different stage groups.The rising time and peak time were negatively correlated with MVDs.ConclusionUterine diseases have showed different enhancement characters including the enhancement phase and patterns.CEUS is valuable for diagnosis and differentiation of these diseases.The TIC parameters of uterine cancer have relationship with the MVD of carcinoma. Part Two Pilot study of real-time gray-scale contrast-enhanced ultrasound in evaluation of pelvic lesionsPurposeObserve the enhancement patterns and time-intensity curve characters of pelvic lesions except of uterus using contrast-enhanced ultrasound(CEUS).Assess the value of CEUS in differentiation of benign and malignant lesions.Materials and methods1.Contrast agent was SonoVue.The technique was low medical index real-time gray scale harmonics contrast-enhanced ultrasound.The tumors were divided by routine ultrasonography into 5 types:①mono-cystic lesion;②multi-cystic lesion;③mono-cystic and solid lesion;④poly-cystic and solid lesion;⑤solid lesion.The peak intensity statuses of the lesions were named enhancement patterns,which were divided into the same named-patterns.The differences between the routine ultrasound and enhancement patterns were compared.We tried to find out the differences of enhancement patterns of benign and malignant lesions.The differentiation diagnoses of benign and malignant lesions were performed through routine ultrasonography with gray and colorful ultrasonography and contrast-enhanced ultrasound.The diagnostic efficiencies were calculated and ROC curves were given.The helpful cases which CEUS were useful for diagnosis were listed.2.Time-intensity curve(TIC) analysis.The lesions which contain solid enhancement parts were chosen into this analysis.It was commanded there was not any movement between the lesions and probes.In software QLAB,TICs were given taken the solid parts as the regions of interest(ROIs).The curve shapes were analysed and the kinetic parameters of TIC were compared between benign and malignant lesions.Results1.76 pelvic lesions,including 49 benign and 27 malignant cases,were recruild in this study.There was significant difference between benign and malignant tumors number in solid and cystic group.The accuracies of three methods in differentiation of benign and malignant lesions were 81.6%and 90.8%separately.The areas under the ROC curves (AUCs) were 0.832 and 0.904.CEUS were helpful in diagnosis of ovarian fibromas, ovary adenomyosis cysts,ovary metastatus cancers and lymphoma metastatus.2.35 lesions were recuilded.The shapes of the descending part of curves were divided into two groups:mono-phased and hi-phased.93.3%of mono-phased curves were malignant,65%of bi-phased curves were benign.The diagnose specificity of malignant tumors according to the shapes of curves reach to 92.9%which was higher than the combination of CEUS(75%).The areas under the ROC curves of them were 0.798 and 0.845 separately.The parameters of benign and malignant groups also showed significant differences.The half wash-out time and half eliminate time were lower in benign group than in the other one.ConclusionsBenign and malignant of pelvic lesions have shown significant differences in enhancement patterns,shape and the parameters of time-intensity curves.CEUS can reflect the blood distribution and its richness degree which provide richful information as for the differentiation between benign and malignant adnexal tumors.