Contrast-enhanced Ultrasonography In The Diagnosis Of Female Pelvic Masses: A Preliminary Study

Objective: This study was designed to investigate the value of contrast-enhanced ultrasonography in the diagnosis of female pelvic masses.Materials and Methods: Thirty-one patients with forty-three female pelvic masses were examined by conventional ultrasonography and contrast-enhanced ultrasound (CEUS) combined with contrast tuned imaging (CnTI). Of them, twenty-one patients confirmed with uterine tumors (include thirty uterine myomas in nineteen patients, and two cases of malignant tumor) and eleven with adnexal masses (include seven cases of benign tumor, two malignant tumors and two adnexitis). The perfusion process and sonographic characteristics of lesions were observed; the enhanced parameters of the masses were analyzed with time-intensity curves (TIC); and then compared with results of conventional ultrasonography and pathological findings.Results:①Of the thirty uterine myomas from nineteen patients, peripheral globular enhancement pattern were showed in twenty-three myomas, homogeneous enhancement in five and centripetal enhancement in two. The half-intensity washout time of myomas were shorter than that of normal myometrium (P＜0.01).②The enhancement extent of uterine malignant tumors were lower than normal myometrium, or the washout of contrast agents were faster than normal myometrium. Compared with uterine myomas, uterine malignant tumors were enhanced early.③Adnexal tumors: After administrating of contrasted agents, cystic neoplasms were enhancement as ring-shape, and solid part of cystic-solid adnexal tumors or solid tumors were enhancement with different extent. Compared adnexal benign tumors, the uptake time, the time-to-peak of malignant tumors were shorter, the half-intensity washout time was longer, and the peak-baseline intensity was higher. The case of ovarian cancer after chemotherapy enhanced scarcely. (4) Adnexitis: One case enhanced significantly which developed like an abscess, the other enhanced scarcely.Conclusion:①The perfusion pattern of female pelvic masses could be visualized using CEUS with CnTI. Quantification of the perfusion characteristics with time-intensity curve is helpful to the differential diagnosis of female pelvic masses.②CEUS can demonstrate the lesions better than conventional ultrasonography for the difference of enhancement time or extent between the lesions and normal tissue around.③The perfusion pattern of most uterine myomas can be depict by peripheral globular enhancement. The washing-out of contrast agents in myomas was faster than normal myometrium. This distinctive perfusion pattern is helpful to the differential diagnosis of uterine myomas, especially cases with atypical appearance on conventional ultrasonography.