The Value Of Contrast-enhanced Ultrasound In Differential Diagnosis Of Different Types Of Uterine Fibroids

Objective: By studying the characteristics and quantitative parameters of contrastenhanced ultrasound in different types of uterine fibroids,to explore the value of contrast-enhanced ultrasound in the differential diagnosis of different types of uterine fibroids,and to provide imaging basis for clinical surgery.Methods: Data of 114 lesions of 96 patients with uterine fibroids who underwent routine ultrasound and contra-ultrasound examination in the Woman′s Hospital School of Medicine Zhejiang University from June 2021 to March 2023 were collected.All patients underwent surgical treatment and pathological results were found.T here were101 benign lesions(research group),including 56 common leiomyomas,45 special types and fibroid degeneration,13 malignant lesions(control group).The contraultrasound characteristics of different types of uterine fibroids were investigated,and quantitative parameters of contra-ultrasound were compared in each group,including AT(arrival time),TTP(peak time),PI(peak intensity)and AUC(area under the curve).Results:(1)A total of 96 patients with uterine fibroids and 114 lesions were included in this study,including 101 benign lesions,including 56 cases of ordinary leiomyomas,45 cases of special and degenerative leiomyomas(9 cases of intravenous leiomyomatosis,7 cases of cellular leiomyoma,1 case of epithelioid leiomyoma,and 1case of fumaric acid hydrase deficient leiomyoma).There were 8 hysteromyomas with hyaline degeneration,12 hydropic degeneration of uterine leiomyoma,5 red degeneration of uterine leiomyoma,2 myxoid degeneration of uterine leiomyoma),13 malignant lesions,including 9 epithelioid leiomyosarcoma and 4 endometrial stromal sarcoma.(2)Different pathological types of uterine fibroids showed typical performance on contrast-enhanced ultrasound,and ordinary leiomyomas showed equal or high enhancement,uniform concentric enhancement and synchronous enhancement.Special types of leiomyomas,such as intravenous leiomyomatosis,are often shown by contrast-enhanced ultrasound as high enhancement of the peripheral vascular wall,low enhancement of the internal leiomyoma and concentric enhancement,combined with solid hypoechoic mass connected to the leiomyoma beside the uterus,or beaded nodules distributed along the uterine veins,which can assist in diagnosis.Cellular leiomyoma color doppler ultrasound showed abundant blood flow signals in fibroids,and contrast-enhanced ultrasound usually showed concentric high enhancement.Hydropic degeneration of uterine leiomyoma are often characterized by high enhancement of non-uniformity and multiple small dark areas of honeycomb or ethmoid cyst can be seen in the fibroids.Hysteromyomas with hyaline degeneration often showed equal heterogeneous enhancement and no contrast media filling in the local liquefaction necrotic area.Red degeneration of uterine leiomyoma showed no internal enhancement and enhanced annular uniformity in the periphery by contrastenhanced ultrasound,which combined with the patient’s pregnancy history can assist in diagnosis.The number of cases of leiomyoma with myxoid degeneration of uterine leiomyoma,epithelioid leiomyoma and fumaric acid hydration enzyme defect leiomyoma was small.Although the contrast ultrasound findings had their own characteristics,they were not representative yet,and the sample size needed to be expanded for further study.Malignant lesions,such as epithelioid leiomyosarcoma,were often accompanied by necrosis,and contrax-enhanced ultrasound showed high enhancement of non-uniformity.The enhancement mode was all concentric enhancement,and the enhancement time was all early enhancement.Color Doppler ultrasound showed chaotic and irregular blood flow signals in the tumor.Endometrial stromal sarcoma was characterized by high heterogeneous enhancement,early enhancement time,concentric or annular enhancement mode,and often cystic changes.(3)Quantitative analysis of contrast-enhanced ultrasound showed that malignant lesions were AT 15.64(12.81,16.97),TTP 21.51(18.03,23.48),PI-34.32(-37.91,-30.06)and AUC 3168.93(2847.87,3738.45).In the ordinary leiomyoma group,the AT,TTP,PI and AUC were 18.32(13.50,20.48),25.90(21.19,32.55),-39.05(-44.01,-35.75)and 1868.68(1189.01,2442.10)respectively.Special type and degenerative leiomyoma were AT 18.00(16.20,22.29),TTP 29.76(24.33,38.08),PI-43.91(-51.56,-41.95),and AUC 1504.03(1061.02,2403.74).There were significant differences in contrast parameters AT,TTP,PI and AUC between malignant lesion and common leiomyoma group,special type and degenerative leiomyoma group(P < 0.05),showed that for malignant lesions,the contrast agent for benign lesions,such as the common leiomyoma group,special type and degenerative leiomyoma,had early arrived time,peak time and high peak intensity,and had steeper slope of ascending branch,showing a fast in and fast out type.Conclusions:(1)Different types of uterine fibroids have typical contrastenhanced ultrasound manifestations.Contrast-enhanced ultrasound can improve the accuracy of diagnosis and obtain more objective results.(2)Contrast-enhanced ultrasound findings and TIC curves were significantly different between benign and malignant uterine fibroids.Benign lesions showed obvious subcapsular except for small fibroids,and the remaining fibroids showed obvious subcapsular when enhanced,while malignant lesions showed no obvious subcapsular when enhanced,and the boundary of malignant fibroids was not clear.For malignant lesions,the contrast agent for benign lesions,such as ordinary leiomyoma group,special type and denatured leiomyoma,has early arrival time,short peak time,high peak intensity and steeper slope of ascending branch,showing a fast in and fast out type,which is helpful for clinicians to make preoperative decisions.(3)The sample size of special types and degenerative fibroids is small.Although the CEUS has its own characteristics,it is not representative yet,and the sample size needs to be expanded for further study.