Patel Maitray D, Feldstein Vickie A, Filly Roy A
Department of Radiology, Mayo Clinic, 13400 E Shea Blvd, Scottsdale, AZ 85259, USA.
J Ultrasound Med. 2005 May;24(5):607-14; quiz 615. doi: 10.7863/jum.2005.24.5.607.
The purpose of this study was to quantify the likelihood ratio (LR) of specific sonographic features and experienced sonologist assessment in diagnosing a hemorrhagic ovarian cyst and to better understand the diagnostic power of sonography in making this diagnosis.
Two sonologists, blinded to the patient's clinical history, independently reviewed the sonograms of 252 adnexal masses. For each mass, each sonologist recorded features using a standardized checklist, which included observations regarding the presence of fibrin strands, a retracting clot, septations, and wall irregularity. Each reviewer independently chose 1 specific conclusion from a list of possibilities that included the diagnosis of a hemorrhagic ovarian cyst. Sonographic observations and sonologist predictions were compared with pathologic findings (n = 214) or follow-up sonography (n = 38).
Of the 252 masses, there were 30 hemorrhagic cysts. One sonologist correctly identified 25 hemorrhagic cysts, with 1 false-positive, 2 false-negative, and 3 indeterminate calls (LR 185). The other sonologist correctly identified 24 hemorrhagic cysts, with 1 false-positive, 0 false-negative, and 6 indeterminate calls (LR 178). The 2 cases incorrectly diagnosed as hemorrhagic cysts were endometriomas at pathologic diagnosis. Specific sonographic observations and combinations of observations performed as follows: retracting clot (LR >67); fibrin strands (LR 40); fibrin strands and no septations (LR 100); and fibrin strands, no septations, and smooth wall (LR 200).
Fibrin strands and a retracting clot are paramount observations in allowing high confidence in the diagnosis of hemorrhagic ovarian cysts. Approximately 90% of hemorrhagic ovarian cysts will exhibit at least 1 of these 2 features.
本研究旨在量化特定超声特征及经验丰富的超声科医生评估在诊断出血性卵巢囊肿时的似然比（LR），并更好地理解超声在做出该诊断时的诊断能力。
两名对患者临床病史不知情的超声科医生独立审查了252例附件包块的超声图像。对于每个包块，每位超声科医生使用标准化检查表记录特征，其中包括关于纤维蛋白条索、退缩性血凝块、分隔及壁不规则情况的观察结果。每位审查者从包括出血性卵巢囊肿诊断在内的一系列可能性中独立选择1个特定结论。将超声观察结果及超声科医生的预测与病理结果（n = 214）或随访超声检查结果（n = 38）进行比较。
在252个包块中，有30个出血性囊肿。一名超声科医生正确识别出25个出血性囊肿，有1例假阳性、2例假阴性及3个不确定诊断（LR 185）。另一名超声科医生正确识别出24个出血性囊肿，有1例假阳性、0例假阴性及6个不确定诊断（LR 178）。病理诊断为子宫内膜瘤的2例被误诊为出血性囊肿。特定超声观察结果及观察结果组合表现如下：退缩性血凝块（LR >67）；纤维蛋白条索（LR 40）；纤维蛋白条索且无分隔（LR 100）；纤维蛋白条索、无分隔且壁光滑（LR 200）。
纤维蛋白条索和退缩性血凝块是对出血性卵巢囊肿诊断具有高度信心的关键观察结果。约90%的出血性卵巢囊肿将表现出这两种特征中的至少一种。
