Department of Obstetrics and Gynecology, Catholic University of Rome, Italy.
Ultrasound Obstet Gynecol. 2009 Dec;34(6):699-710. doi: 10.1002/uog.7464.
To determine whether intravenous contrast ultrasound examination is superior to gray-scale or power Doppler ultrasound for discrimination between benign and malignant adnexal masses with complex ultrasound morphology.
In an international multicenter study, 134 patients with an ovarian mass with solid components or a multilocular cyst with more than 10 cyst locules, underwent a standardized transvaginal ultrasound examination followed by contrast examination using the contrast-tuned imaging technique and intravenous injection of the contrast medium SonoVue(R). Time intensity curves were constructed, and peak intensity, area under the intensity curve, time to peak, sharpness and half wash-out time were calculated. The sensitivity and specificity with regard to malignancy were calculated and receiver-operating characteristics (ROC) curves were drawn for gray-scale, power Doppler and contrast variables and for pattern recognition (subjective assignment of a certainly benign, probably benign, uncertain or malignant diagnosis, using gray-scale and power Doppler ultrasound findings). The gold standard was the histological diagnosis of the surgically removed tumors.
After exclusions (surgical removal of the mass > 3 months after the ultrasound examination, technical problems), 72 adnexal masses with solid components were used in our statistical analyses. The values for peak contrast signal intensity and area under the contrast signal intensity curve in malignant tumors were significantly higher than those in borderline tumors and benign tumors, while those for the benign and borderline tumors were similar. The area under the ROC curve of the best contrast variable with regard to diagnosing borderline or invasive malignancy (0.84) was larger than that of the best gray-scale (0.75) and power Doppler ultrasound variable (0.79) but smaller than that of pattern recognition (0.93).
Findings on ultrasound contrast examination differed between benign and malignant tumors but there was a substantial overlap in contrast findings between benign and borderline tumors. It appears that ultrasound contrast examination is not superior to conventional ultrasound techniques, which also have difficulty in distinguishing between benign and borderline tumors, but can easily differentiate invasive malignancies from other tumors.
确定静脉对比超声检查在鉴别具有复杂超声形态的良性和恶性附件肿块方面是否优于灰阶或能量多普勒超声检查。
在一项国际多中心研究中，对 134 例具有实性成分的卵巢肿块或具有超过 10 个囊腔的多房性囊肿的患者进行了标准化经阴道超声检查，随后使用对比调谐成像技术和静脉注射对比剂声诺维（SonoVue(R)）进行对比检查。构建时间强度曲线，并计算峰值强度、强度曲线下面积、达峰时间、锐利度和半排空时间。计算恶性肿瘤的敏感性和特异性，并绘制灰阶、能量多普勒和对比变量以及模式识别（使用灰阶和能量多普勒超声检查结果主观分配肯定良性、可能良性、不确定或恶性诊断）的接收者操作特征（ROC）曲线。金标准是手术切除肿瘤的组织学诊断。
排除（超声检查后 3 个月以上切除肿块、技术问题）后，我们对 72 个具有实性成分的附件肿块进行了统计分析。恶性肿瘤的峰值对比信号强度和对比信号强度曲线下面积值明显高于交界性肿瘤和良性肿瘤，而良性和交界性肿瘤的值相似。最佳对比变量诊断交界性或侵袭性恶性肿瘤的 ROC 曲线下面积（0.84）大于最佳灰阶（0.75）和能量多普勒超声变量（0.79），但小于模式识别（0.93）。
超声对比检查结果在良性和恶性肿瘤之间存在差异，但良性和交界性肿瘤之间的对比结果存在很大重叠。似乎超声对比检查并不优于常规超声技术，后者也难以区分良性和交界性肿瘤，但可以容易地区分侵袭性恶性肿瘤与其他肿瘤。
