Department of Ultrasound, Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510630, China.
Chin Med J (Engl). 2010 Nov;123(21):3095-9.
Ultrasound (US) is a popular method in the diagnosis and treatment of uterine leiomyomas, but the lack of accuracy greatly limits its application. Recently, microbubble enhancement technique affords direct depiction of tumor neovascularity and establishes a more precise vascular map of the tumor. This study was undertaken to describe the distribution patterns of SonoVue, a second-generation contrast agent, in the microcirculation of uterine leiomyomas, and to investigate the potential use of contrast-enhanced ultrasound (CEUS) in the characterization and treatment of uterine leiomyomas.
Ninety-six patients with uterine leiomyomas were enrolled in this study. The CEUS was performed using cadence pulse sequencing technique (CPS) and SonoVue. Enhancement patterns of different lesions were observed. The diagnostic accuracy of CEUS was compared with that of conventional ultrasound.
After contrast injection, vessels of macro- and micro-circulation of the myoma first appeared, followed by the normal myometrium and finally the endometrium. During the washout phase, the myoma exhibited homogeneous enhancement followed by apparent hypoenhancement. The margin of the tumor was depicted clearly. There was no agent perfusion in the benign degenerative or necrotic area. However in sarcomas degeneration, the feeding vessels appeared markedly earlier than those in myometrium. In addition, the tumor exhibited heterogeneous hyperenhancment with no agent perfusion in the center and no membraniform sign was observed in the late phase. In subserous and submucous leiomyomas, the feeding arteries in the pedicle arising from the uterine could be seen. In this study, the diagnostic accuracy of CEUS and conventional US for uterine leiomyomas was 96.7% (160/165) and 82.4% (136/165) respectively.
CEUS can provide a precise description of the leiomyomas vascularization. The specific enhancement pattern may be helpful for the characterization, treatment choice and therapeutic monitoring of leiomyomas.
超声（US）是诊断和治疗子宫肌瘤的常用方法，但准确性的缺乏极大地限制了其应用。最近，微泡增强技术提供了肿瘤新生血管的直接描绘，并建立了肿瘤更精确的血管图谱。本研究旨在描述第二代造影剂 SonoVue 在子宫肌瘤微循环中的分布模式，并探讨对比增强超声（CEUS）在子宫肌瘤特征描述和治疗中的应用潜力。
本研究纳入了 96 例子宫肌瘤患者。使用节奏脉冲序列技术（CPS）和 SonoVue 进行 CEUS。观察不同病变的增强模式。比较了 CEUS 的诊断准确性与常规超声。
造影剂注射后，肌瘤的巨、微循环血管首先出现，然后是正常的子宫肌层，最后是子宫内膜。在洗脱期，肌瘤表现为均匀增强，随后明显低增强。肿瘤边缘清晰描绘。良性变性或坏死区无造影剂灌注。然而，在肉瘤变性中，滋养血管出现的时间明显早于子宫肌层。此外，肿瘤表现为不均匀高增强，中心无造影剂灌注，晚期无膜状征象。浆膜下和黏膜下肌瘤可见发自子宫的蒂部的供血动脉。在本研究中，CEUS 和常规超声诊断子宫肌瘤的准确性分别为 96.7%（160/165）和 82.4%（136/165）。
CEUS 可以提供子宫肌瘤血管化的精确描述。特定的增强模式可能有助于子宫肌瘤的特征描述、治疗选择和治疗监测。
