Ambrosio Marco, Raimondo Diego, Savelli Luca, Salucci Paolo, Arena Alessandro, Borghese Giulia, Mattioli Giulia, Giaquinto Ilaria, Scifo Maria Cristina, Meriggiola Maria Cristina, Casadio Paolo, Seracchioli Renato
Department of Obstetrics and Gynecology, S. Orsola Malpighi Hospital, University of Bologna, Bologna, Italy.
J Ultrasound Med. 2020 Jul;39(7):1253-1259. doi: 10.1002/jum.15213. Epub 2020 Jan 16.
To describe the ultrasound (US) features of intraligamental myomas (IMs) using Morphological Uterus Sonographic Assessment group standardized terminology.
This was a retrospective monocentric study. A total of 125 consecutive women with a preoperative US diagnosis of a myoma located close to the uterine isthmus (International Federation of Gynecology and Obstetrics stages 5, 6, and 7) from 2016 to 2019 who underwent laparoscopic or laparotomic myomectomy or hysterectomy were included for study analyses. The US data were retrieved from US reports and stored digital images by 2 authors. Ultrasound features of myomas were described according to Morphological Uterus Sonographic Assessment terminology. Clinical data for the study population were retrieved from the patients' records.
Nineteen women with a surgical confirmation of an IM were included in the study group; the remaining population constituted the control group (n = 106). Non-uniform echogenicity was detected in 17 of 19 (89%) of IMs compared to 26 of 106 (25%) fibroids in the control group (P < .001). The presence of shadowing was detected in 12 of 19 (63%) IMs compared to 94 of 106 (89%) cases in the control group (P = .004). Intraligamental myomas were more vascularized tumors compared to myomas in the control group (P = .004). Transvaginal US showed high specificity for the diagnosis of an IM (0.93; 95% confidence interval, 0.87-0.96).
On US imaging, IMs appear as vascularized solid tumors with nonuniform echogenicity; cones of shadows were less frequent in IMs than the control group, and this finding can help in the differential diagnosis. Knowledge of their specific US features could help sonographers make an accurate diagnosis, allowing them to plan correct surgery and avoid severe complications.
使用子宫形态超声评估组的标准化术语描述韧带内肌瘤（IMs）的超声（US）特征。
这是一项回顾性单中心研究。纳入了2016年至2019年间连续125例术前经超声诊断肌瘤位于子宫峡部附近（国际妇产科联盟分期5、6和7期）并接受腹腔镜或开腹肌瘤切除术或子宫切除术的女性进行研究分析。超声数据从超声报告中获取，并由2位作者存储数字图像。肌瘤的超声特征根据子宫形态超声评估术语进行描述。研究人群的临床数据从患者记录中获取。
研究组纳入了19例经手术证实为IM的女性；其余人群构成对照组（n = 106）。19例IM中有17例（89%）检测到回声不均匀，而对照组106例肌瘤中有26例（25%）出现回声不均匀（P <.001）。19例IM中有12例（63%）检测到声影，而对照组106例中有94例（89%）出现声影（P = .004）。与对照组的肌瘤相比，韧带内肌瘤的血管化程度更高（P = .004）。经阴道超声对IM的诊断具有较高的特异性（0.93；95%置信区间，0.87 - 0.96）。
在超声成像中，IM表现为血管化的实性肿瘤，回声不均匀；IM中声影圆锥比对照组少见，这一发现有助于鉴别诊断。了解其特定的超声特征有助于超声检查人员做出准确诊断，从而能够规划正确的手术并避免严重并发症。
