Ge Zhitong, Wang Yahong, Wang Ying, Fang Song, Wang Hongyan, Li Jianchu
Department of Ultrasound, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
Front Oncol. 2022 Aug 11;12:963675. doi: 10.3389/fonc.2022.963675. eCollection 2022.
Intravenous leiomyomatosis (IVL) is a rare disease, and few studies have focused on the diagnostic value of contrast-enhanced ultrasound (CEUS) in this condition. This study aimed to investigate the diagnostic value of CEUS in IVL and summarize the specific CEUS characteristics of IVL.
From December 2016 to March 2021, 93 patients admitted to our hospital with inferior vena cava (IVC) occupying lesions were prospectively enrolled and underwent detailed ultrasound multi-modality examinations, including conventional and contrast-enhanced ultrasound scans. The diagnostic value of CEUS and conventional ultrasound (CU) in IVL was compared, and the specific IVL signs were summarized.
Among the 93 patients with inferior vena cava mass, 67 were IVL while 26 were non-IVL. The inter-observer agreement of the two senior doctors was good, with Kappa coefficient = 0.71 (95% CI: 0.572-0.885). The area under the ROC curve of CU for IVL diagnosis was 0.652 (95% CI: 0.528-0.776), and its sensitivity, specificity, accuracy, positive predictive value, negative predictive value, missed diagnosis rate, and misdiagnosis rate were 61.1%, 69.2%, 63.4%, 83.7%, 40.9%, 38.8%, and 30.8%, respectively. The area under curve (AUC) for IVL diagnosis by CEUS was 0.807 (95% CI: 0.701-0.911), and the sensitivity, specificity, accuracy, positive predictive value, negative predictive value, missed diagnosis rate, and misdiagnosis rate were 82.0%, 84.6%, 82.8%, 93.2%, 64.7%, 15.4%, and 17.9%, respectively. In CEUS mode, "sieve hole sign" and "multi-track sign" were detected in 57 lesions, and the detected rate was higher than that of CU ( < 0.01).
CEUS can better show the fine blood flow inside the IVL, which is important for IVL differential diagnosis. Moreover, CEUS can obtain more information about IVL diagnosis than CU, compensating for the shortcomings of CU in detecting more blood flow within the lesion. Thus, this technique has great significance for IVL diagnosis.
静脉内平滑肌瘤病（IVL）是一种罕见疾病，很少有研究关注超声造影（CEUS）在该疾病中的诊断价值。本研究旨在探讨CEUS在IVL中的诊断价值，并总结IVL的CEUS特征。
2016年12月至2021年3月，前瞻性纳入我院收治的93例下腔静脉（IVC）占位性病变患者，进行详细的超声多模态检查，包括常规超声和超声造影扫描。比较CEUS和常规超声（CU）在IVL中的诊断价值，并总结IVL的特征性表现。
93例下腔静脉肿块患者中，67例为IVL，26例为非IVL。两位资深医生的观察者间一致性良好，Kappa系数=0.71（95%CI：0.572-0.885）。CU诊断IVL的ROC曲线下面积为0.652（95%CI：0.528-0.776），其灵敏度、特异度、准确度、阳性预测值、阴性预测值、漏诊率和误诊率分别为61.1%、69.2%、63.4%、83.7%、40.9%、38.8%和30.8%。CEUS诊断IVL的曲线下面积（AUC）为0.807（95%CI：0.701-0.911），其灵敏度、特异度、准确度、阳性预测值、阴性预测值、漏诊率和误诊率分别为82.0%、84.6%、82.8%、93.2%、64.7%、15.4%和17.9%。在CEUS模式下，57个病灶中检测到“筛孔征”和“多轨征”，其检出率高于CU（<0.01）。
CEUS能更好地显示IVL内部的细微血流情况，对IVL的鉴别诊断具有重要意义。此外，CEUS在IVL诊断中能比CU获得更多信息，弥补了CU在检测病灶内更多血流方面的不足。因此，该技术对IVL诊断具有重要意义。
