Department of Radiology, Stanford University School of Medicine, 300 Pasteur Drive, H1307, Stanford, CA, 94305, USA.
Abdom Radiol (NY). 2022 Dec;47(12):4227-4236. doi: 10.1007/s00261-022-03666-3. Epub 2022 Sep 13.
To evaluate the diagnostic performance of refractive edge shadow in evaluation of ovarian dermoids compared to other benign adnexal masses.
Ultrasound images of 139 patients with 154 dermoids, endometriomas, and hemorrhagic cysts were retrospectively reviewed by 3 radiologists blinded to final diagnosis. Ultrasound and clinical features were compared to pathology or follow-up ultrasound results as reference standard. Inter-reader agreements with free-marginal kappa and diagnostic performance were evaluated. The former was compared using Fisher's exact test or Mann-Whitney test with p < 0.05 to determine statistical significance.
The study sample consisted of 154 lesions: 50 dermoids, 50 endometriomas, and 54 hemorrhagic cysts. Refractive edge shadow, homogeneous echogenic appearance, tip of the iceberg sign, mural echogenic nodule, echogenic shadowing focus, and dot-dash sign all were statistically significant across all readers for the diagnosis of dermoid. Prevalence of each feature in dermoids compared to other entities were as follows: refractive edge shadow (70% vs 8%; p < 0.001), homogeneously echogenic appearance (34% vs 2%; p < 0.001), tip of the iceberg sign (16% vs 1%; p < 0.001), mural echogenic nodule (38% vs 2%; p < 0.001), echogenic shadowing focus (13% vs 1%; p < 0.001), and dot-dash sign (44% vs 1%; p < 0.001). Refractive edge shadow had the highest sensitivity, negative predictive value, and accuracy among all ultrasound features associated with dermoids (70%, 86%, and 85%, respectively).
Refractive edge shadow is a promising ultrasound feature for diagnosis of dermoids, with the highest diagnostic accuracy and prevalence compared to other previously described features associated with dermoids.
评估折射边缘阴影在评价卵巢皮样囊肿与其他良性附件肿块中的诊断性能。
对 139 例 154 例皮样囊肿、子宫内膜异位囊肿和出血性囊肿患者的超声图像进行回顾性分析，由 3 名放射科医生对最终诊断进行盲法评估。将超声和临床特征与病理或随访超声结果作为参考标准进行比较。采用边缘自由kappa 检验和诊断性能评估读者间的一致性。采用 Fisher 精确检验或 Mann-Whitney 检验比较前者，p<0.05 为差异有统计学意义。
研究样本包括 154 个病变：50 个皮样囊肿、50 个子宫内膜异位囊肿和 54 个出血性囊肿。折射边缘阴影、均匀高回声表现、冰山一角征、壁内点状强回声结节、回声影聚焦和点划线征在所有读者中均对皮样囊肿的诊断具有统计学意义。与其他实体相比，每种特征在皮样囊肿中的发生率如下：折射边缘阴影（70% vs 8%；p<0.001）、均匀高回声表现（34% vs 2%；p<0.001）、冰山一角征（16% vs 1%；p<0.001）、壁内点状强回声结节（38% vs 2%；p<0.001）、回声影聚焦（13% vs 1%；p<0.001）和点划线征（44% vs 1%；p<0.001）。折射边缘阴影在与皮样囊肿相关的所有超声特征中具有最高的敏感性、阴性预测值和准确性（70%、86%和 85%）。
折射边缘阴影是一种有前途的超声特征，可用于诊断皮样囊肿，与其他先前描述的与皮样囊肿相关的特征相比，具有最高的诊断准确性和发生率。
