Li Xiaochun, Lu Huanchong, Zeng Ruhui, Wang Youping, Chen Shigao, Chen Shaoqi
Department of Ultrasound, The First Affiliated Hospital of Shantou University Medical College, Shantou, China.
Department of Gynecology, The First Affiliated Hospital of Shantou University Medical College, Shantou, China.
Quant Imaging Med Surg. 2025 May 1;15(5):3875-3890. doi: 10.21037/qims-24-2200. Epub 2025 Apr 17.
Ovarian thecoma-fibroma groups (OTFGs) are uncommon sex cord-stromal neoplasms. Ultrasound (US) is one of the imaging modalities frequently used to evaluate pelvic masses. It has the advantages of safety, convenience, and noninvasive diagnosis. However, there are still shortcomings in accurately diagnosing OTFGs. The present study aimed to describe the conventional ultrasound and high-frame-rate contrast-enhanced ultrasound (HiFR-CEUS) characteristics of OTFGs and to compare the diagnostic efficacy of these 2 methods and their combination to improve the diagnosis of OTFGs.
The study included 68 patients diagnosed with ovarian tumors with complete US images from January 2021 to December 2023. Based on pathology results, there were 35 OTFGs and 33 non-OTFGs. All patients underwent preoperative conventional US and HiFR-CEUS. A 3×2 Chi-squared test and paired Chi-squared test were used to compare the diagnostic concordance of the 3 methods to diagnose OTFGs. Sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) of these 3 methods were calculated to determine their efficacy for diagnosing OTFGs.
Among the 35 OTFGs, 77.1% tumors (27/35) showed hypoechogenicity in solid parts, with granular or linear hyperechogenicity. All tumors with recorded color Doppler signals (27/27) had no-to-sparse vascularization (color score 1-2). HiFR-CEUS showed typical linear perfusion in the OTFG tumors; 94.3% tumors (33/35) showed hypoenhancement at the peak intensity, as compared to the surrounding myometrium. Seven patients (7/35, 20.0%) had cystic lesions with no internal enhancement. The combination of conventional US and HiFR-CEUS showed the highest diagnostic efficacy for diagnosing OTFGs [sensitivity: 97%, specificity: 100%, accuracy: 99%, PPV: 100%, NPV: 97%, area under the curve (AUC): 0.99] as compared to conventional US (sensitivity: 23%, specificity: 100%, accuracy: 60%, PPV: 100%, NPV: 55%, AUC: 0.61) and HiFR-CEUS (sensitivity: 94%, specificity: 97%, accuracy: 96%, PPV: 97%, NPV: 94%, AUC: 0.96).
Most of the OTFGs showed characteristic linear perfusion in HiFR-CEUS. The combination of conventional US and HiFR-CEUS greatly improved the diagnosis rate of OTFGs. In summary, the combination of conventional US and HiFR-CEUS has significant value in the accurate diagnosis of OTFGs.
卵巢纤维瘤-卵泡膜细胞瘤组（OTFGs）是罕见的性索间质肿瘤。超声（US）是常用于评估盆腔肿块的影像学检查方法之一。它具有安全、便捷和无创诊断的优点。然而，在准确诊断OTFGs方面仍存在不足。本研究旨在描述OTFGs的常规超声和高帧率对比增强超声（HiFR-CEUS）特征，并比较这两种方法及其联合应用对OTFGs的诊断效能，以提高OTFGs的诊断水平。
本研究纳入了2021年1月至2023年12月期间68例经超声检查图像完整的卵巢肿瘤患者。根据病理结果，其中35例为OTFGs，33例为非OTFGs。所有患者术前均接受常规超声和HiFR-CEUS检查。采用3×2卡方检验和配对卡方检验比较这三种方法诊断OTFGs的一致性。计算这三种方法的灵敏度、特异度、准确度、阳性预测值（PPV）和阴性预测值（NPV），以确定它们对OTFGs的诊断效能。
35例OTFGs中，77.1%（27/35）的肿瘤实性部分呈低回声，伴有颗粒状或线状高回声。所有记录到彩色多普勒信号的肿瘤（27/27）均无至稀疏血管化（彩色评分1-2）。HiFR-CEUS显示OTFGs肿瘤典型的线状灌注；94.3%（33/35）的肿瘤在峰值强度时呈低增强，与周围肌层相比。7例患者（7/35，20.0%）有囊性病变，内部无增强。与常规超声（灵敏度：23%，特异度：100%，准确度：60%，PPV：100%，NPV：55%，曲线下面积（AUC）：0.61）和HiFR-CEUS（灵敏度：94%，特异度：97%，准确度：96%PPV：97%，NPV：94%，AUC：0.96）相比，常规超声与HiFR-CEUS联合应用对OTFGs的诊断效能最高（灵敏度：97%，特异度：100%，准确度：99%，PPV：100%，NPV：97%，AUC：0.99）。
大多数OTFGs在HiFR-CEUS中显示出特征性的线状灌注。常规超声与HiFR-CEUS联合应用大大提高了OTFGs的诊断率。总之，常规超声与HiFR-CEUS联合应用在OTFGs的准确诊断中具有重要价值。
