Study On The Correlation Between Real-time Gray Scale Contrast-Enhanced Ultrasonography And Microvessel Density In Diseases Of Uterine Cavity

ObjectiveMany studies indicate malignant tumors are highly dependent on vascularization for their growth and spread.Microvessel density(MVD)has correlation with the formation of tumors'vessels,and can be mostly used to detect the formation of tumor angiogenesis.Real-time gray scale contrast-enhanced ultrasonography(CEUS),a new ultrasonic diagnostic technique present during recent years,is able to estimate the condition of organ blood flow,with more sensitive and better efficacy of the detection than those of CDFI(Color Doppler Flow Imaging).It will be a new method of estimating tumor angiogenesis.The purpose of the study is to investigate the value of real-time gray scale CEUS in the differentiation of benign and malignant diseases in uterine cavity,by studying on the correlation between CEUS and MVD.MethodsWe examined 27 women patient who were suspected acquiring diseases in uterine cavity and 8 women patient who had normal endometfia,from January 2007 to January 2008.All the patients underwent real-time gray scale CEUS examination during the week prior to surgery,with SonoVue(BR1,Bracco,Milan,Italy)and Code PI(Coded Pulse Inversion Harmonic Imaging).All the patients of malignant tumors were staged clinically according to the staging system of the International Federtion of Gynecology and Obstetrics(FIGO,2000).The equipment used in the study was GE logiq 9 with 2～4MHz abdominal transducer.After examination,the specified procedure was to define the contrast-enhanced patterns into 2 grades:GradeⅠ:quickly entirely engorging;GradeⅡ: peripherally engorging.Compared the differences of the contrast-enhanced patterns of all patients.Then started TIC soft ware to analysis all images,to draw TIC,to obtain the shapes of curves and contrast parameters:baseline intensity,peak intensity,time to peak,arrival time,area under curve(AUC),relative rise in intensity.Comparing with the pathological results,we divided the contrast parameters into three groups:normal control group,benign group and malignant group.All the tissue samples were obtained after operation.MVD of the tissue samples was assessed by immuno-histochemical method(SP method).The statistical data were analyzed using the Statistical Package for the Social Sciences(SPSS)13.0.Comparisons were performed by One-Way ANOVA, Dunnett-t-test,Independent-Samples T Test and Pearson correlation analysis.P value <0.05 was considered to be significant.Result1.The analysis of contrast-enhanced patternsThe diseases in uterine cavity and normal endomembrane have different contrast-enhanced patterns:Endometrial cancer shows GradeⅠ,contrast agent engorges and subsides more quickly than peripheral myometrium;Benign diseases show GradeⅡ.In submucous myoma,contrast agent engorges more quickly and subsides more slowly from peripheral than center;In endometrial polyp,contrast agent engorges less slowly than peripheral myometrium or at the same time,and subsides less slowly than peripheral myometrium or at the same time;In hyperplasy endomembrane and normal endomembrane,contrast agent engorges more slowly,and subsides less quickly than peripheral myometrium or at the same time.2.TIC analysisThe shapes of malignant group generally show 'quickly rising and quickly descending'with sharp peak.The shapes of benign group and normal control group generally show 'quickly rising and slowly descending' with round peak.In contrast parameters,time to peak,relative rise in intensity and AUC all have significant difference between benign group and malignant group(p＜0.05).3.The analysis of correlation of contrast parameters and MVD There is a negative correlation between time to peak and MVD(r=-0.779)and a positive correlation between AUC and MVD(r=0.758).On the basis of the analysis of ROC curve,the area under ROC curve of time to peak is 0.903 and that of AUC is 0.750.ROC curve shows the cut off values respectively are 13.685s,1435.860dB*s, the sensitivities respectively are 93.8%,90.9%and the specificities respectively are72.7 %,43.7%.ConclusionReal-time gray scale CEUS can display the filling character of vessels of the diseases in uterine cavity.Through describing the contrast-enhanced patterns and analyzing TIC,CEUS can elevate the accuratissme of ultrasound discriminating between benign and malignant diseases in uterine cavity.The correlation between contrast parameters and MVD shows the potentiality of predicting tumor angiogenesis, and thus,CEUS is an available method to diagnose and discriminate the diseases in uterine cavity before operation.