Differentiation Of Uterine Myoma And Adenomyosis With Real-time Gray-scale Contrast-enhanced Ultrasonography

ObjectiveThe objective of the study is to assess the characteristics and the value of real time gray-scale contrast-enhanced ultrasound (CEUS) in the differential diagnosis between uterine leiomyoma and uterine adenomyosis .Materials and MethodsFrom May 2007 to February 2008 , an analysis was performed on 26 patients with 32 uterine lesions(24 cases of uterine leiomyoma , 8 cases of uterine adenomyosis) at Shengjing Hospital , China Medical University . All the patients underwent CEUS examination during the week prior to surgery . The equipment used in the study was American GE-L0GIQ9 with 2～4 MHz transabdominal transducers . Each patient underwent CEUS with Time Intensity Curve (TIC) software . The acoustic contrast agent we used was SonoVue that producted by Italy Bracco company. New contrast agent SonoVue was injected intravenously as a bolus in 1.5ml and CEUS was performed to observe the enhanced pattern and characteristics . The TIC parameters of uterine leiomyoma and uterine adenomyosis were analysised by TIC software . The results of CEUS were compared with those of conventional ultrasound and pathology .ResultsAfter the administration of SonoVue , 18 (18/24 , 75%) patients with uterine leiomyoma showed peripherial globular enhancement pattern and centripetal filling immediately . There was a clear border between the tumor and the adjacent uterine parenchyma in 17 (17/24 , 70.83%)uterine lesions when to peak . But the other cases(7/24 , 29.17%) had no clear border . Three cases of small myoma that the conventional ultrasound did not detected was diagnosised by CEUS . These small myomas could show atypical contrast pattern. It showed no ring enhancement and contrast agent appearing from centre to surround. Additionally , it showed earlier wash-out than the adjacent uterine parenchyma . The uterine parenchyma showed to have a "black hole" .The feeding artery from uterus depicted clearly in some subserous myomas . The subserous myomas showed earlier wash-out than the capsule and the border was clear . Additionally , when the myoma had glassy degeneration, no contrast agent appeared in the degeneration area . But the rest part was similar to the characteristics of the typical uterine myoma.All the eight patients with uterine adenomyosis showed intratumor enhancement pattern and remained isoechoic with respect to the surrounding tissue . There was no clear border between the tumor and the adjacent uterine parenchyma.Significant differences between means for uterine leiomyoma and uterine adenomyosis were found for following parameters : Time to Peak intensity , Peak intensity , Enhancement duration, Enhancement intensity (p<0.05). But there were no significant differences in Arrival Time, Arrival enhancement between uterine leiomyoma and uterine adenomyosis (p<0.05).Conclusion1. Real time contrast-enhanced ultrasound shows different enhancement pattern and characteristics of uterine leiomyoma and uterine adenomyosis . It should be used as an important tool for differential diagnosis .2. There were significant differences in Time to Peak intensity , Peak intensity, Enhancement duration , Enhancement intensity between leiomyoma and uterine adenomyosis . They may provide more information for the diagnosis of them .3. Real time contrast-enhanced ultrasound can detect the non-typical uterine leiomyoma that conventional ultrasound(CUS) can not find .4. Real time contrast-enhanced ultrasound may provide more information for the diagnosis of subserous and submucous myomas .