| ObjectiveTo investigate the characteristics of contrast perfusion and wash mode in patients who have been confirmed of endometrial carcinoma by diagnostic curettage with contrast-enhanced ultrasound(CEUS) by using the second-generation contrast agent SonoVue and RP-pulse harmonic ultrasound imaging technique. To provide the theoretical basis of preoperative diagnosis and staging of endometrial carcinoma.Subjects and Methods1. CEUS Methods:Philips IU22-based color Doppler ultrasonic diagnostic apparatus (Philips, Netherlands), vaginal probe, frequency 4～8MHz. RP-pulse harmonic imaging technology was used, contrast agent was SonoVue. First, routine two-dimensional scanning was performed, the blood flow within and surrounding the lesion was demonstrated by color Doppler. In CEUS, the suspicious myometrial invasion or the deepest infiltration was selected as the section of intereste. The trocar was inserted into the peripheral vein (most on the left elbow vein) to establish intravenous access, and then injected the microbubble suspension 2.4ml rapidly, washed with 5ml normal saline. To observe the initiation site of enhanced lesion, the enhanced morphology from the beginning of injection carefully. The whole process of CEUS was recorded and stored as Dicom format in the hard disk of apparatus. If necessary, a second CEUS was performed, cross-cutting and slitting were both observed.2. Observation items of CEUS:the contrast enhancement was divided into early and late enhancement phase. Early phase means the time from the start of the uterine artery perfusion to peak enhancement of the muscle layer, the late phase is from the echo decreasing of the myometrium to the level before CEUS. Take the echo intensity of the myometrium as a enhancement reference to investigate the enhancement time, enhancement level, the enhancement patterns and their changes.ResultsThe enhancement signals was first arrived at the lesion of the nourishing blood vessels(the first area of enhancement) from the muscles outside the uterus (nourished by arcuate arteries), and then expanded and branch into the inner part of the carcinoma, finally, the contrast was diffused as punctiform signal in the lesion. The carcinoma was filled with contrast agent except the necrosis or fluid. Most cases (22/30,73.3%) demonstrate the tumor feeding vessels in the myometrium, few cases (8/30,26.7%) show the inner part of the carcinoma was first enhanced, slightly earlier than the surrounding muscle. Thick stripe signals were seen in larger tumors, contrast agents were unevenly distributed; the smaller tumors were mainly spotty enhancement, evenly and densely.Most carcinoma (20/30,66.7%) was washed out earlier than the surrounding tissues, which formed a sharply marginated hypoechoic zone, and consistent with the two-dimensional image. The time of wash out was different, especially in larger tumor.The location, shape and extension of the carcinoma 36.7%(11/30) demonstrated by CEUS was clearer than conventional ultrasound.2 cases showed no lesions in conventional ultrasound was demonstrated by CEUS; the necrosis failed to show by conventional ultrasound in 1 case was demonstrated in CEUS.ConclusionThe enhancement pattern of endometrial cancer with CEUS has some characteristics which is definitely different with the normal endometrium and could provide microcirculation information to make the preoperative diagnosis easily. CEUS is recommended as a new non-invasive diagnostic methods. |
PDF Full Text Request