Clinical Value Of Contrast Enhanced Ultrasound(CEUS) For The Differential Diagnosis Of Special Types Of Uterine Leiomyomas

Objective: To improve the accuracy of clinical diagnosis,we need to analyze different CEUS images of special types of uterine leiomyomas.Methods: Perspective study,enrolling 153 patients' images of CEUS who were considered as uterine leiomyomas before operations between May 2016 and March 2018 in Zhongda Hospital.All of them did CEUS before surgery.Parameters include: enhanced form,enhancement level,enhancement time,edge condition,peak intensity(PI),time to peak(TTP),rise time(RT),mean transit time(MTT)and quality of fit(QOF).They were divided into four groups according to the postoperative pathology: uterine leiomyomas group(A group),cellular uterine leiomyoma group(B group),hysteromyoma with hyaline degeneration group(C group)and uterine sarcomas group(D group).SPSS 22.0 statistical software was used to analyze the differences in ultrasound image indexes between the groups.Results 1.The study enrolled 153 cases according to the inclusion criteria and exclusion criteria.147 cases of good images included in the data analysis.Six cases were not included in the study because 2 cases failed due to unfixed study area caused by postural change and 4 cases' postoperative pathology suggest non-research disease.Of the 147 patients,there were 4 cases of uterine sarcoma and 143 cases of benign tumors,of which 71 cases were uterine leiomyomas,38 cases were cellular uterine leiomyomas,and 34 cases were hysteromyoma with hyaline degeneration.4 cases were uterine sarcomas.2.In group A,the ratios of high enhancement,early enhancement and even enhancement of leiomyomas were higher than that in group B and C.The ratios of equal enhancement and synchronized enhancement of leiomyomas were lower than that of group B,and the ratios oflow enhancement and delayed enhancement of leiomyomas were lower than that of group C(P<0.05).There is no significant difference in the degree of ring enhancement among the three groups(P>0.05).There is no statistical difference in the rate of ring enhancement and edge shape among the three groups(P>0.05).All patients in group C showed no enhancement areas,which was significantly different from those in group A and B(P<0.05).3.The ratios of PI in group B were higher than that in group C and lower than that in group A.The ratios of RT,TTP and MTT in group C were higher than those in group B and A.The ratios of RT and TTP in group A were lower than those in group B and C(P<0.05).4.Comparing with uterine leiomyomas,when the PI ratio was ?0.998,the sensitivity and specificity for diagnosis of cellular uterine leiomyomas were the highest,which were 84.2% and 73.2%,respectively.The PI ratio ?0.469,the highest sensitivity and specificity in the diagnosis of hysteromyoma with hyaline degeneration were 73.5% and 80.3%.5.Uterine sarcoma showed inhomogeneous enhancement,hyper-enhancement and early enhancement,the tumor borders are not clear,and the lesions contain no enhanced areas.However,the PI,RT,TTP and MTT between the lesions and the surrounding muscles were not obvious.Conclusions 1.Different pathological types of uterine leiomyomas have their own typical signal performance in CEUS.We can infer the pathological types by CEUS.2.Patients with uterine sarcoma showed inhomogeneous high enhancement and early enhancement on ultrasonographic microbubbles,and their tumor borders were not clear.The PI,RT,TTP and MTT between the lesion and the surrounding muscles were not obvious.