【摘要】 目的探讨经阴道彩色多普勒超声检查宫颈癌的影像学特征及其诊断价值。方法选取130例经新柏氏液基细胞学技术(TCT)、宫颈活检和病理检查证实为宫颈上皮内瘤样变(CIN)Ⅰ-Ⅲ级及宫颈癌的病例进行经阴道彩色多普勒检查,对声像图特征及彩色多普勒血流显像(CDFI)结果进行分析。选取同期宫颈视诊和细胞学检查均无异常的41例就诊患者为正常对照。结果由正常宫颈、CIN、宫颈原位癌到宫颈浸润癌,经阴道彩色多普勒超声检查中测量宫颈径线增大、宫颈呈低回声病灶表现的病例逐渐增多,其中宫颈低回声病灶仅出现在宫颈癌中,是宫颈癌的特异性超声影像变化,特异度为100%。宫颈黏膜线缺失是宫颈癌Ⅱ期特有的表现,特异度为100%。CDFI和血流阻力指数(RI)均提示宫颈浸润癌局部血流明显较正常宫颈、CIN和原位癌丰富,宫颈浸润癌Ⅰ期与Ⅱ期之间差异亦有统计学意义(P<0.05)。Kappa分析显示,宫颈径线增大诊断宫颈浸润癌的敏感度和特异度分别为89.1%和82.8%,宫颈低回声病灶在诊断宫颈癌和宫颈浸润癌中的特异度分别为100%和94.8%,树枝状血流分布诊断宫颈浸润癌的特异度为100%。结论经阴道彩色多普勒超声检查在宫颈浸润癌中有较多特征性影像学改变,其诊断可信度较高,对宫颈癌前病变、原位癌的诊断可靠性较低,联合其他辅助检查,可作为宫颈癌诊断以及放疗与化疗前后评价疗效的方法之一。更多还原

【Abstract】 Objective To investigate the imaging features of cervical cancer by transvaginal color Doppler sonography(TVCS),and evaluate the diagnostic value of TVCS.Methods A hundred and thirty cases of cervical intraepithelial neoplasia(CIN) grade Ⅰ-Ⅱ and cervical cancer,diagnosed by Thinprep cytologic test(TCT),cervical biopsy and pathological examination,received TVCS examination.The image characters and color Doppler flow imaging(CDFI) were collected and analyzed.Another 41 cases with normal cervices as determined by inspection and cytological examination were involved as control.Results In order of normal cervix,CIN,cancer in situ and cervical cancer,the cervical diameter showed a tendency of increase,also with an increase incidence of low-level echo focus in cervix.As a specific image of cervical cancer,the low level echo focus occurred only in cervical cancer with a specificity of 100%.The absence of mucosal line in cervical canal was a specific character of stage Ⅱ cervical cancer with a specificity of 100%.CDFI and resistance index(RI) revealed that the local blood flow was more abundant in invasive cancer than in CIN and cancer in situ,and significant difference was found between stage Ⅰ and stage Ⅱ cervical cancer(P<0.05).The sensitivity and specificity of enlarged cervical diameters in diagnosis of cervical cancer were 89.1% and 82.8%.The specificity of cervical low level echo focus in diagnosis of cervical cancer and invasive cervical cancer were 100% and 94.8%,respectively.The specificity of abundant blood flow in dendritic form in diagnosis of invasive cervical cancer was 100%.Conclusions Invasive cervical cancer may present several specific features in TVCS images.TVCS examination is of high reliability in diagnosis of invasive cervical cancer,but is not so reliable in diagnosing precancerous lesion and preinvasive cancer.Combined with other auxiliary examinations,TVCS could be considered as one of the methods to diagnose cervical cancer and evaluate therapeutic effect of chemotherapy and radiotherapy of cervical cancer in late stage.更多还原