摘要
目的:探讨超声造影(contrast-enhanced ultrasound,CEUS)在调整卵巢附件肿块的卵巢附件超声报告和数据风险系统(Ovarian-Adnexal Reporting and Data System,O-RADS)分级中的应用价值.方法:选取上海交通大学医学院附属第一人民医院接诊的98例行二维超声及CEUS检查的卵巢-附件肿块患者作为研究对象,二维声像图通过O-RADS进行评估,并分析CEUS灌注特征.以病理学检查结果为金标准,绘制受试者工作特征(receiver operating characteristic,ROC)曲线分析O-RADS及O-RADS联合CEUS对卵巢-附件恶性肿块的诊断效能.结果:病理学检查结果显示恶性肿块25例,良性肿块73例.恶性肿块囊壁/分隔厚度≥3 cm、有实性成分、乳头状突起≥4个、血流评分3～4分、有腹水者占比分别为68.00%、80.00%、24.00%、60.00%、60.00%,均显著高于良性肿块的8.22%、27.40%、5.48%、4.11%、5.48%,均P<0.05.在CEUS征象方面,良性肿块主要表现为无/低/等的均匀增强,且为慢/同步增强;恶性肿块主要表现为不均匀的高增强,且为快速增强.ROC曲线显示O-RADS+CEUS诊断卵巢-附件恶性肿块的曲线下面积(area under curve,AUC)大于O-RADS(0.972 vs 0.860,P＜0.05).与O-RADS相比,O-RADS+CEUS诊断卵巢-附件恶性肿块的灵敏度、特异度、阳性预测值、阴性预测值及准确度明显更高,分别为95.03%、96.78%、92.02%、96.84%和96.17%(P＜0.05).2名超声科医师对灰阶超声、灰阶超声+CEUS的O-RADS分类结果评估均有较高的一致性(Kappa=0.885、0.871).结论:超声O-RADS分类可较为准确地判定卵巢-附件肿块风险分层,增加CEUS检查可调整O-RADS分级,进一步提高诊断的准确度.
Abstract
Objective:To explore the application value of contrast-enhanced ultrasound(CEUS)in adjusting the Ovarian-Adnexal Reporting and Data System(O-RADS)grading for ovarian adnexal masses.Methods:A total of 98 patients in Shanghai General Hospital,Shanghai Jiao Tong University School of Medicine with ovarian adnexal masses who underwent two-dimensional ultrasound and CEUS examinations were selected as the study subjects.The two-dimensional ultrasound images were evaluated through O-RADS and CEUS perfusion characteristics were analyzed.With pathological diagnosis as the gold standard,the receiver operating characteristic(ROC)curve was drew,and the diagnostic efficacy of O-RADS and O-RADS+CEUS in ovarian accessory malignant tumors were analyzed.Results:The pathological results showed 25 cases of malignant masses and 73 cases of benign masses.The proportion of malignant masses with cyst wall/septal thickness≥3 cm,solid components,papillary protrusions≥4,blood flow score 3-4,and ascites were 68.00%,80.00%,24.00%,60.00%,and 60.00%,respectively,which were significantly higher than those of benign masses with 8.22%,27.40%,5.48%,4.11%,and 5.48%,all P＜0.05.In terms of CEUS signs,benign masses mainly exhibit uniform enhancement of no/low/equal,and slow/synchronous enhancement;Malignant masses are mainly characterized by uneven high enhancement and rapid enhancement.The ROC curve showed that the area under curve(AUC)value of O-RADS+CEUS in diagnosing ovarian adnexal malignant masses was higher than that of O-RADS(0.972 vs 0.860,P＜0.05).Compared with O-RADS,O-RADS+CEUS has significantly higher sensitivity,specificity,positive predictive value,negative predictive value,and accuracy in diagnosing ovarian adnexal malignant masses,and they were 95.03%,96.78%,92.02%,96.84%,and 96.17%respectively(P＜0.05).Two ultrasound physicians had high consistency in evaluating the O-RADS classification results of grayscale ultrasound and grayscale ultrasound+CEUS(Kappa=0.885,0.871).Conclusion:Ultrasound O-RADS classification can accurately determine the risk stratification of ovarian adnexal masses.The addition of CEUS can adjust the O-RADS grading,further improving the accuracy of diagnosis.
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