Clinical value of contrast‐enhanced ultrasound for the differential diagnosis of specific subtypes of uterine leiomyomas

Abstract

ObjectiveTo improve the accuracy of clinical diagnosis by analyzing different contrast‐enhanced ultrasound (CEUS) imagines of specific subtypes of uterine leiomyomas.MethodsA total of 147 female patients received preoperative CEUS examination. The scanning plane of the biggest tumors for CEUS was found by common B‐mode ultrasonographic scanning on pelvic cavity, then 1.5 mL SonoVue were injected into the median cubital vein. According to the CEUS images, the lesion enhanced time, enhanced level and enhanced morphology were recorded. The time‐intensity curve was acquired and analyzed, meanwhile, the relevant parameters were calculated, including rise time (RT), peak intensity (PI), time to peak (TTP) and mean transit time (MTT).ResultsIn cellular uterine leiomyoma group, the percentage of high enhancement, early enhancement was higher, equal enhancement and synchronic enhancement were lower than those in the common uterine leiomyomas group. In hysteromyoma with hyaline degeneration group, the percentage of high enhancement, early enhancement was lower, while low enhancement and delayed enhancement were higher than those in the common uterine leiomyomas group. The ratio of PI in cellular uterine leiomyoma group was the highest, but the ratios of RT, TTP and MTT were the lowest of the three benign groups. The ratio of PI in hysteromyoma with hyaline degeneration group was the lowest, while the ratios of RT and TTP was the highest among the three benign groups.ConclusionDifferent pathological types of uterine leiomyomas have their own signal performance on CEUS. CEUS can be used to infer their pathological types and help differential diagnosis.

Contrast-Enhanced Ultrasound Imaging of Uterine Disorders: A Systematic Review

“…Three studies described CEUS enhancement characteristics of fibroids ( n = 348 fibroids. 5,26,34 ). Fibroids enhanced earlier than the surrounding myometrium and the peak intensity differs between the two depending on the degree of fibroid degeneration.…”

“…Two studies evaluated women with different types of fibroids, including leiomyosarcomas. 5,26 Zhang et al 5 evaluated 96 women with fibroids (also discussed under “uterine fibroids”) and leiomyosarcomas using CEUS and conventional ultrasound, with histology (after surgery or biopsy) as reference test. Li et al 26 performed CEUS in 147 patients pre-operatively, with post-operative histology as reference test.…”

“…5,26 Zhang et al 5 evaluated 96 women with fibroids (also discussed under “uterine fibroids”) and leiomyosarcomas using CEUS and conventional ultrasound, with histology (after surgery or biopsy) as reference test. Li et al 26 performed CEUS in 147 patients pre-operatively, with post-operative histology as reference test. The contrast-enhancement pattern was similar for all leiomyosarcomas ( n = 9 and 4, in studies by Zhang et al 5 and Li et al 26 respectively).…”

“…Li et al 26 performed CEUS in 147 patients pre-operatively, with post-operative histology as reference test. The contrast-enhancement pattern was similar for all leiomyosarcomas ( n = 9 and 4, in studies by Zhang et al 5 and Li et al 26 respectively). Sarcomatous lesions showed a heterogeneous hyper-enhancement due to increased blood flow, whereas fibroids ( n = 156 and 143 respectively) showed homogeneous enhancement.…”

“…By this feature, CEUS was able to detect all nine sarcomas, while conventional US was able to detect only two. 5 Neither studies reported on perfusion parameters or diagnostic accuracy, possibly due to the low number of leiomyosarcomas, yet a diagnostic accuracy of 97% for leiomyosarcoma can be deduced for the study of Zhang et al, 5 but not for the study by Li et al 26 Adenomyosis is characterized by benign growth of endometrial tissue into the myometrium. The diagnosis is often missed due to its diffuse character 30,52 which often requires an additional MRI scan.…”