Quantitative contrast-enhanced ultrasonography for the differential diagnosis of endometrial hyperplasia and endometrial neoplasms

Abstract

The present study aimed to investigate the feasibility of applying contrast-enhanced ultrasonography (CEUS) imaging technology for distinguishing between benign and malignant endometrial lesions, and to screen markers that could be correlated with the pathological results. In this study, endometrial diseases were diagnosed by biopsy under hysteroscopy and CEUS examinations. The intensity and time parameters of the time-intensity curve (TIC) were analyzed. The mean arrival time (AT), time-to-peak (TTP), rise time (RT), washout half-time and clearance half-time of malignant lesions were shorter than those of benign lesions (P<0.05), whereas the average peak intensity (PI) and enhancement intensity (EI) of malignant lesions were higher than those of benign lesions (P<0.05). The receiver operating characteristic curve showed the following cut-off values: PI, 29.2 dB; EI, 21.35 dB; AT, 12.75 sec; TTP, 26.75 sec; RT, 13.2 sec; clearance half-time, 89.3 sec; and washout half-time, 75.45 sec. The lesions with PI, an EI higher than that of the cut-off and lesions with an AT, TTP, RT, half clearing time and washout half-time shorter than the cut-off were considered malignant. The TTP, RT and half clearing time were negatively correlated with microvessel density (MVD), i.e., MVD was higher when the TTP, RT and half clearing time were shorter. Overall, changes in the enhancement and clearing of lesions could be quantitatively analyzed by CEUS TIC and further discriminate benign from malignant lesions. In the present study, CEUS appeared to indirectly reflect blood vessel changes inside the lesions and provided a pre-operative non-invasive fast imaging method for the diagnosis of endometrial disease.

Prognostic value of enhancement rate by enhanced ultrasound in hepatitis B virus‐positive hepatocellular carcinoma undergoing radiofrequency ablation

“…CEUS is able to show the characteristics of liver tumors accurately and clearly, as well as the perfusion status . During CEUS examination, the perfusion time parameters including AT, PT and ET can reflect the blood flow velocity while intensity parameters including EI and ER directly reflected that perfusion volume of lesion . tumor with lower perfusion time parameters and higher intensity parameters displayed a quick rise‐quick decline blood flow profile, thus resistant to heat energy deposition, and had poor ablation efficacy, which is consistent with our results …”

“…All imaging data were stored for later analysis. The built‐in auto contrast quantification software was used to select the appropriate region of interest, and to quantitatively measure the following parameters: time parameters including arrival time (AT), peak time (PT), enhancement time (ET = PT – AT) and intensity parameters including basis intensity (BI), peak intensity (PI), enhancement intensity (EI = PI − BI) and enhancement rate (ER = EI/ET) . Therefore, ER was selected as a standing indictor of perfusion parameters.…”

Predictive Value of Quantitative Uterine Fibroid Perfusion Parameters From Contrast‐Enhanced Ultrasound for the Therapeutic Effect of High‐Intensity Focused Ultrasound Ablation

“…In this study, we evaluated the perfusion status of fibroids by CEUS before HIFU treatment, and the results indicated that the arrival time, peak time, and enhancement time in the group with a nonperfused volume ratio of 70% or higher were significantly longer than those in the group with a volume ratio lower than 70%, whereas patients with a volume ratio of 70% or higher had a lower mean enhancement intensity and enhancement rate than those with a volume ratio lower than 70%. The perfusion time parameters, including arrival time, peak time, and enhancement time, can reflect the blood flow velocity, whereas the intensity parameters, including enhancement intensity and enhancement rate, directly reflect the perfusion volume of a lesion . Fibroids with lower perfusion time parameters and higher intensity parameters showed a quick‐rise–quick‐decline blood flow profile; thus, they were resistant to HIFU and had poor ablation efficacy.…”

“…The perfusion time parameters, including arrival time, peak time, and enhancement time, can reflect the blood flow velocity, whereas the intensity parameters, including enhancement intensity and enhancement rate, directly reflect the perfusion volume of a lesion. 34 Fibroids with lower perfusion time parameters and higher intensity parameters showed a quick-risequick-decline blood flow profile; thus, they were resistant to HIFU and had poor ablation efficacy. Furthermore, in the Spearman analysis and multivariate analyses, we found that the nonperfused volume ratio was negatively correlated with the enhancement intensity and enhancement rate but positively correlated with the arrival time, peak time, and enhancement time, which was consistent with previous studies.…”

Dynamic contrast‐enhanced ultrasound improves diagnostic performance in endometrial cancer staging

“…In healthy women, contrast enhancement is normally lower in the endometrium than in the myometrium but, in cancerous endometrium, contrast enhancement is often higher than in the myometrium, which is indicative of higher capillary blood flow, with earlier arrival time, shorter time-to-peak, higher peak intensity and steeper wash-in slope 6,7 . Some studies have shown that these TIC measures can distinguish benign from malignant endometrial lesions [8][9][10] , and can also be used in the assessment of cervical cancer 11 .…”