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中华医学超声杂志(电子版) ›› 2019, Vol. 16 ›› Issue (03) : 181 -185. doi: 10.3877/cma.j.issn.1672-6448.2019.03.005

所属专题: 文献

妇产科超声影像学

彩色多普勒超声在获得性子宫动静脉瘘的诊断及疗效评估中的应用
吕小利1, 陈萍1,(), 徐惠英1, 胡丹1, 杨清1   
  1. 1. 201240 上海,同济大学附属第一妇婴保健院超声科
  • 收稿日期:2018-06-08 出版日期:2019-03-01
  • 通信作者: 陈萍

Application of color Doppler ultrasound in acquired arteriovenous malformations

Xiaoli Lyu1, Ping Chen1,(), Huiying Xu1, Dan Hu1, Qing Yang1   

  1. 1. Department of Ultrasound, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai 201240, China
  • Received:2018-06-08 Published:2019-03-01
  • Corresponding author: Ping Chen
  • About author:
    Corresponding author: Chen Ping, Email:
引用本文:

吕小利, 陈萍, 徐惠英, 胡丹, 杨清. 彩色多普勒超声在获得性子宫动静脉瘘的诊断及疗效评估中的应用[J]. 中华医学超声杂志(电子版), 2019, 16(03): 181-185.

Xiaoli Lyu, Ping Chen, Huiying Xu, Dan Hu, Qing Yang. Application of color Doppler ultrasound in acquired arteriovenous malformations[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2019, 16(03): 181-185.

目的

探讨获得性子宫动静脉瘘(AVM)的二维及多普勒超声特征,分析二维及彩色多普勒超声在经子宫动脉栓塞治疗后疗效观察中的价值。

方法

选择11例获得性子宫AVM患者为研究对象。回顾性分析其子宫及病灶区二维声像图、彩色多普勒血流(CDFI)表现,量化分析多普勒流速曲线特点,包括收缩期峰值速率(PSV)和阻力指数(RI),结合临床症状对经子宫动脉栓塞术(UAE)治疗后病灶的声像图变化,进行分析。

结果

11例患者均经彩色多普勒超声诊断为子宫AVM,二维超声图像显示为子宫肌层内见单发类圆形无回声区和(或)多个小无回声区伴低回声呈"蜂窝状",彩色多普勒显示无回声区内有丰富红蓝镶嵌血流信号充填,呈"马赛克"或"湖泊样"改变;脉冲多普勒呈高速低阻血流流速曲线,典型者表现出静脉血流动脉化表现,11例超声检查结果与子宫动脉造影结果基本一致。患者均接受了UAE治疗,10例栓塞术后1周~6个月复查,二维超声见病灶均有明显减小或逐渐消失,彩色多普勒超声表现为低速静脉血流信号或异常血流信号消失;1例随访1周~11个月表现为病灶减小但低速低阻动脉流速曲线持续存在,再次栓塞后仍复发出血,患者因无生育需求最终切除子宫。

结论

彩色多普勒超声对获得性子宫动静脉瘘的诊断及UAE后对其治疗效果的评估监测有重要价值。

Objective

To investigate the characteristics of two dimensional ultrasound and Doppler ultrasound in acquired uterine arteriovenous malformations (AVM), and to analyze their value in the observation of curative effect after uterine artery embolization.

Methods

Eleven patients with acquired uterine AVM were selected as the study subjects. Retrospective analysis was made on the two-dimensional sonographic and color Doppler flow imaging (CDFI) performance of the uterus and lesion area, and quantitative analysis was made on its Doppler waveform characteristics, including peak systolic velocity (PSV) and resistance index (RI), combined with clinical symptoms and the changes in the sonogram of the lesion after uterine artery embolization.

Results

All 11 patients were diagnosed as uterine AVM by color Doppler ultrasound. Two-dimensional ultrasound images showed a single rounded anechoic area and/or multiple small anechoic areas with hypoechoic honeycomb-like area in the myometrium, while their color Doppler showed that there was a rich red-blue mosaic blood flow signal filling in the anechoic zone, showing a mosaic or lake-like change; Doppler waveform showed a high-speed, low-impedance blood flow spectrum, and 11 cases of ultrasound examination results and uterine artery angiography results were basically consistent. All patients underwent UAE treatment. Ten patients were re-examined at 1 week to 6 months after embolization. Two-dimensional ultrasound showed significant reduction or gradual disappearance. The color Doppler ultrasound showed low-velocity venous blood flow signal or abnormal blood flow signal disappearance compared with before treatment. One case followed up at 1 week to 11 months after embolization showed lesions reduced but low-speed and low-resistance arterial spectrum persisted, and recurrent bleeding occurred after re-embolization. The patient eventually had her uterus removed due to no fertility requirements.

Conclusions

Color Doppler ultrasound has significant importance in the diagnosis of acquired AVMs and in monitoring the efficacy of embolotherapy in patients with acquired uterine AVMs.

图1~3 子宫动静脉瘘患者超声声像图及脉冲多普勒图。图1二维声像图示子宫肌层多个无回声区伴低回声呈"蜂窝状"、"湖泊样"改变;图2彩色多普勒显示无回声区内有丰富红蓝镶嵌血流信号充填,呈"马赛克"样;图3脉冲多普勒呈高速低阻血流流速曲线,并见典型静脉血流动脉化表现
图4~6 子宫动静脉瘘患者接受子宫动脉栓塞治疗前后超声声像图及脉冲多普勒图。图4治疗前声像图示子宫肌层病灶区丰富血流充填;图5治疗前病灶区脉冲多普勒显示高速低阻血流流速曲线;图6治疗后7 d,彩色多普勒显示病灶区血流信号减少
图8 子宫动静脉瘘患者接受子宫动脉栓塞治疗后43 d二维超声显示原病灶缩小,但仍存在较大的湖泊样无回声区,彩色多普勒仍见较丰富血流,脉冲多普勒呈低速低阻血流流速曲线
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