探讨超声造影（CEUS）评估子宫剖宫产瘢痕的应用价值。

选取2017年5月至2019年5月就诊于首都医科大学附属北京世纪坛医院，剖宫产术后6个月以上的患者75例行前瞻性诊断试验研究，所有患者均接受经阴道超声（TVS）及CEUS检查，其中11例接受宫腔水造影检查。与TVS和宫腔水造影对比，分析CEUS对剖宫产瘢痕憩室的检出率及诊断符合率。对CEUS与TVS两种方法测量瘢痕憩室形态学参数的结果进行比较。根据检查结果将病例分为瘢痕憩室组和完整瘢痕组，对比分析2组瘢痕部位的时间-强度曲线参数。

TVS检出瘢痕憩室40例，检出率为53.3%（40/75）；CEUS检出瘢痕憩室51例，检出率为68%（51/75），2者间差异有统计学意义（χ²=40.336，P<0.05）。CEUS测量瘢痕憩室的深度、瘢痕残余肌层厚度平均值分别为（5.55±1.55）mm、（3.22±1.37）mm；与TVS的测量值（4.24±2.76）mm、（3.96±1.80）mm比较，差异均有统计学意义（t=4.463、6.480；P均<0.001）。瘢痕憩室组瘢痕部位的峰值强度及增强速率分别为（15.07±1.82）dB、（2.60±0.61）dB/s；均明显低于完整瘢痕组的（17.37±1.97）dB、（3.72±1.89）dB/s，差异均有统计学意义（t=4.961、-3.837；P均<0.001）。

CEUS对子宫剖宫产瘢痕憩室的检出能力优于TVS，时间-强度曲线参数（峰值强度、增强速率）可以通过造影剂微泡的灌注情况，反映瘢痕部位的微血管密度，对瘢痕愈合情况进行评估，CEUS在子宫剖宫产瘢痕评价中具有较好的应用前景。

To assess the diagnostic value of contrast-enhanced ultrasound (CEUS) in uterine scar after cesarean section by comparing with transvaginal ultrasound (TVS).

From May 2017 to May 2019, 75 patients at Beijing Shijitan Hospital with a history of previous cesarean section for more than 6 months were included. All the patients underwent TVS and CEUS, and 11 patients underwent saline infusion sonohysterography. The detection rate and diagnosis accuracy of CEUS were assessed by comparing with TVS and saline infusion sonohysterography. The results of CEUS and TVS in measuring the morphological parameters of cesarean scar diverticulum (CSD) were compared. The relationship between TIC parameters and CSD was analyzed.

The detection rate of CSD by TVS was 53.3% (40/75) versus 68% (51/75) by CEUS, and there was a statistical difference between them (χ²=40.336, P<0.05). Compared with TVS, the CSD measured by CEUS was deeper, and the residual myometrium was thinner; there was a statistical difference between them (t=4.463 and 6.480, respectively; P<0.001). CSD showed higher peak intensity and greater enhancement rate in the CSD group than in the intact scar group (t=-4.961 and -3.837, respectively; P<0.001).

CEUS can provide more accurate evidence for uterine scar than TVS, and TIC parameters (peak intensity and enhancement rate) can reflect the microvascular density of uterine scar through the perfusion of contrast agent microbubbles, and evaluate the scar healing. The application of CEUS in the evaluation of cesarean scar has a good prospect.