探讨子宫平滑肌肉瘤超声图像特征、分析术前超声误诊原因。

选取于2013年6月至2018年12月经解放军总医院第一医学中心手术病理证实为子宫平滑肌肉瘤16例患者的术前临床影像检查资料进行研究分析。

16例患者术前超声显示子宫内多发病灶7例，单发病灶9例；子宫肌壁间12例，黏膜下3例，宫颈部1例；形态规则9例，不规则7例；边界清晰6例，边界不清10例；病灶内部呈不均匀高回声9例，囊实混合回声4例（内有液化坏死区），低回声3例。16例中9例病灶内部或子宫黏膜下偏后方衰减不明显，后方回声略增强，彩色多普勒示病灶内血流较丰富；2例为晚期肿瘤病灶，形态不规则，内有坏死区，呈囊实混合回声改变，侵犯浆膜层向子宫外膨胀性生长，见髂血管旁淋巴结转移及盆腹腔静脉瘤栓形成。

超声诊断子宫平滑肌肉瘤有难度和局限性，但对于子宫肌层内单发病灶，呈稍高回声或不均质回声，且边界不清，内部回声不均匀，血供丰富，病灶质地柔软，探头加压变形时可能为恶性病变，待病理诊断确诊。

To investigate the ultrasonographic features of uterine leiomyosarcoma and analyze the causes of misdiagnosis.

Preoperative clinical imaging data of 16 patients with uterine leiomyosarcoma confirmed by surgery and pathology at the First Medical Center of PLA General Hospital from June 2013 to December 2018 were selected for analysis.

Preoperative ultrasound showed multiple intrauterine lesions in six cases and single lesions in nine cases. Among the 16 cases included, 12 were intramural, 3 were submucosal, and 1 was cervical. The morphology of lesions was regular in 9 cases and irregular in 7 cases. The boundary was clear in 6 cases and unclear in 10 cases. Inhomogeneous hyperechogenicity was found in 9 cases, mixed echogenicity found in 4 (with liquefactive necrotic areas), and hypoechogenicity in 3. In 9 of the 16 cases, there was no significant attenuation in the inner or submucosal posterior lesions, and the posterior echo was slightly enhanced. When the shape of the lesion was irregular, there were necrotic areas in the lesion, which showed mixed echogenic cystic and solid changes, and the serosal layer was involved in the extrauterine expansion growth. At the late stage, metastases of adjacent iliac vessels lymph nodes and the formation of tumor thrombolytic in the pelvic and abdominal veins were observed.

Utrasound diagnosis of uterine leiomyosarcoma has some limitations, but for a single lesion in the myometrium, it is slightly hyperechoic or has heterogeneous echo, with unclear boundary, uneven internal echo, rich blood supply, and soft lesion texture. It is necessary to be on alert for possible malignant lesions when the probe is deformed under pressure, and in this case, confirmation by pathological diagnosis is recommended.