Contrast-enhanced ultrasound features of highly vascularized uterine leiomyoma and their correlation with pathology

doi:10.3877/cma.j.issn.1672-6448.2025.01.003

Abstract

Abstract:

Objective

To explore the correlation between contrast-enhanced ultrasound (CEUS)characteristics and pathology of highly vascularized uterine leiomyoma, in order to provide a reliable imaging basis for the selection of clinical treatment.

Methods

A total of 78 patients who were hospitalized and underwent surgical treatment for uterine leiomyoma in the Women’s Hospital School of Medicine Zhejiang University from June 2021 to October 2023 were collected.Finally, 97 lesions were diagnosed as highly vascularized uterine leiomyoma by color/energy Doppler ultrasonography, all of which underwent contrastenhanced ultrasound before surgery.According to pathology, the 97 lesions were divided into common uterine leiomyomas, common uterine leiomyomas with degeneration, special types of uterine leiomyomas,and uterine sarcoma for comparison.The edematous uterine leiomyomas and uterine leiomyomas with hyaline degeneration in the common leiomyomas with degeneration group, and the cellular leiomyomas in the special leiomyoma group were also compared with the common uterine leiomyomas group.Fisher exact probability method was used to compare the overall difference between groups, and Bonferroni test was used for pairwise comparisons.The contrast-enhanced ultrasound mode features, arrival time, time to peak,and late enhancement features were also compared among the groups.

Results

Ninety-three (95.9%) of 97 highly vascularized uterine leiomyomas diagnosed by color/energy Doppler ultrasonography were eventually diagnosed as benign leiomyoma by histopathology, and four (4.1%) were diagnosed as uterine sarcomas.The arrival time (P=0.004), the degree of enhancement at the peak (P=0.013), the uniformity of internal contrast distribution (P＜0.001), the speed of wash-out (P＜0.001), and the degree of lesion enhancement (P=0.005)differed significantly among the common uterine leiomyomas group (51 lesions), the uterine leiomyomas with degeneration group (23 lesions), the special type of uterine leiomyomas group (19 lesions), and the uterine sarcomas group (4 lesions).There were significant differences in the arrival time (P=0.001), the degree of enhancement (P=0.014), the uniformity of internal contrast distribution (P＜0.001), and the speed of washout (P＜0.001) among common leiomyoma (51 lesions), edematous uterine leiomyomas (11 lesions) and uterine leiomyomas with hyaline degeneration (11 lesions) in the common leiomyomas with degeneration group, and cellular leiomyomas (11 lesions) in the special type of leiomyomas group, though there was no significant difference in the degree of enhancement in the late stage of enhancement (P=0.329).The contrastenhanced ultrasound patterns of different pathology classifications of highly vascularized uterine leiomyoma were as follows: (1) The enhanced mode such as synchronous uniformity and equal enhanced ratio was higher in the common leiomyomas group; (2) The time to peak and inhomogeneity enhancement ratio was higher in the common leiomyomas with degeneration group.The fast-in hyperenhancement pattern was the main pattern of edematous degeneration, “honeycomb-like” hypoperfusion areas were seen internally,and hyaline degeneration was dominated by synchronous equal enhancement or low enhancement patterns;(3) The uterine sarcomas group had the highest proportion fast wash-out and inhomogeneity enhancement,and 3 lesions (75.0%) showed non-perfusion areas of “map pattern”; and (4) The proportion of cellular leiomyomas in the special type of leiomyomas group with fast-in and high enhancement was high, but lower than that of the uterine sarcoma group.

Conclusion

There are differences in contrast-enhanced ultrasound patterns between different pathologic types of highly vascularized uterine leiomyomas and uterine sarcomas.These differences can help to infer the pathology classification before surgery and provide an imaging basis for clinical decision-making.

Key words: Uterine leiomyoma, Ultrasound, Contrast-enhanced ultrasound, Pathology

Shuang Yu, Qian Wang, Yun Fang, Min Chen, Lichen Wang, Jiang Zhu. Contrast-enhanced ultrasound features of highly vascularized uterine leiomyoma and their correlation with pathology[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2025, 22(01): 15-24.

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URL: https://chaosheng.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1672-6448.2025.01.003

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References 32

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项目	普通子宫肌瘤组（n=51）	普通子宫肌瘤变性组（n=23）	特殊类型子宫肌瘤组（n=19）	子宫肉瘤组（n=4）	P 值
增强早期
造影剂到达时间					0.004
早	9（17.6）	8（34.8）	8（42.1）	4（100）^a
同步	34（66.7）	11（47.8）	5（26.3）^a	0（0）^a
晚	8（15.7）	4（17.4）	6（31.6）	0（0）
达峰时
强化程度					0.013
高增强	10（19.6）	8（34.8）	7（36.8）	4（100）^a
等增强	29（56.9）	12（52.2）	5（26.3）	0（0）
低增强	12（23.5）	3（13.0）	7（36.8）	0（0）
分布					＜ 0.001
均匀	49（96.1）	7（30.4）	14（73.7）^ab	1（25.0）^a
不均匀	2（3.9）	16（69.6）	5（26.3）^ab	3（75.0）^a
增强晚期
造影剂消退					＜ 0.001
早	3（5.9）	2（8.7）	4（21.1）	4（100）^abc
同步	43（84.3）	14（60.9）	7（36.8）^a	0（0）^a
晚	5（9.8）	7（30.4）	8（42.1）^a	0（0）
强化程度					0.005
高增强	9（17.6）	0（0）	5（26.3）	3（75.0）^ab
等增强	27（52.9）	17（73.9）	7（36.8）	0（0）^b
低增强	15（29.4）	6（26.1）	7（36.8）	1（25.0）

项目	普通子宫肌瘤组（n=51）	普通子宫肌瘤变性组（n=23）	特殊类型子宫肌瘤组（n=19）	子宫肉瘤组（n=4）	P 值
增强早期
造影剂到达时间					0.004
早	9（17.6）	8（34.8）	8（42.1）	4（100）^a
同步	34（66.7）	11（47.8）	5（26.3）^a	0（0）^a
晚	8（15.7）	4（17.4）	6（31.6）	0（0）
达峰时
强化程度					0.013
高增强	10（19.6）	8（34.8）	7（36.8）	4（100）^a
等增强	29（56.9）	12（52.2）	5（26.3）	0（0）
低增强	12（23.5）	3（13.0）	7（36.8）	0（0）
分布					＜ 0.001
均匀	49（96.1）	7（30.4）	14（73.7）^ab	1（25.0）^a
不均匀	2（3.9）	16（69.6）	5（26.3）^ab	3（75.0）^a
增强晚期
造影剂消退					＜ 0.001
早	3（5.9）	2（8.7）	4（21.1）	4（100）^abc
同步	43（84.3）	14（60.9）	7（36.8）^a	0（0）^a
晚	5（9.8）	7（30.4）	8（42.1）^a	0（0）
强化程度					0.005
高增强	9（17.6）	0（0）	5（26.3）	3（75.0）^ab
等增强	27（52.9）	17（73.9）	7（36.8）	0（0）^b
低增强	15（29.4）	6（26.1）	7（36.8）	1（25.0）

项目	普通子宫肌瘤组（n=51）	普通子宫肌瘤水肿变性组（n=11）	普通子宫肌瘤透明变性组（n=10）	富细胞性平滑肌瘤组（n=11）	P 值
增强早期
造影剂到达时间					0.001
早	9（17.6）	7（63.6）^a	1（10.0）	8（72.7）^ab
同步	34（66.7）	3（27.3）	6（60.0）	2（18.2）^a
晚	8（15.7）	1（9.1）	3（30.0）	1（9.1）
达峰时					0.014
强化程度
高增强	10（19.6）	6（54.5）	1（10.0）	7（63.6）^a
等增强	29（56.9）	4（36.4）	5（50.0）	4（36.4）
低增强	12（23.5）	1（9.1）	4（40.0）	0（0）
分布					＜ 0.001
均匀	49（96.1）	5（45.5）^a	2（20.0）^a	9（81.8）^b
不均匀	2（3.9）	6（54.5）^a	8（80.0）^a	2（18.2）^b
增强晚期
造影剂消退					＜ 0.001
早	3（5.9）	2（18.2）	0（0）	7（63.6）^ab
同步	43（84.3）	5（45.5）^a	5（50.0）	3（27.3）^a
晚	5（9.8）	4（36.4）	5（50.0）^a	1（9.1）
强化程度					0.329
高增强	9（17.6）	0（0）	0（0）	3（27.3）
等增强	27（52.9）	8（72.7）	5（50.0）	4（36.4）
低增强	15（29.4）	3（27.3）	5（50.0）	4（36.4）

项目	普通子宫肌瘤组（n=51）	普通子宫肌瘤水肿变性组（n=11）	普通子宫肌瘤透明变性组（n=10）	富细胞性平滑肌瘤组（n=11）	P 值
增强早期
造影剂到达时间					0.001
早	9（17.6）	7（63.6）^a	1（10.0）	8（72.7）^ab
同步	34（66.7）	3（27.3）	6（60.0）	2（18.2）^a
晚	8（15.7）	1（9.1）	3（30.0）	1（9.1）
达峰时					0.014
强化程度
高增强	10（19.6）	6（54.5）	1（10.0）	7（63.6）^a
等增强	29（56.9）	4（36.4）	5（50.0）	4（36.4）
低增强	12（23.5）	1（9.1）	4（40.0）	0（0）
分布					＜ 0.001
均匀	49（96.1）	5（45.5）^a	2（20.0）^a	9（81.8）^b
不均匀	2（3.9）	6（54.5）^a	8（80.0）^a	2（18.2）^b
增强晚期
造影剂消退					＜ 0.001
早	3（5.9）	2（18.2）	0（0）	7（63.6）^ab
同步	43（84.3）	5（45.5）^a	5（50.0）	3（27.3）^a
晚	5（9.8）	4（36.4）	5（50.0）^a	1（9.1）
强化程度					0.329
高增强	9（17.6）	0（0）	0（0）	3（27.3）
等增强	27（52.9）	8（72.7）	5（50.0）	4（36.4）
低增强	15（29.4）	3（27.3）	5（50.0）	4（36.4）

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