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目的评价彩色多普勒超声多参数联合对卵巢肿瘤良恶性的诊断性能,寻找鉴别肿瘤性质的显著彩色多普勒超声特征。方法对2013年8月—2015年2月167例需手术治疗的卵巢肿瘤患者行彩色多普勒超声检查,观察肿瘤超声显像和肿瘤新生血管形态及血流动力学特征,包括肿瘤位置、大小、形态、边界、回声、突起、收缩期峰值流速(VPS)、舒张末期流速(VED)、平均流速(VM)、阻力指数(resistance index,RI)和搏动指数(pulsatility index,PI)等指标,追踪病理结果。单因素分析采用t检验和χ2检验,多变量Logistic回归筛选预测卵巢肿瘤性质是独立因素,受试者工作特征曲线(receiver operating characteristic,ROC)评价预测能力,P<0.05为差异有统计学意义。结果 (1)单因素分析显示:卵巢良、恶性肿瘤在体积、形态、边界、内部回声、内壁突起、血管分级、VED、VM、RI和PI方面差异均有统计学意义(均P<0.05)。(2)二分类Logistic回归分析显示肿瘤形态(OR=19.306)、RI(OR=0.011)、血管分级(OR=2.614)、肿瘤边界(OR=4.503)是鉴别肿瘤良恶性质的独立指标,肿瘤恶性肿瘤风险指数(HI)=-1.218+2.960×肿瘤形态-4.476×RI+0.961×血管分级+1.505×肿瘤边界。(3)HI、肿瘤形态、RI、血管分级和肿瘤边界诊断恶性肿瘤的ROC曲线下面积分别为0.927、0.743、0.734、0.719和0.714;敏感性分别为0.848、0.793、0.783、0.609和0.761;特异性分别为0.880、0.693、0.587、0.747和0.667;一致率分别为86.23%、74.85%、96.46%、67.07%和71.86%。结论彩色多普勒超声对卵巢肿瘤良、恶性有良好诊断性能;肿瘤形态、边界、血管分级和RI是判断肿瘤良恶性最有意义的指标。多指标联合较单一指标可提供更可靠的诊断效能。
Objective To evaluate the diagnostic value of multi-parameter color Doppler ultrasound in the diagnosis of benign and malignant ovarian tumors and to find out the significant features of color Doppler ultrasound in differentiating the nature of tumors. Methods From August 2013 to February 2015, 167 patients with ovarian tumors requiring surgical treatment underwent color Doppler ultrasonography to observe the tumor ultrasound imaging and tumor angiogenesis and hemodynamic characteristics, including tumor location, size (VPS), mean flow velocity (VM), resistance index (RI) and pulsatility index (PI) Track the pathological results. Univariate analysis using t-test and χ2 test, multivariate logistic regression analysis to predict the ovarian tumor is an independent factor, the receiver operating characteristic (receiver operating characteristic, ROC) evaluation of prediction ability, P <0.05 for the difference was statistically significant. Results (1) Univariate analysis showed that there were significant differences in the volume, shape, boundary, internal echo, internal wall protrusion, vascular grading, VED, VM, RI and PI between benign and malignant ovarian tumors (all P <0.05) . (2) Logistic regression analysis showed that the tumor morphology (OR = 19.306), RI (OR = 0.011), vascular grade (OR = 2.614) and tumor borderline (OR = 4.503) Malignant tumor risk index (HI) = -1.218 + 2.960 × tumor morphology -4.476 × RI + 0.961 × vessel classification + 1.505 × tumor border. (3) The area under the ROC curve of HI, tumor morphology, RI, vascular grading and tumor borderline were 0.927,0.743,0.734,0.719 and 0.714 respectively; the sensitivity were 0.848,0.793,0.783,0.609 and 0.761 respectively; Sex respectively 0.880,0.693,0.587,0.747 and 0.667; the concordance rates were 86.23%, 74.85%, 96.46%, 67.07% and 71.86% respectively. Conclusions Color Doppler ultrasound has good diagnostic value for the benign and malignant ovarian tumors. The morphology, border, vessel grade and RI are the most significant indexes for judging the benign and malignant tumors. Multi-indicator combination of more than a single indicator can provide more reliable diagnostic performance.