Role of transvaginal contrast-enhanced ultrasound in the early diagnosis of endometrial carcinoma

Background Endometrial carcinoma is one of the most common gynecological malignancies among women. Early diagnosis and correct preoperative evaluation of myometrial invasion are necessary to improve the prognosis. This study aimed to determine whether features and time-intensity curves (TIC) of transvaginal contrast-enhanced ultrasound (CEUS) differ from those of conventional ultrasound for endometrial carcinoma, and to further explore the clinical role of transvaginal CEUS in the early diagnosis of endometrial carcinoma. Methods Forty women with a normal uterus and seventy-nine patients with endometrial carcinoma were examinedby the transvaginal CEUS with SonoVue (Bracco, Imaging B.V, Switzerland). The enhancement patterns and TIC of lesions were analyzed. The results of CEUS were compared with those of conventional ultrasound and pathology. Results In the early and late enhanced stages, the intensity of enhancement of the normal endometrium was always lower than that in the myometrium, and the boundary between normal endometrium and myometrium was clear. A total of 65.8% (52/79) of lesions presented with inhomogeneous enhancement, 34.2% (27/79) presented with homogeneous enhancement; 60.8% (48/79) presented with hyperechoic enhancement, 27.8% (22/79) presented with isoechoic enhancement, and 11.4% (9/79) presented with hypoechoic enhancement. The average arrival time, time to peak, rise time, half-wash out time of lesions were shorter than of normal endometrium (P<0.05). The average peak intensity, relative rise in intensity, half-wash out intensity of lesions were higher than of normal endometrium <0.05). There were 49 (must be and may be present) cases of endometrial carcinoma by ultrasound (US); 24 cases were consistent with pathology results, 16 cases were underestimated and 9 cases were overestimated. There were 72 (must be and may be present) cases of endometrial carcinoma by CEUS; 53 cases were consistent with pathology results, 12 cases were underestimated and 7 cases were overestimated. The qualitative diagnosis of endometrial carcinoma by CEUS was more accurate and definite than that by US (P<0.01). Conclusions By evaluating contrast-enhanced patterns and analyzing TIC, we found that CEUS can increase the accuracy of ultrasound qualitative diagnosis of endometrial carcinoma. CEUS shows lesions more clearly than conventional ultrasound, which is an advantage in evaluating the encroachment of endometrial carcinoma. Chin Med J 2012;125(3):416-421