多普勒超声在附件囊肿及异位妊娠中的应用

The use of color and pulsed Doppler could improve the sensitivity of making the diagnosis of ectopic pregnancy. The rationale for using Doppler is to detect a high-velocity,low-resistance arterial flow patterns within the trophoblastic tissue in the ectopic pregnancy. Once color flow identifies a possible ectopic pregnancy, the use of pulsed Doppler and determining the resistance index could differentiate an ectopic pregnancy from a corpus luteum[1].There is an overlap in the resistance index of the ectopic pregnancy and corpus luteum. The blood flow around the ectopic is sometimes referred to as the “ring of fire.” In contrast, the lack of flow cannot be used to exclude an ectopic pregnancy.

彩色多普勒和脉冲多普勒的使用可以提高诊断异位妊娠的敏感性。使用多普勒的诊断基本原理在于是否检测异位妊娠滋养细胞组织内的高速、低阻力动脉血流模式。一旦彩色血流识别出可能的异位妊娠，使用脉冲多普勒和确定阻力指数可以区分异位妊娠和黄体[1]。异位妊娠和黄体的阻力指数存在重叠。异位周围的血流有时被称为“火环”。相比之下，血流不足不能用来排除异位妊娠。

Pellerito et al.performed endovaginal sonography and endovaginal imaging in 155 patients with clinical suspicion of ectopic pregnancy[2]. Sixty-five patients (42%), had surgically confirmed ectopic pregnancies. They diagnosed 36 of the ectopic pregnancies with endovaginal sonography alone, the criteria being an extrauterine gestational sac or an ectopic fetus (sensitivity 54%). Endovaginal color flow imaging diagnosed 62 ectopic pregnancies when an ectopic fetus or sac was visualized or placental was flow identified in an adnexal mass separate from the uterus, with a sensitivity of 95%. The authors concluded that the use of color Doppler flow imaging,in addition to vaginal sonography, increased the sensitivity in the detection of ectopic pregnancy.They utilized a low-impedance pattern separate from the ovary to suggest or diagnose placental flow. Several of the early or dead ectopic pregnancies demonstrated no evidence of placental flow. All the avascular ectopic pregnancies demonstrated serum hCG levels less than 6000 mIU/ml. Only one of the 65 ectopic pregnancies (1.5%) was a solid avascular mass.Doppler may provide additional information about some adnexal masses[2] . However,the actual diagnosis depends on the gray scale features, and Doppler should not be considered mandatory during the evaluation of an ectopic pregnancy [3,4,5].

Pellerito等对155名疑似临床异位妊娠的患者进行了阴道内超声和阴道内成像检查[2]。65名患者 (42%) 经手术证实为异位妊娠。他们仅通过阴道内超声检查就诊断出36例异位妊娠，评判标准是出现宫外孕囊或异位胎儿(敏感性 54%)。阴道内彩色血流成像诊断了62例异位妊娠，当可见异位胎儿或孕囊，或在与子宫分离的附件肿块中发现胎盘血流时，灵敏度为95%。作者得出结论，除了阴道超声检查外，彩色多普勒血流成像的使用增加了异位妊娠检测的灵敏度。他们利用与卵巢分离的低阻抗模式来提示或诊断胎盘血流。一些早期或死亡的异位妊娠没有表现出胎盘流动的迹象。所有无血管异位妊娠的血清 hCG 水平均低于6000 mIU/ml。65例异位妊娠中仅有1例(1.5%)为实性无血管肿块。多普勒可能为附件肿块提供一些额外信息[2]。然而，实际诊断取决于肿块的灰度特征，在评估异位妊娠时，不应将多普勒视为强制性检查 [3，4，5]。

Reference 数据参考:

1. Kurjak A, Zalud I, Schulman H. Ectopic Pregnancy: transvaginal color doppler of tropholastic flow in questionable adnexa. J Ultrasound Med 1991; 10”685-9

2. Pullerito JS, Taylor kj, Quedens-Case C, et al. Ectopic pregnancy:evaluation with endovaginal color flow imaging. Radiology 1992;183:407-11

3. Filly RA. Ectopic pregnancy.In: Callen P,ed.Ultrasonography in Obstetricsand Gynecology, 3rd edn.Philadelphia and London:WB Saunders, 1994; 641-59.

4. Laing FC. Ectopic pregnancy.In: Timor-Tritsch IE,Goldstein SR, eds. Ultrasoundin Gynecology, 2nd edn.Philadelphia: ChurchillLivingstone Elsevier, 2007;161-75.

5. Doubilet PM,Benson CB.Ectopic Pregnancy. In:Doubilet PM, Benson CB,eds. Atlas of Ultrasound inObstetrics and Gynecology: AMultimedia Reference.Philadelphia: LippincottWilliams and Wilkins, 2003;318-30.