Abstract
OBJECTIVE: To investigate the diagnostic value of contrast-enhanced ultrasound (CEUS) in differentiating benign and malignant endometrial diseases by analyzing the early arterial vascular architecture on CEUS images. METHODS: A prospective study was conducted at the Sichuan Integrative Medicine Hospital to enroll 70 suspected endometrial lesion patients with a mean age of 42.5 ± 8.2 years (range 27-69 years). The patients underwent conventional ultrasound and CEUS examinations, and pathological examinations were obtained through surgery or curettage. They were divided into the benign group and malignant group according to their pathological types. The CEUS image features were analyzed, and the sensitivity, specificity, positive predictive value, and other parameters were compared between the two groups by carefully observing the early enhancement images and comparing the differences in the vascular architecture, including the shape of the vessels, the number of vessels, and the vessel diameter. RESULTS: There were significant differences in vascular shape, number, and diameter between the two groups. The difference in vascular morphology was highly statistically significant (p < 0.001). The "vascular supply" was used for the diagnosis of malignant diseases of the endometrium with a high sensitivity of 95.8%, specificity of 77.5%, positive predictive value of 71.8%, and accuracy of 84.4%. When the maximum inner diameter exceeded 1.5 mm, the sensitivity and specificity for the diagnosis of malignant lesions were 95.8% and 82.5%, respectively, with a positive predictive value of 76.6% and an accuracy of 87.5%. When the average inner diameter exceeded 1.22 mm, the sensitivity for the diagnosis of malignant endometrial lesions was 87.5%, the specificity was 80%, and the accuracy was 82.8%. CONCLUSIONS: The utilization of CEUS vascular architecture holds significant clinical value in the diagnosis of both benign and malignant endometrial diseases, thereby warranting further comprehensive investigation.