Value of contrast-enhanced ultrasound with SonoVue in differentiation between uterine leiomyoma and uterine adenomyosis

Objective:To investigate the value of contrast-enhanced ultrasound(CE-US) with SonoVue in the differentiating between uterus leiomyoma with uterine adenomyosis.Methods:A retrospective analysis of preoperative pelvic CE-US with SonoVue(Bracco,Milano,Italia) was performed in 50 patients with pathologically proven uterine leiomyoma and 20 patients with histopathologically confirmed uterine adenomyosis.All the patients underwent hysterectomy or myomectomy.The echogenicity,enhancement extent,degree,patterns at different phases on CEUS were evaluated.Results:72 foci were found in the 50 patients with uterine leiomyoma.Of the 72 uterine leiomyoma foci,56 were larger than 3cm in diameter,and 16 were smaller than 3cm in diameter.For lesions with a diameter ≥3cm,uterine leiomyoma showed a typical peritumoral(pseudocapsule) rim enhancement pattern with fill-in towards the center of the lesion in the early phase,and the center of the lesion lost much of its contrast with continue enhancement of pseudocapsule in the later phase.For lesions with a diameter 3cm,uterine leiomyoma showed peripheral rim enhancement pattern(n=8),branch-like enhancement pattern(n=2),and reticular enhancement pattern(n=6).Uterine leiomyoma appeared as well-circumscribed nodules with sharp margins.Adenomyosis is similar in enhancement pattern to the surrounding myometrium,but with lower enhancement degree and heterogeneous enhancement with moth-eaten filling defect appearance on CEUS.Conclusions:Real time CE-US with SonoVue is an important preoperative diagnostic tool for uterine leiomyoma and adenomyosis.