Ultrasound Diagnosis and Misdiagnosis Analysis of Accessory Cavitated Uterine Malformation

子宫附腔畸形的超声诊断及误诊原因分析 Ultrasound Diagnosis and Misdiagnosis Analysis of Accessory Cavitated Uterine Malformation - 摘要:目的 探讨子宫附腔畸形(accessory cavitated uterine malformation, ACUM)的超声声像图特征, 并分析误诊原因, 以加强对本病的认识, 提高超声医师的诊断能力。方法 收集2013年12月—2023年12月于北京协和医院就诊, 并经手术病理确诊为ACUM的患者临床、病理及影像学资料, 分析其超声特征、首诊误诊原因。结果 共11例患者纳入本研究, 平均确诊年龄(27.1±7.4)岁, 平均初潮(6.1±5.5)年后出现痛经。术前超声显示ACUM均为单一病灶, 位于圆韧带附着处下方子宫肌层内, 平均最大直径(3.0±1.0)cm。病灶整体呈形态规则的厚壁囊实性结构, 多数呈圆形或椭圆形(90.9%, 10/11), 边界清晰(72.7%, 8/11), 且与宫腔不相通(100%, 11/11)。所有病灶内部均为囊性空腔, 多呈磨玻璃样改变(90.9%, 10/11), 囊腔内衬呈内膜样线状高回声(90.9%, 10/11)。病灶周边均由肌层样低回声或中等回声包绕, 彩色多普勒超声示周边环状或半环状血流信号。所有患者均未合并腺肌症等其他子宫病变。误诊分析: 11例患者中, 首次超声正确诊断6例, 首次MRI正确诊断5例, 其中2例MRI误诊为残角子宫而超声检查均提示ACUM且双侧宫角可见。结论 ACUM具有特征性的超声声像图表现, 当年轻女性出现进行性痛经, 超声于一侧圆韧带下方子宫肌层内探及形态规则的厚壁囊实性包块时, 需考虑ACUM可能。Abstract:Objective To explore the ultrasound characteristics of accessory cavitated uterine malformation (ACUM) and the causes of misdiagnosis, in order to better understand the disease and improve the diagnostic ability of radiologists.Methods We retrospectively collected clinical, pathological and imaging data of ACUM patients who were diagnosed after surgery at Peking Union Medical College Hospital from December2013 to December 2023. Besides, we analyzed ultrasound features of ACUM and the cause of misdiagnosis.Results A total of 11 patients were included, with a mean age of diagnosis of (27.1±7.4)years. There was a mean interval of (6.1±5.5)years between menarche and onset of dysmenorrhea. Preoperative ultrasound showed that ACUM appeared as solitary lesions located under the insertion of the round ligament, with a mean maximum diameter of (3.0±1.0)cm. Lesions were round or oval (90.9%, 10/11) and not connected to the uterine cavity (100%, 11/11) with clear boundaries (72.7%, 8/11), presenting as regular thick-walled cystic-solid structures. Cystic areas were observed within the mass (100%, 11/11) with a ground-glass-like appearance (90.9%, 10/11) and hyperechoic endometrial lining (90.9%, 10/11). The surrounding of the mass showed hypoechoic or isoechoic areas resembling the muscular layer and circular or semi-circular vascularity was detected around the mass. No adenomyosis or other uterine lesions were found. Analysis of misdiagnosis: Among the 11 ACUM cases, 6 were correctly diagnosed by the initial ultrasound examination, and 5 cases by MRI. Two patients were misdiagnosed as residual horn uterus by MRI, despite ultrasound suggesting ACUM with visible bilateral uterine horns.Conclusions ACUM exhibits distinct ultrasound characteristics. When young women present with progressive dysmenorrhea and ultrasound reveals a regular cystic-solid mass with thick wall located under the round ligament insertion, ACUM should be considered.