title: The use of contrast-enhanced ultrasound in uterine leiomyomas.
abstract: BACKGROUND
  Ultrasound (US) is a popular method in the diagnosis and treatment of uterine leiomyomas, but the lack of accuracy greatly limits its application. Recently, microbubble enhancement technique affords direct depiction of tumor neovascularity and establishes a more precise vascular map of the tumor. This study was undertaken to describe the distribution patterns of SonoVue, a second-generation contrast agent, in the microcirculation of uterine leiomyomas, and to investigate the potential use of contrast-enhanced ultrasound (CEUS) in the characterization and treatment of uterine leiomyomas.
  
  
  METHODS
  Ninety-six patients with uterine leiomyomas were enrolled in this study. The CEUS was performed using cadence pulse sequencing technique (CPS) and SonoVue. Enhancement patterns of different lesions were observed. The diagnostic accuracy of CEUS was compared with that of conventional ultrasound.
  
  
  RESULTS
  After contrast injection, vessels of macro- and micro-circulation of the myoma first appeared, followed by the normal myometrium and finally the endometrium. During the washout phase, the myoma exhibited homogeneous enhancement followed by apparent hypoenhancement. The margin of the tumor was depicted clearly. There was no agent perfusion in the benign degenerative or necrotic area. However in sarcomas degeneration, the feeding vessels appeared markedly earlier than those in myometrium. In addition, the tumor exhibited heterogeneous hyperenhancment with no agent perfusion in the center and no membraniform sign was observed in the late phase. In subserous and submucous leiomyomas, the feeding arteries in the pedicle arising from the uterine could be seen. In this study, the diagnostic accuracy of CEUS and conventional US for uterine leiomyomas was 96.7% (160/165) and 82.4% (136/165) respectively.
  
  
  CONCLUSIONS
  CEUS can provide a precise description of the leiomyomas vascularization. The specific enhancement pattern may be helpful for the characterization, treatment choice and therapeutic monitoring of leiomyomas.
authors.affiliation: Department of Ultrasound, Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510630, China.
authors.forename: Xin-Ling
authors.initials: XL
authors.lastname: Zhang
authors.forename: Rong-Qin
authors.initials: RQ
authors.lastname: Zheng
authors.forename: Yue-Bo
authors.initials: YB
authors.lastname: Yang
authors.forename: Dong-Mei
authors.initials: DM
authors.lastname: Huang
authors.forename: Qian
authors.initials: Q
authors.lastname: Song
authors.forename: Yong-Jiang
authors.initials: YJ
authors.lastname: Mao
authors.forename: Yu-Hua
authors.initials: YH
authors.lastname: Li
authors.forename: Zhi-Juan
authors.initials: ZJ
authors.lastname: Zheng
mesh_terms: D000328:Adult; D003287:Contrast Media; D005260:Female; D006801:Humans; D007889:Leiomyoma / Q000000981:diagnostic imaging*; D008875:Middle Aged; D014463:Ultrasonography; D014594:Uterine Neoplasms / Q000000981:diagnostic imaging*; D055815:Young Adult
chemical_list: D003287:Contrast Media