经阴道二维超声联合三维超声容积成像技术对宫腔粘连及分型的诊断价值

Diagnostic value of two-dimensional transvaginal ultrasound combined with three-dimensional volume contrast imaging for intrauterine adhesions and their classification

摘要:

目的 分析经阴道二维超声联合三维超声容积成像技术对宫腔粘连（IUA）及其分型的诊断价值。方法 选取2020年5月—2022年6月海口市妇幼保健院收治的128例IUA患者为研究组，另取同期该院宫腔检查正常的71例女性为对照组。所有患者行经阴道二维超声、三维超声容积成像检查，将宫腔镜检查结果作为金标准。比较两组宫腔血流参数，对比经阴道二维超声、三维超声容积成像技术诊断IUA结果，比较研究组不同IUA程度患者宫腔血流参数，比较经阴道二维超声、三维超声容积成像技术诊断IUA分型结果。结果 宫腔镜检查显示，128例IUA患者中，78例轻度粘连，27例中度粘连，23例重度粘连；其中，20例周围型，45例中央型，63例混合型。研究组子宫内膜厚度（ED）、子宫内膜容积（EV）、血管指数（VI）、血流指数（FI）、血管化血流指数（VFI）均低于对照组（P <0.05）。经阴道二维超声、三维超声容积成像技术及两者联合诊断IUA的敏感性分别为85.16%（95% CI：0.775，0.906）、94.53%（95% CI：0.886，0.976）、97.66%（95% CI：0.928，0.994），经阴道三维超声诊断及两者联合诊断IUA的敏感性高于二维超声诊断（P <0.05）。经阴道二维超声、三维超声容积成像技术及两者联合诊断IUA特异性分别为94.37%（95% CI：0.855，0.982）、98.59%（95% CI：0.914，0.999）、100.00%（95% CI：0.936，0.100），差异无统计学意义（χ²=5.325，P =0.070）。研究组重度粘连患者ED、EV、VI、FI、VFI低于轻、中度粘连患者（P <0.05），中度粘连患者ED、EV、VI、FI、VFI低于轻度粘连患者（P <0.05）。经阴道三维超声容积成像技术诊断IUA分型的检出率为93.75%，高于二维超声的83.59%（P <0.05）。结论 经阴道二维超声联合三维超声容积成像技术诊断IUA及分型可提高诊断效能。

Abstract:

Objective To analyze the diagnostic value of two-dimensional transvaginal ultrasound and three-dimensional volume contrast imaging in intrauterine adhesions (IUA) and their classification.Methods The 128 IUA patients admitted to our hospital from May 2020 to June 2022 were selected as the research group, and 71 women with normal intrauterine cavity findings in the hospital during the same period were selected as the control group. All patients underwent two-dimensional transvaginal ultrasound and three-dimensional volume contrast imaging, and the results of hysteroscopy were regarded as the "gold standard". The uterine blood flow parameters were compared between the two groups, and the results of two-dimensional transvaginal ultrasound and three-dimensional volume contrast imaging in the diagnosis of IUA were compared. The uterine blood flow parameters of patients with different degrees of IUA in the research group were compared, and the results of two-dimensional transvaginal ultrasound and three-dimensional volume contrast imaging in the diagnosis of IUA classification were compared.Results Hysteroscopy showed that among the 128 patients with IUA, there were 78 mild IUA, 27 moderate IUA, and 23 severe IUA. Besides, 20, 45 and 63 of them were peripheral, central and mixed types of IUA, respectively. The endometrial thickness (ED), endometrial volume (EV), vascular index (VI), flow index (FI), and vascularization flow index (VFI) in the study group were lower than those in the control group (P < 0.05). The sensitivities of two-dimensional transvaginal ultrasound, three-dimensional volume contrast imaging and the combination of the two for the diagnosis of IUA were 85.16% (95% CI: 77.54%, 90.60%), 94.53% (95% CI: 88.64%, 97.58%) and 97.66% (95% CI: 92.78%, 99.39%). The sensitivities of three-dimensional volume contrast imaging and the combination of the two for the diagnosis of IUA were higher compared with the sensitivity of two-dimensional transvaginal ultrasound (P < 0.05). The specificities of two-dimensional transvaginal ultrasound, three-dimensional volume contrast imaging and the combination of the two for the diagnosis of IUA were 94.37% (95% CI: 85.46%, 98.18%), 98.59% (95% CI: 91.35%, 99.93%) and 100.00% (95% CI: 93.60%, 100.00%), with no significant difference among them (P > 0.05). Within the research group, ED, EV, VI, FI, and VFI in patients with severe IUA were lower than those with mild and moderate IUA (P < 0.05), and those in patients with moderate IUA were even lower compared with patients with mild IUA (P < 0.05). The detection rate of three-dimensional volume contrast imaging (93.75%) was higher than that of two-dimensional transvaginal ultrasound (83.59%) (P < 0.05).Conclusions Two-dimensional transvaginal ultrasound combined with three-dimensional volume contrast imaging could improve the efficacy in diagnosing IUA and the classification thereof.