三维超声造影在诊断宫腔粘连中的应用价值

Application of sonovue three-dimensional ultrasound imaging in diagnosis of intrauterine adhesion

目的探讨三维超声造影（3D-CEUS）在诊断宫腔粘中的应用价值。方法对71例经阴道三维超声（3DTVS）检查提示怀疑宫腔粘连的患者行宫腔镜检查,以宫腔镜检查为金标准,比较两者诊断宫腔粘连的准确率;在月经20-23d对3D-TVS诊断疑似宫腔粘连的患者行声诺维（sonovue）3D-CEUS检查,获得内膜厚度、容积（V）、回声强度（MG）、血管指数（VI）、血流指数（FI）、血管血流综合指数（VFI）等相关指标;对经sonovue 3D-CEUS疑似宫腔粘连的的患者,于月经第3-7天行宫腔镜检查,回顾性分析不同程度宫腔粘连的患者与3D-CEUS获得的V、MG、VI、FI、VFI值的关系。结果 3DTVS与宫腔镜比较,3D-TVS诊断宫腔粘连的符合率是90.14%;宫腔镜检查轻、中、重度3组,各组间子宫内膜厚度和容积比较均有显著性差异（P〈0.05）;轻度和重度组子宫内膜MG分别（39.75±7.46）、（45.64±6.10）,其差异具有统计学意义（P〈0.05）;轻度和重度组组间子宫内膜VI、FI、VFI相比较,差异均具有统计学意义（P〈0.05）,而中度组与其它两组比较均无显著性差异（P〉0.05）。经静脉推注30mg sonovue造影剂后,3D-CEUS检查结果显示：3组内膜血流VI值分别较造影前显著增加（P〈0.001）,轻度和重度、中度和重度组的内膜VI、FI、VFI相比较,差异均具有统计学意义（P〈0.05）。结论 3DCEUS检查不仅可以较准确的诊断宫腔粘连,而且通过计算机辅助分析技术对宫腔粘连患者子宫内膜V、MG、VI、FI、VFI进行定量测量,对宫腔粘连的程度有更客观的评价。

Objective： To investigate the diagnostic value of the sonovue three-dimensional transvaginal ultrasound imaging for intrauterine adhesion. Methods： Seventy one patients with intrauterine adhesion were diagnosed by three-dimensional transvaginal ultrasound（3D-TVS）, and then they were accepted hysteroscopy examination. The accuracy rate was compared between the two methods in diagnosis of uterine cavity adhesion. In the 20-23 days of menstruation, all patients diagnosed intrauterine adhesion by 3D-TVS were examined by sonovue three- dimensional contrast enhanced ultrasound （3D-CEUS） to obtain endometrial thickness, volume （V）, mean gray value（MG）, vascularization index（VI）, flow index（FI）, vascularization flow index（VFI）etc. In the 3- 7 days of menstruation, the patients diagnosed intrauterine adhesion by 3D-CEUS were proceeded the hysteroscopy inspection. According to the classification of March, the patients diagnosed intrauterine adhesion by hysteroscopy were divided into ＂mild＂, ＂medium＂ and ＂severe＂ groups. The correlations between the different degrees of intrauterine adhesion diagnosed by hysteroscopy and the indexes（V,MG, VI,FI and VFI）measured by 3D-CEUS were retrospectively analyzed. Results： Compared to the results of hysteroscopy which is recognized as golden standard for diagnosing uterine adhesion,the accuracy rate of 3D-TVS was 90.14%. Among the patients with different degrees of intrauterine adhesion, the endometrial thickness and volume were significantly different （P〈 0.05）. The endometrial MG was significant different between the mild（39.75±7.46）and severe（45.64±6.10）groups（P〈0.05）. There were significant differences in endometrial VI,FI and VFI between the mild and severe groups（P〈0. 05）,but there no significant differences compared the medium group with the other two groups （P〈 0.05）. The results of 3D-TVS showed that endometrial blood flow increased significantly after pushing 30 mg sonovue in all three groups（P〈0.001）. The VI, FI and VFI had significant differences among the three groups（P〈0.05）. Conclusions： The sonovue three-dimensional transvaginal ultrasound imaging not only can precisely diagnose intrauterine adhesion, but also objectively evaluate the degree of intrauterine adhesion by measuring the endometrial indexes related intrauterine adhesion quantitatively.