基于盆腔MR图像预设参考线用于超声评估盆底器官脱垂的可行性

Feasibility of presupposed reference line based on MRI as ultrasound reference line in pelvic organ prolapsed

目的基于MRI图像预设参考线,选取其中重复性好、可识别率高的参考线,以期为盆底器官脱垂(POP)的超声参考线选择提供参考依据。方法回顾性分析107例接受盆腔MR检查的女性患者资料,根据年龄分为6组:第1组(20~29岁组)、第2组(30~39岁组)、第3组(40~49岁组)、第4组(50~59岁组)、第5组(60~69岁组)、第6组(≥70岁组)。于正中矢状位盆腔T2WI图像设定参考线:PS-PS线,耻骨联合两端点连线;PIAS线,耻骨联合下缘与肛管内括约肌下端端点的连线;PPC线,耻骨联合下缘与耻骨尾骨肌在直肠后缘的附着点之间的连线;PM线,耻骨联合下缘与M点(PCC线直肠黏膜前壁交叉点与肛管内括约肌下端端点连线的中点)之间的连线。分别测量PS-PS线、PIAS线、PM线、PPC线与水平线之间的夹角(角1、角2、角3、角4)。比较各年龄组间参考线测量指标的差异,并评估2名观察者间测量结果的一致性。结果 PM线最接近水平线。角1、角2、角3在各年龄组间差异均无统计学意义(P均>0.05)。各年龄组间角4差异有统计学意义(F=3.42,P=0.01),组间两两比较显示:第1组与第4、第5及第6组间、第2组与第4、第5及第6组间、第3组与第4、第5及第6组间差异均有统计学意义(P均<0.05),其余各组间差异均无统计学意义(P均>0.05)。2名观察者测量角1、角3及角4的一致性好,测量角2的一致性差。结论 PM线是预设的参考线中最接近水平线、不受年龄影响且重复性较好的参考线,但PM线作为POP超声参考线的实用性有待于进一步研究。

Objective To provide valuable references for ultrasonic diagnosis of pelvic organ prolapsed（POP）by finding an easily detecting referential line based on MRI.Methods Data of 107 patients who underwent pelvic MRI were retrospectively analyzed.All the patients were divided into 6 groups according to age：Group 1（20—29 years old）,group 2（30—39 years old）,group 3（40—49 years old）,group 4（50—59 years old）,group 5（60—69 years old）and group 6（≥70 years old group）.Four reference lines were set basing on the median sagittal view of T2WI：PS-PS line（the line connecting the two endpoint of the pubic symphysis）,PIAS line（the line connecting the inferior margin of pubic symphysis and the bottom of sphincter internal anal sphincter）,PPC line（the line connecting of the inferior margin of pubic symphysis and the point of the pubococcygeous attached on the rectum）and PM line（the line connecting of the inferior margin of pubic symphysis and the M point[the midpoint of the line from the crosspoint of PPC line and the front wall of the rectum mucosa to the bottom of sphincter internal anal sphincter]）.The angles between the horizontal line and PS-PS line,PIAS line,PM line,PPC line（angle 1,angle 2,angle 3,angle 4）were measured,respectively.The differences of the angle among various age-groups were compared.The consistency between the two observes were evaluated.Results PM line was the closest line to the horizontal line.There was no statistical differences of angle 1,angle 2 and angle 3 among the 6groups（all P〉0.05）.The difference of angle 4among the 6 groups were significant（F=3.42,P=0.01）.Intergroup pairwise comparisons showed that significant differences were found between group 1 and group 4,group 5,group 6,between group 2 and group 4,group 5,group 6,between group 3 and group 4,group 5,group 6,respectively（all P〈0.05）.And no significant difference was found in the other comparisons.The consistency of the two observers in meaning angle 1,angle3 and angle 4 were good,but the consistency of angle 2 was poor.Conclusion Of all the referential lines,PM is the closest to the horizontal line and is less influenced by the patient＇s age.However,the feasibility of using PM lines as the ultrasound referential line is still unclear.