经阴道三维能量多普勒超声对子宫内膜癌肌层浸润判断的应用

Application of transvaginal three-dimensional energy Doppler ultrasound in the diagnosis of myometrial invasion in endometria

目的探讨经阴道三维能量多普勒超声对子宫内膜癌肌层浸润判断的价值。方法依据病理对子宫内膜癌术后患者84例进行分期,术前行阴道超声检查,采集子宫内膜血流频谱参数:收缩期峰值流速(Vs)、搏动指数(PI)、阻力指数(RI)及三维能量血流参数:血管形成指数(VI)、血流指数(FI)、血管形成—血流指数(VFI),评价各参数在子宫内膜癌分期及肌层浸润的意义;依据病理分期结果,比较二维联合彩色血流及二维联合三维能量多普勒2种方法的敏感性、特异性、阳性预测值、阴性预测值及准确率。结果Ⅰa期及Ⅰb期肌层浸润组血管参数VI、FI、VFI值均高于Ⅰa期肌层未浸润组(均P<0.05);Ⅱ期病变组的血管参数VI、FI、VFI值均高于Ⅰa期肌层未浸润组(均P<0.01)Ⅰa期肌层浸润及Ⅰb期(均P<0.05);以术后病理结果为金标准,二维联合三维能量多普勒敏感性、特异性、阳性预测值、阴性预测值及准确率较二维联合彩色血流高。结论三维能量多普勒超声能够预测子宫内膜癌Ⅰ期及Ⅱ期肌层浸润,有较高的临床应用价值。

Objective To investigate the values of transvaginal three-dimensional power Doppler ultrasound in the diagnosis of myometrial invasion in endometrial cancer. Methods Three-dimensional power Doppler ultrasonography was used to preoperatively observe the endometrium of 84 patients with endometrial carcinoma（according to pathology）. The endometrial blood flow parameters were collected, including systolic peak velocity（Vs）, resistance index（RI）, pulsatility index（PI） and three-dimensional power Doppler parameters including： vascularization index（VI）, blood flow index（FI）, vascularization-blood flow index（VFI）, to evaluate the significance of the parameters in staging of endometrial cancer and myometrial invasion. The sensitivity, specificity, positive and negative predictive values and accuracy were compared between the two-dimensional combined color flow with the two-dimensional combining three-dimensional power Doppler in accordance with the pathological staging results. Results The vascular parameters VI, FI and VFI in stage Ⅱ group were higher than those in stage Ⅰa myometrial invasion and stage Ⅰb groups（P〈0.05）. The vascular parameters VI, FI and VFI in stage Ⅱ group were higher than those in stage Ⅰ a no-myometrial-invasion group（P〈0.01）. The vascular parameters VI, FI and VFI in group Ⅰb and stage Ⅰa myometrial invasion were higher than those in group Ⅰa no-myometrial-invasion group（all P〈0.05）. The postoperative pathological stage was used as the gold standard; the sensitivity, specificity, positive and negative predictive values and accuracy of the two-dimensional combining three-dimensional energy Doppler imaging were higher than those of two-dimensional combined color flow. Conclusion Three-dimensional power Doppler ultrasound can predict stage Ⅰand Ⅱ myometrial invasion of endometrial carcinoma with a higher clinical value.