三维超声在绝经前子宫内膜息肉诊断和鉴别诊断中的应用价值

Clinical value three-dimensional ultrasound technology in diagnosing and identifying premenopausal endometrial polyps

目的探讨三维多普勒超声诊断和鉴别绝经前子宫内膜息肉与子宫内膜增生的价值。方法收集156例经二维超声拟诊为宫腔占位或内膜增厚并行宫腔镜手术或诊断性刮宫治疗的患者;术前24h内行二维和三维多普勒超声检查,观察患者子宫内膜血管分布。测定内膜体积、内膜血管指数(VI)、血流指数(FI)和血管-血流指数(VFI)等参数。以病理诊断结果为诊断标准,采用受试者工作特性(ROC)曲线分析三维多普勒超声和宫腔镜诊断和鉴别绝经前子宫内膜息肉和子宫内膜增生的效能。结果本组子宫内膜息肉75例、子宫内膜增生67例、其他14例;子宫内膜息肉患者平均内膜体积低于子宫内膜增生者,VI、FI和VFI高于子宫内膜增生者,差异均有统计学意义(P <0. 05)。ROC曲线结果:VI和VFI的AUC、敏感度、特异度和约登指数优于其他两种指标,Cut-off值分别为1. 565和1. 04,诊断子宫内膜息肉的敏感度和特异度分别为97. 3%和99. 4%、98. 7%和99. 7%。结论三维多普勒能量超声能够准确、快速、无创诊断和鉴别绝经期前子宫内膜息肉和子宫内膜增生。

Objective To evaluate the clinical value of three-dimensional Doppler ultrasound technology in the diagnosis and identification of endometrial polyps and endometrium hyperplasia before menopause. Methods Firstly,156 patients diagnosed with two-dimensional ultrasound as cases of uterine cavity occupying or endometrial thickening and respectively treated with hysteroscopy or diagnostic curettage were chosen as the subjects of study. The patients were then subjected to check-ups with both two-dimensional or three-dimensional Doppler ultrasound 24 hours before surgery for observation on the vascular distribution of the endometrium in the patients. Endometrial vascular index（ VI）,flow index（ FI） and vascular flow index（ VFI） and other parameters were then tested and documented. Results obtained from pathological diagnosis being the diagnostic criteria,receiver operating characteristic（ ROC） curve was applied to evaluate the efficacy of three-dimensional Doppler ultrasound and hysteroscopy in the diagnosis and identification of premenopausal endometrial polyps and endometrial hyperplasia. Results Of the 156 patients,75 were diagnosed as cases of endometrial polyps,67 as cases of endometrium hyperplasia and 14 as cases of other diseases. The average endometrial volume of patients of endometrial polyps is lower than that of patients of endometrial hyperplasia. The levels of VI,FI and VFI of patients of endometrial polyps are significantlyhigher than those of the patients with endometrial hyperplasia（ P〈0. 05）. ROC curve results showed that VI and VFI as per AUC,the sensitivity,specificity and Youden index were better than the other two indexes. The Cut-off values were 1. 565 and1. 04 while the index for the diagnosis of the endometrial polyp sensitivity and specificity were 97. 3% and 99. 4%,98. 7%and 99. 7%. Conclusions Three-dimensional Doppler ultrasound can serve as an accurate,efficient and noninvasive technology in diagnosing and identifying endometrial polyps and endometrium hyperplasia before menopause.