三维超声造影诊断宫腔镜分离术后合并重度宫腔粘连的价值

Clinical value of 3D-CEUS detection in patients with severe uterine adhesion after hysteroscopy separation

目的探讨三维超声造影(3D-CEUS)诊断宫腔镜下宫腔粘连分解术(TCRA)后重度宫腔粘连(SIUA)的价值。方法回顾性分析83例TCRA术后IUA患者临床资料,所有患者均行宫腔镜、经阴道二维三维超声检查、3D-CEUS检查,获得子宫内膜相关参数:子宫内膜厚度、容积、血管指数、血流指数、血管化血流指数。以宫腔镜检查结果为准,分析3D-CEUS诊断TCRA术后SIUA的价值。结果本组TCRA术后确诊SIUA 36例,SIUA三维成像表现为宫腔形态异常、狭小、边缘不规则,内膜回声不连续等。经阴道三维超声诊断TCRA术后IUA分级准确率90.36%,与宫腔镜检查结果一致性较好(Kappa=0.795,P<0.05)。SIUA患者子宫内膜厚度、容积、血管指数、血流指数、血管化血流指数低于中度组和轻度组(P<0.05),二元Logistic回归分析子宫内膜厚度、容积、血管指数、血流指数、血管化血流指数与TCRA术后SIUA发生显著相关(P<0.05)。ROC结果显示,子宫内膜厚度、血管化血流指数鉴别SIUA的效能较高,曲线下面积分别为0.794、0.856,灵敏度为80.56%、74.47%,特异度为88.89%、82.98%。结论经阴道三维超声可清晰显示TCRA术后宫腔粘连程度和累及范围,为IUA分级提供可靠参考。3DCEUS测量相关子宫内膜参数可作为SIUA诊断的定量指标。

Objective To investigate the value of three-dimensional contrast-enhanced ultrasound(3 D-CEUS) in the diagnosis of severe intrauterine adhesions(SIUA) after transcervical resection of adhensions(TCRA). Methods The clinical data of 83 patients with IUA after TCRA were retrospectively analyzed. All patients underwent hysteroscopy, transvaginal twodimensional ultrasonography and 3 D-CEUS. The endometrial thickness, volume, vascular index(VI), flow index(FI),vascularization flow index(VFI) were analyzed. Based on the results of hysteroscopy, the value of 3 D-CEUS in diagnosing SIUA after TCRA was analyzed. Results Thirty-six cases of SIUA were confirmed after TCRA. The three-dimensional imaging of SIUA showed abnormal uterine cavity shape, narrow, irregular margin and discontinuous endometrial echo. The accuracy rate of IUA classification of TCRA by transvaginal three-dimensional ultrasound was 90.36%, which was in good agreement with hysteroscopy(kappa=0.795, P<0.05). The endometrial thickness, volume, VI, FI, VFI index of SIUA patients were lower than those of moderate and mild groups(P<0.05). Dual Logistic regression analysis showed that the thickness, volume, VI, FI and VFI of endometrium were significantly correlated with SIUA after TCRA(P<0.05). The results of ROC analysis showed that endometrial thickness and VFI had a higher efficiency in identifying SIUA, with AUC of 0.794 and 0.856, sensitivity and specificity of 80.56%, 74.47%, 88.89% and 82.98%, respectively. Conclusion Transvaginal three-dimensional ultrasound can clearly show the degree and extent of intrauterine adhesions after TCRA. It provide a reliable reference for IUA classification.The measurement of endometrial parameters by 3 D-CEUS can be used as a quantitative index for SIUA diagnosis.