经阴道超声多模态成像对子宫颈病变的临床诊断价值

The value of transvaginal ultrasound multimodal imaging in the diagnosis of cervicallesions

目的联合经阴道二维超声、彩色多普勒血流频谱技术及实时剪切波弹性成像(SWE)比较正常子宫颈、子宫颈良性病变及子宫颈癌的灰阶二维图像、彩色血流显像、频谱参数及杨氏模量值,探讨其对于子宫颈病变的临床诊断价值。方法选取40例正常宫颈纳入正常宫颈组,将30例经手术病理证实为宫颈息肉、宫颈肌瘤及宫颈上皮内瘤变的患者纳入宫颈良性组,将32例经手术病理证实为子宫颈癌的患者纳入宫颈恶性组。3组研究对象均经阴道超声检查,观察其二维图像、彩色血流显像并进行多普勒频谱测量、杨氏模量值测量,比较3组子宫颈的杨氏模量值及频谱测值差异。结果正常宫颈组回声均匀,未见或有少许点状血流,RI>0.55。宫颈良性组宫颈回声均匀或不均匀,有少许点状血流,RI>0.55。宫颈恶性组回声不均匀,血流丰富,血流信号多为低阻力,RI<0.55。3组感兴趣区(ROI)杨氏模量平均值比较,宫颈恶性组〔(123.28±23.98)kPa〕大于宫颈良性组〔(56.12±15.34)kPa〕和正常宫颈组〔(38.78±9.98)kPa〕,差异有统计学意义(P<0.05),但宫颈良性组与正常宫颈组相比,差异无统计学意义(P>0.05)。结论经阴道联合二维超声、彩色多普勒血流频谱技术及SWE多模态检查可以鉴别宫颈良恶性病变,对宫颈癌有较高的临床诊断价值。

Objective To compare the two-dimensional gray scale images,color flow imaging,the values of frequency spectrum and Young′s modulus of normal cervix,cervical benign lesions and cervical cancer by transvaginal two-dimensional ultrasound,color Doppler flow spectrum and real-time shear wave elastography(SWE),and to evaluate their application in the diagnosis of cervical lesions.Methods A total of 40 patients with normal cervix were enrolled in a normal cervix group,and 30 patients who were pathologically diagnosed with cervical polyps,cervical myomas and cervical intraepithelial neoplasia were enrolled in a benign cervix group.Furthermore,32 patients who were pathologically diagnosed with cervical cancer were enrolled in a cervical malignancy group.The three groups were examined by transvaginal ultrasound,and their two-dimensional images,color flow imaging,Doppler spectrum and Young′s modulus were measured.Meanwhile,their values of Young′s modulus and frequency spectrum of the cervix were compared.Results The normal cervix group presented uniform echo,without or with little spotted blood flow signals(RI>0.55).In the benign cervix group,the echo was uniform or uneven,with little spotted blood flow signals(RI>0.55).In the cervical malignancy group,the echo was uneven,and the blood flow was rich,with low resistance in most of the blood flow signals(RI<0.55).Remarkable increases were found as to the mean Young′s modulus in the region of interest(ROI)in the cervical malignancy group[(123.28±23.98)kPa],compared with the benign cervix group[(56.12±15.34)kPa]and the normal cervix group[(38.78±9.98)kPa](P<0.05).There was no significant difference as to the mean Young′s modulus between the benign and normal cervix groups(P>0.05).Conclusions Transvaginal ultrasound combined with two-dimensional ultrasound,color Doppler flow spectrum and SWE multimodal examination can distinguish benign and malignant cervical lesions,which is effective to diagnose cervical cancer in clinical setting.