彩色多普勒超声血流成像评分评估附件扭转后卵巢活性的研究

The value of CDFI score in assessing the activity of ovaries after adnexal torsion

目的:研究彩色多普勒血流成像(CDFI)评分在评估附件扭转后卵巢活性中的价值。方法:选取经卵巢囊肿蒂扭转手术确诊的28例附件扭转患者,所有患者均经多普勒超声检查,分析其临床特点及超声图像,根据附件血流信号进行评分,并与术中卵巢活性进行对比分析。结果:在28例患者中,附件扭转发生于左侧者12例、右侧者16例;超声显示附件无血流信号者14例,血流评分1分,其中卵巢坏死9例、存活5例;有血流信号者14例,其中血流评分2分者10例,3分者4例,卵巢全部存活。患者附件扭转的预后与血流信号存在一定的相关性。超声血流评分判断卵巢坏死的的灵敏度为100%,特异度为73.7%,准确率为82.1%,约登指数为73.7%,阳性预测值为64.3%,阴性预测值为100%。血流评分为1分、2分和3分的患者,其卵巢存活率分别为35.7%、100%和100%。超声结果与手术结果具有中等强度的一致性(Kappa=0.643,P<0.05)。结论:多普勒超声能够对附件扭转后卵巢活性进行预估,血流评分判断卵巢坏死的准确率、灵敏度和特异度均较高,可为临床提供较为可靠、有效的影像学依据。

Objective:To investigate the value of the color Doppler flow imaging(CDFI)score in assessing the activity of ovary post adnexal torsion.Methods:28 patients with adnexal torsion who were confirmed by the surgery of torsion of the pedicle of ovarian cyst were selected,and all patients underwent the examination of Doppler ultrasound.The clinical characteristics and ultrasound images of them were analyzed,and were scored according to the blood flow signal of adnexa.And then,they were compared and analyzed with the intraoperative activity of ovaries.Results:In 28 patients,the adnexa torsion of 12 cases occurred on the left side and that of 16 cases occurred on the right side.The ultrasound indicated that the adnexa without blood flow signal occurred in 14 cases,which were 1 score,and 9 cases of them were ovarian necrosis and 5 cases of them were survival.And the adnexa with blood flow signal occurred in other 14 cases,and 10 cases of them were 2 scores as blood flow score,and 4 cases of them were 3 scores,and all of the ovaries of them were survival.The prognosis of adnexal torsion was correlated with blood flow signal at a certain of extent.The sensitivity,specificity,accuracy,Yoden index,positive predictive value and negative predictive value of ultrasound blood flow score were 100%,73.7%,82.1%,73.7%,64.3% and 100% in judging the necrosis of ovary,respectively.The survival rates of the ovaries of patients with 1 score,2 scores and 3 scores of blood flow score were 35.7%,100% and 100%,respectively.There was a moderate consistency between ultrasound results and surgical results,with(Kappa=0.643,P<0.05).Conclusion:The color Doppler ultrasound can assess the activity of ovaries after adnexal torsion,and blood flow score has high accuracy,sensitivity and specificity in judging the necrosis of ovary,which can provide relatively reliable and effective imaging basis for clinical practice.