经阴道与经腹部彩色多普勒超声对子宫肌瘤及子宫腺肌病的鉴别诊断

Differential diagnosis of uterine fibroids and adenomyosis by transvaginal and transabdominal color Doppler ultrasound

目的通过观察彩色多普勒超声检查在子宫肌瘤与子宫腺肌症中的诊断价值,已期指导临床治疗。方法回顾性分析,采集南京市儿童医院全椒分院2016年12月至2020年12月期间收治的80例子宫肌瘤与50例子宫腺肌病患者的临床资料,纳入患者均给予经腹部与阴道彩色多普勒超声检查,明确经阴道与经腹部彩色多普勒超声在子宫肌瘤及子宫腺肌病中的鉴别诊断价值。结果纳入的80例子宫肌瘤患者经腹部彩色多普勒超声检查,阳性61例,阴性19例;经阴道彩色多普勒超声检查阳性71例,阴性9例;将病理诊断作为金标准,经腹部超声诊断子宫肌瘤与病理诊断结果Kappa值为0.775(P<0.05);阴道超声诊断子宫肌瘤与病理诊断结果Kappa值为0.763(P<0.005);与经腹部彩色多普勒超声相比,经阴道彩色多普勒超声检查在子宫肌瘤患者中诊断中的特异度与敏感性较高,但差异无统计学意义(P>0.05);入组的50例子宫腺肌病患者中,经腹部彩色多普勒超声检查,阳性44例,阴性6例,阴道彩色多普勒超声检查,阳性46例,阴性4例,将病理诊断作为金标准,腹部超声诊断子宫肌瘤与病理诊断结果Kappa值为0.396(P=0.003),阴道超声诊断子宫肌瘤与病理诊断结果Kappa值为0.540(P=0.000);与经腹部彩色多普勒超声检查相比,经阴道彩色多普勒超声检查在子宫腺肌病患者诊断中的敏感性、符合率更高,单差异无统计学意义(P>0.05);经绘制受试者ROC曲线结果显示,患者RI、PI、Vd、Vs参数各指标预测子宫腺肌症的AUC均>0.8,预测价值较好。结论经阴道超声检查在子宫腺肌症与子宫肌瘤患者诊断中价值显著,可通过阴道彩超中相关指标参数水平进一步明确诊断,指导临床治疗方案制定。

Objective To observe the diagnostic value of color Doppler ultrasonography in uterine fibroids and adenomyosis,which has been used to guide clinical treatment.Methods Retrospective analysis,clinical data of 80patients with uterine fibroids and 50patients with uterine adenomyosis admitted to our hospital between December 2016and December 2020were collected,and all included patients were given transabdominal and vaginal color Doppler ultrasound examinations to clarify the differential diagnostic value of transvaginal and transabdominal color Doppler ultrasound in uterine fibroids and adenomyosis.Results Of the 80patients with uterine fibroids included,61were positive and 19 were negative by abdominal color Doppler ultrasound;71were positive and 9 were negative by transvaginal color Doppler ultrasound;using pathological diagnosis as the gold standard,the Kappa value of transabdominal ultrasound diagnosis of uterine fibroids versus pathological diagnosis was 0.775(P<0.05);vaginal ultrasound diagnosis of uterine fibroids versus pathological diagnosis The Kappa value was 0.763(P<0.005);compared with transabdominal color Doppler ultrasound,transvaginal color Doppler ultrasound had higher specificity and sensitivity in the diagnosis of uterine fibroids,but the difference was not statistically significant(P>0.05);among the 50patients with uterine adenomyosis enrolled,transabdominal color Doppler ultrasound was positive in 44cases and negative in 6cases,while vaginal Among the 50patients with adenomyosis enrolled,46were positive and 6were negative by transabdominal color Doppler ultrasound,and 4were negative by vaginal color Doppler ultrasound;using pathological diagnosis as the gold standard,the Kappa value between abdominal ultrasound diagnosis of uterine fibroids and pathological diagnosis was 0.396(P=0.003),and the Kappa value between vaginal ultrasound diagnosis of uterine fibroids and pathological diagnosis was 0.540(P=0.000);compared with transabdominal color Doppler ultrasound,transvaginal The sensitivity and compliance rate of color Doppler ultrasonography was higher in the diagnosis of patients with adenomyosis,and the single difference was not statistically significant(P>0.05);the results of the ROC curve of the subjects were plotted and showed that when the AUC of each of the patient’s RI,PI,Vd,and Vs parameters predicted adenomyosis was>0.8,the predictive value was better.Conclusion Transvaginal ultrasonography is of significant value in the diagnosis of patients with adenomyosis and uterine fibroids,and the levels of relevant index parameters in vaginal ultrasound can be used to further clarify the diagnosis and guide the development of clinical treatment plans.