超声实时剪切波成像诊断绝经后子宫内膜病变价值

Value of ultrasound real-time shear wave elastrography for diagnosing endometrial lesions of postmenopausal women

目的:分析超声实时剪切波成像(SWE)对女性绝经后子宫内膜病变的诊断价值。方法:选择2017年3月-2020年5月本院诊治的子宫内膜≥5 mm的绝经后女性230例临床资料,按照子宫内膜活检病理结果分为良性病变组、不典型增生组、恶性病变组。均行二维、三维超声及SWE检查,获取二维血流分级、三维血流VI、FI、VFI及杨氏模量Emax、Emean,分析超声血流及杨氏模量影响子宫内膜病变可能因素,探讨Emax、Emean对子宫内膜病变的预测价值。结果:良性病变组、不典型增生组、恶性病变组年龄及内膜厚度逐渐升高,恶性病变组与不典型增生组体质指数无差异但均大于良性病变组(均P<0.05);良性病变组、不典型增生组、恶性病变组Emean、Emax逐渐升高,2、3级血流构成比逐渐升高,0、1级血流逐渐降低,恶性病变组与不典型增生组三维血流VI、FI、VFI无差异但均大于良性病变组(均P<0.05)。年龄、体质指数、内膜厚度、血流3级、Emean、Emax异常均是子宫内膜病变升级的独立危险因素(P<0.05),Emax、Emean对子宫内膜恶性病变均具有预测价值,曲线下面积分别为0.813、0.826。结论:SWE对子宫内膜恶性病变有较好诊断价值。

Objective:To analyze the value of ultrasound real-time shear wave elastrography(SWE)for diagnosing endometrial lesions of postmenopausal women.Methods:The clinical data of 230 postmenopausal women with endometrium≥5 mm from March 2017 to May 2020 were selected in this study.According to endometrial biopsy pathological results,these women were divided into group A(women with benign lesion of endometrium),group B(women with atypical hyperplasia of endometrium),and group C(women with malignant lesion of endometrium).The eaxaminations of two-dimensional ultrasound,three-dimensional ultrasound,and SWE were performed on all these women in the three groups to obtain blood flow classification by two-dimensional ultrasound,the values of blood flow VI,FI,VFI by three-dimensional ultrasound,and the values of Emax and Emean by Young’s modulus.The possible factors affecting endometrial lesions by ultrasonic blood flow examination were analyzed.The predictive value of Emax and Emean for endometrial lesions was explored.Results:Age and the endometrial thickness of the women in group A,group B,and group C had increased gradually.The BMI value of the women had no significant different between group C and group B,but which of the women in group C and group B were significantly higher than that of the women in group A(all P<0.05).The values of Emean and Emax of the women in group A,group B,and group C had increased gradually.The composition ratio of grade 2 and 3 of blood flow of the women in group A,group B,and group C had increased gradually.The composition ratio of grade 0 and 1 of blood flow of the women in group A,group B,and group C had decreased gradually.The values of blood flow VI,FI and VFI by three-dimensional ultrasound of the women had no significant difference between group C and group B,but which of the women in group C and group B were all significantly higher than those of the women in group A(all P<0.05).Age,body mass index,endometrial thickness,blood flow grade 3,and Emean and Emax abnormality were all the independent risk factors of endometrial progression of the women(P<0.05).Emax and Emean values had predictive value for endometrial malignant lesions(P<0.001),and which area under the curve were 0.813 and 0.826,respectively.Conclusion:SWE has good diagnostic value for endometrial malignant lesions of postmenopausal women.