三维超声成像定量分析宫腔粘连的研究

Quantitative analysis of intrauterine adhesion by three-dimensional ultrasound imaging

目的:观察三维超声成像定量分析宫腔粘连的临床应用价值。方法:选取2019年4月—2021年9月在北京百子湾和美妇儿医院经宫腔镜确诊为宫腔粘连的患者24例,设为异常组,另选取同期本院正常体检人员52名设为正常组。应用二维超声测量子宫大小及内膜厚度;应用三维超声成像测量侧壁内聚角、侧壁内聚深度、宫腔宽度、两侧宫角间距与宫腔宽度比值,比较并分析正常组与异常组之间以上参数的差异,绘制受试者操作特征(receiver operating characteristic,ROC)曲线,计算侧壁内聚角及侧壁内聚深度诊断宫腔粘连的临界值。结果:异常组侧壁内聚角、宫腔宽度显著小于正常组,侧壁内聚深度、两侧宫角间距与宫腔宽度比值显著大于正常组(P<0.01)。ROC曲线示侧壁内聚角、侧壁内聚深度对宫腔粘连有较好的预测能力,侧壁内聚角145°(灵敏度95.8%,特异度90.3%),侧壁内聚深度0.375 cm(灵敏度86.4%,特异度74.8%)。异常组子宫内膜厚度小于正常组,差异具有统计学意义(P<0.05)。结论:三维超声成像定量分析可提高周围性宫腔粘连评估能力,特别对于宫底部和侧壁的周围性粘连敏感性更高,此方法对宫腔粘连的诊断具有临床应用价值。

Objective Clinical application value of three-dimensional ultrasound imaging in quantitative analysis of intrauterine adhesion.Methods 24 patients with intrauterine adhesion which was diagnosed by hysteroscopy in Beijing Baiziwan Hemei Women and Children's Hospital from April 2019 to September 2021 were selected as the abnormal group,and 52 normal physical examination personnel in our hospital during the same period were selected as the normal group.Uterine size and endometrial thickness were measured in two dimensions ultrasound imaging.Three-dimensional ultrasound imaging was used for measurement the lateral indentation angle,the lateral indentation depth,the width of the uterine cavity and the ratio of bilateral angular spacing to uterine cavity width.The differences of above parameters between normal group and abnormal group were compared and analyzed,the receiver operating characteristic(ROC)curve was drawn,the critical values of lateral indentation angle and lateral indentation depth were calculated to diagnose intrauterine adhesion.Results The lateral wall cohesion angle and uterine cavity width in the abnormal group were significantly smaller than those in the normal group,and the ratio of lateral wall cohesion depth,bilateral uterine angle spacing and uterine cavity width was significantly greater than that in the normal group(P<0.01).ROC curve showed that the lateral indentation angle and the lateral indentation depth had a better ability to predict intrauterine adhesion,the lateral indentation angle 145(sensitivity 95.8%,specificity 90.3%),the lateral indentation depth 0.375 cm(sensitivity 86.4%,specificity 74.8%).The endometrial thickness of the abnormal group was smaller than that of the normal group,and the difference was statistically significant(P<0.05).Conclusion Quantitative analysis of three-dimensional ultrasound imaging can improve the evaluation ability of peripheral intrauterine adhesion,especially for the peripheral adhesion of the uterine bottom and lateral wall,which has a higher sensitivity.This method has clinical application value in the diagnosis of intrauterine adhesion.