宫腔粘连患者子宫内膜超声造影特征及其应用价值

Characteristics and application value of endometrial contrast-enhanced ultrasonography in patients with intrauterine adhesion

目的:探讨宫腔粘连(IUA)患者子宫内膜经静脉超声造影(CEUS)特征及其与美国生育协会(AFS)评分的相关性。方法:收集2020年12月至2021年12月71名IUA患者的临床资料,患者均进行了宫腔镜检查,根据宫腔镜检查结果及AFS评分将患者分为轻度组、中度组及重度组。比较不同组间的患者一般资料、二维超声参数、血流指标参数及CEUS定量参数,并对CEUS定量参数与不同级别的AFS评分进行相关性分析。绘制受试者工作特征曲线(ROC),分析CEUS定量参数对重度IUA患者的诊断效能的影响。结果:子宫动脉血流频谱搏动指数(PI)在AFS评分中重度组高于中度组(P<0.05),收缩期峰值流速(Vmax)、舒张期最低流速(Vmin)、血流阻力指数(RI)3组间差异无统计学意义(P>0.05)。在CEUS中有44例显示宫腔分离,但其中31例二维超声未显示宫腔分离,6例CEUS显示宫腔分离程度较二维超声检查明显,7例CEUS显示宫腔分离程度同二维超声检查一致。在CEUS定量指标中,CEUS 3组之间内膜区达峰时间(TtoPK)、内膜下区TtoPK差异具有统计学意义(P<0.05),中度组内膜区及内膜下区TtoPK均显著快于重度组(P<0.05)。内膜下区TtoPK与AFS评分分组呈正相关(r=0.251,P<0.05)。ROC提示内膜下区TtoPK评估重度IUA的曲线下面积(AUC)为0.711(95%CI为0.568~0.854,P<0.05),切点值为15.29,灵敏度为92.3%,特异性为43.6%。结论:多数IUA患者CEUS过程中会出现宫腔分离的改变。IUA患者不同AFS评分分组的子宫内膜CEUS特征具有差异性,且内膜下区TtoPK与AFS评分分组呈正相关,表明其能较为灵敏地提示重度IUA的发生的可能。CEUS对IUA的早期筛查及分组评估具有一定的价值。

Objective:Exploring the characteristics of uterine endometrium in patients with intrauterine adhesions(IUA)using contrast-enhanced ultrasound(CEUS)and its correlation with the American Fertility Society(AFS)score.Methods:Clinical data of Seventy-one patients with IUA were collected from December 2020 to December 2021.All patients underwent hysteroscopy examination,and they were classified into mild,moderate,and severe groups based on the hysteroscopy results and AFS score.Compare the general data,two-dimensional ultrasound parameters,blood flow index parameters,and CEUS quantitative parameters among different groups of patients,and analyze the correlation between CEUS quantitative parameters and AFS in different groups.The Receiver Operating Characteristic Curve(ROC)was drawn to analyze the influence of CEUS quantitative parameters on the diagnostic efficiency of severe IUA patients.Results:The uterine artery blood flow spectral pulsatility index(PI)in the severe AFS group was higher than that in the moderate group(P<0.05).There was no statistical significance in systolic peak flow velocity(Vmax),diastolic minimum flow velocity(Vmin)and resistance index(RI)between the three groups(P>0.05).There were 44 cases of CEUS showing uterine separation,but 31 cases of two-dimensional ultrasonography did not show uterine separation,6 cases of CEUS showed uterine separation degree was more obvious than two-dimensional ultrasonography,and 7 cases of CEUS showed uterine separation degree was consistent with two-dimensional ultrasonography.In the CEUS quantitative parameters,there is a statistically significant difference in the time to peak(TtoPK)between the endometrial region and the sub-endometrial region among the three CEUS groups(P<0.05).The TtoPK in the endometrial region and sub-endometrial region of the moderate group is significantly faster than that of the severe group(P<0.05).TtoPK in the sub-endometrial region was positively correlated with AFS score grouping(r=0.251,P<0.05).ROC analysis demonstrated that the area under the curve(AUC)for severe IUA diagnosed by TtoPK in the subintimal region was 0.711(95%CI:0.568~0.854,P<0.05).The cut-off value was 15.29,the sensitivity of 92.3%and the specificity of 43.6%.Conclusion:The majority of IUA patients showed changes in uterine separation during CEUS.The characteristics of endometrial CEUS in IUA patients with different score groups were different.There was a positive correlation between TtoPK and AFS score grouping in the sub-endometrial region(r=0.251,P<0.05),which could sensitively suggest the possibility of severe IUA.CEUS is valuable for the early screening and classification of IUA.