经阴道二维超声及三维超声容积成像技术对宫腔粘连的诊断价值

The diagnostic value of transvaginal two-dimensional ultrasound and three-dimensional ultrasound volume imaging technology for intrauterine adhesions

目的分析经阴道二维超声及三维超声容积成像(3DVI)技术对宫腔粘连的诊断价值。方法选择2022年7月至2023年6月北京市通州区妇幼保健院收治的120例疑似宫腔粘连患者为研究对象,均行经阴道二维超声及3DVI技术检查,以宫腔镜检查结果为金标准,比较阴道二维超声及3DVI技术单项检查与联合检查的诊断价值;比较宫腔粘连组与非宫腔粘连组以及不同宫腔粘连程度患者的超声参数[子宫内膜厚度(ED)、子宫内膜容积(EV)、血管指数(VI)、血流指数(FI)、血管血流综合指数(VFI)]。结果 120例疑似宫腔粘连患者中,宫腔镜检查结果阳性104例,阳性率为86.67%,其中轻度50例,中度36例,重度18例。阴道二维超声检查结果阳性76例,阳性率为63.33%;3DVI技术检查结果阳性79例,阳性率为65.83%;阴道二维超声及3DVI技术联合检查结果阳性87例,阳性率为72.50%。阴道二维超声检查的灵敏度、特异度、阳性预测值、阴性预测值分别是68.27%、68.75%、93.42%、25.00%,3DVI技术检查分别是73.08%、81.25%、96.20%、31.71%,联合检查分别是83.65%、100.00%、100.00%、48.48%,联合检查的灵敏度、特异度、阳性预测值、阴性预测值均高于阴道二维超声检查(均P<0.05)。宫腔粘连组104例,非宫腔粘连组16例;宫腔粘连组的ED、EV、VI、FI、VFI小于非宫腔粘连组(均P<0.05)。不同宫腔粘连程度患者的ED、EV、VI比较差异有统计学意义(均P<0.05);中度组ED、EV、VI小于轻度组(均P<0.05),重度组ED、EV、VI小于轻度组与中度组(均P<0.05),FI小于轻度组(P<0.05)。结论经阴道二维超声联合3DVI技术对宫腔粘连的诊断价值较高,可用于评估宫腔粘连程度。

Objective To analyze the diagnostic value of transvaginal two-dimensional ultrasound and three-dimensional ultrasound volume imaging(3DVI)technology for intrauterine adhesions.Methods A total of 120 suspected patients with intrauterine adhesions admitted to Beijing Tongzhou District Maternal and Child Health Hospital from July 2022 to June 2023 were selected as the research subjects.All patients underwent transvaginal two-dimensional ultrasound and 3DVI technology examination,and the diagnostic value of vaginal two-dimensional ultrasound and 3DVI technology single examination and combined examination was compared based on the results of hysteroscopy examination as the gold standard;Comparison of ultrasound parameters between the intrauterine adhesions group and the non intrauterine adhesions group,as well as patients with different degrees of intrauterine adhesions[endometrial thickness(ED),endometrial volume(EV),vascular index(VI),blood flow index(FI),vascular comprehensive index(VFI)].Results Among 120 suspected patients with intrauterine adhesions,104 cases were positive in hysteroscopy examination,with a positive rate of 86.67%.Among them,50 cases were mild,36 cases were moderate,and 18 cases were severe.76 cases were positive in vaginal two-dimensional ultrasound examination,with a positive rate of 63.33%;79 cases were positive for 3DVI technology examination,with a positive rate of 65.83%;The combined examination results of vaginal two-dimensional ultrasound and 3DVI technology were positive in 87 cases,with a positive rate of 72.50%.The sensitivity,specificity,positive predictive value,and negative predictive value of vaginal two-dimensional ultrasound examination were 68.27%,68.75%,93.42%,and 25.00%,respectively.The 3DVI technique examination was 73.08%,81.25%,96.20%,and 31.71%,respectively.The combined examination was 83.65%,100.00%,100.00%,and 48.48%,respectively.The sensitivity,specificity,positive predictive value,and negative predictive value of the combined examination were all higher than those of vaginal two-dimensional ultrasound examination(all P<0.05).104 cases in the intrauterine adhesions group and 16 cases in the non intrauterine adhesions group;The ED,EV,VI,FI,and VFI of the intrauterine adhesions group were lower than those of the non intrauterine adhesions group(all P<0.05).The differences in ED,EV,and VI among patients with different degrees of intrauterine adhesions were statistically significant(all P<0.05);The ED,EV,and VI in the moderate group were lower than those in the mild group(all P<0.05),while the ED,EV,and VI in the severe group were lower than those in the mild and moderate groups(all P<0.05),and the FI was lower than those in the mild group(P<0.05).Conclusions Transvaginal two-dimensional ultrasound combined with 3DVI technology has high diagnostic value for intrauterine adhesions and can be used to evaluate the degree of intrauterine adhesions.