二维超声联合三维血管成像对慢性子宫内膜炎的诊断价值

Diagnostic value of two-dimensional ultrasound combined with three-dimensional angiography in chronic endometritis

目的 探讨经阴道二维超声联合三维能量多普勒血管成像(3D-PDA)检查子宫内膜对慢性子宫内膜炎(CE)的诊断价值。方法 选取2023年1月至2023年8月西安市第四医院收治的210例女性患者作为研究对象,均行经阴道超声及宫腔镜检查,以病理诊断结果为标准,分为CE组(n=119)和无CE的对照组(n=91),比较两组经阴道二维超声检查的子宫内膜厚度、回声均匀性、子宫内膜Applebaum分型情况,以及3D-PDA检查的子宫内膜血流参数,包括血管化指数(VI)、血流指数(FI)及血管-血流指数(VFI)。采用受试者工作特征(ROC)曲线分析子宫内膜厚度、回声均匀性、子宫内膜Applebaum分型、VI、FI、VFI对CE的诊断价值。结果 CE组子宫内膜厚度、Ⅱ型及Ⅲ型血流占比、VI、FI、VFI均小于对照组,内膜回声不均匀占比、Ⅰ型血流占比均多于对照组(t/χ^(2)值介于-2.831~89.249之间,P<0.05)。ROC曲线分析显示,子宫内膜厚度、内膜回声均匀性、VI、FI、VFI五项联合检测的诊断价值最高,AUC值为0.942,灵敏度87.90%,特异度为79.50%。结论 经阴道二维超声联合三维能量多普勒血管成像检查子宫内膜对CE的诊断价值较高,可作为一种无创性的临床诊断方法推广使用。

Objective To explore the diagnostic value of transvaginal two-dimensional ultrasound combined with three-dimensional power Doppler angiography(3D-PDA)in evaluating the endometrium for chronic endometritis(CE).Methods A total of 210 female patients admitted to the Xi′an Fourth Hospital were selected as the study objects.They all underwent transvaginal ultrasound and hysteroscopy examinations,and were divided into chronic endometritis group(CE group,n=119 cases)and non-chronic endometritis group(control group,n=91 cases)according to the pathological diagnosis results.Endometrial thickness,echo uniformity,endometrial applebaum typing detected by two-dimensional ultrasound and endometrial blood flow parameters,including vascularization index(VI),blood flow index(FI)and vascular-flow index(VFI)detected by 3D-PDA were compared between the two groups.Receiver operating characteristic(ROC)curve analysis was used to analyze the diagnostic value of endometrial thickness,echo uniformity,endometrial applebaum typing,VI,FI and VFI in CE.Results The endometrial thickness,proportion of typeⅡand typeⅢblood flow,VI,FI and VFI in the CE group were all lower than those in control group,the proportion of heterogeneous endometrial echogenicity and typeⅠblood flow in CE group was higher than that in control group(t/χ^(2) values ranged from-2.831 to 89.249,P<0.05).ROC curve analysis showed that the combined detection of endometrial thickness,echo uniformity,VI,FI and VFI had the highest diagnostic value,with an AUC value of 0.942,sensitivity of 87.9%and specificity of 79.5%.Conclusion Transvaginal two-dimensional ultrasound combined with three-dimensional power Doppler angiography for evaluating the endometrium shows a higher diagnostic value for CE.It can be promoted as a non-invasive clinical diagnostic method.