Evaluation of Tubal Patency with Transvaginal Three-dimensional Hysterosalpingo-contrast Sonography

Objective To investigate diagnostic efficacy of transvaginal three-dimensional hysterosalpingo-contrast sonography(3D-Hy Co Sy) in assessing tubal patency with chromolaporoscopy. Methods A total of 157 infertile women underwent 3D-Hy Co Sy to evaluate tubal patency. Among these patients, 39 patients were also examined by chromolaporoscopy. The concordance of the two clinical assessment methods was analyzed by the Kappa coefficient test. Results Among the 306 oviducts examined by 3D-Hy Co Sy, 99(32.4%) were patent, 126(41.2%) partially obstructed, and 81(26.5%) completely obstructed. Diagnostic results with 3D-Hy Co Sy were not statistically different from those obtained in the 39 women(78 oviducts) who also underwent chromolaporoscopy, and the two methods showed a high concordance(κ=0.747, P=0.000). The 3D-Hy Co Sy procedure had a sensitivity of 84.8%(28/33), a specificity of 96.2%(25/26), and positive and negative predictive values of 93.3%(28/30) and 86.2%(25/29) respectively. Conclusion Transvaginal 3D-Hy Co Sy can accurately reveal the spatial path and morphology of the oviduct and is a safe and effective method to evaluate tubal patency.

Detection of Congenital Uterine Malformation by Using Transvaginal Three-dimensional Ultrasound

This study assessed the clinical application of transvaginal three-dimensional ultrasound （3D TVUS） in the diagnosis of congenital uterine malformation. A retrospective study was performed on 62 patients with congenital uterine malformation confirmed hysteroscopically and/or laparoscopically. The patients were subjected to transvaginal two-dimensional ultrasound （2D TVUS） and 3D TVUS. The accuracy rate was compared between the two methods. The accuracy rate of 3D TVUS was （98.38%, 61/62）, higher than that of 2D TVUS （80.65%, 50/62）. 3D TVUS coronal plane imaging could demon- strate the internal shape of the endometrial cavity and the external contour of the uterine fundus. It al- lowed accurate measurement on the coronary plane, and could three-dimensionally show the image of cervical tube, thereby providing information for the diagnosis of some complex uterine malformation. 3D TVUS imaging can obtain comprehensive information of the uterus malformation, and it is superior to 2D TVUS for the diagnosis of congenital uterine malformations, especially complex uterine anomaly.

A Comparative Study of Transvaginal Sonography and Pelvic MRI in Patients with Endometrial Cancer

Background:The most prevalent type of gynecological cancer is endometrial cancer.Accurate surgical staging is the most important aspect in the management of endometrial cancer.Preoperative evaluation of myometrial invasion and appropriate management could be achieved by transvaginal sonography and pelvic MRI.Methods:A total of 53 patients with endometrial cancer,who were referred to a gynecology oncology department of an academic hospital in Mashhad University of Medical Sciences from 2018 to 2020,were evaluated in this study.Data were collected using a questionnaire on endometrial cancer.All the patients underwent preoperative transvaginal sonography and pelvic MRI to evaluate myometrial invasion.The involvement of myometrium thickness and histological findings were compared between two imaging modalities,and SPSS 23.0 was used to analyze the data.Results:Junctional irregularity was the most prevalent finding on transvaginal sonography.Based on transvaginal sonography,myometrial invasion of less than 50%was found in 73%of patients,while invasion of more than 50%was observed in 26.31%.In 57.44%of MRIs,there was less than 50%myometrial invasion,while in 42.55%of MRIs,there was more than 50%myometrial invasion.In both modalities,the most common finding was myometrial invasion of less than 50%.The accuracy,sensitivity,and specificity of transvaginal sonography were 0.47,0.27,and 0.75,respectively,whereas the accuracy,sensitivity,and specificity of MRI were 0.54,0.45,and 0.61,respectively.Conclusion:MRI can be the modality of choice for evaluating myometrial invasion and optimizing endometrial cancer treatment planning,as well as reducing the complications of non-indicated lymphadenectomy.

Comparison of Transvaginal Ultrasound, Saline Infusion Sonohysterography versus Diagnostic Hysteroscopy in Evaluation of Endometrial Cavity Pathology amongst Women with Abnormal Uterine Bleeding in Low Resource Setting

Introduction: Hysteroscopy is currently the gold-standard protocol for evaluating patients with abnormal uterine bleeding (AUB). Unfortunately, though accurate, its adoption in low-resource countries such as in Africa is limited due to lack of equipment and qualified personnel. As such, there is a need for an alternative diagnostic procedure that is as accurate as hysteroscopy, but also affordable, easy to administer, and acceptable by women with endometrial pathologies. Transvaginal Sonography (TVS) and Saline Infusion Sonohysterography (SIS) are proposed. However, their diagnostic accuracy versus hysteroscopy has not been determined in low resource setting. Objective: To compare the diagnostic efficacy of TVS and SIS versus diagnostic hysteroscopy in evaluation of endometrial pathology among pre-menopausal and post-menopausal women and to determine the etiology of AUB amongst these women. Methodology: A prospective cohort study was done at a hospital in Nairobi, Kenya between May and September 2019. Forty patients with AUB were recruited using consecutive sampling, and women who consented were recruited. The etiology of AUB was recorded. All participants underwent TVS, SIS and Diagnostic Hysteroscopy (DH) evaluation in the first half of the menstrual cycle and the findings recorded on a patient’s information sheet. The sociodemographic and bleeding characteristics of patients and the outcomes of TVS, SIS, and DH evaluations were also recorded and the data was analysed using version 5 of the Software for Statistics and Data Science (STATA). Summary statistics on the etiology of AUB were presented and the sensitivity of TVS and SIS versus DH as the gold-standard evaluated using two by two tables and the ROC curve. Results: The mean age of participants was 38.1 ± 8.8 years, range of 25 - 71 years. Heavy Menstrual Bleeding (HMB) was reported in 70.0% of participants, while about 12.0%, 7.5%, and 7.5% had post-menopausal bleeding, amenorrhea, and hypomenorrhea. The incidence of submucosal fibroids and endometrial polyps was 17.5% and 15.0% via TVS, 47.5% and 20.0% via SIS and 52.5% and 20% via DH respectively. The overall sensitivity, specificity, Positive Predictive Value (PPV), Positive Predictive Value (NPV), and diagnostic accuracy of SIS were 92.1%, 83.3%, 96.9%, 62.5%, and 90.0% while TVS was 38.2%, 100%, 100%, 22.2%, and 47.5%. The sensitivity, specificity, PPV, and NPV of TVS in diagnosis of endometrial polyp were 75.0%, 100%, 100%, and 94.0%. SIS did better with a sensitivity, specificity, PPV, and NPV of 100%, 100%, 100%, and 100%. Conclusion: Our data suggests SIS had a higher diagnostic accuracy than TVS and showcased a comparable diagnostic accuracy to hysteroscopy. SIS is more suitable safe alternative technique for investigating AUB in pre/post-menopausal women in low resource setting where hysteroscopy is unavailable or unaffordable.

Sonographic appearance of anal cushions of hemorrhoids

AIM To evaluate the diagnostic value of different sonographic methods in hemorrhoids.METHODSForty-two healthy volunteers and sixty-two patients with gradesⅠ-Ⅳhemorrhoids received two different sonographic examinations from January 2013 to January2016 at the First and Second Hospitals of Xinjiang Medical University in a prospective way.We analyzed the ultrasonographic findings of these participants and evaluated the outcomes.Resected gradesⅢandⅣhemorrhoid tissues were pathologically examined.The concordance of ultrasonographic results with pathologyresults was assessed with the Cohen’s kappa coefficient.RESULTS All healthy volunteers and all patients had no particular complications related to sonography.There were no statistically significant differences between the participants regarding age(P=0.5919),gender(P=0.4183),and persistent symptoms(P>0.8692).All healthy control participants had nospecial findings.However,30 patients with hemorrhoids showed blood signals around the dentate line on ultrasonography.When gradesⅠandⅡhemorrhoids were analyzed,there were no significant differences between transrectal ultrasound(TRUS),transperianal ultrasound(TPUS),and transvaginal ultrasound(TVUS)(P>0.05).GradesⅢandⅣhemorrhoids revealed blood flow with different directions which could be observed as a"mosaic pattern".In patients with gradesⅢandⅣhemorrhoids,the number of patients with"mosaic pattern"as revealed by TRUS,TPUS and TVUS was 22,12,and 4,respectively.Patients with gradesⅢandⅣdisease presented with a pathologically abnormal cushion which usually appeared as a"mosaic pattern"in TPUS and an arteriovenous fistula in pathology.Subepithelial vessels of resected gradesⅢandⅣhemorrhoid tissues were manifested by obvious structural impairment and retrograde and ruptured changes of internal elastic lamina.Some parts of the Trietz’s muscle showed hypertrophy and distortion.Arteriovenous fistulas and venous dilatation were obvious in the anal cushion of hemorhoidal tissues.After pathological results with arteriovenous fistulas were taken as the standard reference,we evaluated the compatibility between the two methods according to the Cohen’s kappa coefficiency calculation.The compatibility(Cohein kappa co-efficiency value)between"mosaic pattern"in the TPUS and arteriovenous fistula in pathology was very good(?=0.8939).When compared between different groups,TRUS presented the advantage that the mosaic pattern could be confirmed in more patients,especially for group A.There was a statistical difference when comparing group A with group B or C(P<0.05 for both).There were obvious statistical differences between group A and group B with regard to the vessel diameter and blood flow velocity measured by TRUS(P<0.05).CONCLUSION Patients with gradesⅢandⅣhemorrhoids present with a pathologically abnormal cushion which usually appears as a"mosaic pattern"in sonography,which is in accord with an arteriovenous fistula in pathology.There are clearly different hemorrhoid structures shown by sonography."Mosaic pattern"may be a parameter for surgical indication of gradesⅢandⅣhemorrhoids.

经阴道四维子宫输卵管超声造影评估输卵管的通畅性

目的 探讨经阴道四维子宫输卵管超声造影(TVS-4D-HyCoSy)评估不孕症患者输卵管通畅性的价值。方法 选取2018年9月至2020年7月在江西省妇幼保健院就诊的女性不孕症患者96例共184条输卵管(8例因宫外孕行单侧输卵管切除术),应用经阴道四维子宫输卵管超声造影技术,观察并分析输卵管的通畅性,造影检查后均行腹腔镜下输卵管通液术。以腹腔镜下输卵管通液术的结果为“金标准”,通过Kappa检验分析两种检查方法诊断的一致性。结果 TVS-4D-HyCoSy对输卵管的通畅、通而不畅及不通畅的诊断符合率分别为97.32%(109/112)、81.08%(30/37)、74.28%(26/35)。2种方法对于输卵管通畅性的诊断一致性较好(Kappa=0.809,P<0.001)。结论 TVS-4D-HyCoSy能较准确地评估输卵管的通畅性。

聚焦超声消融治疗前子宫肌瘤超声指标与MRI T2WI信号强度的相关性

目的 分析子宫肌瘤超声指标与MRI T2WI信号强度的相关性,预测聚焦超声消融治疗的难易程度。资料与方法 回顾性分析2020年5月—2021年7月遂宁市中心医院聚焦超声消融治疗前238例单发子宫肌瘤患者的经阴道超声及MRI T2WI图像,获取子宫肌瘤T2WI信号强度类型与超声指标;采用Logistic回归分析超声指标与T2WI信号强度的相关性,通过受试者工作特征曲线分析超声指标对T2WI高信号肌瘤的预测价值。结果 238例患者T2WI信号表现:高信号组86例、非高信号组152例。子宫肌层与肌瘤灰度值差(Z=6.025,P<0.001)、能量多普勒血流信号像素面积比率(Z=5.957,P<0.001)、黏膜下肌瘤(Z=15.882,P=0.047)是不同T2WI信号强度的相关因素;使用受试者工作特征曲线验证Logistic回归模型,曲线下面积为0.817,约登指数为0.51,敏感度为0.826,特异度为0.684。结论 超声指标可在聚焦超声消融术前预测MRI T2WI高信号子宫肌瘤,具有一定的临床实用价值。

子宫内膜癌患者经阴道彩色多普勒超声分期与病灶血供的关系

目的研究子宫内膜癌患者超声参数对术前分期诊断的准确性及经阴道彩色多普勒超声(transvaginal color Doppler sonography,TVCDS)分期与病灶血供的关系。方法采用前瞻性研究设计,选取南京医科大学附属无锡妇幼保健院2019年1月至2021年12月收治的110例子宫内膜癌患者为子宫内膜癌组,另选取同期进行治疗的110例子宫内膜增厚患者为子宫内膜增生组,110例健康体检志愿者作为健康组,比较3组研究对象的子宫内膜厚度、国际妇产科联盟(International Federation of Gynecology and Obstetrics,FIGO)超声指标、TVCDS分期与病灶血供之间的差异。结果子宫内膜癌组、子宫内膜增生组、健康组的子宫内膜厚度比较差异有统计学意义(P<0.05),且子宫内膜厚度从厚到薄依次为子宫内膜癌组、子宫内膜增生组、健康组。子宫内膜癌组、子宫内膜增生组、健康组的子宫动脉阻力指数(resistance index,RI)、搏动指数(pulsatile index,PI)、收缩期峰值流速(peak systolic velocity,PSV)、舒张末期流速(end-diastolic volume,EDV)比较差异有统计学意义(P<0.05),且RI、PI从高到低依次为健康组、子宫内膜增生组、子宫内膜癌组,PSV、EDV从高到低依次为子宫内膜癌组、子宫内膜增生组、健康组。不同FIGO分期的子宫内膜癌组患者(Ⅰ期、Ⅱ期、Ⅲ期和Ⅳ期)的RI、PI、PSV、EDV比较差异有统计学意义(P<0.05),且PI、PSV、EVD从高到低依次为Ⅳ期、Ⅲ期、Ⅱ期以及Ⅰ期,RI从高到低依次为Ⅰ期、Ⅱ期、Ⅲ期以及Ⅳ期。子宫内膜癌组患者的不同FIGO分期与TVCDS检查分级一致性强(P<0.001)。不同FIGO分期的子宫内膜癌组患者(Ⅰ期、Ⅱ期、Ⅲ期和Ⅳ期)病灶部位血流分级比较差异有统计学意义(P<0.05)。结论子宫内膜癌患者超声参数对术前分期的诊断较为准确,TVCDS分期与病灶血供存在相关性,可作为临床诊断的重要依据。

Diagnostic value of endometrial thickness determined by transvaginal sonography in infertile women with endometrial polyps

Background Endometrial polyps （EPs） occur in approximately 34.9% of infertile women. Transvaginal sonography （TVS） is a routine, non-invasive component of fertility evaluation. Most ultrasonographic studies of EPs have focused on abnormal uterine bleeding; few have assessed EPs in infertile women. Furthermore, no studies have explored endometrial thickness and its correlation with EPs in infertile women. This study aimed to assess transvaginal sonographic assessment of endometrial thickness and its value in diagnosis and prediction of EPs in infertile women. Methods A retrospective study on 314 infertile women was conducted from June to December 2010. After TVS, endometrial biopsies were obtained by hysteroscopy. Pathologically confirmed EPs were taken as the gold standard. Results Based on recognized criteria, TVS had a sensitivity of 37.04%, specificity of 98.71%, positive predictive value of 90.91%, negative predictive value of 81.85%, and accuracy of 82.80% for diagnosing EPs. Mean endometrial thickness was significantly different in patients with and without EPs （P=0.0001）. In women in the mid and late-proliferative phase, the endometrial thickness was significantly greater in those with EPs than in those without them （P=0.0001 and 0.024）. Receiver operating characteristic analysis showed that endometrial thickness had a sensitivity of 85.2% and specificity of 38% in the diagnosis of EPs, the area under the curve being 0.64. In the mid-proliferative phase, sensitivity was up to 90.9%, the area under the curve being 0.70. Conclusions TVS is poor at detecting EPs in infertile women; however, transvaginal sonographic measurement of endometrial thickness is helpful. It is suggested that the diagnostic value of TVS for EPs in infertile women could be improved by adding the measurement of endometrial thickness to the variables that are routinely assessed.

经阴道三维超声输卵管造影和X线子宫输卵管造影在输卵管通畅性评价中的应用

目的探讨经阴道三维超声子宫输卵管造影(3D-HyCoSy)和X线子宫输卵管造影(X-HSG)在输卵管通畅性评价中的应用。方法选取湖北民族大学附属民大医院妇科2020年2月-2021年4月收治的142例因输卵管而不孕的女性作为研究对象,其中71例接受经阴道三维超声子宫输卵管造影纳入3D-HyCoSy组,71例接受X线子宫输卵管造影,纳入X-HSG组。以腹腔镜下输卵管通液术检查结果为金标准,比较3D-HyCoSy和X-HSG诊断女性输卵管性不孕症的价值。结果3D-HyCoSy的准确度、特异度、敏感度均高于X-HSG(P<0.05);3D-HyCoSy组患者阴道流血、疼痛、恶心呕吐、低血压不良反应的发生率均低于X-HSG组(P<0.05);3D-HyCoSy组患者3个月、6个月、9个月、1年的自然受孕率均高于X-HSG组患者(P<0.05)。结论针对女性输卵管的通畅性评估,相较于X-HSG,3D-HyCoSy具有更高的准确度、敏感度、自然受孕率及更低的不良反应发生率。

经阴道彩色多普勒超声联合磁共振成像检查在宫颈癌术前分期中的应用价值

目的探究经阴道彩色多普勒超声(TVCDS)联合磁共振成像(MRI)检查在宫颈癌术前分期中的应用价值。方法选取47例疑似宫颈癌患者,均采用TVCDS、MRI检查,以术后病理学结果作为金标准,比较TVCDS、MRI单一检查与联合检查在宫颈癌术前分期评估中的诊断效能。结果TVCDS与MRI联合检查肿瘤术前分期的检出率与病理学检查比较差异无统计学意义(P>0.05)。MRI与TVCDS联合检查宫颈癌术前分期的准确率显著高于MRI、TVCDS单一检查,差异有统计学意义(P<0.05)。结论TVCDS联合MRI检查可有效提升宫颈癌术前分期的诊断准确率,有助于后续治疗。

TVS 4D-HyCOSy评价输卵管通畅准确性的回归分析

目的探究经阴道子宫输卵管四维超声造影(TVS 4D-HyCOSy)评价输卵管通畅的准确性。方法回顾性分析2019年2月至2022年6月于惠东县妇幼保健计划生育服务中心检查的120例疑似输卵管不通畅所致不孕症患者资料,全部患者均行TVS4D-HyCOSy和X线造影检查,对比不同影像学方法的诊断结果。结果TVS 4D-HyCOSy的诊断灵敏度、准确度及特异度均高于X线造影,差异有统计学意义(P<0.05);Logistic回归显示,TVS 4D-HyCOSy的OR值显著高于X线造影。结论TVS 4D-HyCOSy具有安全、无创和实用性强等特点,能够清晣显示输卵管空间形态,可作为女性不孕症患者输卵管检查的有效手段。

经腹与经阴道超声对输卵管妊娠诊断价值的比较研究

目的 研究经腹超声 (TAS)与经阴道超声 (TVS)对输卵管妊娠的诊断价值。方法 44例输卵管妊娠患者行TAS与TVS ,并与手术结果进行对比分析。结果 输卵管妊娠直接声像图表现为环状回声与附件区非特异性包块 ;TAS对附件包块的诊断敏感性与包块大小相关 ;TAS与TVS对破裂型输卵管妊娠诊断的敏感性无差异 ;TVS对早期未破裂型输卵管妊娠的诊断明显优于TAS。结论 TVS对输卵管妊娠的早期诊断具有重要的临床应用价值。

经阴道超声检查对输卵管妊娠诊断的价值

目的 探讨经阴道超声对输卵管妊娠的诊断价值。方法 经手术、病理证实的 6 3例输卵管妊娠患者与其经阴道超声检查进行对比分析。结果 输卵管妊娠超声图像为附件区出现环状回声、低回声或混合回声包块 ,其中环状回声是其特征性表现。超声诊断准确率为 96 83%。结论 经阴道超声检查可早期诊断输卵管妊娠 ,结合彩色多普勒血流测定可提高诊断敏感性。

经腹与经阴道超声诊断异位妊娠符合率的Meta分析

目的:应用荟萃(Meta)分析探讨经腹超声与经阴道超声对异位妊娠诊断符合率。方法:采用Review Manager4.2软件,应用Meta分析固定效应模型和随机效应模型对1995年1月—2008年12月国内外有关经腹与经阴道超声诊断异位妊娠符合率的研究进行综合定量评价。结果:经筛选并纳入本次Meta分析的文献共22篇。累计经阴道超声组2010例,经腹超声组2015例,RR随机值为1.37(95%CI1.24～1.52),差别有统计学意义(P<0.00001)。结论:经阴道超声诊断异位妊娠优于经腹超声,有条件的单位应将经阴道超声作为诊断异位妊娠的首选方法。

阴道超声监测卵泡生长及排卵的临床意义

目的 观察阴道超声监测卵泡发育及排卵在不孕症中的作用。方法 对 6 9例 15 7周期不孕症患者采用阴道超声监测卵泡发育及排卵。自月经第 8天开始 ,每 2天监测 1次 ,当卵泡直径大于 15mm时 ,每天监测 1次 ,直至排卵 ;如仍未排卵 ,则改为 2～ 3d测 1次 ,直至下次月经来潮。结果 排卵的85个周期中 ,最大卵泡平均值为 2 3.4mm ,平均增长率为 2 .42mm d ,消失在周期的 13～ 16d ;排卵延缓期8例 32个周期 ,卵泡最大平均值出现在月经第 2 4～ 39天 ,最大直径为 2 4.1mm ,排卵在月经第 2 6～ 42天 ;无卵泡发育的 9例 14个周期 ;无优势卵泡的 5例 18个周期 ;8例因服用克罗米芬或hCG出现卵巢过度刺激综合征。结论 阴道超声监测卵泡发育直观性好 ,对于准确测定排卵时间、指导受孕起着非常重要的作用 ,是治疗不孕症不可缺少的重要手段。

经阴道超声对子宫肌腺病的诊断价值评价

目的 探讨经阴道超声在子宫肌腺病诊断中的价值。方法 52例子宫肌腺病患者均行经阴道超声检查 ,其中 9例加做经腹部超声检查 ,将超声结论与手术及病理诊断进行对照分析。结果 超声诊断与病理诊断符合者 3 5例 (67.3 % ) ,不符者 1 7例 (3 2 .7% )。其中误诊 7例 ,漏诊 1 0例。结论 经阴道超声是临床诊断子宫肌腺病的主要依据之一 ,可作为首选检查方法。

宫腔镜在宫腔因素不孕不育症诊治中的应用

目的探讨宫腔镜检查在宫腔因素不孕不育症诊治中的作用。方法收集2012年6月至2013年8月在我院生殖中心就诊,并经阴道超声和宫腔镜检查确诊的不孕不育症患者,经入选和排除标准筛查后,最终有432例纳入本研究并行数据分析。结果本研究432例不孕不育症患者中,继发性不孕组的宫腔异常发生率(73.36%)显著高于原发性不孕组(54.68%)(P<0.05);继发性不孕组的宫腔形态、输卵管开口、子宫内膜颜色、弹性、腺体开口、厚度的异常发生率显著高于原发性不孕组,差异有统计学意义(P<0.05);经阴道超声诊断宫腔病变的敏感度和特异度分别为66.89%、66.47%。结论宫腔镜检查在宫腔因素不孕不育症诊治中具有重要的临床应用价值。

经阴道超声联合宫腔声学造影在宫腔病变中的诊断价值

采用阴道超声(TVS)联合宫腔声学造影(SHG)检查诊断出宫腔内病变130例,并以病理检查结果为金标准计算其诊断敏感性及准确性。TVS联合SHG诊断子宫内膜增生、子宫内膜息肉、子宫黏膜下肌瘤、子宫内膜炎、不全流产的灵敏度分别为94.1%、72.7%、88.9%、83.3%、81.8%,准确性分别为76.2%、88.9%、80.0%、87.0%、81.8%。

阴道超声诊断卵巢正常大小的原发性卵巢上皮性癌综合征的临床价值

目的 :探讨经阴道超声术前诊断卵巢正常大小的原发性卵巢上皮性癌综合征的应用价值。方法 :总结分析经阴道超声对 32例卵巢正常大小的卵巢癌患者的诊断结果 ,观察其声像图特征 ,术后经病理组织学验证。结果 :经阴道超声检测卵巢正常大小的卵巢癌的准确率为 91%。结论 :经阴道超声检查能较准确地早期诊断卵巢正常大小的原发性卵巢上皮癌综合征 ,可作为该病患者术前的首选影像学检查方法。以二维阴道超声为基础 ,结合彩色多普勒血流显像 ,可以提高对该病的诊断准确率。