三维超声对绝经后子宫内膜良恶性病变的诊断价值

发布时间：2018-05-22 09:40

本文选题：三维超声 + 三维能量多普勒超声　；参考：《大连医科大学》2014年硕士论文

【摘要】：研究背景: 子宫内膜病变多发生在绝经后妇女，常以不规则阴道流血作为其首发症状。子宫内膜病变妇女多为内膜息肉、内膜增生、子宫黏膜下肌瘤等良性病变，只有1-15%为子宫内膜恶性病变[1-3]，现2D-TVS（Two-dimensional transvaginalsonography，经阴道二维超声）测量子宫内膜厚度作为初步诊断子宫内膜病变的方法，但对子宫内膜病变性质的确诊需要诊断性刮宫、宫腔镜等获取组织的侵入性方法。为减小侵入诊断方法给患者带来的痛苦、避免因过度治疗给患者和医生造成的负担，需要寻求更佳的进一步鉴别子宫内膜良恶性病变的超声方法。目的：比较子宫内膜厚度、子宫内膜体积和三维能量多普勒（Three-dimensionalpower Doppler angiography，3D-PDA）超声的血流参数在绝经后子宫内膜病变妇女良性及恶性之间的不同，计算三维超声参数在子宫内膜良性病变与恶性病变之间的诊断标准值，比较二维超声子宫的内膜厚度、三维超声的子宫内膜体积（EV，Endometrial volume）和3D-PDA血流参数对绝经后妇女子宫内膜良性病变与恶性病变的鉴别价值。方法：选取在2013年6月至2013年10月期间在大连医科大学附属第一医院进行诊治的36例子宫内膜病变妇女，排除放疗、化疗、激素治疗等影响因素，所有研究对象在超声仪器上采集信息之后，经诊断性刮宫或宫腔镜等手术治疗的病理组织学证实为子宫内膜病变，其中恶性病变组的患者为17例，良性病变组的患者为19例。研究对象均在2D-TVS下测量子宫内膜厚度，用三维超声下的VOCAL (VirtualOrgan Computer-aided Analysis，虚拟器官计算机辅助分析)软件测量子宫内膜体积，并用3D-PDA计算血流参数：VI (Vascularization Index，血管指数)，FI (Flow Index，血流指数)、VFI (Vascularization Flow Index，血管血流指数)。使用SPSS19统计软件用两个独立样本的t检验来比较参数在良性病变组与恶性病变组之间的统计学差异；应用变异系数和配对t检验分析应用三维超声检测的可重复性。用ROC(Receiver operating characteristic，受试者工作特性)曲线评价本研究所测量的参数（子宫内膜厚度、子宫内膜体积、VI、FI、VFI）在鉴别子宫内膜良性病变与恶性病变方面的灵敏度及特异度，并且建立诊断标准值。结果： 1.子宫内膜恶性病变组内膜平均厚度（17.28士7.03mm）和平均体积(13.54士9.89cm3)均高于子宫内膜良性病变组（11.00士4.06mm）(3.91士2.98cm3)，，具有非常显著的统计学差异(p0.01)。 2.子宫内膜恶性病变组的3D-PDA血流参数(VI、FI和VFI)均高于子宫内膜良性病变组,而且均具有显著性的统计学差异(p0.05)。 3.在鉴别绝经后妇女子宫内膜良恶性病变时,EV的ROC曲线下面积最，0.842，最佳临界值选取敏感性和特异性之和最大的数值，得到鉴别子宫内膜良恶性病变的内膜体积诊断标准值为4.10cm3，其灵敏度为88.2%，特异度为73.7%。3D-PDA血流参数的诊断标准值如下：VI为2.8、FI为28.89、VFI为0.83，相对应的3D-PDA鉴别绝经后子宫内膜良性与恶性病变的灵敏度和特异度为：64.7%和89.3%,82.4%和73.7%,70.6%和89.5%。结论： 1.三维超声子宫内膜体积和血流参数对绝经后子宫内膜良恶性病变的鉴别有重要参考价值。 2.二维超声的子宫内膜厚度是筛查绝经后子宫内膜病变的方法；本研究中，经ROC曲线下面积比较，内膜厚度区分子宫内膜良性与恶性病变的效能比内膜体积低，所以，内膜体积是较二维超声下内膜厚度更佳的指标。 3.三维超声子宫内膜体积对鉴别绝经后子宫内膜良性与恶性病变的参考价值最高。
[Abstract]:Background of Study :

In order to reduce the burden on patients and doctors , it is necessary to seek a better ultrasonic method for further differential diagnosis of benign and malignant lesions .

Purpose :

To compare the diagnostic value of three - dimensional ultrasound parameters between benign and malignant lesions of endometrium , and to compare the diagnostic value of three - dimensional ultrasound parameters between benign and malignant lesions of endometrium . The value of three - dimensional ultrasound parameters in the diagnosis of benign and malignant lesions in postmenopausal women was compared .

Method :

The endometrial thickness was measured with 3D - PDA . The parameters of blood flow : VI ( Vascularization Index , Vascular Index ) , FI ( Flow Index ) , VFI ( Vascularization Flow Index ) were measured by 3D - PDA . The statistical difference between benign lesion group and malignant lesion group was compared with t - test of two independent samples of SPSS 19 statistical software .
The sensitivity and specificity of parameters ( endometrial thickness , endometrial volume , VI , FI , VFI ) measured by this study were evaluated by ROC ( Receiver operating characteristic , subject working characteristics ) curve . The sensitivity and specificity of the parameters measured by this study ( endometrial thickness , endometrial volume , VI , FI , VFI ) were evaluated and the diagnostic standard value was established .

Results :

1 . The mean thickness ( 17.28 卤 7.03mm ) and the mean volume ( 13.54 卤 9.89 cm3 ) of endometrial malignant lesions were higher than those in benign lesions ( 11.00 卤 4.06mm ) ( 3.91 卤 2.98 cm3 ) .

2 . The 3D - PDA blood flow parameters ( VI , FI and VFI ) of endometrial malignant lesions were higher than those in benign lesions of the endometrium ( p < 0.05 ) .

The sensitivity and specificity of 3D - PDA blood flow parameters were as follows : VI was 2.8 , FI was 28.89 , VFI was 0.83 , and the sensitivity and specificity of 3D - PDA were 64.7 % and 89.3 % , 82.4 % and 73.7 % , 70.6 % and 89.5 % respectively .

Conclusion :

1 . Three - dimensional ultrasound endometrial volume and blood flow parameters have important reference value for the differential diagnosis of benign and malignant lesions of the postmenopausal endometrium .

2 . The endometrial thickness of two - dimensional ultrasound is a method of screening endometrial lesions after menopause ;
In this study , compared with the ROC curve , the endometrial thickness was lower than that of the endometrium , so the endometrial volume was a better index than that of the two - dimensional ultrasound .

3 . The value of three - dimensional ultrasound endometrial volume in differentiating benign and malignant lesions of postmenopausal endometrium is the highest .
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R737.33;R445.1

【参考文献】