三维能量多普勒对绝经期子宫内膜良恶性病变的鉴别价值

摘要

目的探讨三维容积和能量多普勒血流参数对绝经期出血患者子宫内膜良恶性病变的鉴别价值。方法对79例绝经期阴道出血患者行三维能量多普勒超声检查，以病理结果分为良性组（子宫内膜息肉25例，子宫内膜良性增生34例）、恶性组（子宫内膜癌20例）。测量三维能量多普勒血流参数包括子宫内膜体积（V）、血管指数（VI）、血流指数（FI）和血管-血流指数（VFI）。应用接受者操作特性曲线（ROC）比较上述各项指标的诊断价值。结果良、恶性两组V分别为：（7.02±3.02）mL、（8.61±2.43）mL，比较差异有统计学意义（P＜0.05）；脉冲重复频率（PRF）0.9 MHz时，良性组的VI、FI及VFI值分别为（1.67±1.11%）、（25.07±2.67）、（0.43±0.29），恶性组VI、FI及VFI值分别为（6.00±5.58%）、（31.56±4.54）、（2.05±1.72），比较差异有统计学意义（P＜0.05）；设置不同PRF：0.9 MHz/0.6 MHz时，测良、恶性组VI、FI、VFI值，VI、VFI差异有统计学意义（P＜0.05），FI差异无统计学意义（P＞0.05）。ROC曲线VI、FI、VFI的曲线下面积（AUC）分别为0.966、0.913、0.973，预测子宫内膜恶性病变准确性较高，其中VFI的曲线下面积最大，当VFI截值0.814时，敏感性为95%、特异性为91.5%。结论三维能量多普勒能量化病变子宫内膜血管分布及密度情况，对鉴别绝经期子宫内膜良恶性病变具有较高应用价值。%Objective To evaluate the value of blood flow parameters measured through the three-dimensional power Doppler angiography (3D- PDA) in discrimination between benign and malignant endometria in women with postmenopausal bleeding. Methods With examination of 79 women suffering from postmenopausal bleeding with 3D- PDA, blood flow parameters involving volume (V), vascularization index (VI), flow index (FI) and vascularization flow index (VFI) could be measured. On the basis of pathological results, all the patients were divided into two groups: the Benign Group (25 cases with endometrial polyps and 34 cases with endometrial hyperplasia) and the Malignant Group (20 cases with endometrial carcinoma). The receiver operating characteristic (ROC) curve was applied to evaluate the blood flow parameters in discrimination of benign and malignant endometria. Results The endometrial volume was 7.02±3.02 ml and 8.61±2.43 ml in the Benign Group and Malignant Group respectively, which showed significant difference between two groups (P<0.05). When pulse repetition frequency (PRF) was set at 0.9 MHz, the VI, FI and VFI in the Benign Group were 1.67±1.11%, 25.07±2.67 and 0.43±0.29 respectively; while the VI, FI and VFI in the Malignant Group were 6.00±5.58 %, 31.56±4.54 and 2.05±1.72 respectively, which were of statistical significance between two groups (P<0.05). When different PRF were set at 0.9 MHz/0.6 MHz, the parameters of VI and VFI were considered statistically significant (P<0.05) while the parameter of FI had no significant differences (P>0.05) in the Benign Group and Malignant Group. The area under curve (AUC) of the VI, FI and VFI in ROC were 0.966, 0.913 and 0.973 respectively, which accurately predicted malignant lesions of endometria. Among these parameters, VFI had the highest diagnostic value for differentiation between benign and malignant endometria. The sensitivity and specificity were 95% and 91.5% respectively when the cut-off value of VFI was 0.814. Conclusion 3D-PDA could quantify the vascular distribution and density of lesioned endometria and was a good diagnostic tool in differentiation between benign and malignant endometria in women with postmenopausal bleeding.