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Role of Three-dimensional Ultrasound in Diagnosing and Differential Diagnosing Endometrial Polyps of Premenopausal Women

Author: ZhaoWei
Tutor: ChangCai；LiuZhi
School: Fudan University
Course: Obstetrics and Gynaecology
Keywords: Three-dimensional ultrasound hysteroscopy endometrial volume gray scale three-dimensional power Doppler imaging (3D-PDI) premenopausal endometrial polyp endometrial hyperplasia
CLC: R737.33
Type: Master's thesis
Year: 2009
Downloads: 23
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Abstract

Ultrasound has played an important role in clinical examination and diagnosis,because it has merits of safety,convenience,non-invasiveness, non-radiation,cheapness and so on.However,the resolution of two-dimensional ultrasound so far has not been able to match computer tomography（CT） or magnetic resonance imaging（MRI）,and moreover, the diagnosis of ultrasonic scanning mainly depends on the sonographer’s recognition of ultrasonic images and judgement of the grades of the echoes of lesions,which is subjective and lacks objective criteria.These cause that the clinical use of ultrasonic image still stays at the stage of qualitative or semi-quantitative detection and confine the further application of ultrasonic imaging in the diagnosis of diseases.To make the ultrasonic diagnosis approach the "golden standard"—histopathological diagnosis as close as possible,many new methods have been applied in clinical practice,including three-dimensional ultrasound and power Doppler.Conventional grey-scale sonography can detect many uterine disorders,but its sensitivity to the focal intrauterine lesions is limited.In the last few years three-dimensional ultrasound has been introduced,enabling the accurate measurement of volumes of the region of interesting.The measurement of endometrial volume was proven to be accurate and reproducible.Recently,transvaginal power Doppler imaging has become widely available.The sensitivity of power Doppler imaging is superior to color Doppler imaging in the detection of small caliber and low perfusion vessels.Imaging the vascularity of the female internal genitalia gives additional information on the pathologic morphology and might reveal small structures.More recently,ultrasound machines have become equipped with the ability to estimate flow in the volume measured.The three-dimensional power Doppler imaging（3D-PDI） was found to be a reliable method for evaluating pathologic and physiologic changes in the endometrium.The image was stored and analyzed by using the VOCAL（Virtual Organ Computer-aided Analysis） program. The volume,gray scal,Vascularity Index（VI）,Flow Index（FI） and Vascularity Flow Index（VFI） of the region of interest were recorded. These all improve the ratio of diagnosis of diseases.As the main method of assistant diagnosis in clinical practice of gynecology,ultrasonic examination is facing the problem about how to improve the ratio of diagnosis and differential diagnosis of the focal intrauterine lesions.As one kind of the focal intrauterine lesions,endometrial polyps have a higher incidence and are easy to be confused with endometrial hyperplasia in premenopausal women.Hence,this dissertation would discuss the feasibility and clinical value of three-dimensional ultrasound in diagnosing and differentiating the endometrial polyps of premenopausal women.It consists of two sections:（1） The clinical value of three-dimensional ultrasound in diagnosing premenopausal endometrial polyps.（2） The role of three-dimensional ultrasound in predicting endometrial polyps and endometrial hyperplasia of premenopausal women.Section 1 Clinical value of three-dimensional ultrasound in diagnosing the endometrial polyps of premenopausal womenObjective:To compare the diagnostic value of three-dimensional ultrasound and hysteroscopy in premenopausal patients with endometrial polyp of uterus.Methods:Patients were recruited from April 2008 to the end of June 2009.All women who were diagnosed as thick and inhomogeneous endometrium or hyperechogenic focal intrauterine structures by two-dimensional ultrasound were consecutively considered for participation.The women had all been scheduled to undergo hysteroscopy. The study ultrasound examinations were performed in proliferative stage and within 24 hours prior to the procedure.Three-dimensional ultrasound and hysteroscopy were compared using ROC curves.All sonographic images were interpreted by the sonographer according to the imaging recorded.The sonographer and the hysteroscopy operator did not know the histopathologic examination findings.To estimate the likelihood of endometrial polyp,they all used a five-point confidence scale in which "1" for definitely endometrial polyp;"2" for probably endometrial polyp;"3" for indeterminate;"4" for probably not endometrial polyp;"5" for definitely not endometrial polyp.The correlation of data and ROC curves were made using SPSS11.5 software.Result:Area under the ROC curves(ROC^AUG) of the three-dimensional ultrasound group was 0.889 and that of the hysteroscopy group was 0.924. ROC analysis indicated that there was no significant difference between the three-dimensional ultrasound group and the hysteroscopy group.Conclusion:Three-dimensional ultrasound is convenient,accurate and noninvasive,which combined with two-dimensional ultrasound is a good diagnostic tool in diagnosing endometrial polyps in premenopausal women.Section 2 Role of three-dimensional ultrasound in predicting endometrial polyps and endometrial hyperplasia of premenopausal womenObjective:To evaluate the difference of endometrial volume measurement,gray scal and three-dimensional power Doppler analysis （3D-PDA） in the diagnosis of endometrial polyps and endometrial hyperplasia in premenopausal women.Methods:Patients were recruited from April 2008 to the end of June 2009.All women who were diagnosed as thick and inhomogeneous endometrium or hyperechogenic focal intrauterine structures by two-dimensional ultrasound were consecutively considered for participation and scheduled to undergo either hysteroscopy or dilatation and curettage（D & C）.The data of patients were collected include symptoms and signs,general conditions,marital and fertile history, menstrual history,height and weight,past history and treatments.The study ultrasound examinations were performed in proliferative stage and within 24 hours prior to the procedure.Two-dimensional untrasound was performed to exam uterus,ovaries and pelvic cavity. Then the three-dimensional program was activated with fixed settings using maximal sweep angle to assure that all the endometrial volume was included in the volume acquired.The image was stored and analyzed later. The VOCAL program was employed to measure endometrium volume and mean gray（MG）,gray scal of intrauterine lesions and myometrium, VI,FI and VFI of the endometrium.Statistical analysis were used to compare the demographic characteristics and the ultrasound indices （Endometrial volume,gray scal,MG,VI,FI and VFI） among patients with endometrial polyps and patients with endometrial hyperplasia.Result:1.Body mass index（BMI） of the endometrial hyperplasia group was much higher than that of the endometrial polyps group（25.28±3.98 vs. 22.29±2.42;p＜0.01）.2.Endometrial volume of the endometrial hyperplasia group was statistically higher than that of the endometrial polyps group （[6.82±1.49]cm³ vs.[4.95±1.83]cm³;p＜0.01）.3.The differences of MG and gray scal between two groups were not statistical significant.4.Compared with the endometrial hyperplasia group,the endometrial polyps group had significantly higher VI,FI and VFI（p＜0.01）.5.The ROC^AUC of VI and VFI were higher than others.When VI= 2.746,VFI=0.665,we had the highest sensitivity and specificity for differentiating endometrial polyps and endometrial hyperplasia.Conclusion:1.Three-dimensional endometrial volume and three-dimensional power Doppler analysis are good diagnostic tools in predicting endometrial polyps and endometrial hyperplasia in premenopausal women.2.VI and VFI are the best indices for differentiating endometrial polyps and endometrial hyperplasia.

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