The Value Of Real Time Shear Wave Elastography In Diagnosis Of Uterine Fibroids And Adenomyosis

Objective: To explore the value of real time shear wave elastography(SWE)on differentiating uterine fibroids from adenomyoma,identify and evaluate quantitative indicators.Methods: 119 patients who were treated at the Fourth Hospital of Hebei Medical University from August 2018 to Janurary 2020 were selected and divided into two groups based on postoperative pathology:(1)Uterine fibroids group: 72 uterine fibroids of 66 patients.(2)Adenomyosis and adenomyoma: 53 cases.And 58 healthy women were selected as normal control group.A French Supersonic Imagine Aix Plorer SWE ultrasound system was used.First,a routine transvaginal ultrasound examination was performed.The uterus was clearly displayed in two-dimensional ultrasound mode.The uterus and lesion location,size,internal echo,boundary,and blood flow characteristics were observed.In the SWE mode,the Q-box function is started to measure the Young’s modulus value in regions of interest(ROI).Record the mean elastic value(Emean),the maximum elastic value(Emax),the minimum elastic value(Emin),and the elastic standard deviation(Esd).Repeat the measurement 3 times and take the average.Date analysis was performed using the SPSS 17.0 statistical software.The measurement data is expressed as(?).The data between the two groups are more consistent with normality and homogeneity of variance using independent sample t test,and those who meet normality but not homogeneity of variance use t ’test.There is a statistical difference.If there are statistical differences,use the receiver operating characteristic(ROC)to calculate the area under the curve(AUC).It is considered to be the best diagnostic dividing standard when " Yordon index = sensitivity + specificity-1" is at its maximum.Calculate the cutoff value when Yordon index is at its maximum.And find out its sensitivity,specificity,and accuracy.Results: 1.The t-test was performed on the data of patients with adenomyosis and patients with adenomyoma,and there is no significant difference between them(P> 0.05).2.Comparison of the Young’s modulus values among the fibroids group,the adenomyosis and adenomyoma group,and the control group.The t-test between two pairs,all were P <0.05,and the differences were statistically significant.3.The ROC curve was constructed by Emax and Emean of the uterine fibroids group and the adenomyosis and adenomyoma group.The results showed that the area under curve(AUC)are both(0.70 ± 0.05)of Emax and Emean.The cutoff value is 121.89 k Pa of Emax and 90.25 k Pa of Emean when Yordon index is at its maximum.The accuracy rate is the highest when the best cutoff value is 90.25 k Pa of Emean,which is 67.2 %,at this time the sensitivity is 62.3%,and the specificity is 70.8%.It’s considered as fibroids when Emean ≤90.25 k Pa,and adenomyosis when Emean > 90.25 k Pa.4.The ROC curve was constructed by Emax and Emean of the control group and the adenomyosis and adenomyoma group.The results showed that the area under curve of Emax(0.99 ± 0.01)is greater than Emean(0.98 ± 0.01).The cutoff value is 72.88 k Pa of Emax and 50.22 k Pa of Emean when Yordon index is at its maximum.The accuracy rate is 96.4% when the best cutoff value is 72.88 k Pa of Emax,at this time the sensitivity is 94.3% and the specificity is 98.3%.It’s considered as normal myometrium when Emax ≤72.88 k Pa,and adenomyosis when Emax > 72.88 k Pa.5.The ROC curve was constructed by Emax and Emean of the control group and the uterine fibroids group.The results showed that the area under curve of Emax(0.92 ± 0.03)is greater than Emean(0.82 ± 0.04).The cutoff value is 72.28 k Pa of Emax and 47.17 k Pa of Emean when Yordon index is at its maximum.The accuracy rate is 89.2% when the best cutoff value is 72.28 k Pa of Emax,at this time the sensitivity is 83.3% and the specificity is 96.6%.It’s considered as normal myometrium when Emax ≤72.28 k Pa,and uterine fibroids when Emax > 72.28 k Pa.6.Combined diagnosis with SWE and conventional ultrasound between adenomyoma and uterine fibroid.The diagnostic sensitivity is 98.1%,the specificity is 70.8%,and the accuracy is 82.4%.Conclusion: Real-time SWE could be considered as a useful tool in the differential diagnosis of uterine fibroids from adenomyoma,and adenomyosis from normal myometrium.It can provide quantitative indicators,which has clinical practical value in differential diagnosis of uterine fibroids,adenomyoma and adenomyosis which are not typical in two-dimensional images.