| Objective:To explore the value of the diagnosis and degree classification of intrauterine adhesions(IUA) by the combination of the technique of tomographic ultrasound imaging(TUI)and three-dimensional power doppler ultrasound(3D-PD U).Methods:Collected from July 2018 to December 2019 in our Hospital seek medical advice 120 suspected IUA patients with decreased menstruation,amenorrhea and infertility,examined by transvaginal two-dimensional ultrasound,endometrial thickness(ET)was measured,and then transvaginal three-dimensional ultrasound was performed.The three-dimensional reconstruction of volume data was performed by using the technique of TUI,and the image of endometrium was observed and recorded,including whether the edge of endometrium was smooth,whether there were defects,calcification,angularity of the two sides of the endom etrial cavities and adhesion types of endometrium.Three dimensional reconstruction of endometrium was performed by Computer aided analysis of virtual organs(VO-CAL)analysis software to obtain endometrial volume(EV).3D-PDU technology was used to measure endometrial blood flow parameters: Vascularizat ion-flow index(VFI),flow index(FI),Vascularization index(VI),mean gray scale(MG).The degree of intrauterine adhesions was graded by ultrasound accor ding to the Chinese standard of intrauterine adhesions.All the patients underwent hysteroscopy and classified the degree of uterine adhesions according to the March classification standard.The results of ultrasound were compared with the hysteroscopy.The sensitivity,specificity,accuracy,positive predictive value,negative predictive and the jouden index value of TUI in the diagnosis of IUA and the classification of adhesiveness were observed,and the consistency between TUI and hysteroscopy was evaluated;To analyze the changes of ET,EV,VI,FI,VFI,MG in different degrees of intrauterine adhesions.Results:1.120 cases of clinically suspected IUA were selected and hysteroscopy was the gold standard.The sensitivity of TUI was 100.00%(74 / 74),the specificity was 97.83%(45 / 46),the positive predictive value was 98.67%(74 / 75),the negative predictive value was 100.00%(45 / 45),the jouden index was 0.978,and the diagnostic accuracy was 99.17%(119 / 120).The concordance coefficient of the two methods was 0.982,which was statistically significant(P <0.001).2.28 cases were diagnosed as mild,31 as moderate and 15 as severe by hysteroscopy;26 cases were diagnosed as mild,34 as moderate and 14 as severe by TUI.The accuracy of TUI in judging the degree of intrauterine adhesions was 85.14%(63 / 74).The consistency coefficient of the two methods was0.766(P < 0.001).3.The results of TUI showed that there was a significant difference in the types of endometrial adhesion and irregular margin(P < 0.001).4.The EV,VI,FI,VFI and ET in the adhesions group were lower than those in the normal group,and the MG in the adhesions group was higher than that in the normal group,with statistical significance(P < 0.05);the differences in EV,VI,FI,VFI,MG and ET in the adhesions group were statistically significant(P < 0.05).5.EV,VI,FI,VFI,ET were negatively correlated with the degree of intraut erine adhesions,MG was positively correlated with the degree of intrauterine a dhesions.6.The accuracy of TUI combined with 3D-PDU technology was 91.87% higher than that of TUI alone(85.14%).Conclusion:TUI technology has high sensitivity,specificity and accuracy in the diagnosis of intrauterine adhesions.TUI combined with 3D-PDU,it can better determin e the degree of intrauterine adhesions. |
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