The Clinical Application Of Transvaginal Three-dimensional Ultrasound In Quantitative Evaluation Of Intrauterine Adhesions And Its Degree

Objectives: 1.To investigate the accuracy of transvaginal three-dimensional ultrasonography in the diagnosis of intrauterine adhesions and adhesion degree classification.2.The value of the quantitative measurement of endometrial volume and sub-endometrial blood flow parameters for intrauterine adhesions degree classification by transvaginal three-dimensional ultrasound.Methods: From October 2015 to December 2017 in Changzhou Maternal and Child Health Hospital,75 patients with clinical suspicion of intrauterine adhesions who chose hysteroscopic diagnosis and treatment were selected.During the first three months of the month,routine transvaginal two-dimensional ultrasound and transvaginal three-dimensional ultrasound were performed,and the degree of intrauterine adhesions was graded according to March classification.These 75 patients were re-prepared by three-dimensional transvaginal sonography on the sub-uterine endometrium on the 20 th to 23 rd day of the month before surgery to calculate the endometrium volume;The technique measures the blood flow parameters VI(blood vascularization index),FI(blood flow index),and VFI(blood vascularized blood flow index).The final 68 patients confirmed by hysteroscopy for intrauterine adhesions,and according to the American Reproductive Association(AFS)classification,it was divided into mild,moderate and severe three groups.Transvaginal two-dimensional ultrasound and transvaginal three-dimensional ultrasound diagnosis results were compared with the hysteroscopy golden standard,to study the diagnostic accuracy,sensitivity and specificity of the differences between the analysis of three-dimensional The differences in subendometrial volume(V)and endometrial blood flow parameters(VI,FI,VFI)measured at over-the-counter volume were not different in the degree of intrauterine adhesions.Results: 1.Transvaginal three-dimensional ultrasound diagnosis of intrauterine adhesions,the diagnostic accuracy,sensitivity and specificity were significantly higher than the diagnostic accuracy of two-dimensional vaginal ultrasound alone(?2=13.19,P=0.003<0.05),and two diagnostic methods for the diagnosis of severe intrauterine adhesions Consistent with hysteroscopy,the use of three-dimensional ultrasonographic examination of the uterine cavity for mild and moderate adhesions than the two-dimensional ultrasound diagnosis better(mild?2=8.08,P=0.005<0.01;moderate ?2=6.26,P=0.009<0.01).2.The difference of endometrial volume(V),endometrial blood flow parameters(VI,FI,VFI)and normal uterine cavity in patients with intrauterine adhesion was statistically significant(V:U=18,P=0.0007<0.01;VI:U=101.5,P=0.017<0.05;FI:U=103.5,P=0.018<0.05;VFI:U=98,P=0.014<0.05);VI?FI?VFI was in mild adhesion group there was no significant difference between the normal group and the unnormal group(VI:U=83.5,P=0.09>0.05;FI:U=83.5,P=0.09>0.05;VFI:U=84.5,P=0.09>0.05).There was a significant difference between the moderate and severe groups(moderate VI:U=17,P=0.005<0.01;FI:U=20,P=0.009<0.01;VFI:U=12.5,P=0.002<0.01;severe VI:U=1,P=0.003<0.01:FI:U=0,P=0.002<0.05;VFI:U=1,P=0.003<0.01).V was significantly different among the mild,moderate and severe groups(mild U=18,P=0.0003<0.01;moderate U=0,P=0.0001<0.01;severe U=0,P=0.0017 < 0.05).The area under the ROC curve of endometrium volume V and endometrium VI,FI,VFI in predicting intrauterine adhesions were 0.9604,0.7769,0.7725,0.7846,and the cutoff values were 2.84,3.91,28.43,and 0.97,respectively.The sensitivity was 100%,85.7%,57.1%,and 85.7%,respectively.The sensitivity was 83.1%,80%,90.8%,and 72.3%.When V,VI,FI,and VFI evaluated the extent of intrauterine adhesion,the cutoff values were >2.26 and >2.68,respectively >26.26,>0.97 were classified as mild adhesions,and the cutoff values were 2.26-1.53,2.68-1.54,26.26-20.09,and 0.97-0.40,respectively,classified as moderate adhesions,and the cutoff values were <1.53,<1.54,<20.09,respectively<0.40 classified as severe adhesion.Conclusion: The use of transvaginal three-dimensional ultrasound in the diagnosis of intrauterine adhesions and the degree of adhesions are highly accurate and highly identifiable,the quantitative measurements of the parameters of endometrial volume and endometrial blood flow can better diagnose intrauterine adhesions and evaluate adhesion degree.