| Purpose:(1)To observe and describe the characteristics of normal uterus,uterine fibroids,endometrial polyps,endometrial cancer,cervical cancer and other two-dimensional ultrasound,color doppler and elastography images under different uterine states.(2)The Strain ratio(SR)was used to study the optimal critical point for the diagnosis of benign and malignant uterine lesions,which provides a new indicator for the differential diagnosis of benign and malignant uterine lesions by ultrasound.(3)The accuracy of Strain ratio(SR)was compared with that of elasticity score in differentiating benign and malignant uterine lesions.To explore and analyze whether ultrasound elastography combined with vaginal ultrasonography is of higher value in the differential diagnosis of benign and malignant uterine lesions,and to provide relevant imaging basis for its clinical application.Methods:102 patients admitted to the gynecology department of our hospital from January 2018to January 2019,aged 27-66 years old,with an average age of 46.84 5.33 years,were collected.A total of 102 lesions were identified,including 52 benign lesions and 50malignant lesions.According to the pathological results,benign lesions included 25cases of endometrial fibroids,8 cases of endometrial polyps,5 cases of cervical polyps and 14 cases of submucosal fibroids,while malignant lesions included 26 cases of endometrial cancer and 24 cases of cervical cancer.Another 20 women with normal uterine examination were collected as normal uterine group,aged 20-67 years,with an average age of 34 6.01 years.Conventional vaginal ultrasound and vaginal hyperelastography were performed,their two-dimensional images and color doppler image characteristics were analyzed,and the elastic image characteristics of normal and different uterine diseases were analyzed by ultrasonic elastic strain rate software,and the elastic score(5-point method)was made.The SR values of each of the 102 uterine lesions were obtained and the SR ratio was analyzed.SPSS 24.0 was used for statistical analysis of all the data to compare whether the SR values of benign and malignant lesions were statistically different.All measurement data were expressed as mean standard deviation,and P<0.05 was considered statistically significant.In addition,surgical treatment and pathological diagnosis results in our hospital were taken as the gold standard,and the Receive Operating Characteristic curve(ROC)of the positive group was drawn to determine the optimal critical value of SR for the diagnosis of benign and malignant uterine lesions.The sensitivity,specificity,accuracy and Area Under Curve(AUC)were used to evaluate whether the combined application of ultrasound elastography and vaginal ultrasound was of higher application value in differentiating benign and malignant uterine lesions.Results:(1)characteristics of ultrasound elastography images of different uterine states Normal uterus:mostly green with occasional redMyometrioma:green is the main color.The location of myoma may be blue and green,blue and redEndometrial polyps:Mainly green,with a small amount of red and/or blueEndometrial carcinoma:the intrauterine cavity is predominantly or entirely blue,with parts of the muscular layer showing blue-greenUterine submucosal myoma:mainly green,with a small amount of blue and green or blue and redCervical cancer:blue in the cervix and green and red in the uterusCervical polyp:part of the cervix is mostly green with a small amount of red and blue.(2)The ultrasound elasticity score of benign and normal uterine lesions group was 1~3points,while that of malignant uterine lesions group was 4~5 points.There was no statistically significant difference between the normal uterine group and the benign lesion group(P=0.135),and the elasticity score of the malignant lesion group was higher than that of the benign lesion group and the normal uterine group(P<0.01).(3)The sensitivity,specificity and accuracy index of transvaginal ultrasonography in the diagnosis of uterine lesions were 50%,76.92%and 26.92%,respectively.The sensitivity,specificity and correct index of elasticity scoring were 54%,78.85%and 32.85%,respectively.The sensitivity,specificity and correct index of the joint examination were90%,88.46%and 78.46%,respectively.There was no significant difference between vaginal ultrasonography and elasticity scoring(P=1.000).Elastic scoring method,vaginal ultrasound were compared with the two joint inspection,examined the pairingc~2 differences were statistically significant(P value were 0.041 and 0.038).(4)In 52 cases of benign uterine lesions,the mean value of SR was 3.75(2.40-4.71).The mean value of SR in 50 cases with malignant lesions was 6.69(3.58-12.29).The mean SR of benign and malignant lesions was compared,and the statistical result was(Z=4.458,P<0.001),and the difference was statistically significant.(5)The optimal critical value of benign and malignant uterine lesions was determined by ROC curve(4.78).The area under the ROC curve for the determination of the characteristics of uterine lesions by elastic scoring was 0.746(0.653-0.839),the area under the ROC curve for the determination of the characteristics of uterine lesions by SR value was 0.756(0.660-0.852),and the area under the ROC curve for the determination of the characteristics of uterine lesions by Yin ultrasound combined with elastography was 0.892(0.823-0.962).The results showed that the area under the curve using the combination of Yin and ultrasound and elastic imaging was greater than that using SR value and elastic scoring method alone,and the difference was statistically significant(P=0.013 and 0.005,respectively).However,the difference between the area under the curve using SR value and the area under the curve using the operating elasticity scoring method was not statistically significant(P=0.886).Conclusion:(1)The SR value of uterine malignant lesions was higher than that of benign lesions,and the optimal critical value for differentiating benign from malignant lesions was(4.78).In general,the elasticity score of malignant uterine lesions was higher than that of normal uterine and benign uterine lesions.(2)It is a new technique to use elastic score and ratio of elastic strain rate to diagnose benign and malignant uterine lesions.The accuracy of the former is slightly lower than that of the latter,and the difference between the two is not statistically significant.(3)The accuracy of the diagnosis can be improved obviously by the combination of ultrasound and ultrasound elastography.As a good supplement to transvaginal ultrasonography,elastography provides more valuable information for the diagnosis of lesions and provides more visual and powerful evidence for the identification of the nature of uterine lesions. |
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