Adenomyosis: three-dimensional sonographic findings of the junctional zone and correlation with histology
Adenomyosis: three-dimensional sonographic findings of the junctional zone and correlation with histology
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DOI：
10.1002/uog.8900
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发表时间：
2011-04-01
影响因子：
7.1
通讯作者：
Arduini, D.
中科院分区：
文献类型：
--
作者：
Exacoustos, C.;Brienza, L.;Arduini, D.
目的 将二维 (2D) 和三维 (3D) 经阴道超声成像 (TVS) 可检测到的子宫腺肌病引起的外肌层和内肌层（“交界区”，JZ）形态学改变与组织病理学特征相关联，并评估其对子宫腺肌病的诊断准确性。方法 因良性病变而计划行子宫切除术的绝经前患者被纳入这项前瞻性研究。在子宫切除术之前，所有患者均接受了整个子宫的详细 2D-TVS 和 3D 体积采集。注意到子宫腺肌病的主要超声征象。在通过 3D-TVS 获得的多平面冠状和纵向视图上，我们测量了从基底子宫内膜到外肌层内层的最大和最小 JZ 厚度（JZmax、JZmin）、它们之间的差值（JZdif = JZmax - JZmin）以及 JZmax/总最大肌层厚度的比率。这些检查结果与组织学标本上子宫腺肌病的存在盲目相关。结果 共有 72 名绝经前患者在子宫切除术前接受了 2D-和 3D-TVS。子宫腺肌病的组织学患病率为 44.4%（32/72 例患者）。在诊断子宫腺肌病时，子宫肌层囊肿的存在是最特异的 2D-TVS 特征（特异性，98%；准确度，78%），异质性子宫肌层是最敏感的（敏感度，88%；准确度，75%）。 3D-TVS 标记 JZdif = 4 mm 和 JZ 渗透和扭曲具有高灵敏度 (88%) 和最佳准确度（分别为 85% 和 82%）。 2D-TVS和3D-TVS诊断子宫腺肌病的总体准确率分别为83%和89%，敏感性分别为75%和91%，特异性分别为90%和88%，阳性预测值分别为86%和85%，阴性预测值分别为82%和92%。 结论 3D-TVS获得的子宫冠状切片允许JZ的准确评估和测量及其改变对子宫腺肌病具有良好的诊断准确性。版权所有 (C) 2011 ISUOG。由约翰·威利父子有限公司出版
Objective To correlate with histopathological features the adenomyosis-induced morphological alterations of the outer myometrium and the innermyometrium ('junctional zone', JZ) detectable on two-(2D) and three-dimensional (3D) transvaginal ultrasound imaging (TVS), and to evaluate their diagnostic accuracy for adenomyosis. Methods Premenopausal patients scheduled for hysterectomy for benign pathology were enrolled in this prospective study. Before hysterectomy all patients underwent detailed 2D-TVS and 3D volume acquisition of the entire uterus. The major sonographic signs of adenomyosis were noted. On the multiplanar coronal and longitudinal views obtained by 3D-TVS we measured the maximum and minimum JZ thickness from the basal endometrium to the internal layer of the outer myometrium (JZmax, JZmin), the difference between them (JZdif = JZmax - JZmin) and the ratio JZmax/total maximum myometrial thickness.Results of these examinations were correlated blindly to the presence of adenomyosis on histological specimens. Results A total of 72 premenopausal patients underwent 2D- and 3D-TVS before hysterectomy. The histological prevalence of adenomyosis was 44.4% (32/72 patients). In diagnosing adenomyosis, the presence of myometrial cysts was the most specific 2D-TVS feature (specificity, 98%; accuracy, 78%) and heterogeneous myometrium was the most sensitive (sensitivity, 88%; accuracy, 75%). The 3D-TVS markers JZdif = 4 mm and JZ infiltration and distortion had high sensitivity (88%) and the best accuracy (85% and 82%, respectively). For 2D-TVS and 3D-TVS, respectively, the overall accuracy for diagnosis of adenomyosis was 83% and 89%, the sensitivity was 75% and 91%, the specificity was 90% and 88%, the positive predictive value was 86% and 85% and the negative predictive value was 82% and 92%.Conclusions The coronal section of the uterus obtained by 3D-TVS permits accurate evaluation and measurement of the JZ, and its alteration has good diagnostic accuracy for adenomyosis. Copyright (C) 2011 ISUOG. Published by John Wiley & Sons, Ltd.