Quantifying Levator Ani Muscle Elasticity Under Normal and Prolapse Conditions by Shear Wave Elastography A Preliminary Study
Quantifying Levator Ani Muscle Elasticity Under Normal and Prolapse Conditions by Shear Wave Elastography A Preliminary Study
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通过剪切波弹性成像量化正常和脱垂条件下提肛肌的弹性初步研究
DOI：
10.1002/jum.15232
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发表时间：
2020-01-31
影响因子：
2.3
通讯作者：
Du, Lian-fang
中科院分区：
文献类型：
--
作者：
Tang, Jin-hua;Zhong, Chen;Du, Lian-fang
本研究的主要目的是确定使用剪切波弹性成像（SWE）对有和没有盆腔器官脱垂（POP）的女性的提肛肌（LAM）的弹性量化是否不同，并确定LAM的弹性是否与脱垂阶段或提肛肌裂孔的尺寸有关。第二个目的是评估使用SWE的LAM弹性测量的观察者内部和观察者之间的可靠性。方法研究对象包括20名骨盆支撑正常的妇女和38名脱垂妇女（I-III期）。经会阴三维超声成像提上睑肌裂孔，静息和Valsalva手法时用SWE测量LAM弹性和弹性模量。结果所有女性的弹性模量从休息到最大Valsalva动作（29.2比54.1 kPa, P < 0.05）显著增加。在脱垂状态下，提肛肌弹性明显高于正常状态（27.9比31 kPa， P < 0.001），但在最大Valsalva动作时，提肛肌弹性低于正常状态（57.3比53.1 kPa, P < 0.05）。静息时提肛肌弹性与Valsalva动作时的裂孔面积相关（Spearman r = 0.608, P < 0.001），提肛肌裂孔扩张率相关（r = 0.594, P < 0.001），最大Valsalva动作时，随着LAM弹性模量的增加，裂孔面积减小（r = -0.414, P < 0.05）。此外，LAM弹性与脱垂的严重程度相关（P < 0.001）。结论SWE作为一种无创的定量方法，可用于评估骨盆底肌肉的生物力学特性，为深入了解POP及其治疗和预防提供一定的研究基础。
Objectives The primary purpose of this study was to determine whether elasticity quantification of the levator ani muscle (LAM) using shear wave elastography (SWE) is different between women with and without pelvic organ prolapse (POP) and to determine whether LAM elasticity is associated with the prolapse stage or the dimensions of the levator hiatus. The secondary aim was to evaluate the intraobserver and interobserver reliability of LAM elasticity measurements using SWE. Methods The study participants included 20 women with normal pelvic support and 38 women with prolapse (stages I-III). The levator hiatus was imaged by transperineal 3-dimensional ultrasound, and LAM elasticity and the elastic modulus were measured by SWE at rest and while performing the Valsalva maneuver. Results The elastic modulus increased significantly from rest to during to maximal Valsalva maneuver (29.2 versus 54.1 kPa; P < .05) in all women. Levator ani muscle elasticity was significantly higher under prolapse conditions than under normal conditions at rest (27.9 versus 31 kPa; P < .001) but was lower during the maximal Valsalva maneuver than under normal conditions (57.3 versus 53.1 kPa; P < .05). Levator ani muscle elasticity at rest was associated with the hiatus area during the Valsalva maneuver (Spearman r = 0.608; P < .001) and distensibility of the levator hiatus (r = 0.594; P < .001), and the hiatus area decreased as the LAM elastic modulus increased during the maximal Valsalva maneuver (r = -0.414; P < .05). Moreover, LAM elasticity was associated with the severity of prolapse (P < .001). Conclusions As a noninvasive quantitative method, SWE, may be used to assess the biomechanical properties of the pelvic floor muscle, providing some research basis for a thorough understanding of POP and its treatment and prevention.