Characterizing Human Uterine Cervix Using Quantitative Ultrasound and Microscopy

 描述(申请人提供)：宫颈重塑是正常妊娠的重要组成部分，其特征是柔软、缩短和扩张，以便足月分娩。这些事件的时间错误可能与早产有关。目前，评估宫颈的两种主要工具包括宫颈长度测量和数字触诊“柔软”。前者是定量的，而‘柔软度’是通过给它一个‘软’、‘中等’或‘fiRm’的分数来主观判断的。这项研究的主要目标是开发一种可靠的、非侵入性的方法来定量评估怀孕期间子宫颈的结构完整性。我们的初步研究表明，剪切波速(SWS)估计可以客观地评估宫颈的柔软度，囊性结构干扰了这些估计，应避免。然而，fluence SWS估计，其他较强的孤立散射体，如血管或致密的胶原结构，也可能存在。我们可以使用回波信号的相干性来帮助指导位置选择，以避免这些结构，以获得更稳健的SWS估计。我们已经完成了在体外子宫切除标本和体内妊娠晚期受试者中评估SWS的可行性的研究，并证明了该方法的优点。对于这项拟议调查的第一部分，超声数据已经从之前的子宫切除术研究中收集，所有样本都在福尔马林中进行了fifi。我们计划完成回声信号相干分析，以便在空间上识别可能在fl表面波谱测量中使用的胶原结构，并用显微镜对fi样品进行验证。这项拟议研究的第二部分将测试在妊娠fi、第一个月和第二个三个月期间体内SWS估计的重复性和敏感性。我们将测量接受宫颈成熟手术提前终止妊娠的妇女的SWS。测量将在宫颈催熟剂使用前和4小时后进行。将对每个妇女成熟前和成熟后的SWS估计进行比较，并将第一和第二孕期组与(非妊娠)子宫切除术数据和已经获得的第三孕期数据进行比较。这一建议为了解宫颈结构完整性在整个妊娠过程中的变化奠定了基础，这对于了解正常和异常妊娠是必不可少的。此外，对fl结构如何使用定量超声测量的充分理解将指导未来的活体研究。培训计划包括在犹他州进行的field工作，在该工作中，PI将沉浸在 临床环境和更多的参与管理的第一和第二个三个月的研究。

 DESCRIPTION (provided by applicant): Cervical remodeling is an essential part of normal pregnancy and is characterized by softening, shortening and dilation to allow for delivery at term. Errors in timing of these events may be associated with preterm birth. Currently, two of the main tools for assessment of the cervix include a cervical length measurement and digital palpation of `softness'. While the former is quantitative, the `softness' is subjectively determine by giving it a score of `soft', `medium', or `firm'. The primary goal of this research is to develp a reliable, noninvasive method to quantitatively assess the structural integrity of the uterine cervi during pregnancy. Our preliminary studies show that Shear Wave Speed (SWS) estimation can objectively assess the softness of the cervix and that cystic structures perturb these estimates and should be avoided. However, other strong isolated scatterers such as blood vessels or dense collagen structures may also influence SWS estimates. We can use echo signal coherence to help guide location se- lection to avoid these structures for more robust SWS estimates. We have completed studies showing feasibility of SWS estimation in ex vivo hysterectomy specimens and in vivo third trimester pregnant subjects and demonstrated that the approach has merit. For the first portion of this proposed investigation, ultrasound data has already been collected from a previous hysterectomy study and all samples have been fixed in formalin. We plan to complete echo signal coherence analysis in order to identify collagen structures spatially that may influence SWS measurement and validate with microscopy of the fixed samples. The second portion of this proposed investigation will test reproducibility and sensitivity of SWS estimation in vivo during the first and second trimester of pregnancy. We will measure SWS in women undergoing cervical ripening procedures for early termination of pregnancy. Measurements will be made before and 4 hours after a cervical ripening agent is administered. Pre- and post-ripening SWS estimates will be compared within each woman and the 1st and 2nd trimester groups will be compared to the (nonpregnant) hysterectomy data and the 3rd trimester data already acquired. This proposal lays the foundation for understanding how cervical structural integrity changes throughout pregnancy which is essential for understanding normal and abnormal pregnancy. In addition, a full understanding of how structure influences quantitative ultrasound measure- ments will guide future in vivo study. The training plan includes field work to be performed in Utah, in which the PI will be immersed in the clinical environment and have more involvement in management of 1st and 2nd trimester study.