目的探讨三维能量多普勒(three-dimensionalpowerdopplerangiography,3D-PDA)血流参数测定对鉴别阴道出血子宫内膜良性与癌前病变的临床价值。方法选择65例阴道出血临床怀疑子宫内膜病变的患者行3D-PDA检查,定量检测子宫内膜容积(V),血流参数血流指数(FI),血管指数(VI)及血管-血流指数(VFI),以子宫内膜病理学结果为标准,评价其诊断符合率。应用接受者操作特性曲线(ROC曲线)比较各项指标的诊断价值。结果子宫内膜癌前病变三维彩色多普勒能量图示血供丰富及较丰富,子宫内膜良性病变大多彩色多普勒能量图示血供不丰富。脉冲重复频率PRF:0.9MHz时,良性病变组FI、VI和VFI分别为:3.98%±3.42%、21.13±3.15和0.643±0.328癌前病变组FI、VI和VFI分别为:5.903%±2.761%、28.964±2.446和1.705±0.928;两组比较差异有统计学意义(P<0.05);不同脉冲重复频率PRF:0.9MHz/0.6MHz,VI、FI、VFI值差异有统计学意义(P<0.05);两组子宫内膜体积(V)比较,差异无统计学意义;3D-PDA检测的灵敏性88.9%,特异性100%。VI、FI和VFI的ROC曲线下面积(AUC)分别为:0.851、0.772、0.950,其中VFI值AUC最大,VFI截断值取0.81时,灵敏性为94.4%,特异性为12.8%。结论通过对病变子宫内膜进行3D-PDA及其血流定量检测,并结合子宫内膜声像图特点,能对子宫内膜良性与癌前病变鉴别提供有价值的信息。

Objective To evaluate the value of three-dimensional power Doppler angiography (3D-PDA) in the discrimination between benign and endometrial precancerous lesions in women with bleeding. Methods Sixty-five women with bleeding who examined by 3D-PDA were enrolled. Endometrial volume(V), vascularity index(VI),flow index(FI) and vaseularity flow index(VFI)were measured with the comparison of the final pathology results. The diagnostic value of parameters derived from 3D- PDA was evaluated by using the receiver operating characteristic (ROC) curve.Results The majority of endometrial precancerous lesions in three-dimensional power Doppler angiography ultrasonography were abundant and rich, while endometrial benign lesions in three-dimensional power Doppler angiography ultrasonography were not rich. In benign group, VI, FI and VFI:3.98%?3.42%,21.13?3.15 and 0.643?0.328;in endometrial precancerous lesions group, VI, FI and VFI:5.903%?2.761%,28.964?2.446 and 1.705?0.928 when impulse repeat frequency (PRF) 0.9 MHz;differences of these parameters (VI,FI and VFI)were considered statistically significant between the two groups(P<0.05); differences of these parameters (VI,FI and VFI) were considered statistically significant in differences of PRF, 0.9 MHz/0.6 MHz(P<0.05); the parameters of endometrial volume had no significant differences between two groups;3D-PDA examination sensitivity was 88.9%, and specificity was 100%. the area under ROC curve (AUC) of the meaningful data were 0.851,0.772,0.950 respectively.Among these parameters,VFI had the highest diagnostic value for discriminating benign and endometrial precancerous lesions,the cut-off value of which was 0.81 with a sensitivity of 94.4%and a specificity of 12.8%.Conclusions 3D-PDA is a good diagnostic tool in the discriminations between benign and endometrial precancerous in women with bleeding.