Alcázar Juan Luis, Mercé Luis T, Manero Manuel García, Bau Santiago, López-García Guillermo
Department of Obstetrics and Gynecology, Clínica Universitaria de Navarra, Pamplona, Spain.
J Ultrasound Med. 2005 Aug;24(8):1091-8. doi: 10.7863/jum.2005.24.8.1091.
The purpose of this study was to evaluate interobserver reproducibility of endometrial volume and vascular indices of the endometrium and subendometrial area estimated by 3-dimensional power Doppler angiography (3D-PDA) using the Virtual Organ Computer-Aided Analysis program, determining the influence of the endometrial growth etiology on measurements.
Forty women underwent 3D-PDA ultrasonography. Group A comprised 25 women scanned on the day after controlled ovarian stimulation with human chorionic gonadotropin. Group B comprised 15 patients who had uterine bleeding and questionable endometrial thickening. (Histologic evaluation revealed 10 endometrial cancers and 5 endometrial hyperplasias.) A single observer examined all patients and acquired all volume data sets. Forty volume data sets were then analyzed with the Virtual Organ Computer-Aided Analysis program by 2 different observers. Endometrial volume and vascularity indices (vascularization index [VI], flow index [FI], and vascularization flow index [VFI]) of the endometrium and subendometrium were manually calculated in the coronal plane with a 9 degrees rotation step. An intraclass correlation coefficient (ICC) was used to assess interobserver reliability.
Endometrial volume was more reproducible in group A (ICC = 0.98) than in group B (ICC = 0.58) (P < .05). Endometrial and subendometrial VI, FI, and VFI also presented good reproducibility with ICC greater than 0.84. The ICC was not statistically different for endometrial and subendometrial VI, FI, and VFI according to patient group, although subendometrial VFI was less reproducible in group B (ICC = 0.53) than in group A (ICC = 0.88).
Endometrial volume and endometrial and subendometrial 3D power Doppler indices have acceptable reproducibility. The interobserver reproducibility in tumoral endometrium was more similar than in stimulated endometrium. Our results indicate that 3D-PDA is a reliable method to evaluate physiologic and pathologic endometrial changes.
本研究旨在评估使用虚拟器官计算机辅助分析程序通过三维能量多普勒血管造影（3D-PDA）估计的子宫内膜体积以及子宫内膜和内膜下区域的血管指数的观察者间再现性，确定子宫内膜生长病因对测量结果的影响。
40名女性接受了3D-PDA超声检查。A组包括25名在人绒毛膜促性腺激素控制性卵巢刺激后第二天进行扫描的女性。B组包括15名有子宫出血和可疑子宫内膜增厚的患者。（组织学评估显示10例子宫内膜癌和5例子宫内膜增生。）由一名观察者检查所有患者并获取所有体积数据集。然后由2名不同的观察者使用虚拟器官计算机辅助分析程序对40个体积数据集进行分析。在冠状面以9度旋转步长手动计算子宫内膜和内膜下的体积以及血管指数（血管化指数[VI]、血流指数[FI]和血管化血流指数[VFI]）。使用组内相关系数（ICC）评估观察者间的可靠性。
A组（ICC = 0.98）的子宫内膜体积比B组（ICC = 0.58）具有更高的再现性（P <.05）。子宫内膜和内膜下的VI、FI和VFI也具有良好的再现性，ICC大于0.84。根据患者组，子宫内膜和内膜下的VI、FI和VFI的ICC在统计学上没有差异，尽管B组（ICC = 0.53）内膜下VFI的再现性低于A组（ICC = 0.88）。
子宫内膜体积以及子宫内膜和内膜下的三维能量多普勒指数具有可接受的再现性。肿瘤性子宫内膜的观察者间再现性比受刺激的子宫内膜更相似。我们的结果表明，3D-PDA是评估生理性和病理性子宫内膜变化的可靠方法。
