Reich A, Muche R, Wiesner K, Kreienberg R, Flock F
Obstetrics and Gynecology, University of Ulm, Ulm.
Ultraschall Med. 2011 Dec;32 Suppl 2:E80-5. doi: 10.1055/s-0031-1273319. Epub 2011 May 25.
To date, the evaluation of TVT by ultrasound has not been standardized. The aim of this observational study was to evaluate the intraobserver and interobserver variability of introital ultrasound.
Follow-up was performed for 202 patients after TVT procedure. The tape was characterized by the position in relation to urethral length (%) and the distance to the hypoechoic center of the urethra (mm). Furthermore, we assessed the shape of the tape (straight, curved or folded). All evaluations were performed by two experienced examiners (A, B) at rest and during Valsalva maneuver. All sonograms were archived digitally without measurement results. After 6 to 12 months, the sonograms were re-evaluated by one investigator (A). Depending on the first investigator, the results were compared as intraobserver (A-A) or interobserver (B-A) agreement. The first results were blinded for the second measurement. Agreement concerning the distances was assessed using the intraclass correlation coefficient (ICC). The concordance of the descriptive evaluation of the shape of the tape was characterized by the kappa coefficient (KC).
The tape was regularly identified as an echogenic structure dorsal to the urethra. The intraobserver reliability concerning the position of the tape in relation to urethral length showed good reproducibility (at rest ICC 0.90, Valsalva maneuver: ICC 0.96). For the distance between the tape and the urethra at rest (ICC 0.83), there was also good reproducibility, but not during Valsalva maneuver (ICC 0.74). The shape of the tape showed only moderate reproducibility with accordance of 81 % at rest (KC 0.68) and of 79 % during Valsalva maneuver (KC 0.6). The interobserver comparisons showed good concordance in measuring the POS at rest (ICC 0.93), and during Valsalva maneuver (ICC 0.89), and the DIS at rest (ICC 0.89), and during Valsalva maneuver (ICC 0.87). The congruence of the estimation of the shape was 71 % at rest (KC 0.44) and 72 % during Valsalva maneuver (KC 0.49).
The characterization of the TVT in the sagittal view by introital ultrasound shows good reproducibility with respect to position and distance, but not shape.
迄今为止，经阴道超声对经阴道无张力尿道中段吊带术（TVT）的评估尚未标准化。本观察性研究的目的是评估经阴道超声检查中观察者内和观察者间的变异性。
对202例行TVT手术的患者进行随访。吊带的特征在于其相对于尿道长度的位置（%）以及与尿道低回声中心的距离（mm）。此外，我们评估了吊带的形状（直的、弯曲的或折叠的）。所有评估均由两名经验丰富的检查者（A、B）在静息状态和瓦尔萨尔瓦动作时进行。所有超声图像均进行数字存档，不记录测量结果。6至12个月后，由一名研究者（A）对超声图像进行重新评估。根据第一名研究者的情况，将结果作为观察者内（A - A）或观察者间（B - A）一致性进行比较。第一次结果对第二次测量进行盲法处理。使用组内相关系数（ICC）评估距离的一致性。吊带形状描述性评估的一致性用kappa系数（KC）表示。
吊带通常被识别为尿道背侧的一个强回声结构。观察者内关于吊带相对于尿道长度位置的可靠性显示出良好的可重复性（静息时ICC为0.90，瓦尔萨尔瓦动作时：ICC为0.96）。对于静息时吊带与尿道之间的距离（ICC为0.83），也有良好的可重复性，但在瓦尔萨尔瓦动作时则不然（ICC为0.74）。吊带的形状仅显示出中等程度的可重复性，静息时符合率为81%（KC为0.68），瓦尔萨尔瓦动作时为79%（KC为0.6）。观察者间比较显示，在测量静息时的位置（ICC为0.93）、瓦尔萨尔瓦动作时的位置（ICC为0.89）、静息时的距离（ICC为0.89）以及瓦尔萨尔瓦动作时的距离（ICC为0.87）方面具有良好的一致性。形状估计的一致性在静息时为71%（KC为0.44），瓦尔萨尔瓦动作时为72%（KC为0.49）。
经阴道超声矢状面观察TVT，在位置和距离方面显示出良好的可重复性，但形状方面并非如此。
