New York University Medical Center, New York, New York, USA.
J Am Coll Radiol. 2011 Jul;8(7):460-8. doi: 10.1016/j.jacr.2011.03.011.
In evaluating a woman with abnormal vaginal bleeding, imaging cannot replace definitive histologic diagnosis but often plays an important role in screening, characterization of structural abnormalities, and directing appropriate patient care. Transvaginal ultrasound (TVUS) is generally the initial imaging modality of choice, with endometrial thickness a well-established predictor of endometrial disease in postmenopausal women. Endometrial thickness measurements of ≤5 mm and ≤4 mm have been advocated as appropriate upper threshold values to reasonably exclude endometrial carcinoma in postmenopausal women with vaginal bleeding; however, the best upper threshold endometrial thickness in the asymptomatic postmenopausal patient remains a subject of debate. Endometrial thickness in a premenopausal patient is a less reliable indicator of endometrial pathology since this may vary widely depending on the phase of menstrual cycle, and an upper threshold value for normal has not been well-established. Transabdominal ultrasound is generally an adjunct to TVUS and is most helpful when TVUS is not feasible or there is poor visualization of the endometrium. Hysterosonography may also allow for better delineation of both the endometrium and focal abnormalities in the endometrial cavity, leading to hysteroscopically directed biopsy or resection. Color and pulsed Doppler may provide additional characterization of a focal endometrial abnormality by demonstrating vascularity. MRI may also serve as an important problem-solving tool if the endometrium cannot be visualized on TVUS and hysterosonography is not possible, as well as for pretreatment planning of patients with suspected endometrial carcinoma. CT is generally not warranted for the evaluation of patients with abnormal bleeding, and an abnormal endometrium incidentally detected on CT should be further evaluated with TVUS.
在评估患有异常阴道出血的女性时，影像学检查不能替代明确的组织学诊断，但在筛查、结构性异常特征描述以及指导适当的患者治疗方面通常发挥着重要作用。经阴道超声（TVUS）通常是首选的初始影像学检查方法，绝经后妇女的子宫内膜厚度是子宫内膜疾病的一个既定预测指标。已经提倡将子宫内膜厚度测量值≤5mm 和≤4mm 作为适当的上限值，以合理排除绝经后阴道出血妇女的子宫内膜癌；然而，无症状绝经后患者的最佳上限子宫内膜厚度仍然存在争议。在绝经前患者中，子宫内膜厚度是子宫内膜病变的一个不太可靠的指标，因为这可能因月经周期的阶段而有很大差异，而且尚未确定正常的上限值。经腹超声通常是 TVUS 的辅助检查方法，在 TVUS 不可行或子宫内膜显示不佳时最有帮助。子宫声像图检查也可以更好地描绘子宫内膜和子宫内膜腔内的局灶性异常，从而进行宫腔镜引导下的活检或切除。彩色和脉冲多普勒检查可以通过显示血管来进一步描述局灶性子宫内膜异常的特征。如果在 TVUS 和子宫声像图检查无法观察到子宫内膜，MRI 也可以作为一种重要的解决问题的工具，以及用于疑似子宫内膜癌患者的治疗前计划。CT 一般不适用于评估异常出血患者，如果在 CT 上偶然发现异常子宫内膜，则应进一步进行 TVUS 检查。
