经阴道三维超声测量子宫下段厚度的可靠性。

Reliability of 3-dimensional transvaginal sonographic measurement of lower uterine segment thickness.

机构信息

Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Quebec, Quebec, Canada.

出版信息

J Ultrasound Med. 2012 Jun;31(6):933-9. doi: 10.7863/jum.2012.31.6.933.

DOI:10.7863/jum.2012.31.6.933

PMID:22644690

Abstract

OBJECTIVES

The purpose of this study was to report the intraobserver and interobserver reliability of transvaginal 3-dimensional (3D) sonographic measurement of lower uterine segment thickness.

METHODS

A prospective study of 60 pregnant women with previous low transverse cesarean deliveries was performed between 35 and 39 weeks' gestation. Two observers, blinded to the clinical data, independently measured the full lower uterine segment thickness by 2-dimensional (2D) transvaginal sonography. Three-dimensional volume data sets of the lower uterine segment were captured and analyzed more than 2 months later by both observers independently. Intraobserver, interobserver, and intermethod reliability was evaluated by median absolute differences, nonparametric limits of agreement, intraclass correlation coefficients (ICCs), and κ coefficients.

RESULTS

The median full lower uterine segment thickness was 3.6 mm (range, 0.9-8.0 mm). Intraobserver reliability (median difference, 0.3 mm [interquartile range (IQR), 0.1-0.6 mm]; ICC, 0.88 [95% confidence interval (CI), 0.81-0.93]; κ, 0.87 [95% CI, 0.69-1.00]) and interobserver reliability (median difference, 0.3 mm [IQR, 0.1-0.5 mm]; ICC, 0.88 [95% CI, 0.81-0.93]; κ, 0.86 [95% CI, 0.66-1.00]) were excellent. Reliability between 3D and 2D sonography was moderate (median difference, 0.6 mm [IQR, 0.2-0.9 mm]; ICC, 0.78 [95% CI, 0.66-0.86]; κ, 0.56 [95% CI, 0.28-0.85]). However, intermethod reproducibility was improved when the full lower uterine segment thickness was less than 3.0 mm (median difference, 0.4 mm [IQR, 0.2-0.9 mm]).

CONCLUSIONS

Full lower uterine segment thickness measured with 3D transvaginal sonographic data sets has excellent intraobserver and interobserver reliability. It also has good reproducibility with 2D sonography when the full lower uterine segment thickness is less than 3.0 mm.

摘要

目的

本研究旨在报告经阴道三维（3D）超声测量子宫下段厚度的观察者内和观察者间可靠性。

方法

对 60 例既往行子宫下段剖宫产术的孕妇进行前瞻性研究，检查时间为 35 至 39 孕周。两位观察者在不知道临床数据的情况下，分别通过经阴道二维（2D）超声对子宫下段全长进行测量。2 个月后，两位观察者独立使用 3D 容积数据对子宫下段进行分析。通过中位数绝对差、非参数一致性界限、组内相关系数（ICC）和κ系数评估观察者内、观察者间和两种方法间的可靠性。

结果

子宫下段全长的中位数为 3.6mm（范围，0.9-8.0mm）。观察者内可靠性（中位数差值，0.3mm[四分位间距（IQR），0.1-0.6mm]；ICC，0.88[95%置信区间（CI），0.81-0.93]；κ，0.87[95%CI，0.69-1.00]）和观察者间可靠性（中位数差值，0.3mm[IQR，0.1-0.5mm]；ICC，0.88[95%CI，0.81-0.93]；κ，0.86[95%CI，0.66-1.00]）均为极好。3D 与 2D 超声之间的可靠性为中度（中位数差值，0.6mm[IQR，0.2-0.9mm]；ICC，0.78[95%CI，0.66-0.86]；κ，0.56[95%CI，0.28-0.85]）。然而，当子宫下段全长小于 3.0mm 时，两种方法的重复性得到改善（中位数差值，0.4mm[IQR，0.2-0.9mm]）。