MBDNB, DABR, Department of Medical Imaging Schulich School of Medicine and Dentistry, University of Western Ontario, London Health Sciences Center-Victoria Hospital, 800 Commissioners Rd E, Room D1-106, London, ON N6A 5W9, Canada.
J Ultrasound Med. 2014 Jan;33(1):149-54. doi: 10.7863/ultra.33.1.149.
The purpose of this study was to determine which combination of sonohysterographic features has the highest likelihood ratios (LRs) in discriminating polyps from submucosal fibroids.
This retrospective study included 200 consecutive patients who underwent both sonohysterography and a procedure resulting in a positive pathologic diagnosis. A reader, masked to the imaging and pathologic findings, independently reviewed the 200 sonograms and recorded the findings using a standardized checklist for sonographic features on sonohysterography. The features assessed included angle, echogenicity, endometrial-myometrial interface, and vascular pattern, among others. The reader chose one final diagnosis from the list of possibilities, which included normal, hyperplasia, polyp, submucosal fibroid, cancer, adhesions, and clots. Sonographic observations were then compared to pathologic findings.
The LR of 13.4 was achieved for polyps when there was a combination of an intact endometrial-myometrial interface, a single vessel, an acute angle, and homogeneous echogenicity. The highest LR of 27.8 was achieved for submucosal fibroids when the combination of sonographic features included an absent endometrial-myometrial interface, an arborized/multiple vascular pattern, an obtuse angle, and heterogeneous echogenicity.
A combination of sonographic findings may provide high LRs for discriminating endometrial polyps from submucosal fibroids.
本研究旨在确定经阴道超声检查（sonohysterography，SHG）中哪些特征组合具有鉴别息肉和黏膜下肌瘤的最高似然比（likelihood ratio，LR）。
这是一项回顾性研究，共纳入 200 例连续接受 SHG 检查且术后病理诊断阳性的患者。一名读者在不了解影像学和病理学结果的情况下，独立分析 200 份 SHG 图像，并使用标准化清单记录 SHG 的超声特征，包括角度、回声强度、子宫内膜-肌层界面和血管模式等。读者从可能的诊断列表中选择一个最终诊断，包括正常、增生、息肉、黏膜下肌瘤、癌症、粘连和血块。然后将超声观察结果与病理发现进行比较。
当子宫内膜-肌层界面完整、单一血管、锐角和均匀回声时，息肉的 LR 为 13.4；当超声特征组合包括子宫内膜-肌层界面缺失、树枝状/多血管模式、钝角和不均匀回声时，黏膜下肌瘤的 LR 最高，为 27.8。
超声特征的组合可能为鉴别子宫内膜息肉和黏膜下肌瘤提供高 LR。
