Asl Bari, DPT Maternal and Child Health, Reproductive and IVF Unit, PTA "F Jaia", 70014, Conversano (Ba), Italy.
University of Bari, Obstetrics and Gynecology, 70100, BARI (Ba), Italy.
Reprod Biol Endocrinol. 2017 Aug 14;15(1):64. doi: 10.1186/s12958-017-0283-0.
Ultrasound elastography is a non-invasive medical imaging technique able to quantitatively characterize the stiffness of a given tissue. It has been shown to predict the risk for cervical insufficiency and preterm delivery, and to allow differentiation of malignancy from normal tissue. The present study sought to evaluate whether cervical tissue dishomogeneity, as assessed by cervical ultrasound elastography, may predict the embryo transfer (ET) ease in infertile women undergoing IVF/ICSI.
We evaluated 154 infertile patients with no history of previous ET or intrauterine insemination. Cervical stiffness was evaluated in six regions of interest (ROI), compared two by two to obtain strain ratio (SR) values. Since a SR value of 1 was suggestive of tissue homogeneity, we computed 1-SR/SR-1 values to obtain a measure of the degree of cervical tissue dishomogeneity that we named "dishomogeneity index" (DI). Ultrasound-guided ET was performed by an expert operator blinded to the results of cervical elastography. The prediction ability of elastography on ET ease was evaluated by binary logistic regression, and the predictive accuracy of the independent variables was quantified with area under the curve (AUC) estimates derived from receiver operating characteristic (ROC) curve.
ET resulted to be easy in 99 out of 154 patients (64,2%), difficult in 54 patients (35%), and impossible in one. DI values in cervical medial lips region correctly classified 86.9% of patients, according to binary logistic regression, with a sensitivity of 81.4% and a specificity of 89,9%, positive likelihood ratio (LR) 8.07 and negative LR of 0.21. A DI cut-off value of 0.29 predicted a difficulty of ET with a sensitivity of 88,9% and a specificity of 85%.
Cervical ultrasound elastography, by allowing the identification of cervical tissue dishomogeneity, may be of help in predicting the ET ease in infertile women candidates to IVF/ICSI.
超声弹性成像是一种非侵入性的医学成像技术，能够定量描述特定组织的硬度。它已被证明可预测宫颈功能不全和早产的风险，并能区分良恶性组织。本研究旨在评估通过宫颈超声弹性成像评估的宫颈组织异质性是否可预测行 IVF/ICSI 的不孕妇女胚胎移植（ET）的难易程度。
我们评估了 154 名无 ET 或宫腔内人工授精史的不孕患者。在 6 个感兴趣区域（ROI）评估宫颈硬度，两两比较以获得应变比（SR）值。由于 SR 值为 1 提示组织均匀性，因此我们计算了 1-SR/SR-1 值以获得宫颈组织异质性的度量，我们将其命名为“异质性指数”（DI）。由一位对宫颈弹性成像结果不知情的专家操作者进行超声引导 ET。通过二元逻辑回归评估弹性成像对 ET 难易程度的预测能力，并通过来自接收器操作特征（ROC）曲线的曲线下面积（AUC）估计值来量化独立变量的预测准确性。
在 154 名患者中，99 名（64.2%）的 ET 容易，54 名（35%）的 ET 困难，1 名（0.7%）的 ET 不可能。根据二元逻辑回归，DI 值在宫颈内侧唇区正确分类了 86.9%的患者，其敏感性为 81.4%，特异性为 89.9%，阳性似然比（LR）为 8.07，阴性 LR 为 0.21。DI 值截断值为 0.29 可预测 ET 困难，其敏感性为 88.9%，特异性为 85%。
宫颈超声弹性成像通过识别宫颈组织异质性，可能有助于预测行 IVF/ICSI 的不孕妇女的 ET 难易程度。
