Academic Unit of Obstetrics and Gynecology, IRCCS Ospedale Policlinico San Martino, Genova, Italy.
DINOGMI, University of Genoa, Genova, Italy.
Ultraschall Med. 2024 Feb;45(1):69-76. doi: 10.1055/a-2028-8214. Epub 2023 Feb 6.
This study aimed to evaluate elastography features of deep infiltrating endometriosis (DIE), and to define whether this technique may discriminate lesions from surrounding non-endometriotic tissue.
This was an exploratory observational study on women affected by DIE treated in a third-level academic hospital gynaecology outpatient facility between 2020 and 2021. Strain elastography (SE) was conducted via transvaginal probe. Tissue deformation of DIE and surrounding tissue was expressed as percentage tissue deformation or as subjective colour score (CS; from blue=stiff to red=soft, assigned numerical values from 0 to 3). Ratios of normal tissue/DIE were compared to ratio of normal tissue/stiffer normal tissue area.
Evaluations were performed on 46 DIE nodules and surrounding tissue of the uterosacral ligaments (n=21), parametrium (n=7), rectum (n=14), and recto-vaginal septum (n =4). Irrespective of location, DIE strain ratio (3.09, IQR 2.38-4.14 vs. 1.25, IQR 1.11-1.48; p<0.001) and CS ratio (4.62, IQR 3.83-6.94 vs. 1.13, IQR 1.06-1.29; p<0.001) was significantly higher than that of normal tissue. ROC AUC of CS ratio was higher than ROC AUC of strain ratio (99.76%, CI.95 99.26-100% vs. 91.35%, CI.95 85.23-97.47%; p=0.007), and best ROC threshold for CS ratio was 1.82, with a sensitivity of 97.83% (CI.95 93.48-100%) and a specificity of 100% (CI.95 100-100%).
Both strain and CS ratios accurately distinguish DIE nodules at various locations. Applications of elastography in improving the diagnosis DIE, in distinguishing different DIE lesions and in monitoring DIE evolution can be envisioned and are worthy of further evaluation.
本研究旨在评估深部浸润型子宫内膜异位症（DIE）的弹性成像特征，并确定该技术是否可将病变与周围非子宫内膜异位组织区分开来。
这是一项在 2020 年至 2021 年间于三级学术医院妇科门诊接受治疗的 DIE 女性患者的探索性观察性研究。经阴道探头进行应变弹性成像（SE）。DIE 和周围组织的组织变形以组织变形百分比或主观颜色评分（CS；从蓝色=僵硬到红色=柔软，分配从 0 到 3 的数值）表示。正常组织/DIE 的比值与正常组织/较硬正常组织区域的比值进行比较。
对 46 个 DIE 结节和子宫骶韧带（n=21）、子宫旁组织（n=7）、直肠（n=14）和直肠阴道隔（n=4）周围组织进行了评估。无论位置如何，DIE 应变比（3.09，IQR 2.38-4.14 与 1.25，IQR 1.11-1.48；p<0.001）和 CS 比（4.62，IQR 3.83-6.94 与 1.13，IQR 1.06-1.29；p<0.001）均显著高于正常组织。CS 比值的 ROC AUC 高于应变比值的 ROC AUC（99.76%，CI.95 99.26-100% 与 91.35%，CI.95 85.23-97.47%；p=0.007），CS 比值的最佳 ROC 阈值为 1.82，灵敏度为 97.83%（CI.95 93.48-100%），特异性为 100%（CI.95 100-100%）。
应变比和 CS 比均能准确区分不同部位的 DIE 结节。弹性成像在提高 DIE 诊断、区分不同 DIE 病变和监测 DIE 演变方面的应用可以预见，值得进一步评估。
