Department of Obstetrics and Gynecology, Amsterdam UMC, location AMC, Amsterdam, The Netherlands.
Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands.
Acta Obstet Gynecol Scand. 2024 Nov;103(11):2193-2202. doi: 10.1111/aogs.14914. Epub 2024 Sep 12.
Imaging fibroid vascularity may predict fibroid growth and aid to determine most appropriate therapy. Microvascular (MV) flow imaging is relatively new and is able to detect slow flow in small vessels. Data on feasibility, reproducibility, and reliability of MV-flow imaging in fibroids is lacking. The purpose of our study was to determine the reproducibility of MV-flow imaging and to explore this technique for clinical practice for assessing blood flow in fibroids.
Thirty patients with one or multiple fibroids (diameter 1.5-12.0 cm) were prospectively included. Transvaginal ultrasound scanning was performed in B-mode, 2D MV-Flow™, 2D and 3D power Doppler mode (HERA W10, Samsung) by two experienced gynecologists at a tertiary care clinic from February to December 2021. The primary outcome was intra- and interobserver agreement of the vascular index (VI) and color score (CS). The following parameters: '2D MV-flow VI', '3DPD VI', '2D MV-flow CS' and '2DPD CS' were measured offline in the center, pseudocapsule, and entire fibroid. Secondary offline outcomes for exploring 2D MV-flow for clinical practice, included (1) ability to discern vascular structures, (2) assessing the degree of vascularity via CS and calculating a VI, and (3) determining penetration depth of the ultrasound signal in both power Doppler and MV-flow imaging.
All scans of the 30 included patients were of sufficient quality to analyze. Inter- and intra-observer correlations of all studied parameters were good to excellent, both for 2D MV-flow and 2D power Doppler (intercorrelation coefficient 0.992-0.996). Using 2D MV-flow different vascular structures were visible in detail, in contrary to using 2D and 3D power Doppler. In significantly more fibroids central flow could be visualized using 2D MV-flow (63%) than with 2D power Doppler (13%, p = 0.001). Finally, penetration of the ultrasound signal was deeper using 2D MV-flow (3.92 cm) than with 2D power Doppler (2.95 cm, p = 0.001).
Using 2D MV-flow imaging for determining vascularity is highly reproducible. It has potential added value for clinical practice as it depicts detailed vascular structures and the degree of vascularity, especially in the center of the fibroid.
成像纤维瘤血管性可能预测纤维瘤的生长，并有助于确定最合适的治疗方法。微血管（MV）血流成像相对较新，能够检测到小血管中的缓慢血流。关于 MV 血流成像的可行性、可重复性和可靠性的数据尚缺乏。我们的研究目的是确定 MV 血流成像的可重复性，并探索该技术在评估纤维瘤血流方面的临床应用。
前瞻性纳入 30 名直径为 1.5-12.0cm 的单发或多发纤维瘤患者。2021 年 2 月至 12 月，两名有经验的妇科医生在一家三级保健诊所，使用经阴道超声扫描仪在 B 模式、2D MV-FlowTM、2D 和 3D 能量多普勒模式（HERA W10，三星）进行检查。主要结果是血管指数（VI）和颜色评分（CS）的观察者内和观察者间一致性。在中心、假包膜和整个纤维瘤中，离线测量以下参数：“2D MV-flow VI”、“3DPD VI”、“2D MV-flow CS”和“2DPD CS”。探索 2D MV-flow 在临床实践中的离线次要结果，包括（1）辨别血管结构的能力，（2）通过 CS 评估血管程度并计算 VI，以及（3）确定能量多普勒和 MV-flow 成像中超声信号的穿透深度。
30 名纳入患者的所有扫描均具有足够的质量进行分析。所有研究参数的观察者内和观察者间相关性均较好到极好，2D MV-flow 和 2D 能量多普勒均如此（相关系数 0.992-0.996）。与使用 2D 和 3D 能量多普勒相比，使用 2D MV-flow 可以详细显示不同的血管结构。在使用 2D MV-flow 时，可在 63%的纤维瘤中观察到中央血流，而在使用 2D 能量多普勒时，这一比例为 13%（p=0.001）。最后，使用 2D MV-flow 时，超声信号的穿透深度更深（3.92cm），而使用 2D 能量多普勒时，穿透深度更浅（2.95cm，p=0.001）。
使用 2D MV-flow 成像确定血管性具有高度的可重复性。它对临床实践具有潜在的附加价值，因为它可以描绘详细的血管结构和血管程度，特别是在纤维瘤的中心。
