Voros Charalampos, Varthaliti Antonia, Mavrogianni Despoina, Athanasiou Diamantis, Athanasiou Antonia, Athanasiou Aikaterini, Papahliou Anthi-Maria, Zografos Constantinos G, Topalis Vasileios, Kondili Panagiota, Darlas Menelaos, Sina Sophia, Daskalaki Maria Anastasia, Antsaklis Panagiotis, Loutradis Dimitrios, Daskalakis Georgios
1st Department of Obstetrics and Gynecology, 'Alexandra' General Hospital, National and Kapodistrian University of Athens, 80 VasilissisSofias Avenue, 11528 Athens, Greece.
IVF Athens Reproduction Center V. Athanasiou, 15123 Maroussi, Greece.
Biomedicines. 2025 Mar 24;13(4):784. doi: 10.3390/biomedicines13040784.
: Elastography is an ultrasound-based imaging technology that allows for quantitative measurement of tissue stiffness and elasticity. In reproductive medicine, it is a potential non-invasive method for assessing ovarian activity, uterine contractility, and endometrial receptivity. While conventional ultrasound provides anatomical and vascular information, it does not assess biomechanical properties, which are important for understanding polycystic ovary syndrome (PCOS), predicting intrauterine insemination (IUI) success, and determining endometrial receptivity in in vitro fertilization (IVF). : A systematic review was conducted in accordance with the PRISMA principles, and the protocol was recorded in PROSPERO. A comprehensive literature search was conducted across several databases to uncover studies that used real-time elastography (RTE) or shear wave elastography (SWE) for PCOS diagnosis, IUI result prediction, or endometrial receptivity evaluation in IVF. The risk of bias was assessed using the ROBINS-I technique. : Four studies fulfilled the inclusion criteria. One study indicated that PCOS patients had considerably increased ovarian stiffness, which supports elastography as a diagnostic marker. Another study found that increased uterine flexibility and decreased contractility were related with better IUI outcomes. A retrospective cohort research discovered that non-uniform endometrial echogenicity had no influence on IVF results. Furthermore, SWE successfully evaluated endometrial receptivity in unexplained infertility, with higher stiffness being related to reduced implantation potential. : Elastography gives real-time, quantitative insights into reproductive biomechanics, with potential applications in infertility diagnosis and ART improvement. However, the absence of defined imaging procedures and confirmed clinical criteria prevent its broad use. More large-scale prospective investigations are required to improve elastographic parameters and define diagnostic cutoffs for clinical use.
弹性成像技术是一种基于超声的成像技术，可对组织的硬度和弹性进行定量测量。在生殖医学中，它是一种潜在的非侵入性方法，用于评估卵巢活性、子宫收缩性和子宫内膜容受性。传统超声可提供解剖学和血管信息，但无法评估生物力学特性，而这些特性对于理解多囊卵巢综合征（PCOS）、预测宫腔内人工授精（IUI）成功率以及确定体外受精（IVF）中的子宫内膜容受性至关重要。
按照PRISMA原则进行了一项系统综述，并将方案记录在PROSPERO中。在多个数据库中进行了全面的文献检索，以发现使用实时弹性成像（RTE）或剪切波弹性成像（SWE）进行PCOS诊断、IUI结果预测或IVF中子宫内膜容受性评估的研究。使用ROBINS-I技术评估偏倚风险。
四项研究符合纳入标准。一项研究表明，PCOS患者卵巢硬度显著增加，这支持将弹性成像作为一种诊断标志物。另一项研究发现，子宫柔韧性增加和收缩性降低与更好的IUI结果相关。一项回顾性队列研究发现，子宫内膜回声不均匀对IVF结果没有影响。此外，SWE成功评估了不明原因不孕症中的子宫内膜容受性，较高的硬度与着床潜力降低相关。
弹性成像为生殖生物力学提供了实时、定量的见解，在不孕症诊断和辅助生殖技术（ART）改进方面具有潜在应用。然而，缺乏明确的成像程序和已证实的临床标准阻碍了其广泛应用。需要更多大规模的前瞻性研究来改善弹性成像参数并确定临床使用的诊断临界值。
