Ryles Hannah T, Agambayev Sumeyra, Omran Mervat, Liao Chuanhong, Alkhrait Samar, Al-Hendy Ayman, Longman Ryan, Abramowicz Jacques, Madueke-Laveaux Obianuju Sandra
Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL 60637, USA.
Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL 60637, USA; Cancer Biology Department, National Cancer Institute - Cairo University, 11769 Cairo, Egypt.
F S Sci. 2025 Sep 9. doi: 10.1016/j.xfss.2025.09.002.
Recent studies suggest that the stiffness of uterine leiomyomas may be related to their growth and behavior. Shear wave elastography, a quantitative method of measuring tissue stiffness, has been increasingly studied for use in gynecologic conditions. However, no protocols have been proposed for its use in this clinical setting. This study aimed to 1) establish a standardized protocol for transvaginal shear wave elastography to measure uterine myometrial and leiomyoma stiffness and 2) assess the reproducibility and reliability of shear wave elastography measurements. We also assessed myometrial versus leiomyoma stiffness, compared myometrial stiffness in participants with and without leiomyomas, and assessed menstrual phase effects on stiffness values.
Transvaginal SWE ultrasound measurements of myometrial and leiomyoma stiffness were obtained. All transvaginal SWE exams were performed by an individual sonographer. Independent raters calculated stiffness measurements. Myometrial and leiomyoma stiffness were compared across menstrual phases.
Twenty-seven premenopausal women, 16 with leiomyomas and 11 without were enrolled. Seventeen participants completed exams during multiple menstrual phases.
EXPOSURE(S): 1. Tissue type (Myometrium/Leiomyoma) 2. Leiomyoma status (Presence/Absence of leiomyomas) 3. Menstrual phase (Follicular/Luteal) MAIN OUTCOME MEASURES: Inter-rater and test-retest reliability of shear wave elastography measurements. Myometrial and leiomyoma shear wave values.
We successfully designed a streamlined protocol for obtaining shear wave elastography measurements in participants with and without leiomyomas. Fifty-one myometrial and 38 leiomyoma stiffness values measured by two independent raters achieved excellent inter-rater reliability: the intraclass correlation coefficients (ICC) between the two raters were 0.990 (p<0.001) and 0.994 (p<0.001), respectively. Fifty myometrial and 42 leiomyoma stiffness measurements calculated by a single rater at two time points at least 90 days apart, achieved excellent test-retest reliability: ICC=0.992, p<0.001; ICC=0.995, p<0.001. Median stiffness values for leiomyomas were significantly higher than the surrounding myometrium (48.1 (IQR 39.7-59.5) versus 31.6 (IQR 22.9-46.9) kPa, p<0.001). There was no significant change in myometrial or leiomyoma median stiffness values between the menstrual phases.
Transvaginal ultrasound shear wave elastography showed excellent reproducibility and reliability in measuring myometrial and leiomyoma stiffness. Leiomyoma stiffness was significantly higher compared to the surrounding myometrium. Together, these findings support shear wave elastography's potential clinical utility in leiomyoma management.
近期研究表明，子宫平滑肌瘤的硬度可能与其生长及行为有关。剪切波弹性成像作为一种测量组织硬度的定量方法，在妇科疾病中的应用研究日益增多。然而，尚未有针对其在该临床环境中使用的方案被提出。本研究旨在：1）建立经阴道剪切波弹性成像的标准化方案，以测量子宫肌层和平滑肌瘤的硬度；2）评估剪切波弹性成像测量的可重复性和可靠性。我们还比较了肌层和平滑肌瘤的硬度，对比了有平滑肌瘤和无平滑肌瘤参与者的肌层硬度，并评估了月经周期对硬度值的影响。
获取经阴道剪切波弹性成像（SWE）对肌层和平滑肌瘤硬度的测量值。所有经阴道SWE检查均由一名超声检查医师进行。独立评估者计算硬度测量值。比较不同月经周期的肌层和平滑肌瘤硬度。
纳入27名绝经前女性，其中16名有平滑肌瘤，11名无平滑肌瘤。17名参与者在多个月经周期完成了检查。
我们成功设计了一个简化方案，用于在有或无平滑肌瘤的参与者中获取剪切波弹性成像测量值。两名独立评估者测量的51个肌层和平滑肌瘤硬度值具有出色的评估者间信度：两名评估者之间的组内相关系数（ICC）分别为0.990（p<0.001）和0.994（p<0.001）。一名评估者在至少相隔90天的两个时间点计算的50个肌层和平滑肌瘤硬度测量值具有出色的重测信度：ICC = 0.992，p<0.001；ICC = 0.995，p<0.001。平滑肌瘤的中位硬度值显著高于周围肌层（48.1（四分位间距39.7 - 59.5）与31.6（四分位间距22.9 - 46.9）kPa，p<0.001）。月经周期之间肌层或平滑肌瘤的中位硬度值无显著变化。
经阴道超声剪切波弹性成像在测量肌层和平滑肌瘤硬度方面显示出出色的可重复性和可靠性。与周围肌层相比，平滑肌瘤硬度显著更高。这些发现共同支持了剪切波弹性成像在平滑肌瘤管理中的潜在临床应用价值。
