The Value Of Transvaginal Three Dimension Ultrasound In Quantitative Assessment On Diminished Ovarian Reserve And Premature Ovarian Failure

ObjectiveTo study the value of transvaginal three dimension ultrasound in quantitative assessment on diminished ovarian reserve and premature ovarian failure by observing ovarian volume, antral follicle count and ovarian vascularity indices.Methods1. Female patients with ovary dysfunction who underwent ultrasound examination in outpatient department of Chinese PLA General Hospital from October 2014 to November 2016 were enrolled. They were divided into normal ovarian reserve group(100 cases)、decreased ovarian reserve group(60 cases) and premature ovarian failure group(60 cases)according to the inclusion and exclusion criteria.2. The patient’s general conditions were recorded, including age, menstrual cycle length and menstrual period length.3. All the patients accepted blood tests of six sex hormones and transvaginal three dimension power doppler ultrasound examination in the early follicular phase between days 3 and 5 of the menstrual cycle, amenorrhea patients were not limited time. The antral follicle number(AFC) and ovarian volume(OV), vascularization index (VI), blood flow index (FI) and vascularization flow index (VFI) were calculated by using VOCAL and SonoAVC post-processing software.4. Comparisons of age, menstrual cycle length, and menstrual period length were made among the three groups. The three dimension ultrasound parameters were compared between left and right ovaries among the three groups. Comparisons of the ultrasound parameters were made among the three groups, ROC analysis was adopted, the area under the curve, sensitivity, and specificity were calculated, and diagnostic threshold was determined according to Youden index.Results1. The age of DOR group and POF group was older than the normal group (P <0.05), but there was no significant difference between DOR group and POF group (P>0.05).2. There was significant difference in menstrual cycle length among the three groups (the normal group <DOR group <POF group, P <0.05).3. There was no significant difference in menstrual period length among the three groups(P>0.05).4. There were no significant differences between the left and right ovaries among the three groups in AFC, OV, VI, FI, VFI (P>0.05).5. There were significant differences among the three groups in AFC, OV, VI, FI, VFI(normal group > DOR group > POF group, P<0.05).6. In the comparison between normal group and DOR group, areas under curve(AUC),sensitivity, specificity for AFC were 0.940, 0.933 and 0.760,respectively. For OV, these were 0.918,0.933 and 0.735, respectively. For VI, these were 0.883, 0.900,and 0.615, respectively. For FI, these were 0.813, 0.917 and 0.475, respectively. For VFI,these were 0.903, 0.917 and 0.645, respectively. In the comparison between DOR group and POF group, AUC, sensitivity, specificity for AFC were 0.929, 0.925 and 0.783,respectively. For OV, these were 0.931,0.958 and 0.750, respectively. For VI, these were 0.934,0.942 and 0.767, respectively. For FI, these were 0.929, 0.925 and 0.733,respectively. For VFI, these were 0.954, 0.942 and 0.842, respectively.ConclusionThere is important predictive value of the three dimension ultrasound parameters for assessing ovarian reserve function. AFC is the best predictor for diminished ovarian reserve,followed by OV, and finally ovarian blood indexes (the value of VFI is higher than that of VI and FI). All these parameters have good predictive value for premature ovarian failure. The application of transvaginal three dimension power doppler ultrasound , VOCAL and SonoAVC post-processing software , which makes the measurement of AFC, OV, ovarian blood indexes more accurate and reliable, and has extensive research and application value for evaluating ovarian reserve function.