| Background and ObjectiveUltrasound elastography as an easier, novel and accurate diagnosis technology. It is a technique for imaging mechanical properties of a material by measuring and imaging induced strain within tissue following the application of an externally applied displacement to the surface of that tissue. Ultrasound tissue elasticity imaging is expected as means for providing novel diagnostic information for tissue disease such as cancer since the tissue hardness is closely related to its pathological state. Therefore, many investigations on imaging tissue elasticity by ultrasound have been carried out from the1991s.The value of replacing invasive methods of evaluation witha non-invasive tool is apparent. It make up for the deficiency of CT, MRI and other imaging.Clinical applications of ultrasound elastography include its use to assist in detection of breast carcinoma, thyroid carcinomas and also to differentiate tumour from a high-intensity focused ultrasound-ablated lesion in the prostate. Investigators have also carried out a series of research in the liver, prostate, kidney, etc. but few studies in the cervix. Cervix lack of nerve, when the lesions occur patients often no self-conscious symptoms, Or just for a small amount of vaginal bleeding,formerly we often depend on gynecological examination, cervical cytology, colposcopy method to diagnose. However, It is difficult to find the cervical canal and cervical muscle lesions by these methods. Because ultrasound can observe lesion features such as size, shape, blood flow, etc. It has became the irreplaceable tool of the department of gynaecology.Malignant cervical tissue hardness increase, Conventional ultrasound can not provide relevant information. Gynecological examination rely on the tactile evaluation softness,subjective is stronger. Transvaginal ultrasound combined with ultrasound elastography using intracavity probes impose certain pressure on the cervix. Different tissue elasticity coefficient is different, when they under the same pressure produce different displacement. According to the elastic tissue hardness information provided by the image characteristics, we identify the nature of the lesions.The main purpose of this study was summary of ultrasound image characteristics of normal cervix and cervical diseases such as cervical cancer, to investigate ultrasound elastography differential diagnosis of benign and malignant cervical placeholder.Objects and Methods1.Based on the diagnosis of20cases of normal cervix, the mean age was31±2.3.20cases of cervical chronic inflammation, the mean age was35±1.6,among the patients,there were11cases with cervical cysts,9cases with cervical hypertrophy.71cases (73lesions) with cervical placeholder,the mean age39±3.1,33benign lesions,40malignant lesions. Normal group and the chronic inflammation group has gynecological examination and Thinprep cytologic test(TCT) results, Cervical placeholder group underwent surgery in our hospital and pathologic examination.2.Hitachi HV-900Ultrasonic imaging apparatus with4.0-8.0MHz frequency was used, The instruments is equipped with real-time elastography function and post-processing software. All of them underwant the vaginal ultrasound scanning, including longitudinal and transverse sesection. After the lesion was found, Observed the location of the lesion, shape, size, border, internal echo, blood flow, preliminary to determine the nature of the lesion. After to obtain ideal two-dimensional image into the elastic mode.We observed the elastic image of normal cervix and cervical lesions.All cerval lesions were evaluated by elasticity score(which were classified into5) and by strain ratio. Results1. Ultrasound elastography score diagnosis of cervical placeholder,the sensitivity, specificity, and accuracy of the elastosonography in differentiating benign and malignant cervical nodules were67.5%,72.7%,69.9%, respectively, Transvaginal ultrasound were:55%,78.8%,65.8%,respectively; The combination imaging were:82.5%,87.9%,84.9%,respectively.The ultrasound elastography score, transvaginal ultrasound, with the combination of the two imaging compared, respectively, has significant differences,statistical results were (X2=2.287, P<0.05;X2=1.625, p<0.05).2. the cutoff point of strain ratio was determinded as3.01.The area under the ROC curve(Az)of strain ratio and5-scoring system were0.816and0.736, significant difference were not found between strain ratio method and5-scoring system (X2=4.178,P>0.05)3. Normal cervix and cervical lesions elastic image features.Normal cervix:rendering more uniform green image, Cervical canal was a long strip of red and green.Cervical hypertrophy:Similar to the normal cervical image features. Cervical mainly green, blue, green and white images.Cervical cysts:Rendered as red, blue, green, Smaller cysts was more uniform green, Large cysts often only partially visible red, green, some regional color defect.Cervical myoma:dominated by green,blue and green image,is visible in blue and red as the main image.Cervical canal polypus:dominated by green with a small amount of red and (or) blue.Cervical cancer:Mainly in blue, or visible around small amounts of green, Or entire lesion area is covered by blue.4.17cases of blood flow-rich type of cervical carcinoma,7cases of5points,6cases of4points,2cases≤3minutes;13of cases Blood flow is not rich type of cervical cancer,1cases of5points,8cases of4points,4cases≤3minutes,4cases;10cases of no blood flow type of cervical Cancer,1cases of5points,2cases of4points,7cases≤3minutes. Conclusions:1.Ultrasonic elastography(UE) is a useful complement transvaginal ultrasound, UE is a promising technology in diagnosis of cervical placeholder.2. Ultrasonic elastic scoring and the strain ratio methods in the diagnosis of cervical benign and malignant lesions have a certain value, the accuracy of the strain ratio method is slightly higher than the elasticity score, but the difference was not statistically significant.3.The blood flow signal of cervical cancer has little effect on the elasticity score. |
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