Clinical auxiliary diagnostic value of super micro-vascular imaging combined with shear wave elastography for endometrial carcinoma

doi:10.3877/cma.j.issn.1673-5250.2025.03.010

Objective

To evaluate the clinical auxiliary diagnostic value of super micro-vascular imaging (SMI) combined with shear wave elastography (SWE) for endometrial carcinoma (EC).

Methods

A total of 99 patients with endometrial lesions admitted to Panzhihua Integrated Traditional Chinese and Western Medicine Hospital from January 2022 to June 2023 were selected. All patients underwent transvaginal ultrasound (TVS), and SMI and SWE techniques were sequentially used to examine the endometrium. Endometrial tissue samples were obtained via diagnostic curettage for histopathological analysis. Based on histopathological results, patients were divided into EC group (n=38, diagnosed with EC) and control group (n=61, diagnosed with benign endometrial lesions). Vascularization index (VI) detected by SMI and maximum elasticity (Emax), mean elasticity (Emean), and standard deviation of elasticity (Esd) detected by SWE were compared between two groups using independent-samples t test or Mann-Whitney U test. Diagnostic accuracy of SMI, SWE, and SMI+ SWE for EC were compared by chi-square test. Receiver operating characteristic (ROC) curve analysis was performed to assess the clinical diagnostic performance of SMI, SWE, and SMI+ SWE for EC. The study protocol was performed in accordance with the Helsinki Declaration of the World Medical Association revised in 2013. There were no significant differences between the two groups in the age, portion of married, body mass index (BMI), and gravidity (P>0.05).

Results

①Using histopathological diagnosis as the gold standard for clinical diagnosis of EC patients, the diagnostic accuracy of SMI+ SWE for EC was 96.0% (95/99), which was significantly higher than that of SMI (82.8%, 82/99) and SWE (79.8%, 79/99) alone (χ²=8.12, P=0.004; χ²=10.34, P=0.001). ②The EC group showed significantly higher VI, Emax, Emean, and Esd values than those of the control group (Z=5.32, P<0.001; t=3.21, P=0.002; t=4.87, P<0.001; Z=4.15, P<0.001). ③ROC analysis demonstrated that the area under the curve (AUC) for SMI+ SWE in diagnosing EC was 0.957 (95%CI: 0.908-0.992), which was significantly higher than the AUC for VI, Emax, Emean, and Esd alone [0.844(95%CI: 0.769-0.915), 0.869(95%CI: 0.794-0.936), 0.751(95%CI: 0.650-0.850), and 0.856(95%CI: 0.776-0.927)], with statistically significant differences (Z=3.27, P=0.001; Z=2.89, P=0.004; Z=4.52, P<0.001; Z=3.05, P=0.002).

Conclusions

SMI+ SWE provides high clinical auxiliary diagnostic efficacy for EC, demonstrating significant clinical value.

Key words: Endometrial neoplasms, Ultrasonography, Doppler, color, Elasticity imaging techniques, Super micro-vascular imaging, Shear wave elastography, Female

图1 1例EC绝经患者(女性，57岁)阴道超声图[图1A：常规TVS子宫纵切超声图，提示子宫后位，内膜增厚，内部回声不均匀，内膜与后壁肌壁分界欠清晰，EC内膜内存在液化坏死病灶(箭头所示)；图1B：SMI模式下阴道超声图，提示子宫内膜内血流丰富，感兴趣区内VI值为88.0%]注：EC为子宫内膜癌。TVS为经阴道彩色多普勒超声，SMI为超微血流成像，VI为血管指数

图2 1例EC绝经患者(女性，51岁)阴道超声图[图2A：常规TVS子宫纵切超声图，提示子宫后位，内膜增厚且回声不均匀；图2B：SWE模式下阴道超声图，提示内膜中心病灶弹性彩图呈蓝色，周边病灶为绿色(箭头所示)，评分为4分]注：EC为子宫内膜癌。TVS为经阴道彩色多普勒超声，SWE为剪切波弹性成像

表1 SMI、SWE、SMI联合SWE技术对99例子宫内膜病变患者的EC诊断结果比较

诊断技术	诊断为子宫内膜良性病变者(例)	诊断为EC者(例)	敏感度(%)	特异度(%)	诊断符合[例数(%)]
SMI	50	32	83.1	84.2	82(82.8)
SWE	46	33	81.1	86.8	79(79.8)
SMI联合SWE	59	36	95.7	96.7	95(96.0)
χ²值	—	—	—	—	82.81
P值	—	—	—	—	<0.001

表1 SMI、SWE、SMI联合SWE技术对99例子宫内膜病变患者的EC诊断结果比较

诊断技术	诊断为子宫内膜良性病变者(例)	诊断为EC者(例)	敏感度(%)	特异度(%)	诊断符合[例数(%)]
SMI	50	32	83.1	84.2	82(82.8)
SWE	46	33	81.1	86.8	79(79.8)
SMI联合SWE	59	36	95.7	96.7	95(96.0)
χ²值	—	—	—	—	82.81
P值	—	—	—	—	<0.001

表2 2组子宫内膜病变患者子宫内膜VI、Emax、Emean、Esd值比较

组别	例数	VI[%，M(Q₁，Q₃)]	Emax(kPa，±s)	Emean(kPa，±s)	Esd[kPa，M(Q₁，Q₃)]
EC组	42	78.6(60.2，95.7)	62.1±16.3	30.6±7.5	13.5(9.4，16.2)
对照组	58	42.4(28.5，66.8)	38.9±14.1	23.6±7.2	7.5(5.8，11.0)
统计量		Z＝5.32	t＝3.21	t＝4.87	Z＝4.15
P值		<0.001	0.002	<0.001	<0.001

表2 2组子宫内膜病变患者子宫内膜VI、Emax、Emean、Esd值比较

组别	例数	VI[%，M(Q₁，Q₃)]	Emax(kPa，±s)	Emean(kPa，±s)	Esd[kPa，M(Q₁，Q₃)]
EC组	42	78.6(60.2，95.7)	62.1±16.3	30.6±7.5	13.5(9.4，16.2)
对照组	58	42.4(28.5，66.8)	38.9±14.1	23.6±7.2	7.5(5.8，11.0)
统计量		Z＝5.32	t＝3.21	t＝4.87	Z＝4.15
P值		<0.001	0.002	<0.001	<0.001

图3 子宫内膜VI、Emax、Emean、Esd各单一指标及4项指标联合对EC诊断的ROC曲线注：VI为血管指数，Emax为杨氏模量最大值，Emean为杨氏模量平均值，Esd为杨氏模量标准差。EC为子宫内膜癌。ROC曲线为受试者工作特征曲线

表3 子宫内膜VI、Emax、Emean、Esd各单一指标及4项指标联合对EC患者的辅助诊断效能

指标	AUC		最佳临界值	敏感度(95%CI)	特异度(95%CI)	约登指数
指标	AUC(95%CI)	P值	最佳临界值	敏感度(95%CI)	特异度(95%CI)	约登指数
VI(%)	0.844(0.769～0.915)	<0.001	53.4	0.842(0.579～1.000)	0.705(0.531～0.968)	0.547
Emax(kPa)	0.869(0.794～0.936)	<0.001	43.0	0.868(0.655～1.000)	0.721(0.557～0.954)	0.590
Emean(kPa)	0.751(0.650～0.850)	<0.001	24.1	0.789(0.526～0.939)	0.672(0.542～0.942)	0.462
Esd(kPa)	0.856(0.776～0.927)	<0.001	8.5	0.874(0.806～1.000)	0.721(0.603～0.881)	0.695
4项指标联合	0.957(0.908～0.992)	<0.001	—	0.947(0.868～1.000)	0.967(0.911～1.000)	0.915

表3 子宫内膜VI、Emax、Emean、Esd各单一指标及4项指标联合对EC患者的辅助诊断效能

指标	AUC		最佳临界值	敏感度(95%CI)	特异度(95%CI)	约登指数
指标	AUC(95%CI)	P值	最佳临界值	敏感度(95%CI)	特异度(95%CI)	约登指数
VI(%)	0.844(0.769～0.915)	<0.001	53.4	0.842(0.579～1.000)	0.705(0.531～0.968)	0.547
Emax(kPa)	0.869(0.794～0.936)	<0.001	43.0	0.868(0.655～1.000)	0.721(0.557～0.954)	0.590
Emean(kPa)	0.751(0.650～0.850)	<0.001	24.1	0.789(0.526～0.939)	0.672(0.542～0.942)	0.462
Esd(kPa)	0.856(0.776～0.927)	<0.001	8.5	0.874(0.806～1.000)	0.721(0.603～0.881)	0.695
4项指标联合	0.957(0.908～0.992)	<0.001	—	0.947(0.868～1.000)	0.967(0.911～1.000)	0.915

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