- Features of hemodynamics of the body of the uterus, depending on its volume and the degree of vascularization of the nodes, examined by the method of three-dimensional Doppler, in patients with leiomyoma
Features of hemodynamics of the body of the uterus, depending on its volume and the degree of vascularization of the nodes, examined by the method of three-dimensional Doppler, in patients with leiomyoma
HEALTH OF WOMAN. 2019.9(145): 64–71; doi 10.15574/HW.2019.145.64
K.V. Yakovenko1, T.I. Tamm2, Ye.A. Yakovenko2
1State Institution «Institute of Medical Radiology. S.P. Grigoriev NAMS of Ukraine », Kharkiv
2Kharkiv Medical Academy of Postgraduate Education
Among objective reasons of attention focus in the study of uterus hemodynamics in female patients with leiomyoma using doppler sonography there is information about the fact that the degree of uterus blood supply in this disease is associated with its proliferative capacities.Use of three-dimensional power doppler sonography allows to evade a subjective assessment of organs and tumors vascularization, present in two-dimensional doppler sonography, by quantitative evaluation of vascular blood flow intensity with calculation of volume indices of uterine body vascularization in female patients with leiomyoma.We decided to conduct this study to develop a standardized approach to the search of differential and diagnostic dopplerometric signs of leiomyoma and uterine sarcoma predictors.
The objective: to study peculiarities of uterine body hemodynamics depending on its volume and vascularization degree in lumps of fertile age patients with leiomyoma, with three-dimensional doppler sonography.
Materials and methods. 238 women aged 18 to 39 years were examined (Me=28.5). The main group consisted of 127 (53.36%) fertile age women aged 27 to 39 years (Me=33.0) with uterine leiomyoma, found during ultrasonography.All of them were divided into further sub-groups: women with small and large leiomyomas, and they, in their turn, into women with uterine leiomyoma of moderate vascularization with single color loci peripherally in the mode of two-dimensional power flow mapping and women with uterine leiomyoma of profound vascularization with a great amount of color loci both peripherally and in the center in the mode of two-dimensional power flow mapping.The comparison group consisted of 111 (46.6%) of apparently healthy women aged 18 to 39 years (Ме=28.5), in which uterus examination allowed to develop new and improve the existent nomograms of uterine body blood flow values (VI, FI, VFI) and develop uterine cervix nomograms.
In case of three-dimensional (3D) reconstruction of the uterus using power mapping and options of VOCAL (Virtual Organ Computer-aided Analysis), an objective assessment of hemodynamics of the uterine body was carried out by calculating the vascularization index (VI) that characterizes the percentage of color voxels in the volume of the uterine body, index of flow intensity (FI) that shows median brightness of the color voxels depending on the flow velocity in a predetermined three-dimensional volume, and vascularization flow index (VFI) that is a measure of organ perfusion and is the product of vascularization index and flow index divided by 100.
Results. In the fertile period the study three-dimensional blood flow indices values, reflecting hemodynamics of uterus, affected by leiomyoma, depended on uterine body volume (Kruskal–Wallis test, p<0.05), falling to the bottom boundary of reference values of the comparison group progressively as the uterine body volume increases by more than 370 cm3 (large uterine leiomyoma) subject to moderate vascularization of lumps, and approaching with some exceedence to median values of norm subject to significant vascularization (CC, Mann-Whitney U-test; p<0.05).Therefore uterine body volume of 370 cm3 we consider the differential criteria, which allows to get oriented in the dynamics of the indices under study.
Characteristics of small (less than 370 cm3) uterine leiomyoma values under study depended on lumps vascularization degree: if vascularization was medium, practically no differences from norm were observed, and if vascularization was profound, the significant exceedence in comparison groups nomograms values was obvious (Mann–Whitney U-test; p<0.05).
Conclusion. Obtained regularities in changes of uterine body hemodynamics depending on its volume and vascularization degree in lumps of fertile age patients with leiomyoma, with three-dimensional doppler sonography, opens new prospects of the search of differential and diagnostic dopplerometric signs of leiomyoma and uterine sarcoma.Use of standardized diagnostic approach should considerably increase the sensibility and specificity of three-dimensional power doppler sonography method in diagnostics of leiomyoma and uterine sarcoma in future.
Key words: three-dimensional power Doppler sonography, hemodynamics of the uterine body, uterine leiomyoma, uterine sarcoma, uterine body volume, lumps vascularization degree.
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