Abstract
Despite the data on the effectiveness of three-dimensional sonography in the improvement of the diagnostic capabilities for predicting the degree of proliferative activity of uterine tumorsalready obtained by other researchers in their previous studies, some aspects of the problem remain insufficiently studied, and the data obtained are contradictory. Thus, there are no quantitative characteristics of threshold values of blood flow indices (VI, FI, VFI) in simple uterine leiomyomas and sarcomas allowing predicting uterine sarcoma with sufficient accuracyat the stage of ultrasound. The objective: comparison of characteristics of uterine body three-dimensional power Doppler sonographyindices in female patients with leiomyosarcoma, leiomyoma, and in a group of healthy women for searching threshold differential diagnostic values of uterine body vascularization indices in patients with leiomyosarcoma. Materials and methods. 74 menopausal women aged 50 to 75 years were examined (Me=62.5). The main group consisted of 46 (62.16%) patients with myometrial tumors. Of these, the study included 10 (21.73%) women with uterine leiomyosarcoma and 36 (78.26%) with uterine leiomyoma. The comparison group consisted of 28 (37.84%) healthy menopausal women aged 50 to 75 years (Me=62.5). In case ofthree-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 flowindex (VFI) that is a measure of organ perfusion and is the product of vascularization index and flow index divided by 100. Results. At pair comparison of the groups among themselves, VI and FI indicesof the uterine body in groups of women with leiomyoma and leiomyosarcoma differ at a statistically significant level (Mann-Whitney U-test, p <0.05) from the comparison group, and when comparing groups with leiomyoma and leiomyosarcoma, differences between VI and VFI indices of the uterine body are statistically significant. According to the results of the study, in menopausal women, the differential diagnostic criteria of three-dimensional Doppler sonography for predicting the presence of uterine leiomyosarcoma are the following threshold critical values: 26.2% for VI index of the uterine body and 2.47 for VFI index of the uterine body. Conclusion. A method of three-dimensional power Doppler sonography increases the information content of the differential diagnosis of benign and malignant tumors of the myometrium. Prospects for further research involve the study of critical threshold values of three-dimensional indices of vascularization, allowing predicting the presence of uterine leiomyosarcoma in the group of women of reproductive age and the group of menopausal women in a larger sample. Key words: three-dimensional power Doppler sonography, hemodynamics of the uterine body, uterine leiomyoma, uterine leiomyosarcoma.
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