Accuracy of Doppler assessment of the uterine arteries in healthy girls for the diagnosis of pubertal onset.

Amanda Veiga Cheuiche,Letícia Guimarães Da Silveira,Fabíola Costenaro,Gustavo Monteiro Escott,Iara Regina Siqueira Lucena,Leila Pedroso De Paula,Márcia Puñales,Cristiane Kopacek,Sandra Pinho Silveiro

doi:10.1007/s12020-021-02948-y

Abstract

To evaluate the accuracy of the uterine artery pulsatility index (PI) for the diagnosis of pubertal onset in girls. Cross-sectional study of girls with normal pubertal development. Puberty was diagnosed by the presence of Tanner breast development score ≥2. All girls underwent pelvic ultrasound and Doppler imaging of the uterine arteries. We evaluated the uterine artery PI and uterine, endometrial, and ovarian measurements. We used ROC curves with cutoffs determined by Youden index for data analysis. We included 169 girls aged 5-16 years who underwent 202 pelvic ultrasound examinations. Prepubertal girls had a significantly higher mean PI (6.70 ± 2.15) than girls in initial puberty (4.14 ± 1.55) and in late puberty (2.81 ± 1.05) (P < 0.001 for all comparisons), which reflects a progressive increase in blood flow to the uterus with the progression of puberty. ROC curve analysis showed that the PI was able to identify the onset of puberty with a mean area under the curve of 0.838 ± 0.04 (P < 0.001), and the PI cutoff point of 5.05 had a sensitivity of 77%, specificity of 85%, positive predictive value (PPV) of 92%, and accuracy of 79%. The combination of PI < 5.05 plus uterine volume >3.75 cm³ had a sensitivity of 73%, specificity of 95%, PPV of 97%, and accuracy of 79% to detect initial puberty. We found a significant reduction in the PI during pubertal development, which can possibly be a valuable noninvasive tool in the evaluation of pubertal disorders, alone or in combination with uterine and ovarian volumes.

Highlights

In the pediatric scenario, pelvic ultrasound is a rapid, low-cost, noninvasive method for the assessment of uterine development, ovarian volume, and for the detection of ovarian cysts and tumors [1]
Considering that the proximal blood flow remains constant, an increase in distal impedance will result in an increase in pulsatility index (PI); likewise, a decrease in distal impedance will result in a decrease in PI, which could reflect a progressive increase in blood flow to the uterus during puberty
Receiver operating characteristic (ROC) curve analysis showed that the PI was able to identify the onset of puberty with a mean area under the curve (AUC) of 0.838 (SD, 0.04) (P < 0.001), which was comparable to the AUC of other ultrasound parameters (Fig. 4)

Summary

Introduction

Pelvic ultrasound is a rapid, low-cost, noninvasive method for the assessment of uterine development, ovarian volume, and for the detection of ovarian cysts and tumors [1]. The size and morphology of the uterus and ovaries are relatively stable during childhood, but during puberty the uterine fundus progressively increases in size and becomes wider than the cervix, assuming the typical pear shape observed in adult women [2,3,4]. Multiple cysts can be seen during each menstrual cycle, representing stimulated follicles [1]. Doppler ultrasound allows the assessment of utero-ovarian blood flow and flow impedance measurement in this vascular tree. Considering that the proximal blood flow remains constant, an increase in distal impedance will result in an increase in PI; likewise, a decrease in distal impedance will result in a decrease in PI, which could reflect a progressive increase in blood flow to the uterus during puberty

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Results