Медицинская литература. Новинки

 

 

 

 

 

 

Количественная оценка эластичности миометрия в норме

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Целью работы явилось определение значений модуля упругости Юнга для миометрия тела матки в норме. В исследование включены 41 пациентка репродуктивного возраста с регулярным двухфазным менструальным циклом и 20 пациенток постменопаузального возраста со средней продолжительностью менопаузы 14 (1–28) лет (здесь и далее медиана, 2,5–97,5Bй процентили). Все пациентки прошли обследование на аппарате Aixplorer (Supersonic Imagine, Франция) с использованием режима эластографии сдвиговой волны при проведении трансвагинального сканирования. Оценивались среднее значение (Emean), максимальное значение (Emax) и стандартное отклонение (σ). Глубина исследования составляла не более 3 см. При сравнительном анализе данных, полученных у пациенток репродуктивного возраста в 1Bю и 2Bю фазы менструального цикла, достоверные различия по всем трем показателям не определялись. В группе пациенток репродуктивного возраста получены следующие значения модуля упругости Юнга для неизмененного миометрия вне зависимости от фазы менструального цикла: Emean – 24,58 (17,84–32,97) кПа, Emax – 29,43 (21,42–36,49) кПа, σ – 1,97 (1,30–4,97) кПа. В группе пациенток постменопаузального возраста Emean – 16,91 (9,58–25,23) кПа, Emax – 20,08 (11,74–33,19) кПа, σ – 1,90 (0,85–4,49) кПа. При сравнении значений Emean и Emax между пациентками репродуктивного и постменопаузального возраста получены достоверные различия.

Ключевые слова:
ультразвуковое исследование, эластография сдвиговой (поперечной) волны, неизмененный миометрий

Литература:
1. Феоктистов А.А. Маточный фактор в клинике
женского бесплодия: Дис. … канд. мед. наук. М.:
НЦ акушерства, гинекологии и перинатологии,
2006. 145 с.
2. Krouskop T.A., Wheeler T.M., Kallel F. et al.
Elastic moduli of breast and prostate tissues under
compression // Ultrason. Imaging. 1998. V. 20. № 4.
P. 260–274.
3. Konofagou E., Ophir J. A new elastographic
method for estimation and imaging of lateral displacements, lateral strains, corrected axial strains
and Poisson’s ratios in tissues // Ultrasound Med.
Biol. 1998. V. 24. № 8. P. 1183–1199.
4. Glaser K.J., Felmlee J.P., Manduca A. et al.
Stiffnessweighted magnetic resonance imaging //
Magn. Reson. Med. 2006. V. 55. № 1. P. 59–67.
5. Ophir J., Cespedes I., Ponnekanti H. et al.
Elastography: a quantitative method for imaging
the elasticity of biological tissues // Ultrason.
Imaging. 1991. V. 13. № 2. P. 111–134.
6. Ophir J., Garra B., Kallel F. et al. Elastographic
imaging // Ultrasound Med. Biol. 2000. V. 26.
Suppl. 1. P. S23–S29.
7. Parker K.J., Huang S.R., Musulin R.A., Lerner
R.M. Tissue response to mechanical vibrations for
“sonoelasticity imaging” // Ultrasound Med. Biol.
1990. V. 16. № 3. P. 241–246.
8. Shiina T., Nitta N., Ueno E., Bamber J.C. Real time
tissue elasticity imaging using the combined autocorrelation method // J. Med. Ultrason. 2002.
V. 29. № 3. P. 119–128.
9. Rao M., Varghese T. Correlation analysis of the
beam angle dependence for elastography // J.
Acoust. Soc. Am. 2006. V. 119. № 6. P. 4093–4101.
10. Thitaikumar A., Ophir J. Effect of lesion boundary
conditions on axial strain elastograms: a parametric study // Ultrasound Med. Biol. 2007. V. 33. № 9.
P. 1463–1467.
11. Zhai L., Madden J., Foo W.C. et al. Acoustic radiation force impulse imaging of human prostates ex
vivo // Ultrasound Med. Biol. 2010. V. 36. № 4.
P. 576–588.
12. Konig K., Scheipers U., Pesavento A. et al. Initial
experiences with realtime elastography guided
biopsies of the prostate // J. Urol. 2005. V. 174.
№1. P. 115–117.
13. Frauscher F., Gradl J., Pallwein L. Prostate ultrasound – for urologists only? // Cancer Imaging.
2005. V. 5. P. S76–S82.
14. Garra B.S. Cespedes E.I., Ophir J. et al.
Elastography of breast lesions: initial clinical
results // Radiology. 1997. V. 202. № 1. P. 79–86.
15. Thomas A., Fischer T., Frey H. et al. Realtime
elastography – an advanced method of ultrasound:
First results in 108 patients with breast lesions //
Ultrasound Obstet. Gynecol. 2006. V. 28. № 3.
P. 335–340.
16. Itoh A., Ueno E., Tohno E. et al. Breast disease:
clinical application of US elastography for diagnosis // Radiology. 2006. V. 39. № 2. P. 341–350.
17. Thomas A., Degenhardt F., Farrokh A. et al.
Significant differentiation of focal breast lesions:
calculation of strain ratio in breast sonoelastography // Acad. Radiol. 2010. V. 17. № 5. P. 558–563.
18. Lyshchik A., Higashi T., Asato R. et al. Thyroid
gland tumor diagnosis at US elastography //
Radiology. 2005. V. 237. № 1. P. 202–211.
19. Dighe M., Bae U., Richardson M.L. et al.
Differential diagnosis of thyroid nodules with US
elastography using carotid artery pulsation //
Radiology. 2008. V. 248. № 2. P. 662–669.
20. Fukunary N., Arai K., Naakamura A. et al. Clinical
evaluation of elastography for the differential
diagnosis of thyroid follicular tumors // Abstracts
from the 12th Congress of World Federation for
Ultrasound in Medicine and Biology. J. Ultrasound
Med. Biol. 2009. V. 35. № 8. P. S230.
21. Varghese T, Shi H. Elastographic imaging of thermal
lesions in liver invivo using diaphragmatic stimuli
// Ultrason. Imaging. 2004. V. 26. № 1. P. 18–28.
22. Fukuda K., Mori M., Koma M. Analysis of train
patterns of common liver tumors using realtime
tissue elastography // Abstracts from the 12th
Congress of World Federation for Ultrasound in
Medicine and Biology. J. Ultrasound Med. Biol.
2009. V. 35. № 8. P. S153.
23. Prasad P., Schmulewitz N., Patel A. et al.
Detection of occult liver metastases during EUS for
staging of malignancies // Gastrointest. Endosc.
2004. V. 59. № 1. P. 49–53.
24. Emelianov S.Y., Lubinski M.A., Weitzel W.F. et al.
Elasticity imaging for early detection of renal
pathology // Ultrasound Med. Biol. 1995. V. 21.
№7. P. 871–883.
25. Furukawa M.K., Kubota A., Hanamura H., Furukawa M. Clinical application of realtime tissue
elastography to head and neck cancer – evaluation
of cervical lymph node metastasis with realtime
tissue elastography // Nippon Jibiinkoka Gakkai
Kaiho. 2007. V. 110. № 7. P. 503–505.
26. Alam F., Naito K., Horiguchi J. et al. Accuracy of
sonographic elastography in the differential diagnosis of enlarged cervical lymph nodes: comparison
with conventional Bmode sonography // Am. J.
Roentgenol. 2008. V. 191. № 2. P. 604–610.
27. Levinson S.F., Shinagawa M., Sato T. Sonoelastic
determination of human skeletal muscle elasticity // J. Biomech. 1995. V. 28. № 10. P. 1145–1154.
28. Thomas A., Kummel S., Gemeinhardt O., Fischer T.
Realtime sonoelastography of the cervix: tissue
elasticity of the normal and abnormal cervix //
Acad. Radiol. 2007. V. 14. № 2. P. 193–200.
29. Thomas A. Imaging of the cervix using sonoelastography // Ultrasound Obstet. Gynecol. 2006. V. 28.
№ 3. P. 356–357.
30. Ami O., Lamazou F., Mabille M. et al. Realtime
transvaginal elastosonography of uterine fibroids //
Ultrasound Obstet. Gynecol. 2009. V. 34. № 4.
P. 486–488.
31. Preis K., SwiatkowskaFreund M., Pankrac Z.
Elastography in the examination of the uterine
cervix before labor induction // Ginekol. Pol. 2010.
V. 81. № 10. P. 757–761.
32. Hobson M.A., Kiss M.Z., Varghese T. et al. In vitro
uterine strain imaging: preliminary results // J.
Ultrasound Med. 2007. V. 26. № 7. P. 899–908.
33. Tessarolo M., Bonino L., Camanni M., Deltetto F.
Elastosonography: a possible new tool for diagnosis
of adenomyosis // Eur. Radiol. 2011. V. 21. № 7.
P. 1546–1552.
34. Sarvazyan A.P., Rudenko O.V., Swanson S.D. et al.
Shear wave elasticity imaging: a new ultrasonic
technology of medical diagnostics // Ultrasound
Med. Biol. 1998. V. 24. № 9. P. 1419–1435.
35. Dutt V., Kinnick R.R., Muthupillai R. et al. Acoustic shearwave imaging using echo ultrasound compared to magnetic resonance elastography // Ultra
sound Med. Biol. 2000. V. 26. № 3. P. 397–403.
36. Bercoff J., Pernot M., Tanter M., Fink M. Monitoring thermallyinduced lesions with supersonic
shear imaging // Ultrason. Imaging. 2004. V. 26.
№ 2. P. 71–84.
37. Tanter M., Touboul D., Gennisson J.L. et al. High-resolution quantitative imaging of cornea elasticity
using supersonic shear imaging // IEEE Trans.
Med. Imaging. 2009. V. 28. № 12. P. 1881–1893.
38. Tanter M., Bercoff J., Athanasiou A. et al.
Quantitative assessment of breast lesion viscoelasticity: initial clinical results using supersonic shear
imaging // Ultrasound Med. Biol. 2008. V. 34. № 9.
P. 1373–1386.
39. Evans A., Whelehan P., Thomson K. et al.
Quantitative shear wave ultrasound elastography:
initial experience in solid breast masses // Breast
Cancer Res. 2010. V. 12. № 6. P. R104.
40. Muller M., Gennisson J.L., Deffieux T. et al.
Quantitative viscoelasticity mapping of human
liver using supersonic shear imaging: preliminary
in vivo feasibility study // Ultrasound Med. Biol.
2009. V. 35. № 2. P. 219–229.
41. Sebag F., VaillantLombard J., Berbis J. et al. Shear
wave elastography: a new ultrasound imaging mode
for the differential diagnosis of benign and malignant thyroid nodules // J. Clin. Endocrinol. Metab.
2010. V. 95. № 12. P. 5281–5288.
42. Kiss M.Z., Hobson M.A., Varghese T. et al.
Frequencydependent complex modulus of the
uterus: preliminary results // Phys. Med. Biol.
2006. V. 51. № 15. P. 3683–3695.
43. Omari E.A., Kiss M.Z., Varghese T. et al. Quantification of the viscoelastic characteristics of the
uterus and associated pathologies // Abstracts of
the Ninth International Conference on the Ultra
sonic Measurement and Imaging of Tissue Elasticity.
October 16–19, 2010, Snowbird, Utah, USA. P. 63.
44. Djahanbakhch O., Ezzati M., Zosmer A. Reproductive ageing in women // J. Pathol. 2007. V. 211.
№2. P. 219–231.

Quantitative Estimation of the Normal Myometrium Elasticity

The aim of the study was to estimate the Young’s modulus values for the corpus uteri myometrium in healthy women. 41 patients of reproductive age with regular menstrual cycle and 20 patients of postmenopausal age with 14 (1–28) years (median, 2.5–97.5 percentile) menopause duration were examined. All examinations were performed with the Aixplorer (Supersonic Imagine, France) scanner equipped with the shear wave elastography module. The mean value of Young’s modulus (Emean), maximum value (Emax), and standard deviation (SD) were estimated. The examination depth didn’t exceed 3 cm. There weren’t any significant differences between Young’s modulus values in proliferative and secretory phases. The following values of Young’s modulus were obtained in the reproductive age women: Emean – 24.58 (17.84–32.97) кPа, Emax – 29.43 (21.42–36.49) кPа, SD – 1.97 (1.30–4.97) кPа (median, 2.5–97.5 percentile). The following values of Young's modulus were obtained in the postmenopausal age women: Emean – 16.91 (9.58–25.23) кPа, Emax – 20.08 (11.74–33.19) кPа, SD –1.90 (0.85–4.49) кPа (median, 2.5–97.5 percentile). The significant differences of Emean and Emax in patients of reproductive and postmenopausal age were revealed.

Keywords:
ultrasound diagnostics, shear wave elastography, and normal myometrium