Corpus luteum blood flow in normal and abnormal early pregnancy: evaluation with transvaginal color and pulsed Doppler sonography.

One hundred and thirteen (66.5%) women in this study had a normal intrauterine pregnancy with ages ranging 6 to 12 weeks of gestation. Fifty-seven (33.5%) patients were admitted to the hospital owing to clinically suspected abnormal early pregnancy. Dilatation and curettage were done on all women and tissue sample sent to the pathologist for a final diagnostic. Diagnosis of ectopic pregnancy was made on laparoscopy. Both ovaries were examined carefully by color Doppler in sonography in all patients. Color flow was used as a guide for pulsed Doppler exploration. Corpus luteum blood flow was defined as random, usually semilunar in appearance, dispersed vessels with very low impedance to blood flow. The resistive index and pulsatility index were calculated. Overall detection rate of corpus luteum blood flow in normal pregnancies was higher for the left ovary (62.6%) than for the right ovary (37.4%) (P < 0.01). The mean resistive and pulsatility indices from corpus luteum blood flow were not influenced by gestational age in normal pregnancy. The overall mean value for for resistive index was 0.452 +/- 0.04 and for pulsatility index 0.636 +/- 0.09. The overall detection rate of corpus luteum in abnormal pregnancies also was higher for the left ovary (56.7%) than for the right ovary (43.4%) (P < 0.01). The mean resistive indices from corpus luteum blood flow in patients with missed abortion was higher than in women with normal pregnancy (P < 0.01). Both resistive and pulsatility indices were higher in patients with incomplete or threatened abortion in comparison with normal pregnancy (P < 0.01). No statistically significant difference was seen in the case of anembryonic, molar, or ectopic pregnancy.     

经阴道彩超检测正常和病理早期妊娠黄体血流状况的探讨

目的观察比较正常和病理早期妊娠中的黄体血流状况,分析其意义。方法采用经阴道彩超声检查215例早期妊娠的孕妇,检出妊娠黄体205例,其中正常早期妊娠组148例、先兆流产组25例、宫外孕组22例,观察卵巢内黄体血流分布特点,检测收缩期峰值流速Vmax)、阻力指数RI及搏动指数PI。结果(()()1经阴道彩超对早期妊娠黄体总检出率95.3%,其中正常组检出率99.38/150);先兆流产组96.1%/26);宫外孕组75.8%(((22/29)。2三组妊娠黄体血流分布特点无差异,均呈连续环状分布。3先兆流产组黄体血流的PVS、PI、RI与正常早期妊娠组比较无差异(P>0.05),宫外孕组病人的黄体血流PVS比正常妊娠组的PVS低(P<0.05),PI、RI与正常组比较无差异(P>0.05)。结论经阴道彩色多普勒超声可以准确地识别妊娠黄体,血流指标中收缩期峰值流速在鉴别正常早孕与宫外孕可能有一定帮助。     

The assessment of normal early pregnancy by transvaginal color Doppler ultrasonography

Transvaginal color Doppler was performed in 198 volunteer pregnant women whose menstrual age ranged from the fifth to the twelfth week. In all patients an attempt was made to obtain signals from both uterine arteries, peritrophoblastic/retroplacental vessels, umbilical arteries, fetal aorta, intracranial vessels, and corpus luteum flow. With the combination of color and pulsed Doppler transvaginal sonography, detection of vascular structures was greatly facilitated and the amount of time for examination significantly reduced. Flow velocity waveforms were measured and results were analyzed by calculation of the Resistance Index. During the early stage of pregnancy, we were able to locate both uterine arteries in all cases and continuous diastolic shift signal was found. Flow in the peritrophoblastic/retroplacental area was observed with an overall success rate of 94%. Blood flow in the umbilical artery and fetal aorta was visualized by color Doppler starting from the seventh week. Intracranial blood flow could be visualized starting from the tenth week in some cases. Diastolic flow in these vessels was detectable starting from the twelfth week. Corpus luteum flow was found in 148 cases (75%) and the Resistance Index decreased as pregnancy progressed © 1993 by John Wiley & Sons, Inc.     

经阴道彩色多普勒超声监测卵泡发育及观察子宫内膜血流变化

目的　观察卵泡发育成熟度及子宫内膜厚度和子宫螺旋动脉血流阻力指数的相互关系。方法 应用经阴道超声监测56例正常月经周期的卵泡发育情况、子宫内膜增殖期厚度及子宫螺旋动脉各项参数。结果　排卵前卵泡直径平均2.1cm,并移至卵巢表面,距卵巢包膜≤1.0cm时即将排卵。子宫内膜相应增厚（达1.4cm),螺旋动脉阻力指数降低(0.45±0.03)。结论　经阴道超声多普勒监测卵泡生长发育,观察子宫内膜厚度及螺旋动脉血流阻力指数,可指导临床提高受孕率。     

经阴道彩色多普勒超声对绝经后期子宫血流动力学的研究

目的 建立绝经后期子宫各段动脉血流参数的正常参考值范围,方法 应用经阴道彩色多勒对46例正常绝经后妇女的子宫动脉（UTA）,弓状动脉（AA）,放射动脉（RA）以及螺旋动脉（SA）的血流分别进行检测,66例正常生育期子宫和5例子宫内膜癌分别作为对照,结果 绝经后期正常子宫内膜面不见血流信号;UTA和RA的阻力指数（RI）随绝经时间的延长而增加。结论 绝经后期的子宫血流灌注减少,且随绝经后时间的延长而更为明显。     

经阴道彩色多普勒超声对排卵期卵巢动脉血流动力学研究

目的 探讨排卵期卵巢动脉在卵泡生长成熟和排卵前后的血流动力学变化.方法 应用经阴道彩色多普勒超声对30例正常生育期妇女（正常对照组）和30例排卵障碍患者（排卵障碍组）进行检查,观察排卵周期中卵巢动脉血流灌注情况,包括收缩期峰值流速（PSV）、舒张末期流速（EDV）、阻力指数（RI）、搏动指数（PI）,并予以对比分析.结果 整个排卵周期中,正常对照组卵巢动脉血流较丰富且随排卵动态改变;排卵障碍组始终呈现血流纤细、低振幅高阻力表现.在排卵前期,正常对照组PSV、EDV高于排卵障碍组（P〈0.01）,RI、PI低于排卵障碍组（P〈0.05）;在排卵期,正常对照组组卵巢动脉血流速度达峰值,PSV、EDV仍高于排卵障碍组（P〈0.01）,RI、PI远低于排卵障碍组（P〈0.01）;在黄体早期,正常对照组流速逐渐下降,RI、PI稍上升,其中EDV仍高于排卵障碍组（P〈0.01）,RI、PI低于排卵障碍组（P〈0.01）;两组差异在排卵期和黄体早期较为明显（P〈0.01）,其中排卵期的卵巢动脉RI〉0.72、PI〉1.50,出现排卵障碍的敏感性及特异性分别为89.5%、83.9%.另外,整个排卵周期正常对照组功能侧卵巢动脉RI、PI分别与对侧卵巢RI、PI相近,差异无统计学意义（P〉0.05）.结论 应用经阴道彩色多普勒超声可分析卵巢动脉血流动力学指标,评价卵泡发育成熟情况,为临床辅助受孕治疗提供可靠依据.     

The assessment of benign uterine tumor vascularization by transvaginal color Doppler.

Transvaginal color flow Doppler was used to study uterine flow and fibroid arterial supply. These studies were carried out in 101 patients with palpable uterine fibroids and 60 women attending the clinic for annual checkups. Blood flow impedance expressed as resistance index (RI), pulsatility index (PI), and blood velocity are calculated from the 5th to the 8th day of the menstrual calendar. Increased blood velocity and decreased RI and PI in both uterine arteries occurred in patients with uterine fibroids. The same technique was also used to study blood flow in the main arteries supplying identifiable fibroid. Diastolic flow in these arteries was always present and increased in comparison with uterine artery blood flow. The difference in uterine artery blood flow between patients with fibroids and healthy volunteers is statistically significant and may have predictable value in growth rate evaluation of the benign uterine mass.     

经阴道彩色多普勒超声在宫腔内残留物鉴别诊断中的应用

目的探讨经阴道超声检查对宫腔内残留物的鉴别诊断价值。方法78例流产后阴道流血超过2周患者,经阴道超声检查发现宫内异常团状回声,观察其二维声像图和团块内、子宫肌壁的彩色血流及多普勒频谱;根据清宫组织病理结果分为绒毛组织、变性的绒毛织组和蜕膜组织,共3组。结果残留绒毛组织为不均匀低回声,变性绒毛组织和脱膜组织为不均匀高回声;残留绒毛组织内部及相邻的子宫肌壁血流信号丰富;变性绒毛组织内部少血流信号,相邻子宫肌壁血流信号丰富;蜕膜组织内部和相邻子宫肌壁少或无血流信号,差异均有统计学意义(P<0.01)。频谱多普勒显示频谱形态以及阻力指数无明显差异(P>0.05),频谱为类滋养血流频谱,阻力指数在0.37~0.45。结论经阴道超声对早孕流产后的宫内残留物可以做出比较明确的诊断,具有鉴别诊断意义。     

经阴道彩色多普勒超声对输卵管炎的声像图分析

目的：探讨经阴道彩色多普勒超声（Transvaginal scaning,Color Doppler flow Image,TVS-CDFI)对不同型输卵管炎的声像图及其意义。方法：应用TVS－CDFI技术对28例不同型输卵管炎患的附件区经阴道二维超声图象、血流显像主流速曲线进分析。结果：总结声像图特征可分为三种类型：（1）输卵管团块型：附件区见形态不规则的稍高回声团块，CDFI示内部可见较丰富的彩色血流信号；（2）输卵管积液积脓型：附件区见扭曲扩张的管状回声区，管壁上见彩色血流信号。（3）输卵管囊肿型：附个区见囊状加声，内见皱襞，呈“车轮”状，皱襞处可见彩色血流信号。结论：TV－CDFI是诊断输卵管炎的有价值的检查手段，其扭曲的输卵管和血流特征具有特殊诊断和鉴别诊断意义。     

Normal uterine arterial blood flow in postmenopausal women assessed by transvaginal color Doppler ultrasonography.

We used transvaginal color Doppler sonography to study uterine artery blood flow velocity waveforms in 345 normal postmenopausal women who had never been on hormone replacement therapy. Our objective was to establish the standard baseline flow values for normal postmenopausal women. The mean pulsatility index was 3.38 +/- 1.04 and the mean resistive index was 0.93 +/- 0.09. There was a positive correlation between arterial blood flow impedance and number of years since menopause. We believe that these levels may become important screening parameters for the detection of endometrial carcinoma in postmenopausal women.     

Prevalence in a volunteer population of pelvic cancer detected with transvaginal ultrasound and color flow Doppler.

Our objective was to find the prevalence of non-symptomatic endometrial and ovarian neoplasms in a volunteer population of women, aged 40 and over. We offered a free volunteer screening program to asymptomatic women for a study using transvaginal ultrasound and color flow Doppler for the detection of pelvic cancer. In the first 2 years, 2117 women were examined, 51.3% post-menopausal. An ovarian cyst was defined as having a maximum diameter of more than 2.4 cm. Color flow was used to identify blood vessels feeding pelvic organs and adnexal enlargements. An abnormal Doppler flow velocity for the ovary was defined as a resistance index of less than 0.41. Ovarian cysts of less than 5 cm with normal Doppler indices were followed up in 6 months to 1 year. An adnexal morphology score was created to quantify the usefulness of this parameter, particularly in postmenopausal women. Indications for surgery were pre-defined as a persistent ovarian cyst of more than 5 cm, a persistent suspicious Doppler and a total endometrial thickness of greater than 0.59 cm in postmenopausal women not taking hormones.A total of 202 women (9.5%) had ovarian cysts. Fourteen women were operated upon because of size criteria, one because of family history and three for persistent abnormal flow. By Doppler study, 15 cysts were predicted to be benign and histology was confirmatory. There were two false positives and one true positive, a stage Ib ovarian cancer. There were no false negatives, although a stage I endometrioid cancer of the ovary was detected 8 months after a negative scan. In those cases in which follow-up data were available, 56% of the cysts regressed in premenopausal women. In postmenopausal women, 28% regressed. Twenty of 1086 postmenopausal women had endometrial biopsies. Three had endometrial cancer, two stage I and one stage IIA. Five had atypical or adenomatous hyperplasia, and seven had benign polyps.So many women have small asymptomatic cysts of the ovary that a major reorientation of physicians' attitudes towards the ovary will have to be introduced to adapt to this new information. In this population, the prevalence of benign epithelial ovarian neoplasms was 7/1000, and of malignancy was 05/1000. In postmenopausal women, the prevalence rate for endometrial cancer was 5/1000, with 5/1000 hyperplasias and 7/1000 benign polyps. When endometrial and ovarian cancer screening are combined, the yield is comparable to that seen in breast and cervical cancer screening.     

经阴道彩色多普勒超声对健康生育期妇女盆腔静脉的研究

目的探讨经阴道彩色多普勒超声(TVCDS)在健康生育期妇女盆腔静脉中的应用价值。方法对30例生育期正常妇女的增生期、分泌期进行经阴道彩色多普勒检测,分别测量宫旁静脉和卵巢周围静脉的内径、流速、静脉丛范围大小。结果①增生期宫旁静脉(PUV)、卵巢周围静脉(POV)显示率分别为90.0%,83.3%,分泌期均为100%。②增生期、分泌期两组PUV、POV的内径、流速及静脉丛范围大小,左右侧间及组间均无显著性差异。③健康生育期妇女盆腔静脉内径、流速、范围分别为(0.30±0.06)cm,(9.82±2.09)cm/s,(1.88±0.35)cm×(1.51±0.32)cm。结论经阴道彩色多普勒超声是检查盆腔静脉的一种有效方法。     

The characterization of uterine tumors by transvaginal color Doppler.

The present study aimed to evaluate the possibility of using transvaginal color Doppler and spectral analysis to differentiate between malignant and benign uterine tumors. This method was performed on 308 patients with uterine tumors before gynecological surgery. The final diagnosis was made following pathological examination of the uterus. There were 291 benign and 17 malignant uterine tumors.Tumor arterial blood flow was detected in 134 (58%) patients with myoma (RI = 0.58 +/- 0.12 SD), 23 (42.6%) patients with adenomyosis (RI = 0.67 +/- 0.14), 12 (92.3%) patients with endometrial carcinoma (RI = 0.34 +/- 0.05)) three (100%) patients with uterine sarcoma (RI = 0.31 +/- 0.03) and in one case (100%) of sarcoma botryoides (RI = 0.33). Blood flow was not detected in patients with endometriotic cysts (n = 6). The comparison of RI between patients with uterine myoma and endometrial cancer showed a significantly lower RI in the cases of endometrial carcinoma (t = 13.5; p < 0.01). Our results showed that transvaginal color Doppler has potential in the non-invasive differentiation of benign and malignant uterine tumors.     

经阴道彩色多普勒对盆腔静脉血流的研究进展

盆腔静脉是一组以静脉丛为特征的静脉血管,没有瓣膜,结构较为薄弱,易受多种因素的影响而发生变化.但是到目前为止,关于盆腔静脉的研究较少,而且内容较为局限,还没有盆腔静脉相关参数正常值的报道.为此我们展开对盆腔静脉的研究,建立盆腔静脉相关参数的正常值,为临床上一些盆腔疾病的诊断提供帮助.     

经阴道彩色多普勒血流显像在盆腔静脉淤血症中的应用

目的评价经阴道彩色多普勒血流显像在盆腔静脉淤血症中的应用价值。方法通过经阴道扫查的二维超声显像、彩色多普勒血流显像,比较了30例正常组和40例盆腔静脉淤血症患者的声像图特征。结果盆腔静脉淤血症患者子宫多呈均匀增大,盆腔内可见走行各异呈蜂窝状的无回声区及“彩球”样彩色血流信号,正常组未见上述改变。结论彩色多普勒血流显像可作为一种简单、方便、无痛苦而又可靠的方法用于盆腔静脉淤血症的诊断。     

Transvaginal color and pulsed Doppler study of uterine blood flow in the first and early second trimesters of pregnancy: normal versus abnormal.

Transvaginal color Doppler ultrasonography was used to study 131 normal early pregnancies, 30 molar pregnancies, 20 threatened abortions, two blighted ova, and five pregnancies with intramural myoma. Four separate parts of the maternal circulation were studied: uterine, arcuate, radial, and spiral arteries. There was statistical difference in the RI and PI among uterine, arcuate, radial, and spiral arteries (P < 0.001) in all observed groups of patients except those with intramural myoma. When the same part of the maternal circulation was compared among different groups of patients, the following results reached statistical significance: uterine artery in normal and molar pregnancy (P < 0.001); arcuate artery in normal and molar pregnancy (P < 0.001); radial artery in normal and molar pregnancy (P < 0.001) and in normal pregnancy and threatened abortion (P < 0.01); spiral artery in normal and molar pregnancy (P < 0.001), in normal pregnancy and threatened abortion (P < 0.01), and in molar pregnancy and threatened abortion (P < 0.01). The standard values of blood flow are different in normal and in some cases of abnormal early pregnancy (molar pregnancy, threatened abortion).     

宫颈淋巴瘤的经阴道彩色多普勒超声表现

宫颈淋巴瘤临床罕见,分为原发性和继发性,最常见的病理学类型是弥漫大B细胞淋巴瘤(diffuse large B-cell lymphoma DLBCL)[1-2]。该病治疗方案及预后与其他宫颈良恶性肿瘤不同,因此治疗前准确诊断至关重要。本组回顾性分析11例经病理证实为宫颈淋巴瘤患者的声像图特征,探讨经阴道超声对其的诊断价值。