实时剪切波弹性成像在评估子宫内膜容受性中的初步应用

背景　子宫内膜容受性是在胚胎着床前，内膜能够使胚胎正常着床的一种综合情况。近年来，超声对子宫内膜容受性的研究成为热点，但既往多倾向于对内膜厚度、回声和血流的研究，随着超声新技术的发展，子宫内膜弹性有望成为内膜容受性研究的新方向。目的　利用实时剪切波弹性成像技术对子宫内膜进行定量测量，对比分析容受期与增殖期子宫内膜弹性模量值的差异，探讨实时剪切波弹性成像在评估子宫内膜容受性中的应用价值。方法　选择2018年1—12月在温州市人民医院门诊行卵泡监测的备孕妇女80例，分别在内膜增殖期和容受期对其行二维超声和实时剪切波超声弹性成像检查，获取并比较两个时相的内膜回声类型、内膜厚度以及内膜平均弹性模量值，进行相关性分析。结果　80例女性的子宫内膜在增殖期主要表现为均匀低回声的三线征，容受期主要表现为均匀高回声。增殖期和容受期内膜厚度和内膜平均弹性模量值分别为7.0（6.0，8.0）mm、（25.7±4.4）kPa及11.0（10.0，12.8） mm、（9.4±2.7）kPa。容受期内膜厚度高于增殖期，容受期内膜平均弹性模量值低于增殖期（P<0.05）。内膜厚度与内膜平均弹性模量值之间呈负相关（rs=-0.849，P<0.05）。不同回声类型内膜平均弹性模量值比较，差异有统计学意义（P<0.05）。结论　实时剪切波弹性成像能定量评估子宫内膜弹性，间接反映内膜时相，结合内膜厚度及回声类型，能为不孕症患者内膜容受性的评估提供新的诊断思路。

Preliminary Application of Real-time Shear Wave Elastography in Evaluating Endometrial Receptivity

Background Endometrial receptivity is a comprehensive condition that makes the endometrium receptive to normal embryo implantation.In recent years,ultrasonic research of endometrial receptivity has become a hot topic,but mainly focuses on endometrial thickness,echo and blood flow.With the development of ultrasonic technology,the tissue elastic properties of endometrium is expected to be a new direction in the study of endometrial receptivity.Objective To explore the value of realtime shear wave elastography(SWE)in evaluating endometrial receptivity by comparatively analyzing the elastic modulus of endometrium in receptive and proliferative phases measured quantitatively with real-time SWE.Methods Participants were 80 women who underwent outpatient follicle monitoring for preparing for a healthy pregnancy in Wenzhou People's Hospital during January to December,2018.The mean echo type,thickness,and elastic modulus of receptive endometrium and proliferative endometrium measured with both real-time SWE and two-dimensional ultrasound were analyzed comparatively,and the relationship of mean thickness with elastic modulus was explored with Spearman correlation analysis.Results The endometrium of 80 women showed three-line sign in proliferative phase and homogenous hyperechoicity in receptive phase.Receptive endometrium had thicker mean endometrial thickness〔11.0(10.0,12.8)mm vs 7.0(6.0,8.0)mm〕and lower mean elastic modulus〔(9.4±2.7)kPa vs(25.7±4.4)kPa〕than proliferative endometrium(P<0.05).There was a negative correlation between the mean value of the endometrial thickness and elastic modulus(rs=-0.849,P<0.05).The mean elastic modulus varied significantly by echo types(P<0.05).Conclusion Endometrial elasticity,thickness and type of echoes quantitatively measured by real-time SWE may indirectly reflect the temporal phase of endometrial mesenchymal,and may provide a new perspective for evaluating endometrial receptivity in infertility patients.