Perfusion magnetic resonance imaging in Asherman syndrome

IF 1.4 4区 医学 Q3 OBSTETRICS & GYNECOLOGY
Rebecca Deans, Daniel Moses, Toos Anthony Sach, Thierry Vancaillie, Bill Ledger, Jason A. Abbott
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Abstract

Background

Microvascular scarring compromises the functionality of the endometrium, and vascular flow at the junctional zone (JZ) may be the key to understanding poor reproductive outcomes in women with Asherman syndrome (AS).

Aims

To investigate whether vascular perfusion of the uterus, measured by dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) is impaired in women with intrauterine adhesions (IUA) and AS.

Materials and Methods

A prospective observational cohort pilot study of 23 women with IUA treated with hysteroscopic synecholysis and a control group of two patients with cervix cancer were subject to DCE-MRI with gadolinium to assess uterine vascularity. Twelve regions of interest (ROIs) were allocated on the DCE-MRI image incorporating the JZ, with control ROI placed at the psoas muscle. Individual ROIs were compared to the mean total perfusion (TP) in the same uterus. Pre- and post-operative perfusion analyses were performed on five women. Receiver operator curves (ROC) were used to analyse MRI as a predictor of IUA.

Results

There was no significant difference in perfusion; a trend toward reduced perfusion was observed in women with IUA compared to the controls. The ROC was predictive of higher-grade and inoperable IUA.

Conclusions

Reduced perfusion on DCE-MRI as assessed by ROC predicted higher-stage AS. The results of this study support further investigation of DCE-MRI as a prognostic tool for AS prior to surgical intervention to assist in providing prognostic guidance for women suffering from AS.

Abstract Image

阿瑟曼综合征的灌注磁共振成像。
背景:微血管瘢痕损害了子宫内膜的功能,而交界区(JZ)的血管流动可能是了解阿什曼综合征(AS)妇女不良生殖结局的关键。目的:研究动态对比增强磁共振成像(DCE-MRI)测量的子宫血管灌注在宫腔内粘连(IUA)和AS妇女中是否受损:一项前瞻性观察性队列试验研究对23名接受宫腔镜溶栓术治疗的IUA妇女和两名宫颈癌患者组成的对照组进行了钆剂DCE-MRI检查,以评估子宫血管情况。在结合 JZ 的 DCE-MRI 图像上分配了 12 个感兴趣区(ROI),对照组的 ROI 位于腰大肌。将单个 ROI 与同一子宫的平均总灌注(TP)进行比较。对五名妇女进行了术前和术后灌注分析。使用接收器操作曲线(ROC)分析核磁共振成像对 IUA 的预测作用:结果:灌注量无明显差异;与对照组相比,IUA妇女的灌注量呈下降趋势。ROC可预测更高等级和无法手术的IUA:结论:根据 ROC 评估,DCE-MRI 上的灌注减少可预测较高分期的 AS。本研究的结果支持在手术干预前将DCE-MRI作为强直性脊柱炎的预后工具进行进一步研究,以帮助为患有强直性脊柱炎的妇女提供预后指导。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
3.40
自引率
11.80%
发文量
165
审稿时长
4-8 weeks
期刊介绍: The Australian and New Zealand Journal of Obstetrics and Gynaecology (ANZJOG) is an editorially independent publication owned by the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) and the RANZCOG Research foundation. ANZJOG aims to provide a medium for the publication of original contributions to clinical practice and/or research in all fields of obstetrics and gynaecology and related disciplines. Articles are peer reviewed by clinicians or researchers expert in the field of the submitted work. From time to time the journal will also publish printed abstracts from the RANZCOG Annual Scientific Meeting and meetings of relevant special interest groups, where the accepted abstracts have undergone the journals peer review acceptance process.
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