Analysis of shear wave elastography and elastometry results in the endometrial pathology diagnosis in patients with secondary infertility

Abstract

Aim. To analyze the results of the application and to study the effectiveness of ultrasound shear wave elastography and elastometry in the endometrial pathology diagnosis in secondary infertility.Methods. Multiparameter ultrasound with shear wave elastography and elastometry modes (Shear Wave Elastography) was performed in 146 women of reproductive age (Aixplorer scanner, Supersonic Imagine, France). The main group (N1) included 101 women with secondary infertility: 43 patients with tuberculous lesions of the uterus, 58 - with chronic endometritis without concomitant tuberculosis. The control group (N2) included 45 healthy women: 22 nulliparous women, 23 - parous women. Age of examined women ranged from 24 to 48 years, mean age in N1 group was 34.4±2.6 years, in N2 group - 33.9±2.9 years.Results.. Depending on the nature of the pathology elastographic cards of examined women in the main group differed in color. Elastographic cards of blue-green range of low intensity dominated in patients with chronic endometritis. In patients with tuberculous lesions of the uterus unevenly colored, non-homogeneous, high intensity, from green to yellow and red in color-grade elastographic cards were determined. Endometrial stiffness values in patients with chronic endometritis and in tuberculous lesions of the endometrium (31.7±4.3 and 89.7±5.7 kPa, respectively) were significantly higher than that in healthy women (16.5±1.0 kPa, pConclusion. The presented analysis indicates the feasibility of the shear wave elastography and elastometry application in multiparameter ultrasound study of the uterus and adnexa in the diagnostic algorithm of patients with secondary infertility.

Quantitative Sonoelastographic Assessment of the Normal Uterus Using Shear Wave Elastography: An Initial Experience

“…The mean elasticity value for endometrium was 25.54 AE 8.56 kPa. There was only 1 study, by Diomidova et al, 14 that reported the elasticity characteristics of the normal endometrium, in which 46 healthy women were assessed by SWE, and a mean elasticity of 16.5 AE 1.0 kPa for the endometrium was found. The same equipment was used in their study, with a similar scale and Q-box size for measuring the elasticity values as in our study.…”

Sonoelastography evaluation in the diagnosis of endometrial pathology combined with chronic endometritis in infertile women

“…In contrast to HE, estrogen dependence of endometrial polyposis is also questionable, and the inflammatory theory comes to the fore, which has put forward a scientific position on the existence of two different pathogenetic types of endometrial polyposis – hormone-dependent and inflammatory ones [ 12 , 13 , 17 – 19 ], in which both bring changes in the immune system, inflammatory factors and hormonal disorders [ 3 , 10 , 14 – 16 ]. In the literature, the influence of persistent chronic inflammatory process of both bacterial and viral etiology on the development of female proliferative diseases is discussed, which activates angiogenesis, alteration of tissue by mast cells, pathological proliferation, and initiates further progression of endometrial pathology [ 11 , 21 , 24 , 26 ]. The etiological theory of polyp formation is ambiguous; issues of their prevention remain controversial when, according to scientific studies, the growth of polyps may be caused by the ovarian pathology (polycystic ovary syndrome, chronic inflammatory process of the uterine appendages, stromal tekomatosis), which can stimulate and support proliferative processes in the endometrium [ 11 , 21 , 24 , 25 ].…”

“…In the literature, the influence of persistent chronic inflammatory process of both bacterial and viral etiology on the development of female proliferative diseases is discussed, which activates angiogenesis, alteration of tissue by mast cells, pathological proliferation, and initiates further progression of endometrial pathology [ 11 , 21 , 24 , 26 ]. The etiological theory of polyp formation is ambiguous; issues of their prevention remain controversial when, according to scientific studies, the growth of polyps may be caused by the ovarian pathology (polycystic ovary syndrome, chronic inflammatory process of the uterine appendages, stromal tekomatosis), which can stimulate and support proliferative processes in the endometrium [ 11 , 21 , 24 , 25 ].…”

“…Publications using this technology in the algorithm of uterine examination are inconsiderable in number in the available literature nowadays. Among them, there are studies evaluating the Young modulus of the uterus in normal and pathological conditions, publications on the assessment of endometrial and myometrial elasticity in healthy women and the diagnosis of uterine tuberculosis, data on the analysis of morphological changes in the structure of the myometrium in adenomyosis [ 24 , 25 , 28 ]. This study demonstrates the feasibility of this diagnostic method for patients with uterine factor infertility.…”

“…In recent years, the so-called micromanipulation technologies, such as endoscopy have been actively introduced, significantly increasing the accuracy of diagnosis and effectiveness of ART programs. The search for an optimal combination of different ultrasound techniques (colour Doppler mapping, energy Doppler mapping, and 3D mode) for maximum accurate visualization of the structural parameters of the endometrium is currently in progress [ 24 – 26 ]. In recent years, according to the results of Belozerova (2016), compression sonoelastography has been used to improve the informativeness of the ultrasound picture of endometrial pathology, which allows supplementing the standard approach, especially in the case of combined HPE pathology with adenomyosis and uterine leiomyoma, which often reduces the diagnosis by 7–10% [ 14 , 24 , 25 , 27 , 28 ].…”