The relevance of the topic, chosen for the study, is caused by the lack of clear diagnostic criteria of 3D dopplerography as to evaluating the specific aspects of the blood flow in the benign and malignant tumors of the uterus.
The thesis is concerned with increasing the efficiency of the differential diagnostics of myometrial tumors through improving the existing diagnostic criteria of 3D dopplerography and developing the new ones.
The study is based on the analysis of the results of the examination and treatment of 382 women aged 18 to 75 years at the premises of the State Institution “Institute of Medical Radiology named after S.P. Hryhoryev” of the National Academy of Medical Sciences of Ukraine, who were divided into 2 groups: to the comparison group (D) and the treatment group, consisting of three subgroups (A, B, C).
46 women with adenomyosis became members of the subgroup A, which was 12.04% of the total number of patients. 169 (44.24%) patients with uterine leiomyoma were included in subgroup B. 10 (2.61%) women with leiomyosarcoma became members of the subgroup B. The group D was made by 157 (41.09%) almost healthy women, in whom the investigation of uterine hemodynamics using 3D dopplerography allowed to develop the new nomograms of neck of the uterus as well as to improve the existing nomograms of indicators of the volumetric blood flow (VІ, FІ, VFІ) of body of the uterus.
Clinical, ultrasonic, morphological, histochemical and statistical methods were used in the work.
For the first time, the nomograms of the indicators of the volumetric blood flow (VІ, FІ, VFІ) of neck of the uterus of healthy women of different ages were developed through the 3D reconstruction of the uterus in angio-mode using VОСАLas well as the nomograms of the indicators of the volumetric blood flow (VІ, FІ, VFІ) of body of the uterus of healthy women of different ages were improved.
The data of the regularities of the dynamics of indicators of the three-dimensional indices of the blood flow were obtained compared with the nomograms of the patients, beingill with adenomyosis, uterine leiomyoma and leiomyosarcoma, depending on the age range of the patients, on the volume of body of the uterus, and on the degree of vascularization. The established regularities of the three-dimensional dopplerograms were confirmed by morphological studies of the vascular bed of the surgically removed uteri with different types of myometrium pathology. Based on the findings of 3D dopplerography and vascular morphology, the three-dimensional angiographic differential diagnostic criteria of adenomyosis, uterine leiomyomas and leiomyosarcomas were obtained.
The test sensitivity as to the diagnostics of adenomyosis in the study undertaken accounted for 85,4%, the specificity – 89,2%, the accuary – 88,1%. The test sensitivity as to the diagnostics of leiomyomas in the study undertaken accounted for 87,6%, the specificity – 88,2%, the accuary – 88,7%. The test sensitivity as to the differential diagnostics of uterine leiomyomas and leiomyosarcomas accounted for 82,3%, the specificity – 76,6%, the accuracy -80,1%
Keywords: 3D dopplerography; three-dimensional indices of the volumetric blood flow (VІ, FІ, VFІ), adenomyosis, leiomyoma, leiomyosarcoma.
