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Abstract Objective To analyze the interobserver and intraobserver reproducibility of the visualization and continuity of the juncional zone (JZ) by three-dimensional (3D) ultrasound in infertile women, and to evaluate the sociodemographic, hormonal, and structural factors that influence these assessments. Methods A prospective study conducted at the Assisted Reproductive Technology Unit of Hospital Senhora da Oliveira, in the city of Guimarães, Portugal. Transvaginal 3D ultrasonography was performed, and 2 volumes were generated per case. Two observers who were blinded to each other's work analyzed these volumes, choosing the best coronal section. Four months later, one of the observers performed the same methodology. The JZ visualization was classified as optimal, satisfactory, and unsatisfactory, and the JZ continuity, as continuous and discontinuous. The interobserver and intraobserver agreements were analyzed. The influence of hormonal, structural, and sociodemographic factors on the JZ was evaluated. Results In total, 65 women were included in the present study. The interobserver reproducibility was substantial for JZ visualization and continuity (k = 0.635 and 0.753 respectively), and the intraobserver reproducibility was very good for JZ visualization and continuity (k = 0.884 and 0.816 respectively). Trilaminar endometrial pattern was associated with optimal JZ visualization (p = 0.012). The increase of 1 unit in the level of serum estradiol represents a 9.9% decrease in the odds of unsatisfactory visualization of the JZ (odds ratio [OR] = 0.9; 95% confidence interval [95%CI] = 0.814-0.996; p = 0.042). Endometriosis increases the odds of unsatisfactory visualization by 24 times (OR = 23.7; 95%CI = 1.262-437.057; p = 0.034). The prevalence of discontinuous JZs was of 60%. Myomas and endometriosis were associated with discontinuous JZs (p = 0.034 and 0.016 respectively). Conclusion The assessment of JZ visualization and continuity by 3D ultrasound is reproducible enough to be used in the clinical practice.
Resumo Objetivo Analisar a reprodutibilidade inter e intraobservador da visualização e continuidade da zona juncional (ZJ) por ecografia tridimensional (3D) em mulheres inférteis, e avaliar os fatores sociodemográficos, hormonais e estruturais que afetam essas avaliações. Métodos Um estudo prospectivo conduzido no Centro de Procriação Medicamente Assistida do Hospital Senhora da Oliveira, em Guimarães, Portugal. Foi realizada ecografia transvaginal 3D e gerados 2 volumes por caso. Dois observadores, cegos às avaliações um do outro, analisaram os volumes obtidos e escolheram o melhor corte coronal. Após quatro meses, a mesma análise foi realizada por um dos observadores. A visualização da ZJ foi classificada como ótima, satisfatória e não satisfatória, e a continuidade, como contínua ou descontínua. Foram avaliadas as reprodutibilidades inter e intraobservador. A influência de fatores sociodemográficos, hormonais e estruturais na ZJ foi analisada. Resultados No total, 65 mulheres foram incluídas no presente estudo. A reprodutibilidade interobservador foi substancial para a visualização e continuidade da ZJ (k = 0,635 e 0,753, respetivamente). A reprodutibilidade intraobservador foi muito boa para a visualização e continuidade da ZJ (k = 0,884 e 0,816, respetivamente). Endométrio trilaminar associou-se à visualização ótima da ZJ (p = 0.012). O aumento de 1 unidade no nível de estradiol diminuiu a chance de visualização não satisfatória da ZJ em 9,9% (razão de probabilidades [RP] = 0,9; intervalo de confiança de 95% [CI95%] = 0,814-0,996; p = 0,042). Endometriose aumentou a chance de visualização não satisfatória da ZJ em 24 vezes (RP = 23,7; CI95% = 1,262-437,057; p = 0,034). A prevalência de ZJs descontínuas foi de 60%. Miomas e endometriose associaram-se a ZJs descontínuas (p = 0,034 e 0,016, respetivamente). Conclusão A avaliação da visualização e continuidade da ZJ por ecografia 3D é reprodutível, podendo ser utilizada na prática clínica.
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Humans , Female , Adult , Young Adult , Endometrium/diagnostic imaging , Infertility, Female , Myometrium/diagnostic imaging , Observer Variation , Prospective Studies , Reproducibility of Results , Ultrasonography , Imaging, Three-DimensionalABSTRACT
Objective To investigate the value of abnormal thickening of the junctional zone, and T1 weighted imaging (WI) and (or) T2WI hyperintense in magnetic resonance imaging (MRI) for the diagnosis of uterine adenomyosis. Methods The MRI images of 37 cases of adenomyosis confirmed by pathology in Changhai Hospital of Navy Medical University (Second Military Medical University) from Jan. 2013 to Jan. 2016 were retrospectively analyzed, and 37 cases of normal uterus and ovary confirmed by MRI in the same period were randomly selected as controls. The maximal junctional zone thickness (JZmax), the difference between the smallest and largest junctional zone thickness (JZdiff), and the ratio of JZmax to maximal myometrium thickness (JZmax/ Mmax) were measured and compared between the two groups. The receiver operating characteristic (ROC) curve of each parameter in diagnosis of adenomyosis was drawn, and the area under curve (AUC), cut-off value, sensitivity, specificity and accuracy were calculated. In addition, the T1WI and T2WI hyperintense and their types in the uterine wall were observed. Results There were significant differences in JZmax, JZdiff and JZmax/Mmax between the adenomyosis and control groups (all P<0.01). The AUC for the diagnosis of adenomyosis by JZmax JZdiff, and JZmax/Mmax were 0.95, 0.90, and 0.85, respectively. When JZmax≥10 mm, the sensitivity, specificity and accuracy were 78.8%, 97.3% and 88.6%, respectively; when JZdiff≥3.4 mm, those were 81.8%, 91.9% and 87.1%, respectively; When JZmax/Mmax≥61%, those were 72.7%, 83.8% and 78.6%, respectively. Eighteen cases (48.6%) had only T2WI hyperintense, while 14 cases (37.8%) had both T1WI and T2WI hyperintense; most of them showed snowdrift sign on T1WI and (or) T2WI. T1WI and (or) T2WI showed linear stripe sign in 5 cases (13.5%), microcapsule sign in 5 cases (13.5%), and cystic hemorrhage syndrome in 1 case (2.7%). Conclusion JZmax≥10 mm, JZdiff≥3.4 mm and JZmax/Mmax≥61% have significant diagnostic value in diagnosis of adenomyosis, and JZmax has the best diagnostic efficiency. Snowdrift sign, linear stripe sign, microcapsule sign and cystic hemorrhage sign on T1WI and (or) T2WI are unique for the diagnosis of adenomyosis. Comprehensive evaluation of the above signs can improve the diagnostic value of MRI and early accurate diagnosis of adenomyosis.
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Objective To investigate the influence of degree of the injury in uterine junctional zone (JZ) of intrauterine adhesions (IUAs) patients on postoperative pregnancy outcomes by magnetic resonance imaging (MRI). Methods Design: Retrospective observational study. Setting: Navy General Hospital of PLA, Beijing. The study included ninety-two patients undergoing preoperative pelvic MRI from June 2011 to June 2014, and they were diagnosed as IUA by hysteroscopy, and hysteroscopic adhesiolysis was conducted under the guidance of abdominal ultrasound. All patients had tried to be pregnant for longer than six months. According to whether uterine junctional zone (JZ) was injured or not, the patients were divided into two groups: group A (JZ was normal) and group B (JZ was partly or completely injured). All patients were followed up with telephone comunication regarding postoperative pregnancy outcome within two weeks in August 2015. The difference of severity of IUAs and pregnancy outcome was compared. Results There were 51 and 41 IUAs cases in Group A and Group B, respectively. According to European Society of Gynecological Endoscopy (ESGE) classification of IUAs, the number of mild, moderate and severe IUA cases were 20, 24 and 7, respectively, in group A; and 10, 12 and 19, respectively, in group B. The proportion of severe IUA cases was significantly higher in group B than in group A (P=0.001). Forty-six of 92 IUAs cases had been pregnant, the pregnancy rate was 50%. Among them 4 had conceived twice. Twenty-one IUAs had given live birth (one had given birth to a pair of twins), and 10 were in pregnancy. The live-birth delivery rate was 42%, and the pregnancy loss rate was 38%. Thirty-one and fifteen IUAs had been pregnant in group A and group B respectively, the pregnancy rate was higher in group A than in group B (60.8% vs 36.6%, P=0.021). The live-birth delivery rate was higher in group A than in group B (47.1% vs 31.3%, P=0.365), while the pregnancy loss rate was higher in group B than in group A (29.4% vs 56.3%, P=0.117), but the difference was not statistically significant. Conclusions The severity of IUAs was associated with the degree of injury of uterine JZ. Especially, when JZ was completely injured, it was meant to have severe IUAs. For IUAs, injured uterine JZ may significantly decrease the postoperative pregnancy rate and live-birth delivery rate, and increase in the pregnancy loss rate. Evaluation of JZ may offer new perspectives to estimate the severity of IUA and the outlook of pregnancy. So it is recommended to evaluate the degree of injury of uterine JZ as an independent predictor for postoperative pregnancy outcome of IUAs. For severe IUAs, once JZ was extensively or completely injured, the outcome of pregnancy may be very poor.
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Objective To study the ultrastructural features of myocytes in uterine junctional zone (JZ).Methods From August 2010 to August 2013,there were 16 pre-menopause patients who suffered from cervical neoplasm to be performed hysterectomy.Samples of JZ and outer myometrium (OM) of hysterectomy specimens were collected.There were 8 specimens from the proliferative-phase and 8 specimens from the secretory-phase of endometrium.Ultrastructural features of JZ and OM were examined by using transmission electron microscopy and the related indices of myocytes were compared by using Student's t test.Results At JZ,there were more cytoplasmic process in the myocytes.The myocytes of JZ exhibited significant difference compared with those of OM.Firstly,the contractile structural components,such as the dense patches,dense bodies and the myofilaments were less abundant.In contrast,the perinuclear cell organelles were more distinct.The mitochondria,endoplasmic reticulum and Golgi apparatus were more prominent,denoting active protein synthesis.Secondly,the mean diameter of cell and nuclei demonstrated cyclic change.In proliferative phase of endometrium,the cell diameters of JZ and OM were (4.70_±0.52) and (4.69± 1.20) μm,respectively,which there were no significant difference(P=0.987).While in secretory phase,the cell diameters of JZ and OM were (3.75±0.36) and (4.92±0.51) μm,which there were significant difference (P=0.006).In proliferative phase,the nuclei diameters of JZ and OM were (3.24±0.41) and (2.90±0.62) μm,and in secretory phase,the nuclei diameters of JZ and OM were (2.44±0.27) and (2.92±0.44) μm.There were no significantly different in both phases (P=0.374,P=0.097).The diameters of cell and nuclei had cyclical changes (P ＜ 0.05).However,the cyclical changes were absent in OM (P＞ 0.05).Thirdly,the myofilaments/cytoplasm ratio of JZ in proliferative and secretory phases were 0.27±0.04 and 0.34±0.03,which were significantly less than those of OM in respective phases (0.49±0.03and 0.54±0.03;P=0.000,P=0.000).The myofilaments/cytoplasm ratio exhibited cyclical changes in JZ (P=0.029),but in OM,the cyclical changes were absent (P=0.083).Conclusions Compared with OM,ultrastructures associated with synthetic organelles are prominent,whereas the contractile organelles are reduced.And there are the cyclical changes in ultrastructural characteristics.The ultrastructural features of JZ are the basis of its physiology.
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Objective To establish a method for isolation, culture, and identification of stem cells in uterine junctional zone (uJZSCs). Methods Specimens of uterus muscle layer at uterine junctional zone (uJZ) were harvested under aseptic condition, and they digested, cultivated and amplified using trypsogen and collagenase. The morphology of uJZSCs was observed with inverted microscope, and cell viability and phenotype were analyzed by flow cytometry. The adipogenic, osteogenic and chondrogenic differentiation was induced in vitro, and their biological growth characteristic was identified by CCK-8 marking. Results The cells were adhered after passage, and they presented long spindle in shape. Flow cytometry showed that the expressions of CD90, CD73, CD105, CD29, CD44, CD13, CD166, and HLA-ABC marking was also positive, while they were negative for CD34, CD45, CD14, HLA-DR and CD19. The CCK-8 growth curve was S-shaped. The induced differentiation experiments indicated that uJZSCs could be induced into osteoblast, adipocyte and chondrocytes. Conclusion uJZSCs possess a strong proliferation capacity, and they might become a new source of mesenchymal stem cells.
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A adenomiose frequentemente teve papel pouco valorizado na etiologia de várias doenças ginecológicas, provavelmente devido a grande dificuldade diagnóstica. Ao longo dos anos, seu diagnóstico ocorria por suspeição ou por achado em peças cirúrgicas de histerectomias. Exames de imagem começaram a ajudar no diagnóstico precoce desta patologia, como ultrassonografia transvaginal, histerossonografia, elastossonografia e, principalmente, ressonância magnética, através da determinação da espessura da zona juncional. Outros exames, como tomografia computadorizada, biópsia miometrial e dosagem de CA-125, não demonstram a mesma acurácia. O tratamento, que até recentemente se restringia à histerectomia, começa a apresentar novas opções como os agonistas e antagonistas do GnRH, os contraceptivos contínuos, danazol, dispositivos intrauterinos medicados, inibidores de aromatase, além de procedimentos mais conservadores como a embolização da artéria uterina, a adenomiomectomia e a ressecção parcial de adenomiose combinada à oclusão da artéria uterina por via laparoscópica.