A Study of Endometrial Pathology by Transvaginal Color Doppler Ultrasonography and its Correlation with Histopathology in Post-menopausal Women.

Objective: Endometrial carcinoma is the most common gynaecological malignancy. Approximately 80% of endomentrial carcinoma occur in post-menopausal women. Present study aimed to evaluate the role of transvaginal ultrasonography and colour flow imaging in diagnosing endometrial pathologies especially endometrial carcinoma and later its confirmation by histopathology. Methods: 38 women presenting with history of at least 6 months amenorrhoea followed by bleeding per vaginum were included in the study. Transvaginal colour Doppler (TVS) followed by fractional curettage was done in all cases and cervical biopsy was done in selected cases. Uterine size, endometrial thickness and blood flow indices (RI, PI) were measured. Analysis of data was done using ‘z’ test and ‘t’ test. Results: Out of 38 women maximum number of cases (39.47%) were between 50 – 55 years. Using 4 mm of endometrial thickness as cut off value for discriminating normal and abnormal endometrium, sensitivity, specificity, PPV and NPV were 94.12%, 50%, 95.12% and 50% respectively (p < 0.05). No case of endometrial carcinoma was detected when the endometrium was <4 mm, making the sensitivity as 100%, NPV 100%, specificity 13.33% and PPV 23.53%. Using RI = 0.81 as cut off value for discriminating benign and malignant endometrium, sensitivity was 62.5%, specificity 53.33%, PPV – 26.3% and NPV as 84.2%. Conclusion: Transvaginal sonographic (TVS) evaluation of endometrial thickness (ET) is a reliable method of screening women with post-menopausal bleeding. Conservative approach may be offered to women showing ET of less than 4 mm and high impedance to flow in uterine and endometrial vessels.

Color doppler study of the subendometrial area [junctional zone] of the uterus in unexplained infertility

A case control study aiming to study endometrial perfusion and receptivity in unexplained infertility as it is simple and is available in many radiological clinics. Thirty-five cases of unexplained infertility and 16 fertile females were submitted, in the midluteal phase of the menstrual cycle; to Color Doppler study of the subendometrial area which is the inner most part of the myometrium, 5 mm outside the echogenic basal layer of the endometrium. Study of vascularization of this area showed that, blood flow was detected in 51.4% of the group of unexplained and 93.8% of the control group. The difference is statistically significant. Mean pulsatility index [P1] in the subendometrial arteries, if detected by color flow mapping was 2.65 +/- 0.37 in unexplained infertility and 1.95 +/- 0.24 in control group. The difference is statistically significant. The mean peak systolic velocity [PSV] in the subendometrial arteries in unexplained infertility was 0.29 +/- 0.0, 02 m/second and in the control group was 0.42 +/- 0.03 m/second. The difference is statisically significant. Our color Doppler study of the uterine arteries showed also that P1, resistance index [RI] are higher and PSV was lower in unexplained infertility than in control ferile group. Our study showed that in midluteal phase of the menstrual cycle in patients with unexplained infertility blood perfusion of the subendometrial area was impaired. Blood perfusion of the endometrium was also impaired as the blood supply to it passes through the subendometrium area. A possible treatment of these patients is uterine perfusion enhancers as sildenafil [Viagra], low dose aspirin and glyceryl trinitrate

Predicting endometrium receptivity with parameters of spiral artery blood flow / 华中科技大学学报（医学）（英德文版）

In order To evaluate whether the parameters of spiral artery blood flow, as measured by transvaginal color Doppler, may be used to assess endometrium receptivity prior to embryo transfer (ET), a retrospective study of 94 infertile women who had undergone ART treatments with different outcomes (pregnant or nonpregnant) was done. Subendometrial blood flow was evaluated. The resistance index (RI), systolic/diastolic ratio (S/D) and pulsatility index (PI) were significantly lower in those who achieved pregnancy as compared with those who did not: 0.62+/-0.04 vs 0.68+/-0.04 (P0. 2, PI>1. , and S/D>3. , no pregnancy occurred. These data suggest that the parameters of spiral artery blood flow could be used as a new assay in predicting endometrial receptivity before ET.

Anginogenesis of eutopic and ectopic endometria in endometriosis / 华中科技大学学报（医学）（英德文版）

In order to study the angiogenesis in endometriosis, the samples of eutopic and ectopic endometria from patients with endometriosis were quantitatively analyzed by color morphometric image system (CMIS) for vascular surface area, and by examining endometrial blood vessel for microvessel density (MVD). The results showed that within each menstrual phase the vascular surface area and MVD were significantly higher in ectopic endometria with endometriosis than those in eutopic endometria with endometriosis or normal endometrium (P < 0.05). It is concluded that angiogenesis might be involved in the development of endometriosis.