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© 2005 by the American Institute of Ultrasound in Medicine
J Ultrasound Med 24:1091-1098 • 0278-4297

Endometrial Volume and Vascularity Measurements by Transvaginal 3-Dimensional Ultrasonography and Power Doppler Angiography in Stimulated and Tumoral Endometria

An Interobserver Reproducibility Study

Juan Luis Alcázar, MD, Luis T. Mercé, MD, Manuel García Manero, MD, Santiago Bau, MD and Guillermo López-García, MD

Department of Obstetrics and Gynecology, Clínica Universitaria de Navarra, School of Medicine, University of Navarra, Pamplona, Spain (J.L.A., M.G.M., G.L.-G.); and Department of Obstetrics and Gynecology, Hospital Ruber Internacional, Madrid, Spain (L.T.M., S.B.).

Address correspondence to Juan Luis Alcázar, MD, Department of Obstetrics and Gynecology, Clínica Universitaria de Navarra, Avenida Pio XII 36, 31008 Pamplona, Spain. E-mail: jlalcazar{at}unav.es

Objective. The purpose of this study was to evaluate interobserver reproducibility of endometrial volume and vascular indices of the endometrium and subendometrial area estimated by 3-dimensional power Doppler angiography (3D-PDA) using the Virtual Organ Computer-Aided Analysis program, determining the influence of the endometrial growth etiology on measurements. Methods. Forty women underwent 3D-PDA ultrasonography. Group A comprised 25 women scanned on the day after controlled ovarian stimulation with human chorionic gonadotropin. Group B comprised 15 patients who had uterine bleeding and questionable endometrial thickening. (Histologic evaluation revealed 10 endometrial cancers and 5 endometrial hyperplasias.) A single observer examined all patients and acquired all volume data sets. Forty volume data sets were then analyzed with the Virtual Organ Computer-Aided Analysis program by 2 different observers. Endometrial volume and vascularity indices (vascularization index [VI], flow index [FI], and vascularization flow index [VFI]) of the endometrium and subendometrium were manually calculated in the coronal plane with a 9° rotation step. An intraclass correlation coefficient (ICC) was used to assess interobserver reliability. Results. Endometrial volume was more reproducible in group A (ICC = 0.98) than in group B (ICC = 0.58) (P < .05). Endometrial and subendometrial VI, FI, and VFI also presented good reproducibility with ICC greater than 0.84. The ICC was not statistically different for endometrial and subendometrial VI, FI, and VFI according to patient group, although subendometrial VFI was less reproducible in group B (ICC = 0.53) than in group A (ICC = 0.88). Conclusions. Endometrial volume and endometrial and subendometrial 3D power Doppler indices have acceptable reproducibility. The interobserver reproducibility in tumoral endometrium was more similar than in stimulated endometrium. Our results indicate that 3D-PDA is a reliable method to evaluate physiologic and pathologic endometrial changes.

Key Words: endometrium • power Doppler angiography • reproducibility • 3-dimensional ultrasonography

Abbreviations: ART, assisted reproduction techniques • CI, confidence interval • FI, flow index • FSH, follicle-stimulating hormone • ICC, intraclass correlation coefficient • IVF, in vitro fertilization • 3D, 3-dimensional • 3D-PDA, 3-dimensional power Doppler angiography • VFI, vascularization flow index • VI, vascularization index • VOCAL, Virtual Organ Computer-Aided Analysis




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