非增强常规盆腔超声应用2024年SRU静态共识标准诊断深部子宫内膜异位症的多读者研究
本研究回顾性分析118例因慢性盆腔痛疑诊子宫内膜异位症的女性，由4名放射科医生用2024年SRU共识中的静态（非动态）标准评估常规盆腔超声图像。卵巢子宫内膜瘤的敏感度61-77%、特异度84-93%、准确率73-82%，读者间一致性中等（Fleiss kappa 0.742）；深部盆腔子宫内膜异位症观察的读者间一致性低（Fleiss kappa 0.002）。结论认为常规盆腔超声对卵巢子宫内膜瘤可靠，但对深部子宫内膜异位症性能有限，需加做增强盆腔超声技术并加强培训。
要点
- 常规盆腔超声对卵巢子宫内膜瘤诊断可靠，敏感度61-77%、特异度84-93%。
- 深部盆腔子宫内膜异位症观察的读者间一致性低（Fleiss kappa 0.002）。
- 静态SRU标准用于常规盆腔超声对深部子宫内膜异位症性能有限。
核心结论
- 常规盆腔超声应用2024年SRU非动态共识观察对卵巢子宫内膜瘤可靠，但对深部盆腔子宫内膜异位症性能有限。
研究设计与样本
- 单中心回顾性IRB批准研究，纳入2018年9月至2024年3月因慢性盆腔痛疑诊子宫内膜异位症的18-55岁女性118例。
- 4名放射科医生使用2024年SRU共识中的静态（非动态）标准评估常规盆腔超声图像，排除需动态手法的观察（如滑动征）。
- 参考标准由独立专家读者基于盆腔MRI、腹腔镜和组织病理学建立。
诊断标准与关键数值
- 卵巢子宫内膜瘤的敏感度61-77%、特异度84-93%、准确率73-82%（p<0.001）。
- 卵巢子宫内膜瘤读者间一致性中等，Fleiss kappa为0.742（95%CI：0.65,0.822）。
- 深部盆腔子宫内膜异位症观察的读者间一致性低，Fleiss kappa为0.002（95%CI：-0.007,0.081）。
临床应用与阅片要点
- 日常阅片可依据2024年SRU静态标准识别卵巢子宫内膜瘤，但报告深部子宫内膜异位症观察需谨慎。
- 对高疑诊深部子宫内膜异位症患者，建议加做增强盆腔超声技术并加强读者培训。
局限性
- 单中心回顾性设计。
- 仅评估常规盆腔超声图像，未包含需动态手法的观察。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
英文原文（摘要）· 点击展开
RATIONALE AND OBJECTIVES: To decrease the existing diagnostic delay of pelvic endometriosis, the Society of Radiologists in Ultrasound (SRU) has proposed consensus criteria using augmented pelvic ultrasound (APU) technique and reporting guidelines based on specific observations. We examined the feasibility of detecting pelvic endometriosis observations by retrospectively applying the static SRU criteria to nonaugmented routine pelvic ultrasound (RPU) performed in everyday practice.
MATERIALS AND METHODS: This single-center retrospective institutional review board (IRB)-approved study included women (18-55 yrs), with RPU performed for chronic pelvic pain and suspicion of endometriosis, between September 2018 to March 2024. Four radiologists evaluated RPU images using the static or non-dynamic 2024 SRU consensus criteria excluding those that required dynamic maneuvers including the sliding sign. Ground truth was established by an independent expert reader using pelvic magnetic resonance imaging (MRI), laparoscopy, and histopathology. Fleiss' and quadratic weighted Kappa for inter-reader agreement and sensitivity; specificity and accuracy for each observation were calculated.
RESULTS: In 118 women (median age, 37 years [Interquartile range (IQR), 30.0-43.8 years]), the sensitivity, specificity and accuracy for ovarian endometrioma (OMA) was 61-77%; 84-93%; 73-82%; p < 0.001. Inter-reader agreement for OMA was moderate (Fleiss' kappa of 0.742 [95% CI: 0.65,0.822]) and for deep pelvic endometriosis (DE) observations was low (Fleiss' kappa of 0.002 [95% CI: -0.007, 0.081]).
CONCLUSION: RPU, although reliable for OMA, has limited performance for DE in a high suspicion patient even if 2024 SRU non-dynamic consensus observations are applied, highlighting the importance of adding APU to RPU and reader training, for early detection of endometriosis.
引用
- Shenoy-Bhangle AS, Ghosh S, Mercaldo SF, et al. Performance of Nonaugmented Routine Pelvic Ultrasound for Deep Endometriosis Using Static 2024 SRU Consensus Criteria: A Multireader Study. Acad Radiol. 2026. PMID: 42062107. doi:10.1016/j.acra.2026.04.010
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。