Junctional Zone in Infertile Women: A Three-dimensional Ultrasound Study

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.

【摘要】 目的：分析不孕女性经三维（three-dimensional, 3D）超声观察连接带（junctional zone, JZ）的可视化程度与连续性的观察者间及观察者内可重复性，并评估影响上述评估结果的社会人口学、激素及结构相关因素。方法：本研究为前瞻性研究，于葡萄牙吉马良斯市圣拉奥菲奥里亚医院辅助生殖技术科开展。所有受试者均接受经阴道三维超声检查，每位受试者生成2份超声容积数据。两名采用盲法、互不了解对方评估结果的观察者分别独立分析上述容积数据，选取最佳冠状切面。4个月后，其中一名观察者重复实施相同的分析流程。将JZ可视化程度分为优、满意、差三个等级，JZ连续性分为连续与不连续两类。分析观察者间及观察者内一致性，并评估激素、结构及社会人口学因素对JZ评估结果的影响。结果：本研究共纳入65名女性受试者。观察者间一致性方面，JZ可视化程度与连续性的kappa值分别为0.635与0.753，均为实质性一致；观察者内一致性方面，JZ可视化程度与连续性的kappa值分别为0.884与0.816，均为极佳一致。三层子宫内膜模式与JZ优等级可视化显著相关（p=0.012）。血清雌二醇水平每升高1个单位，JZ可视化程度不佳的比值比降低9.9%（比值比（odds ratio, OR）=0.9，95%置信区间（95%CI）=0.814~0.996；p=0.042）。子宫内膜异位症可使JZ可视化程度不佳的风险升高24倍（OR=23.7；95%CI=1.262~437.057；p=0.034）。JZ不连续的患病率为60%。子宫肌瘤与子宫内膜异位症均与JZ不连续显著相关（p分别为0.034与0.016）。结论：经三维超声评估JZ可视化程度与连续性的可重复性良好，足以应用于临床实践。