Diagnostic opportunities of echo elastography in obstetrics and gynecology
The data available in the literature on the use of ultrasound elastography (echo elastography) in obstetrics and gynecology were analyzed. The review included data from studies and meta-analyses available in Pubmed on this topic. Searches were carried out using keywords. Echo elastography is used to diagnose female reproductive tract neoplasms (including malignant ones), ectopic pregnancy, to evaluate the uterine scar, placenta and cervix in various pregnancy complications, and to predict spontaneous preterm birth and outcomes of labor induction. Echo elastography is a method for qualitative and quantitative analysis of the mechanical properties of tissues, which is increasingly being used in everyday obstetric and gynecologic clinical practice.Babich D.A., Baev O.R., Fedotkina E.P., Gus A.I.
Keywords
ultrasound elastography
cervical echo elastography
preparation of the cervix for labor
labor induction
childbirth induction
References
- Осипов Л.В. Технологии эластографии в ультразвуковой диагностике. Медицинский алфавит. 2013; 3-4(23): 5-21. [Osipov L.V. Technologies of elastography in ultrasound diagnostics. Review. Meditsinskiy alfavit. Diagnosticheskaya radiologiya i onkoterapiya 2013; 3-4(23): 5-21.(in Russian)]
- Зыкин Б.И., Постнова Н.А., Медведев М.Е. Ультразвуковая эластография. Медицинский алфавит. 2013; 1-2(10): 14-9. [Zykin B.I., Postnova N.A., Medvedev M.E. Ultrasound elastography (review). Meditsinskiy alfavit. Diagnosticheskaya radiologiya i onkoterapiya. 2013;1-2(10):14-9. (in Russian)]
- Зыкин Б.И., Постнова Н.А., Медведев М.Е. Эластография: анатомия метода. Променева дiагностика, променева терапiя. 2012; 2-3: 107-13. [Zykin B.I., Postnova N.A., Medvedev M.E. Elastogaphy: anatomy of the method. Promeneva diagnostika i terapiya. 2012; 2-3: 107-13. (in Russian)]
- Митьков В.В., Митькова М.Д. Ультразвуковая эластография сдвиговой волной. Ультразвуковая и функциональная диагностика. 2015; 2: 89-103.[Mitkov V.V., Mitkova M.D. Ultrasound shear wave elastography. Ultrasound Functional Diagn. 2015; 2: 89-103. (in Russian)]
- Zhang M., Wasnik A.P., Masch W.R., Rubin J.M., Carlos R.C., Quint E.H., Maturen K.E. Transvaginal ultrasound shear wave elastography for the evaluation of benign uterine pathologies: a prospective pilot study. J. Ultrasound Med. 2019; 38(1):149-55. https://doi.org/10.1002/jum.14676 10.1002/jum.14676.
- Frank M.L., Schäfer S.D., Möllers M., Falkenberg M.K., Braun J., Möllmann U. et al. Importance of transvaginal elastography in the diagnosis of uterine fibroids and adenomyosis. Ultraschall Med. 2016; 37(4): 373-8. https://doi.org/10.1055/s-0035-1553266.
- Czuczwar P., Wozniak S., Szkodziak P., Kudla M.J., Pyra K., Paszkowski T. Elastography improves the diagnostic accuracy of sonography in differentiating endometrial polyps and submucosal fibroids. J. Ultrasound Med. 2019; 38(11): 2389-95. https://doi.org/10.7863/ultra.15.12017
- Xie M., Zhang X., Zhang X., Wang W., Hua K. Can we evaluate the levator ani after Kegel exercise in women with pelvic organ prolapse by transperineal elastography? A preliminary study. J. Med. Ultrason (2001). 2018; 45(3): 437-41. https://doi.org/10.1007/s10396-018-0862-5.
- Xie M., Zhang X., Yu M., Wang W., Hua K. Evaluation of the cervix after cervical conization by transvaginal elastography. J. Ultrasound Med. 2018; 37(5): 1109-14. https://doi.org/10.1002/jum.14457.
- Xie M., Zhang X., Wang W., Hua K. Evaluation of tubal pregnancy after treatment with methotrexate by ultrasound elastography. J. Ultrasound Med. 2018; 37(2): 417-22. https://doi.org/10.1002/jum.14348.
- Гажонова В., Чуркина С., Савинова Е., Хохлова Е., Зубарев А. Соноэластография в диагностике образований яичников. Кремлевская медицина. Клинический вестник. 2014; 3: 31-7. [Churkina S., Gazhonova V., Khokhlova E., Zubarev A. Sonoelastography in diagnostic of ovarian tumors. Kremlevskaya Medicina. Klinicheskiy vestnik. 2014; 3: 31-7.(in Russian)].
- Fawzy M., Amer T. Efficacy of transabdominal sonoelastography in the diagnosis of caesarean section scar endometrioma: a pilot study. J. Obstet. Gynaecol. 2015; 35(8): 832-4. https://doi.org/10.3109/01443615.2015.1011107.
- Churkina S., Fedorova A., Gazhonova V. The value of endovaginal sonoelastography (EVSE) in emergency gynaecological pathology. In: ESR 2011: Book of abstracts. 2011; 2(Suppl. 1): S20, B-070.
- Гажонова В.Е., Белозерова И.С., Воронцова Н.А., Титов Д.С. Соноэластография в диагностике рака эндометрия. Акушерство и гинекология. 2014; 1: 54-8. [Gazhonova V.E., Belozerova I.S., Vorontsova N.A., Titov D.S. Sonoelastography in the diagnosis of endometrial cancer Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2014; 1: 54-58. (in Russian)]
- Lu R., Xiao Y., Liu M., Shi D. Ultrasound elastography in the differential diagnosis of benign and malignant cervical lesions. J. Ultrasound Med. 2014; 33(4): 667-71. https://doi.org/10.7863/ultra.33.4.667.
- Bakay O.A., Golovko T.S. Use of elastography for cervical cancer diagnostics. Exp. Oncol. 2015; 37(2): 139-45.
- Mabuchi S., Sasano T., Kuroda H., Takahashi R., Nakagawa S., Kimura T. Real-time tissue sonoelastography for early response monitoring in cervical cancer patients treated with definitive chemoradiotherapy: preliminary results. J. Med. Ultrason (2001). 2015; 42(3): 379-85. https://doi.org/10.1007/s10396-015-0616-6.
- Чуркина С.О., Савинова Е.Б., Хохлова Е.А., Антошечкина М.А., Гажонова В.Е., Зубарев А.В. Соноэластография в ранней диагностике внематочной беременности. Кремлевская медицина. Клинический вестник. 2009; 3: 37-40. [Churkina S.O., Savinova E.B., Khoklova E.A., Antoshechkina M.A., Gazhonova V.E., Zubarev A.V. Sonoelastography in early diagnostic of ectopic pregnancy. Kremlevskaya Medicina. Klinicheskiy vestnik. 2009. 3. 37-40. (in Russian)].
- Краснова И.А., Шишкина Т. Ю., Аксенова В.Б. Ультразвуковая эластография – критерии диагностики трубной беременности. Ультразвуковая диагностика. 2017; 3: 32. [Krasnova I.A., Shishkina T.Yu., Aksenova V.B. Ultrasound strain elastography – criteria for diagnosis of tubal pregnancy. Ultrasound diagnostic. 2017, 3. 32.(in Russian)].
- Xie M., Zhang X., Wang W., Hua K. Evaluation of tubal pregnancy after treatment with methotrexate by ultrasound elastography. J. Ultrasound Med. 2018; 37(2): 417-22. https://doi.org/10.1002/jum.14348.
- Stanziano A., Caringella A.M., Cantatore C., Trojano G., Caroppo E., D’Amato G. Evaluation of the cervix tissue homogeneity by ultrasound elastography in infertile women for the prediction of embryo transfer ease: a diagnostic accuracy study. Reprod. Biol. Endocrinol. 2017; 15: 64. https://doi.org/10.1186/s12958-017-0283-0.
- Öcal F.D., Çekmez Y., Erdoğdu E., Gezer M., Fanuscu İ., Özkan H. et al. The utility of cervical elastosonography in prediction of cervical insufficiency: cervical elastosonography and cervical insufficiency. J. Matern. Fetal Neonatal Med. 2015; 28(7): 812-8. https://doi.org/10.3109/14767058.2014.933801.
- Seliger G., Chaoui K., Lautenschläger C., Jenderka K.V., Kunze C., Hiller G.G.R., Tchirikov M. Ultrasound elastography of the lower uterine segment in women with a previous cesarean section: Comparison of in-/ex-vivo elastography versus tensile-stress-strain-rupture analysis. Eur. J. Obstet. Gynecol. Reprod. Biol. 2018; 225: 172-80. https://doi.org/10.1016/j.ejogrb.2018.04.013.
- Wozniak S., Szkodziak P.R., Czuczwar P., Wozniakowska E., Milart P., Paszkowski M., Paszkowski T. P25.17: Elastographic evaluation of caesarean section uterine scar may be useful in identifying patients with high risk of uterine scar dehiscence. Ultrasound Obstet. Gynecol. 2014; 44(Suppl. 1): 336. (Abstracts of the 24th World Congress on Ultrasound in Obstetrics and Gynecology, Barcelona, Spain. 14-17 September, 2014.)
- Юсупов К.Ф., Недопекина Е.В., Вихарева О.Н. Применение метода эластографии в акушерско-гинекологической практике. Акушерство и гинекология. 2016; 11: 22-7. [Yusupov K.F., Nedopekina E.V., Vikhareva O.N. Use of elastography in obstetric and gynecologic practice. Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2016; (11): 22-7 2014; 3: 31-7. (in Russian)] https://doi.org/10.18565/aig.2016.11.22-7.
- Приходько А.М., Баев О.Р., Луньков С.С., Еремина О.В., Гус А.И. Эхографические и эластографические характеристики состояния матки в зависимости от техники восстановления ее целости при кесаревом сечении. Акушерство и гинекология. 2016; 1: 48-54. https://doi.org/10.18565/aig.2016.1.48-54. [Prikhodko A.M., Baev O.R., Lunkov S.S., Eremina O.V., Gus A.I. Echographic and elastographic characteristics of the uterus in relation to its integrity recovery techniques after cesarean section. Akusherstvo i ginekologiya/Obstetrics and Gynecology. 2016; (1): 48-54. (in Russian)] https://doi.org/10.18565/aig.2016.1.48-54.
- Hasegawa T., Kuji N., Notake F., Tsukamoto T., Sasaki T., Shimizu M. et al. Ultrasound elastography can detect placental tissue abnormalities. Radiol. Oncol. 2018; 52(2): 129-35. https://doi.org/10.2478/raon-2018-0024.
- Arioz Habibi H., Alici Davutoglu E., Kandemirli S.G., Aslan M., Ozel A., Kalyoncu Ucar A. e7 al. I. In vivo assessment of placental elasticity in intrauterine growth restriction by shear-wave elastography. Eur. J Radiol. 2017; 97: 16-20. https://doi.org/10.1016/j.ejrad.2017.10.007.
- Ohmaru T., Fujita Y., Sugitani M., Shimokawa M., Fukushima K., Kato K. Placental elasticity evaluation using virtual touch tissue quantification during pregnancy. Placenta. 2015; 36(8): 915-20. https://doi.org/10.1016/j.placenta.2015.06.008.
- Karaman E., Arslan H., Çetin O., Şahin H.G., Bora A., Yavuz A. et al. Comparison of placental elasticity in normal and pre‐eclamptic pregnant women by acoustic radiation force impulse elastosonography. J. Obstet. Gynaecol. Res. 2016; 42(11): 1464-70. https://doi.org/10.1111/jog.13078.
- Alan B., Tunç S., Agacayak E., Bilici A. Diagnosis of pre‐eclampsia and assessment of severity through examination of the placenta with acoustic radiation force impulse elastography. Int. J. Gynecol. Obstet. 2016; 135(1): 43-46. https://doi.org/10.1016/j.ijgo.2016.03.037.
- Cetin O., Karaman E., Arslan H., Akbudak I., Yıldızhan R., Kolusarı A. Acoustic radiation force impulse elastosonography of placenta in maternal red blood cell alloimmunization: a preliminary and descriptive study. Med. Ultrason. 2017; 19(1): 73-8. https://doi.org/10.11152/mu-924.
- Wu S., Nan R., Li Y., Cui X., Liang X., Zhao Y. Measurement of elasticity of normal placenta using the Virtual Touch quantification technique. Ultrasonography. 2016; 35(3): 253-7. https://doi.org/10.14366/usg.16002.
- Davie S., Wong W.L., Clapham T., Angstetra D., Narayan R. Could Elastography be used in the prediction of morbidly adherent placentation? Case Rep. Obstet. Gynecol. 2016; 2016: 4909431. https://doi.org/10.1155/2016/4909431.
- Akins M.L., Luby-Phelps K., Bank R.A., Mahendroo M. Cervical softening during pregnancy: regulated changes in collagen crosslinking and composition of matricellular proteins in the mouse. Biol. Reprod. 2011; 84(5): 1053-62. https://doi.org/10.1095/biolreprod.110.089599.
- Celik E., To M., Gajewska K., Smith G.C., Nicolaides K.H.; Fetal Medicine Foundation Second Trimester Screening Group. Cervical length and obstetric history predict spontaneous preterm birth: development and validation of a model to provide individualized risk assessment. Ultrasound Obstet. Gynecol. 2008; 31(5): 549-54. https://doi.org/10.1002/uog.5333.
- Souka A.P., Papastefanou I., Michalitsi V., Papadopoulos G.K., Kassanos D. A predictive model of short cervix at 20–24 weeks using first-trimester cervical length measurement and maternal history. Prenat. Diagn. 2011; 31(2): 202-6. https://doi.org/10.1002/pd.2683.
- Hernandez-Andrade E., Hassan S.S., Ahn H., Korzeniewski S.J., Yeo L., Chaiworapongsa T., Romero R. Evaluation of cervical stiffness during pregnancy using semiquantitative ultrasound elastography. Ultrasound Obstet. Gynecol. 2013; 41(2): 152-61. https://doi.org/10.1002/uog.12344.
- Garra B.S. Elastography: current status, future prospects, and making it work for you. Ultrasound Q. 2011; 27: 177-86. https://doi.org/10.1097/RUQ.0b013e31822a2138.
- Myers K., Socrate S., Tzeranis D., House M. Changes in the biochemical constituents and morphologic appearance of the human cervical stroma during pregnancy. Eur. J. Obstet. Gynecol. Reprod. Biol. 2009; 144(1): S82-9. https://doi.org/10.1016/j.ejogrb.2009.02.008.
- Fuchs T., Woytoń R., Pomorski M., Wiatrowski A., Slejman N. et al. Sonoelastography of the uterine cervix as a new diagnostic tool of cervical assessment in pregnant women – preliminary report. Ginekol. Pol. 2013; 84: 12-16.
- Preis K., Swiatkowska-Freund M., Pankrac Z. Elastography in the examination of the uterine cervix before labor induction. Ginekol. Pol. 2010; 81(10): 757-61.
- Molina F.S., Gómez L.F., Florido J., Padilla M.C., Nicolaides K.H. Quantification of cervical elastography: a reproducibility study. Ultrasound Obstet. Gynecol. 2012; 39(6): 685-9. https://doi.org/10.1002/uog.11067.
- Диомидова В.Н., Захарова О.В., Петрова О.В., Сиордия А.А. Ультразвуковая эластография (компрессионная и сдвиговой волной) в акушерстве и гинекологии. Вопросы гинекологии, акушерства и перинатологии. 2016; 2: 52-8. [Diomidova V.N., Zakharova O.V., Petrova O.V., Siordiya A.A. Ultrasound (compression and shear wave) Elastography in obstetrics and gynaecology. Voprosy ginekologii, akušerstva i perinatologii. 2016; 15: 52-58. (in Russian)]. https://doi.org/10.20953/1726-1678-2016-2-52-58.
- Ono T., Katsura D., Yamada K., Hayashi K., Ishiko A., Tsuji S. et al. Use of ultrasound shear‐wave elastography to evaluate change in cervical stiffness during pregnancy. J. Obstet. Gynaecol. Res., 2017; 43(9): 1405-10.https://doi.org/10.1111/jog.13379.
- Muller M., Aït-Belkacem D., Hessabi M., Gennisson J.L., Grangé G., Goffinet F. et al. Assessment of the cervix in pregnant women using shear wave elastography: a feasibility study. Ultrasound Med. Biol. 2015; 41(11): 2789-97.https://doi.org/10.1016/j.ultrasmedbio.2015.06.020.
- Woźniak S., Czuczwar P., Szkodziak P., Wrona W., Paszkowski T. Elastography for predicting preterm delivery in patients with short cervical length at 18-22 weeks of gestation: a prospective observational study. Ginekol. Pol. 2015;86(6): 442-7.
- Meyberg-Solomayer G., Gerlinger C., Hamza A., Schlaegel F., Takacs Z., Solomayer E.F. Cervical strain elastography in pregnancy and association with maternal factors. Ultraschall Med. 2017; 38(1): 71-7.https://doi.org/10.1055/s-0034-1398991.
- Sabiani L., Haumonte J.B., Loundou A., Caro A.S., Brunet J., Cocallemen J.F. et al. Cervical HI-RTE elastography and pregnancy outcome: a prospective study. Eur. J. Obstet. Gynecol. Reprod. Biol. 2015; 186: 80-4.https://doi.org/10.1016/j.ejogrb.2015.01.016.
- Hee L., Sandager P., Petersen O., Uldbjerg N. Quantitative sonoelastography of the uterine cervix by interposition of a synthetic reference material. Acta Obstet. Gynecol. Scand. 2013; 92(11): 1244-9. https://doi.org/10.1111/aogs.12246.
- Fruscalzo A., Londero A.P., Fröhlich C., Möllmann U., Schmitz R. Quantitative elastography for cervical stiffness assessment during pregnancy. Biomed. Res. Int. 2014; 2014: 826535. https://doi.org/10.1155/2014/826535.
- Agarwal S., Agarwal A., Joon P., Saraswat S., Chandak S. Fetal adrenal gland biometry and cervical elastography as predictors of preterm birth: A comparative study. Ultrasound. 2018; 26(1): 54-62.https://doi.org/10.1177/1742271X17748515.
- Oturina V., Hammer K., Möllers M., Braun J., Falkenberg M.K., de Murcia K.O. et al. Assessment of cervical elastography strain pattern and its association with preterm birth. J. Perinat. Med. 2017; 45(8): 925-32. https://doi.org/10.1515/jpm-2016-0375.
- Hernandez-Andrade E., Maymon E., Luewan S., Bhatti G., Mehrmohammadi M., Erez O. et al. A soft cervix, categorized by shear-wave elastography, in women with short or with normal cervical length at 18–24 weeks is associated with a higher prevalence of spontaneous preterm delivery. J. Perinat. Med. 2018; 46(5): 489-501. https://doi.org/10.1515/jpm-2018-0062.
- Kaouther D., Olivier A. Elastography assessment of the cervix during cervical maturation. Tunis Med. 2014; 92(7): 448-51.
- Gultekin S., Gultekin I.B., Icer B., Yilmaz E., Alkan A., Kucukozkan T. Comparison of elastosonography and digital examination of cervix for consistency to predict successful vaginal delivery after induction of labor with oxytocin. J. Matern. Fetal Neonatal Med. 2017; 30(23): 2795-9. https://doi.org/10.1080/14767058.2016.1263296.
- Swiatkowska-Freund M., Preis K. Cervical elastography during pregnancy: clinical perspectives. Int. J. Womens Health. 2017; 9: 245-54. https://doi.org/10.2147/IJWH.S106321.
- Pereira S., Frick A.P., Poon L.C., Zamprakou A., Nicolaides K.H. Successful induction of labor: prediction be preinduction cervical length, angle of progression and cervical elastography. Ultrasound Obstet. Gynecol. 2014; 44(4): 468-75. https://doi.org/10.1002/uog.13411.
- Sonnier L., Bouhanna P., Arnou C., Rozenberg P. Elastography of cervix to predict delay from induction to delivery. Gynecol. Obstet. Fertil. 2014; 42(12): 827-31. https://doi.org/10.1016/j.gyobfe.2014.10.005.
- Londero A.P., Schmitz R., Bertozzi S., Driul L., Fruscalzo A. Diagnostic accuracy of cervical elastography in predicting labor induction success: a systematic review and meta-analysis. J. Perinat. Med. 2016; 44(2): 167-78.https://doi.org/10.1515/jpm-2015-0035..
Reсeived 06.02.2019
Accepted 22.02.2019
About the Authors
Dmitry A. Babich, postgraduate student of Chair of Obstetrics, Gynecology, Perinatology and Reproductology, Faculty of Postgraduate Professional Training of Physicians of the Federal State Autonomous Educational Institution of Higher Education I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University). +7 (903) 2950505. E-mail: babich.d@rambler.ru8-2 Trubetskaya st., Moscow 119991, Russia; 2-4 Bolshaya Pirogovskaya st., 119991 Moscow, Russia
Baev Oleg R., M.D., Professor, the head of the 1-st maternity department, National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V.I. Kulakov of the Ministry of Healthcare of the Russian Federation, professor of Chair of Obstetrics, Gynecology, Perinatology and Reproductology, Faculty of Postgraduate Professional Training of Physicians of the Federal State Autonomous Educational Institution of Higher Education I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University). Tel: +7 (495) 438-11-88. E-mail: o_baev@oparina4.ru https://orcid.org/0000-0001-8572-1971
117997, Russia, Moscow, Ac. Oparina str. 4.
Fedotkina Elena P., doctor of the department of ultrasound and functional diagnostics, National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V.I. Kulakov of the Ministry of Healthcare of the Russian Federation. E-mail: e_fedotkina@oparina4.ru. 117997, Russia, Moscow, Oparina str. 4.
Gus Alexander I., M.D., Professor, National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V.I. Kulakov of the Ministry of Healthcare of the Russian Federation. E-mail: aleksandr_gus@mail.ru https://orcid.org/0000-0003-1377-3128. 117997, Russia, Moscow, Ac. Oparina str. 4.
For citations: Babich D.A., Baev O.R., Fedotkina E.P., Gus A.I. Diagnostic opportunities of echo elastography in obstetrics and gynecology. Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2019; (7): 5-12 (in Russian).
http://dx.doi.org/10.18565/aig.2019.7.5-12