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Review
. 2024 Oct;310(4):2023-2033.
doi: 10.1007/s00404-024-07693-x. Epub 2024 Aug 29.

Recommendations for strain elastography of the uterine cervix

Christine Rohr Thomsen  1   2   3 , Maria Strandbo Schmidt Jensen  1   3 , Pinar Bor  2   3 , Mogens Hinge  4 , Puk Sandager  1   3   5 , Niels Uldbjerg  6   7
Affiliations
Review

Recommendations for strain elastography of the uterine cervix

Christine Rohr Thomsen et al. Arch Gynecol Obstet. 2024 Oct.

Abstract

Purpose: Conventional vaginal strain ultrasound elastography, not based on shear-wave elastography imaging, can assess the biomechanical properties of the uterine cervix. This assessment may inform the risks of preterm birth and failed induction of labor. However, there is considerable variation in the approaches to strain elastography, including the placement of the region of interest (ROI). Therefore, our aim was to provide recommendations for cervical elastography.

Methods: We conducted a literature review on (1) elastography principles, and (2) the cervical anatomy. Subsequently, we performed elastography scanning using a Voluson™ E10 Expert scanner with the BT18 software of (3) polyacrylamide hydrogel simulators, and (4) pregnant women.

Results: Increasing the distance between the ROI and probe led to a decrease in the obtained strain value; a 53% decrease was observed at 17.5 mm. Similarly, an increased angle between the ROI and probe-centerline resulted in a 59% decrease for 40° angle. Interposition of soft tissue (e.g., cervical canal) between the ROI and the probe induced an artifact with values from the posterior lip being 54% lower than those from the anterior lip, even after adjusting for probe-ROI distance. Equipment and the recording conductance significantly influenced the results.

Conclusion: Our findings inform recommendations for future studies on strain cervical elastography.

Keywords: Elasticity imaging techniques (E01.370.350.850.270); Induced labor (E04.520.252.968); Ultrasonography (E01.370.350.850); Uterine cervical incompetence (C12.050.351.500.852.593.120); Uterine cervix (A05.360.319.679.256).

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Conflict of interest statement

All authors declare (1) no relationships with companies that might have an interest in the submitted work in the previous 3 years; (2) no financial relationship of their spouses, partners, or children that may be relevant to the submitted work; and (3) no non-financial interests that may be relevant to the submitted work.

Figures

Fig. 1
Fig. 1
Distance to ROI A B-mode image of a simulator made of polyacrylamide hydrogel with the color box superimposed. Three ROIs (⌀ 5 mm) are placed with the center 5.3, 11.5 and 17.5 mm from the probe. B Strain curves obtained from the three ROIs when using roughly one compression per second. C The dots are based on ten recordings like that illustrated in B. Using polynomial regression, the correction function is given by C = 2.803⋅10–3 x2 + 2.675⋅10–2 x + 0.7737, where C is the amplified signal and x is the distance from the probe surface to the center of the ROI, measured in mm
Fig. 2
Fig. 2
Angle from probe centerline. A B-mode image of a simulator made of polyacrylamide hydrogel with the color box superimposed. Three ROIs (⌀ 5 mm) are placed with the center at 0°, 20°, and 40° to the probe-centerline. To study 40° angle-deviations of the ROI, the angle of the color box has been increased from 75° (default) to 100°. B Displays the computed strain values obtained from the three ROIs
Fig. 3
Fig. 3
Anatomic area of interest. A Sagittal view of a hematoxylin and eosin (HE) stained uterine cervix from a pre-menopausal woman, undergoing a hysterectomy because of benign gynecological conditions. B Sagittal view of a cervix at gestational week 12 with a color box superimposed. The anatomic area of interest is marked with red. *Artifact in the anterior vaginal fornix
Fig. 4
Fig. 4
Influence of cervical canal A B-mode image with the color box superimposed onto a uterine cervix at gestational week 12. Three ROIs (⌀ 5 mm) are placed within the anterior cervical lip, in the cervical canal, and in the posterior cervical lip. B Distance-adjusted strain curves obtained from the three ROIs
Fig. 5
Fig. 5
Proposed recommendations. B-mode image with a sagittal view of a cervix at gestational week 38+0 with a color box superimposed
See this image and copyright information in PMC

References

    1. Ekman G, Malmstrom A, Uldbjerg N, Ulmsten U (1986) Cervical collagen: an important regulator of cervical function in term labor. Obstet Gynecol 67(5):633–636 10.1097/00006250-198605000-00006 - DOI - PubMed
    1. Rechberger T, Uldbjerg N, Oxlund H (1988) Connective tissue changes in the cervix during normal pregnancy and pregnancy complicated by cervical incompetence. Obstet Gynecol 71(4):563–567 - PubMed
    1. Romero R, Espinoza J, Erez O, Hassan S (2006) The role of cervical cerclage in obstetric practice: can the patient who could benefit from this procedure be identified? Am J Obstet Gynecol 194(1):1–9 10.1016/j.ajog.2005.12.002 - DOI - PMC - PubMed
    1. Thorsell M, Lyrenas S, Andolf E, Kaijser M (2011) Induction of labor and the risk for emergency cesarean section in nulliparous and multiparous women. Acta Obstet Gynecol Scand 90(10):1094–1099 10.1111/j.1600-0412.2011.01213.x - DOI - PubMed
    1. Goldberg J, Newman RB, Rust PF (1997) Interobserver reliability of digital and endovaginal ultrasonographic cervical length measurements. Am J Obstet Gynecol 177(4):853–858 10.1016/S0002-9378(97)70282-5 - DOI - PubMed

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