自动乳腺容积超声测量腹直肌间距临床价值的初步研究

Clinical value of automated breast ultrasound in measuring inter‐rectus distance: A preliminary study

摘要

目的：探讨自动乳腺容积超声（ABUS）跨领域应用于腹直肌间距（IRD）测量的技术可行性、性能优势及临床价值，并与传统手持超声（HHUS）对比分析。方法：选取2024年1—3月于四川省妇女儿童医院接受IRD测量的无孕产史健康女性志愿者40例，由3名不同职称医师分别采用ABUS和HHUS，在静息状态及卷腹状态下测量脐上5 cm、3 cm、2 cm、脐部、脐下2 cm、3 cm共6个点位的IRD。采用独立样本t检验比较两种技术的操作时间和图像质量，采用Mann-Whitney U检验分析ABUS与HHUS两种方法IRD测量值有无差异，采用组内相关系数（ICC）评价医师间测量一致性。结果：ABUS操作时间为（3.76±0.46）min，显著短于HHUS的（6.13±0.55）min（t=17.18，P<0.001）；ABUS图像质量评分（4.55±0.49），显著高于HHUS（4.12±0.62）（t=-3.07，P=0.005）。两种方法在6个测量点位的IRD值比较，差异均无统计学意义（均P>0.05）。ABUS组医师间一致性（静息状态ICC: 0.907~0.976，卷腹状态ICC: 0.838~0.955）优于HHUS组（静息状态ICC: 0.725~0.924，卷腹状态ICC: 0.796~0.911）。结论：本研究首次将ABUS跨领域应用于IRD测量，其准确性与HHUS等效，且医师间一致性更优，兼具操作高效、图像质量优异的优势，是一种适用于腹直肌分离的大规模筛查、精准临床评估及长期随访的新方法。

Abstract

Objective: To explore the technical feasibility, performance advantages, and clinical value of the cross-application of automated breast ultrasound (ABUS) in measuring the inter-rectus abdominis distance (IRD), and to compare it with traditional hand-held ultrasound (HHUS). Methods: Forty nulliparous healthy female volunteers who participated in IRD measurement from January to March 2024 were enrolled. Three physicians with different professional titles measured IRD at 6 points (5 cm, 3 cm, and 2 cm above the umbilicus; the umbilicus; and 2 cm and 3 cm below the umbilicus) in the resting and curl-up states using both ABUS and HHUS. The independent samplest-test was used to compare the operation time and image quality between the two techniques; the Mann-Whitney U test was applied to analyze the differences in IRD measurements between ABUS and HHUS; and the intraclass correlation coefficient (ICC) was used to evaluate inter-observer measurement consistency among physicians. Results: The operation time of ABUS was (3.76±0.46) min, which was significantly shorter than that of HHUS (6.13±0.55) min (t=17.18, P<0.001). The image quality score of ABUS was (4.55±0.49), which was significantly higher than that of HHUS (4.12±0.62) (t=-3.07, P=0.005). There were no statistically significant differences in the IRD values between the two methods at the 6 measurement points (all P>0.05). The inter-observer consistency in the ABUS group (ICC: 0.907-0.976 in the resting state; ICC: 0.838-0.955 in the curl-up state) was superior than that in the HHUS group (ICC: 0.725-0.924 in the resting state, ICC: 0.796-0.911 in the curl-up state). Conclusion: This study is the first to apply ABUS for IRD measurement. ABUS demonstrates measurement accuracy equivalent to that of HHUS, along with superior inter-observer reliability, standardized scanning protocols, operational efficiency, and enhanced image quality. This technique is suitable for large-scale screening, accurate clinical assessment, and long-term follow-up of diastasis recti abdominis.

关键词

自动乳腺容积超声 / 腹直肌间距 / 腹直肌分离 / 跨领域应用 / 技术性能 / 临床价值

Key words

Automated Breast Ultrasound / Inter-Rectus Distance / Diastasis Recti Abdominis / Cross-Domain Application / Technical Performance / Clinical Value

参考文献

[1] 李光兴, 申英末 . 腹直肌分离症的外科诊疗研究进展[J]. 中华疝和腹壁外科杂志(电子版), 2021, 15(1): 4-7.

[2] LI G X, SHEN Y M. Research progress on diagnosis and surgical treatment of diastasis rectus abdominis[J]. Chin J Hernia Abdom Wall Surg Electron Ed, 2021, 15(1): 4-7.

[3] LIN S S, LU J J, WANG L L, et al. Prevalence and risk factors of diastasis recti abdominis in the long-term postpartum: A cross-sectional study[J]. Sci Rep, 2024, 14(1): 25640.

[4] LI M R, WANG N N, WANG R, et al. Ultrasonographic evaluation of diastasis recti abdominis and its association with pelvic floor dysfunction in postpartum women: A cross-sectional study of a two-year retrospective cohort[J]. Front Med, 2024, 11: 1441127.

[5] ZHU Y, JIANG L Y, YE T T, et al. Risk factors and patient-reported outcomes in Chinese women with postpartum diastasis recti abdominis: An observational study[J]. Int J Women's Health, 2024, 16: 179-192.

[6] 孙秀丽, 李环, 苏园园, 等 . 产后腹直肌分离诊断与治疗的专家共识[J]. 中国妇产科临床杂志, 2021, 22(2): 220-221.

[7] SUN X L, LI H, SU Y Y, et al. Expert consensus on diagnosis and treatment of postpartum rectus abdominis separation[J]. Chin J Clin Obstet Gynecol, 2021, 22(2): 220-221.

[8] SPERSTAD J B, TENNFJORD M K, HILDE G, et al. Diastasis recti abdominis during pregnancy and 12 months after childbirth: Prevalence, risk factors and report of lumbopelvic pain[J]. Br J Sports Med, 2016, 50(17): 1092-1096.

[9] REINPOLD W, KÖCKERLING F, BITTNER R, et al. Classification of rectus diastasis—A proposal by the German hernia society (DHG) and the international endohernia society (IEHS)[J]. Front Surg, 2019, 6: 1.

[10] VAN DE WATER A T M, BENJAMIN D R. Measurement methods to assess diastasis of the rectus abdominis muscle (DRAM): A systematic review of their measurement properties and meta-analytic reliability generalisation[J]. Man Ther, 2016, 21: 41-53.

[11] 李莉, 邓燕梅, 丘青, 等 . 高频超声在产前和产后腹直肌检查中的应用研究[J]. 中国中西医结合影像学杂志, 2021, 19(6): 576-579.

[12] LI L, DENG Y M, QIU Q, et al. Application of high-frequency ultrasound in the changes of rectus abdominis before and after childbirth[J]. Chin Imag J Integr Tradit West Med, 2021, 19(6): 576-579.

[13] NANIKAWA W, MIYAZAKI J. Intra-rater reliability of measurement of abdominal perimuscular connective tissue thickness on ultrasound images[J]. J Phys Ther Sci, 2021, 33(1): 32-36.

[14] TAN L N, RAN S Z, DONG H M, et al. Ultrasonic characteristics of diastasis recti abdominis in early postpartum[J]. Comput Math Methods Med, 2022, 2022: 3273911.

[15] THEODORSEN N M, FERSUM K V, MOE-NILSSEN R, et al. Effect of a specific exercise programme during pregnancy on diastasis recti abdominis: Study protocol for a randomised controlled trial[J]. BMJ Open, 2022, 12(2): e056558.

[16] CHEN H J, LIN Y H, CAI Y Y, et al. Evaluation of rectus abdominis muscle using high-frequency ultrasound and shear wave elastography to construct a risk prediction model for postpartum low back pain[J]. Acad Radiol, 2025, 32(2): 899-906.

[17] 刘菲菲, 石岩, 李殿城, 等 . 基于高频超声的正常未育女性腹直肌间距测量及其相关因素分析[J]. 临床超声医学杂志, 2021, 23(5): 390-392.

[18] LIU F F, SHI Y, LI D C, et al. Measurement of inter-rectus distance in normal nulliparous women based on high frequency ultrasound and analysis of its correlated factors[J]. J Clin Ultrasound Med, 2021, 23(5): 390-392.

[19] OPALA-BERDZIK A, RUDEK-ZEPRZAŁKA M, NIESPOREK J, et al. Technical aspects of inter-recti distance measurement with ultrasonographic imaging for physiotherapy purposes: The scoping review[J]. Insights Imaging, 2023, 14(1): 92.

[20] 江庆, 顾军, 冯冠男, 等 . 产后42~60 d腹直肌间距的超声参考值范围[J]. 中华医学超声杂志(电子版), 2021, 18(11): 1067-1072.

[21] JIANG Q, GU J, FENG G N, et al. Reference range of inter-recti distance measured by ultrasonography at 42-60 days postpartum[J]. Chin J Med Ultrasound Electron Ed, 2021, 18(11): 1067-1072.

[22] 南淑良, 刘菲菲, 穆靓, 等 . 高频超声测量产后女性腹直肌间距的重复性[J]. 中国医学影像学杂志, 2021, 29(9): 920-923.

[23] NAN S L, LIU F F, MU L, et al. Repeatability of measurement of inter-rectus distance in postpartum women via high frequency ultrasound[J]. Chin J Med Imag, 2021, 29(9): 920-923.

[24] 邵黎阳, 王睿丽, 赵琼蕊, 等 . 高频超声评价无孕产史育龄女性腹直肌间距的影响因素[J]. 中国医学影像学杂志, 2022, 30(5): 490-493.

[25] SHAO L Y, WANG R L, ZHAO Q R, et al. Influencing factors of inter-rectus distance in women of childbearing age without a history of pregnancy: A high-frequency ultrasound study[J]. Chin J Med Imag, 2022, 30(5): 490-493.

[26] MENG Z Y, CHEN C, ZHU Y T, et al. Diagnostic performance of the automated breast volume scanner: A systematic review of inter-rater reliability/agreement and meta-analysis of diagnostic accuracy for differentiating benign and malignant breast lesions[J]. Eur Radiol, 2015, 25(12): 3638-3647.

[27] KWON B R, CHANG J M, KIM S Y, et al. Utility and diagnostic performance of automated breast ultrasound system in evaluating pure non-mass enhancement on breast magnetic resonance imaging[J]. Korean J Radiol, 2020, 21(11): 1210-1219.

[28] 宋灿许, 马菁菁, 李逢生, 等 . 自动乳腺容积成像与手持超声对触诊阴性乳腺的诊断价值比较[J]. 中国医学影像学杂志, 2021, 29(1): 39-41.

[29] SONG C X, MA J J, LI F S, et al. Automated breast ultrasound and handheld ultrasound in diagnosing palpation negative breast: A comparative study[J]. Chin J Med Imag, 2021, 29(1): 39-41.

[30] LIN X, JIA M M, ZHOU X, et al. The diagnostic performance of automated versus handheld breast ultrasound and mammography in symptomatic outpatient women: A multicenter, cross-sectional study in China[J]. Eur Radiol, 2021, 31(2): 947-957.

[31] 王思琪, 邢萍, 张春梅, 等 . 常规超声联合自动乳腺容积成像对乳腺非肿块型病变良恶性的诊断价值[J]. 中华医学超声杂志(电子版), 2025, 22(3): 253-260.

[32] WANG S Q, XING P, ZHANG C M, et al. Diagnostic value of conventional ultrasound combined with automated breast volume scanning in breast non-mass lesions[J]. Chin J Med Ultrasound Electron Ed, 2025, 22(3): 253-260.

[33] 李丛, 黄备建, 李艺, 等 . 医用超声设备浅表基础成像图像质量对比评价[J]. 中国医疗设备, 2020, 35(2): 12-17.

[34] LI C, HUANG B J, LI Y, et al. Comparative evaluation of image quality of superficial basic imaging of medical ultrasonic equipment[J]. China Med Devices, 2020, 35(2): 12-17.

[35] 中国超声医学工程学会仪器工程开发专业委员会, 中国抗癌协会肿瘤影像专委会, 中华医学会超声医学分会浅表组织与血管学组 . 自动乳腺容积超声技术专家共识(2022版)[J]. 中国超声医学杂志, 2022, 38(3): 241-247.

[36] Chinese Ultrasonic Medical Engineering Society (CUMES) Professional Committee of Instrument Engineering and Development, Chinese Anti-Cancer Association (CACA) Specialized Committee of Tumor Imaging, Chinese Medical Association (CMA) Ultrasonic Medicine Branch Superficial Tissue and Vascular Group. Expert consensus on automatic breast volume ultrasound technology (2022 edition)[J]. Chin J Ultrasound Med, 2022, 38(3): 241-247.

基金资助

成都市医学科研项目(2023508)