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Objective:To develop a simple, practical and repeatable ultrasound method to locate the muscle at the trigger point of female myofascial pelvic pain(MPP), which can provide imaging reference for clinical precision treatment.Methods:A total of 113 patients with suspected MPP who came to the Women′s Hospital School of Medicine Zhejiang University from September 1, 2021 to April 20, 2023 were prospectively selected. The gynecologist performed internal examination with index finger on some pelvic floor muscles (puborectalis, pubococcygeus, iliococcygeus, coccygeus) and pelvic wall muscles (piriformis and obturator internus) respectively, searched for the muscles where the pain trigger point was located, and scored the pain by referring to visual analogue scale (VAS) and numerical rating scale (NRS), and then referred the patients to the ultrasound department. The ultrasound doctor used transvaginal ultrasound to display the above muscle groups in real time for observation and appropriate pressure. The muscle where the painful trigger point was located was found through tenderness and the pain score was performed. The two scores were compared for consistency and difference analysis.Results:The trigger point was clear and of good reproducibility. For the location and score of pain trigger points located in bilateral puborectalis, pubococcygeus and coccygeus, there was a strong consistency between the tenderness guided by vaginal ultrasound probe and clinical palpation (the consistency rate was ≥70%), and there was no significant difference in the pain scores of the trigger points located in the puborectalis muscle and coccygeal muscle between the two methods ( P>0.05), and there was statistically significant difference in the pain scores of the trigger points located in the other pelvic floor and pelvic wall muscles (all P<0.05). At the same time, ultrasonic examination made up for the deficiency of clinical palpation in the evaluation of piriformis muscle. Conclusions:The present method for finding the trigger point of MPP guided by the ultrasound probe is a new non-invasive, safe, simple and practical imaging method, which can provide a new imaging reference for the clinical diagnosis of MPP and the formulation of treatment strategies.
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Objective To explore the value of shear wave elastrography (SWE) in diagnosis of prostate cancer.Methods SWE quantitative elastography was preformed in 55 patients with suspected prostate cancer,to obtain the elastic modulus (mean,maximum).Each patient underwent sonography-guided prostatic biopsy on the same day.With the pathologic results as reference,ROC curves were used to assess diagnostic performance.Results ①Pathological tests showed that 39 lesions were benign(hyperplasia) and 16 lesions were malignant.The mean elasticity value of benign lesions was (39.04 ± 8.22) kPa,and the maximum value was (54.10 ± 9.18)kPa,whereas of malignant ones were (53.31 ± 3.92)kPa and (68.71 ±2.57)kPa,respectively (P ＜0.05).② The area under the ROC curve (AZ) of the maximum and mean elasticity value was 0.951 and 0.944.Taking 48.07 kPa as the threshold of the mean elasticity value,the sensitivity was 91.8％ and the specificity was 89.7％.Then taking 65.50 kPa as the threshold of the maximum elasticity value,the sensitivity was 92.1％ and the specificity was 87.5％.Conclusions SWE is helpful to diagnose and differentiate prostate diseases by measuring elastic modulus.