Study of Endometrial Spiral Arteries by Transvaginal Color Doppler Ultrasonography in Assessment of Patients with Dysfunctional Uterine Bleeding

Abstract
Background: Abnormal Uterine Bleeding (AUB) is a common problem. Abnormal uterine bleeding includes both dysfunctional uterine bleeding and bleeding from structural causes. Dysfunctional Bleeding (DUB) can be anovulatory, which is characterized by irregular bleeding, or ovulatory, which is characterized by heavy but regular periods (i.e., menorrhagia). In the past, D & C was considered as the gold standard to exclude endometrial pathology. Transvaginal Sonography (TVS) is relatively cheap, needs no anesthesia and being non-invasive, it can be the first diagnostic step in evaluation of DUB as it measures endometrial thickness and exclude organic causes. Over recent years, Color Doppler Sonography (CDS) have been started to be used to predict endometrial pathologies. CDS, a noninvasive and simple tool, is useful indistinguishing endometrial lesions, helps to decide what is necessary for invasive tests and plans the invasive method to be chosen.
Aim of Study: To investigate the diagnostic value of blood flow measurements in spiral artery by transvaginal Color Doppler Sonography (CDS) in predicting different endometrial pathologies in patients having dysfunctional uterine bleeding.
Patients and Methods: Fifty patients aged between 20 & 39 years presenting with dysfunctional uterine bleeding and requiring endometrial assessment were included in this pro-spective observational study. Endometrial thickness was recorded. Pulsatility Index (PI) and Resistive Index (RI) of the spiral artery were measured by transvaginal CDS. En-dometrial sampling was performed for all subjects. Sonographic and histopathologic findings were compared.
Results: The histopathological diagnoses were as follows; 22 cases (44%) secretory endometrium, 18 cases (36%) proliferative endometrium, 5 cases (10) mixed proliferative and secretory endometrium, 5 cases (10%) endometrial hy-perplasia. There was statistically significant difference between spiral artery RI & PI and histopathological results.