The value of ultrasound parameters in predicting treatment modalities for uterine arteriovenous malformations

The value of ultrasound parameters in predicting treatment modalities for uterine arteriovenous malformations | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The value of ultrasound parameters in predicting treatment modalities for uterine arteriovenous malformations ZiTing Lin, JunFeng Hong, ZuLing LI, LiXian Lin, Fei Xu, FengMei Wang, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7896726/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 9 You are reading this latest preprint version Abstract Objective To analyze the predictive value of ultrasound parameters in selecting clinical treatment options for patients with uterine arteriovenous malformation (AVM). Methods Data and ultrasound parameters of patients with clinically diagnosed uterine AVM who attended the 900TH Hospital of the Joint Logistic Support Force from January 2015 to December 2023 were collected retrospectively. According to the difference in clinical treatment protocols, the differences in lesion length and ultrasound parameters such as PSV, EDV, PI, and RI were analyzed in the expectant observation group, the drug treatment group, and the UAE treatment group. All patients were also divided into UAE-treated and non-UAE-treated groups according to whether or not uterine artery embolization (UAE) was performed, and effective indicators that could predict the need for embolization for hemostasis were screened, and their predictive efficacy was judged by the univariate and multiple logistic regression analyses and plotting the working characteristic curves (ROCs) of the subjects. Results For patients with different treatment protocols, it was found that the mean PSV and EDV values were higher in cases with UAE hemostasis than those with pharmacological hemostasis and expectant treatment (P < 0.001); the mean PSV and EDV values were higher in cases with pharmacological hemostasis than those with expectant treatment (P 0.05). After univariate and multiple logistic regression analyses, it was shown that peak systolic blood flow velocity (PSV) was a significantly effective predictor of the need for UAE hemostasis (P < 0.001), with higher PSV being associated with a higher probability of needing UAE hemostasis. For every 1 cm/s increase in prediction, the likelihood of using UAE for hemostasis increased by 0.065. In addition, the highest accuracy in distinguishing the need for UAE for hemostasis was achieved when the PSV was 61.50 cm/s, with a sensitivity of 72.70%, a specificity of 96.90%, and an AUC of 0.818. Conclusion Blood flow parameters of ultrasound are valuable in the selection of treatment options for uterine AVM. We found that the mean PSV and EDV values of patients with UAE hemostasis were higher than those treated with non-UAE, and PSV was a significantly effective predictor of the need for UAE hemostasis. uterine arteriovenous malformation vaginal bleeding ultrasound Figures Figure 1 Figure 2 Introduction Uterine Arteriovenous Malformation (AVM) is an abnormal traffic between the uterine arteries and veins that does not pass through the capillary network but is directly connected by a cluster of malformed vessels [ 1 ] . Arteriovenous malformations have been recorded in the intracranial and peripheral vascular systems, but their occurrence in the female reproductive system is relatively rare [ 2 ] . Since the first report by Dubreuil and Loubat in 1926 [ 3 ] , only a few cases have been reported [ 4 ] . The incidence of uterine AVM is still unknown [ 5 ] , and Asia has the highest number of reported cases worldwide [ 6 ] . In recent years, ultrasound has become the preferred screening method for AVMs due to its significant advantages of being non-invasive and convenient. There are no guidelines for the treatment of uterine arteriovenous malformation. In recent years, uterine artery embolization (UAE) has gradually become the most effective means of hemostasis. Currently, scholars at home and abroad generally agree that lesion size and Peak Systolic Velocity (PSV) are important references for guiding the selection of treatment modalities, however, there is a lack of systematic research to clarify the exact threshold and predictive efficacy of these effective indexes [ 7 , 8 ] . Therefore, this study retrospectively analyzed 65 patients who were clinically diagnosed with uterine AVM in our hospital to analyze the predictive value of ultrasound parameters in selecting clinical treatment options for patients with uterine arteriovenous malformation (AVM). Methods 1.1 General information Patients who visited our hospital with the clinical diagnosis of uterine AVM from January 2015 to December 2023 were retrospectively selected, and according to the inclusion and exclusion criteria, a total of 65 patients were finally included, with a mean age of 31.65 ± 6.13 years. Inclusion criteria: (1) patients who were finally diagnosed with uterine AVM, of which 33 cases were diagnosed by DSA and treated with embolization, and 32 cases were finally diagnosed by imaging examination combined with clinical manifestations and cured according to the conservative treatment of AVM. (2) Complete medical records and at least 1 ultrasound examination at follow-up. Exclusion Criteria: Patients with incomplete clinical data or lost visits were excluded. This retrospective study was approved by the hospital’s Ethics Committee, with a waiver of informed consent for participants. 1.2 Methods GE-Voluson E8 ultrasonic diagnostic instrument was selected, and the transabdominal probe C1-5, frequency 1 ~ 5MHz, and transvaginal probe RIC5-9D, frequency 5 ~ 9MHz, were used in the process of exploration. Health guidance was given before the examination, and transvaginal ultrasonography was carried out in the truncated position after the patient's bladder was emptied, transrectal ultrasonography could be carried out in the left lateral position in the case of heavy bleeding, but the transrectal ultrasonography should be supplemented with transvaginal ultrasonography in the case of patients with larger uterus or higher position of uterus. However, in cases where the patient has a large uterus or a high uterine position, a supplemental transabdominal ultrasound is necessary. In such instances, the patient is requested to assume a supine position with a moderately full bladder. Multi-directional scanning is required for a complete view of the uterus and lesions. 1.3 Observation indicators The uterine size of all patients, the size, number, location, and internal echoes of the lesions were collected through the image reporting system; the internal color Doppler performance of the lesions; the arterial PSV in spectral Doppler, the End Diastolic Velocity (EDV), the Pulsatility Index (PI), the Resistance Index (RI), and whether the veins showed arterial-like pulsatile changes. 1.4 Statistical methods SPSS27.0 system software was used for statistical analysis, and the measurement data conforming to normal distribution were expressed by (_x±s), and comparisons between two groups were made by two independent samples t-test, and comparisons between three or more groups were made by one-way ANOVA test, and two-by-two comparisons between groups were made by multiple comparisons using the LSD-t-test, and the measurement data that did not conform to normal were expressed by the median (interquartile spacing) to express. Count data were expressed as the number of cases and the composition ratio n(%), and the comparison of count data between two groups was performed by the chi-square test or Fisher's exact test. Effective indicators that could predict the need for embolization for hemostasis were screened by univariate and multivariate logistic regression analyses, and the diagnostic efficacy was assessed by plotting the Receiver Operating Characteristic (ROC) curve of the subjects, and the Area Under Curve (AUC), the sensitivity, and the specificity were calculated. p < 0.05 was considered statistically significant. Results 2.1 Ultrasonographic findings Gray scale ultrasound showed that the uterus was enlarged to different degrees, with a median volume of 68.01 (47.47, 104.68) cm3 (normal volume < 55.88 cm3), and the lesions were often single, mostly located in the myometrium, and only 22 (33.85%) cases showed typical tortuous tubular echogenic areas. Color Doppler ultrasound showed colorful mosaic-like blood flow signals. The arterial spectrum showed high velocity low resistance-like changes, some of which were seen as burr-like changes, with a mean PSV of 58.67 ± 29.23 cm/s and a mean RI of 0.36 ± 0.09. The spectrum of the veins shows arterial-like changes and pelvic varicose veins were seen in some of the cases. Figure 1 . 2.2 Comparison of ultrasound parameters of different treatment options Among 65 AVM patients, 32 cases were clinically treated with non-UAE and 33 cases were treated with UAE. Among the non-UAE treated patients, 9 patients with no obvious symptoms were treated with expectant treatment, 5 patients with combined uterine residuals and persistent spotting bleeding were treated with medication and hysterectomy, and 18 patients were treated with medication due to persistent spotting bleeding. Among the UAE-treated patients, 13 patients were ineffective in medication and combined with UAE for hemostasis, and 20 patients were treated with UAE directly due to sudden and heavy bleeding from the vagina and were treated with other modes of treatment after partial hemostasis and control. After partial hemostasis, they were treated with other modalities. Retrospective analysis of lesion length and blood flow parameters in patients with different treatment regimens revealed that the mean PSV and EDV values were higher in cases with UAE hemostasis than in cases with pharmacological hemostasis and expectant treatment, with statistically significant differences (P < 0.001); and that the mean PSV and EDV values were higher in cases with pharmacological hemostasis than in cases with expectant treatment, with statistically significant differences (P 0.05), as shown in Table 1 . Table 1 Comparison of ultrasound parameters between the three treatment modalities treatment lesion length (mm) PSV (cm/s) EDV (cm/s) PI RI expectant treatment 31.33 ± 12.74 26.67 ± 11.67 *,† 15.11 ± 6.47 *,† 0.55 ± 0.21 0.42 ± 0.12 drug treatment 29.26 ± 16.27 49.13 ± 14.18 † 31.78 ± 9.80 † 0.43 ± 0.12 0.35 ± 0.08 UAE treatment 33.21 ± 13.30 74.06 ± 30.66 47.61 ± 20.94 0.45 ± 0.17 0.36 ± 0.11 F value 0.51 16.68 16.24 1.86 0.51 P value 0.601 <0.001 <0.001 0.164 0.60 * P < 0.05 compared with drug treatment; † P < 0.05 compared with UAE treatment. PSV, Peak Systolic Velocity; EDV, the End Diastolic Velocity; PI, the Pulsatility Index; RI, the Resistance Index; UAE, uterine artery embolization 2.3 Binary logistic regression analysis for predicting the need for UAE hemostasis Using the need for UAE hemostasis as the dependent variable, univariate and multivariate logistic regression analyses revealed PSV to be a significantly effective predictor of the need for UAE hemostasis (P < 0.001). The likelihood of needing UAE hemostasis increased by 0.065 for every 1 cm/s increase in prediction, whereas age, gestational age, uterine volume, lesion size (expressed as longitudinal diameter), EDV, PI, and RI were not able to be effective indicators for predicting the need for UAE hemostasis (P > 0.05), as shown in Table 2 . Table 2 Results of the univariate and multiple logistic regression Variable indicators Univariate logistic regression analysis OR(95%CI) P Multifactor logistic regression analysis OR(95%CI) P age > 32 (years) 0.720(0.267–1.939) 0.516 —— —— Pregnancy ≥ 3 (times) 1.062(0.402–2.811) 0.875 —— —— uterine volume(cm 3 ) 1.003(0.993–1.012) 0.584 —— —— lesion length(mm) 1.017(0.982–1.054) 0.341 —— —— PSV(cm/s) 1.060(1.029–1.092) <0.001 1.065(1.030–1.100) <0.001 EDV(cm/s) 1.082(1.037–1.129) <0.001 1.058(0.978–1.143) 0.160 PI 0.511(0.026–10.194) 0.660 —— —— RI 0.320(0.003–40.136) 0.644 —— —— 2.4 Predictive value of PSV for the need for UAE hemostasis From the above, it can be seen that PSV is an effective predictor of the need for UAE hemostasis, and the higher the PSV, the greater the likelihood of needing UAE hemostasis. The ROC curve was plotted to observe the predictive value of PSV, and the results showed that PSV had the highest accuracy in distinguishing the need for UAE hemostasis at 61.50 cm/s, with a sensitivity of 72.70%, a specificity of 96.90%, and an AUC of 0.818. For details, please see Fig. 2 . Discussion AVMs are caused by abnormal traffic between arteries and veins [ 9 , 10 ] , AVMs documented in the literature are most common in the brain, whereas peripheral AVMs that occur in isolation tend to occur in the uterus, liver, kidneys, and joints. Uterine AVMs are classified as either congenital or acquired, with acquired uterine AVMs being the more common in clinical practice, usually caused by pregnancy, miscarriage, diagnostic or therapeutic curettage, neoplasia, endometriosis, and gestational trophoblastic disease, with a history of uterine trauma being an important reference to differentiate between the two. The ultrasound detection rate of uterine AVM is increasing year by year, which may be related to the increased awareness of uterine AVM among sonographers and improved instrumentation. Typical two-dimensional ultrasound shows varying degrees of uterine enlargement, with curved tubular echogenic structures found mostly in the myometrium [ 11 ] . Color Doppler shows a mosaic of colorful blood flow signals with different orientations, and spectral Doppler ultrasound shows a high-speed, low-resistance arterial flow spectrum and arterial-like changes in the venous blood flow spectrum. UAE is often indicated in patients with high clinical suspicion of uterine AVM, in whom the diagnosis is not clear on conventional imaging, in whom bleeding significantly reaches or exceeds the amount of menstruation and even appears to be in shock, or in whom bleeding fails to improve after medication, and whose efficacy has been widely recognized by domestic and international literature [ 12 ] , with a success rate of 71% to 93% [ 7 , 8 ] 。 A consensus has been reached in several studies at home and abroad [ 13 ] that blood flow parameters measured by color Doppler are informative for the selection of treatment modalities, with expectant treatment being used when the lesion is small or the PSV is 60–70 cm/s. The PSV of all patients in this study ranged from 13 to 170 cm/s. The blood flow parameters of different treatment modalities were retrospectively collected, and the results were consistent with the principle of selecting treatment modalities based on blood flow parameters proposed in the previous study. This individualized treatment strategy based on objective blood flow parameters helps to optimize resource allocation and reduce unnecessary medical interventions while ensuring that high-risk patients receive timely and effective treatment. To determine a critical cut-off value to differentiate between potentially safe and potentially dangerous vascular malformations, this study analyzed age, gestational age, PSV, uterine volume, and lesion size based on logistic regression equations and found that PSV was a significantly effective predictor of the need for hemostasis by UAE (P < 0.001), with a predicted increase in the risk of the need for embolization by 0.065 for each increase of 1 cm/s, and PSV was found to be most accurate in distinguishing the need for UAE at 61.50 cm/s, a finding that provides a quantitative basis for clinical practice. At the same time, clinical treatment decisions should take multiple factors into account to avoid relying solely on ultrasound parameters leading to over-intervention or under-treatment, and to ensure that patients receive the most appropriate treatment for their condition and needs. In conclusion, uterine AVM is a rare but fatal bleeding disorder that is not easy to diagnose. Transvaginal grey-scale and color Doppler ultrasound are becoming the preferred methods of examination because they are non-invasive, easy to perform, and highly accurate. PSV has a predictive value in distinguishing low-risk from high-risk hemorrhage, which can help to avoid rupture of the lesion by blind curettage of unknown etiology, which may lead to massive uterine hemorrhage. Ultrasonographers should improve their knowledge of uterine AVM and be familiar with its ultrasound features so that they can detect suspicious lesions in time in their daily work and provide clinicians with diagnostic clues and suggestions on treatment modalities to avoid delays. Declarations Competing Interest The authors report no conflicts of interest. Authors' contribution Conceptualization, Writing − original draft, Writing −review & editing (ZiTing Lin). Data curation, Writing−review & editing (JunFeng Hong). Resources, Data curation, Investigation, Visualization (ZuLing LI, LiXian Lin, Fei Xu).Funding acquisition, Writing −review & editing, Supervision (Li Jiang, FengMei Wang). All authors read and approved the final manuscript. All authors approved the final version of the article, including the authorship list. Corresponding author Correspondence to FengMei Wang. Funding This work was supported by the Projects of 900TH Hospital of the Joint Logistic Support Force (grant numbers 2022MS37). Acknowledgments All authors have contributed significantly, and all authors agree with the content of the manuscript. Ethics Committee We confirm that the study was conducted in accordance with relevant guidelines and regulations. This study was approved by the medical ethics committee of 900TH Hospital of Joint Logistics Support Force, with a waiver of informed consent for participants. Consent for publication Not applicable. Availability of Data and Materials The datasets used and analysed during the current study are available from the corresponding author on reasonable request. References Giurazza F, Corvino F, Silvestre M et al. Uterine Arteriovenous Malformations[J]. Seminars in Ultrasound, CT and MRI, 2021, 42(1): 37–45. Huang MW, Muradali D, Thurston WA, et al. Uterine arteriovenous malformations: gray-scale and Doppler US features with MR imaging correlation.[J]. Radiology. 1998;206(1):115–23. Abu Musa A, Hata T, Hata K, et al. Pelvic arteriovenous malformation diagnosed by color flow Doppler imaging[J]. Am J Roentgenol. 1989;152(6):1311–2. Timor-Tritsch IE, Haynes MC, Monteagudo A et al. Ultrasound diagnosis and management of acquired uterine enhanced myometrial vascularity/arteriovenous malformations[J]. American Journal of Obstetrics and Gynecology, 2016, 214(6): 731.e1-731.e10. Yazawa H, Soeda S, Hiraiwa T, et al. Prospective Evaluation of the Incidence of Uterine Vascular Malformations Developing After Abortion or Delivery[J]. J Minim Invasive Gynecol. 2013;20(3):360–7. Ruiz Labarta FJ, Pintado Recarte MP, González Leyte M, et al. Uterine Artery Embolization of Uterine Arteriovenous Malformation: A Systematic Review of Success Rate, Complications, and Posterior Pregnancy Outcomes[J]. J Personalized Med. 2022;12(7):1098. Barral PA, Saeed-Kilani M, Tradi F, et al. Transcatheter arterial embolization with ethylene vinyl alcohol copolymer (Onyx) for the treatment of hemorrhage due to uterine arteriovenous malformations[J]. Diagn Interv Imaging. 2017;98(5):415–21. Levy-Zaubermann Y, Capmas P, Legendre G, et al. Laparoscopic Management of Uterine Arteriovenous Malformation Via Occlusion of Internal Iliac Arteries[J]. J Minim Invasive Gynecol. 2012;19(6):785–8. Kelly SM, Belli AM, Campbell S. Arteriovenous malformation of the uterus associated with secondary postpartum hemorrhage[J]. Ultrasound Obstet Gynecol. 2003;21(6):602–5. Gallagher N, Cincotta M, Keblawi H, et al. Uterine arteriovenous malformation leading to postpartum hemorrhage: A case report[J]. Case Rep Women’s Health. 2020;28:e00260. Maleux G, Timmerman D, Heye S, et al. Acquired uterine vascular malformations: radiological and clinical outcome after transcatheter embolotherapy[J]. Eur Radiol. 2006;16(2):299–306. Peitsidis P, Manolakos E, Tsekoura V, et al. Uterine arteriovenous malformations induced after diagnostic curettage: a systematic review[J]. Arch Gynecol Obstet. 2011;284(5):1137–51. Timmerman D, Wauters J, Van Calenbergh S, et al. Color Doppler imaging is a valuable tool for the diagnosis and management of uterine vascular malformations[J]. Ultrasound Obstet Gynecol. 2003;21(6):570–7. Additional Declarations No competing interests reported. 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14:54:10","extension":"html","order_by":8,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":60332,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7896726/v1/6df0afb7239350727347c93c.html"},{"id":97270226,"identity":"f7e6bc14-de0d-40c9-8434-8deb0beea37d","added_by":"auto","created_at":"2025-12-02 14:54:10","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":702007,"visible":true,"origin":"","legend":"\u003cp\u003eUltrasound image of a patient that (A) Gray-scale ultrasound showed that the uterus was significantly enlarged, and a honeycomb-like echogenic area was seen in the myometrium of the uterine fundus; (B) Color Doppler showed that the lesion was filled with colorful mosaic-like blood flow signals; Spectral Doppler demonstrates (C) arteries with high-velocity, low-resistance-like changes (PSV:72.61 cm/s; RI: 0.52) (D) veins with arterial-like changes; (E-F) pelvic varicose veins. PSV, Peak Systolic Velocity; RI , the Resistance Index\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7896726/v1/4de6fced73c822f7b3fd3559.png"},{"id":97368041,"identity":"4688956f-a036-4e96-bd06-c53594f834ac","added_by":"auto","created_at":"2025-12-03 16:21:25","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":32203,"visible":true,"origin":"","legend":"\u003cp\u003eROC curves for PSV predicting the need for UAE hemostasis. ROC, Operating Characteristic; PSV, Peak Systolic Velocity; UAE, uterine artery embolization.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-7896726/v1/404a464f8712d99d94a86a45.png"},{"id":97372744,"identity":"e48efb30-cc9b-43ba-9274-aa9b514e00d2","added_by":"auto","created_at":"2025-12-03 16:33:02","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1449228,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7896726/v1/8fac7244-6a7b-49c0-b32f-7c70b40a9adb.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"The value of ultrasound parameters in predicting treatment modalities for uterine arteriovenous malformations","fulltext":[{"header":"Introduction","content":"\u003cp\u003eUterine Arteriovenous Malformation (AVM) is an abnormal traffic between the uterine arteries and veins that does not pass through the capillary network but is directly connected by a cluster of malformed vessels\u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/sup\u003e. Arteriovenous malformations have been recorded in the intracranial and peripheral vascular systems, but their occurrence in the female reproductive system is relatively rare\u003csup\u003e[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/sup\u003e. Since the first report by Dubreuil and Loubat in 1926\u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/sup\u003e, only a few cases have been reported\u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/sup\u003e. The incidence of uterine AVM is still unknown\u003csup\u003e[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/sup\u003e, and Asia has the highest number of reported cases worldwide\u003csup\u003e[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/sup\u003e. In recent years, ultrasound has become the preferred screening method for AVMs due to its significant advantages of being non-invasive and convenient. There are no guidelines for the treatment of uterine arteriovenous malformation. In recent years, uterine artery embolization (UAE) has gradually become the most effective means of hemostasis. Currently, scholars at home and abroad generally agree that lesion size and Peak Systolic Velocity (PSV) are important references for guiding the selection of treatment modalities, however, there is a lack of systematic research to clarify the exact threshold and predictive efficacy of these effective indexes \u003csup\u003e[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/sup\u003e. Therefore, this study retrospectively analyzed 65 patients who were clinically diagnosed with uterine AVM in our hospital to analyze the predictive value of ultrasound parameters in selecting clinical treatment options for patients with uterine arteriovenous malformation (AVM).\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003e1.1 General information\u003c/h2\u003e\u003cp\u003ePatients who visited our hospital with the clinical diagnosis of uterine AVM from January 2015 to December 2023 were retrospectively selected, and according to the inclusion and exclusion criteria, a total of 65 patients were finally included, with a mean age of 31.65\u0026thinsp;\u0026plusmn;\u0026thinsp;6.13 years. Inclusion criteria: (1) patients who were finally diagnosed with uterine AVM, of which 33 cases were diagnosed by DSA and treated with embolization, and 32 cases were finally diagnosed by imaging examination combined with clinical manifestations and cured according to the conservative treatment of AVM. (2) Complete medical records and at least 1 ultrasound examination at follow-up. Exclusion Criteria: Patients with incomplete clinical data or lost visits were excluded. This retrospective study was approved by the hospital\u0026rsquo;s Ethics Committee, with a waiver of informed consent for participants.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\u003ch2\u003e1.2 Methods\u003c/h2\u003e\u003cp\u003eGE-Voluson E8 ultrasonic diagnostic instrument was selected, and the transabdominal probe C1-5, frequency 1\u0026thinsp;~\u0026thinsp;5MHz, and transvaginal probe RIC5-9D, frequency 5\u0026thinsp;~\u0026thinsp;9MHz, were used in the process of exploration. Health guidance was given before the examination, and transvaginal ultrasonography was carried out in the truncated position after the patient's bladder was emptied, transrectal ultrasonography could be carried out in the left lateral position in the case of heavy bleeding, but the transrectal ultrasonography should be supplemented with transvaginal ultrasonography in the case of patients with larger uterus or higher position of uterus. However, in cases where the patient has a large uterus or a high uterine position, a supplemental transabdominal ultrasound is necessary. In such instances, the patient is requested to assume a supine position with a moderately full bladder. Multi-directional scanning is required for a complete view of the uterus and lesions.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\u003ch2\u003e1.3 Observation indicators\u003c/h2\u003e\u003cp\u003eThe uterine size of all patients, the size, number, location, and internal echoes of the lesions were collected through the image reporting system; the internal color Doppler performance of the lesions; the arterial PSV in spectral Doppler, the End Diastolic Velocity (EDV), the Pulsatility Index (PI), the Resistance Index (RI), and whether the veins showed arterial-like pulsatile changes.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\u003ch2\u003e1.4 Statistical methods\u003c/h2\u003e\u003cp\u003eSPSS27.0 system software was used for statistical analysis, and the measurement data conforming to normal distribution were expressed by (_x\u0026plusmn;s), and comparisons between two groups were made by two independent samples t-test, and comparisons between three or more groups were made by one-way ANOVA test, and two-by-two comparisons between groups were made by multiple comparisons using the LSD-t-test, and the measurement data that did not conform to normal were expressed by the median (interquartile spacing) to express. Count data were expressed as the number of cases and the composition ratio n(%), and the comparison of count data between two groups was performed by the chi-square test or Fisher's exact test. Effective indicators that could predict the need for embolization for hemostasis were screened by univariate and multivariate logistic regression analyses, and the diagnostic efficacy was assessed by plotting the Receiver Operating Characteristic (ROC) curve of the subjects, and the Area Under Curve (AUC), the sensitivity, and the specificity were calculated. p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003e2.1 Ultrasonographic findings\u003c/h2\u003e\u003cp\u003eGray scale ultrasound showed that the uterus was enlarged to different degrees, with a median volume of 68.01 (47.47, 104.68) cm3 (normal volume\u0026thinsp;\u0026lt;\u0026thinsp;55.88 cm3), and the lesions were often single, mostly located in the myometrium, and only 22 (33.85%) cases showed typical tortuous tubular echogenic areas. Color Doppler ultrasound showed colorful mosaic-like blood flow signals. The arterial spectrum showed high velocity low resistance-like changes, some of which were seen as burr-like changes, with a mean PSV of 58.67\u0026thinsp;\u0026plusmn;\u0026thinsp;29.23 cm/s and a mean RI of 0.36\u0026thinsp;\u0026plusmn;\u0026thinsp;0.09. The spectrum of the veins shows arterial-like changes and pelvic varicose veins were seen in some of the cases. Figure\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\u003ch2\u003e2.2 Comparison of ultrasound parameters of different treatment options\u003c/h2\u003e\u003cp\u003eAmong 65 AVM patients, 32 cases were clinically treated with non-UAE and 33 cases were treated with UAE. Among the non-UAE treated patients, 9 patients with no obvious symptoms were treated with expectant treatment, 5 patients with combined uterine residuals and persistent spotting bleeding were treated with medication and hysterectomy, and 18 patients were treated with medication due to persistent spotting bleeding. Among the UAE-treated patients, 13 patients were ineffective in medication and combined with UAE for hemostasis, and 20 patients were treated with UAE directly due to sudden and heavy bleeding from the vagina and were treated with other modes of treatment after partial hemostasis and control. After partial hemostasis, they were treated with other modalities.\u003c/p\u003e\u003cp\u003eRetrospective analysis of lesion length and blood flow parameters in patients with different treatment regimens revealed that the mean PSV and EDV values were higher in cases with UAE hemostasis than in cases with pharmacological hemostasis and expectant treatment, with statistically significant differences (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001); and that the mean PSV and EDV values were higher in cases with pharmacological hemostasis than in cases with expectant treatment, with statistically significant differences (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). In contrast, there were no significant differences in lesion length, PI, and RI values (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05), as shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eComparison of ultrasound parameters between the three treatment modalities\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003etreatment\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003elesion length\u003c/p\u003e\u003cp\u003e(mm)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePSV\u003c/p\u003e\u003cp\u003e(cm/s)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eEDV\u003c/p\u003e\u003cp\u003e(cm/s)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003ePI\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eRI\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eexpectant treatment\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e31.33\u0026thinsp;\u0026plusmn;\u0026thinsp;12.74\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e26.67\u0026thinsp;\u0026plusmn;\u0026thinsp;11.67\u003csup\u003e*,\u0026dagger;\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e15.11\u0026thinsp;\u0026plusmn;\u0026thinsp;6.47\u003csup\u003e*,\u0026dagger;\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.55\u0026thinsp;\u0026plusmn;\u0026thinsp;0.21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.42\u0026thinsp;\u0026plusmn;\u0026thinsp;0.12\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003edrug treatment\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e29.26\u0026thinsp;\u0026plusmn;\u0026thinsp;16.27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e49.13\u0026thinsp;\u0026plusmn;\u0026thinsp;14.18\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e31.78\u0026thinsp;\u0026plusmn;\u0026thinsp;9.80\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.43\u0026thinsp;\u0026plusmn;\u0026thinsp;0.12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.35\u0026thinsp;\u0026plusmn;\u0026thinsp;0.08\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUAE treatment\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e33.21\u0026thinsp;\u0026plusmn;\u0026thinsp;13.30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e74.06\u0026thinsp;\u0026plusmn;\u0026thinsp;30.66\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e47.61\u0026thinsp;\u0026plusmn;\u0026thinsp;20.94\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.45\u0026thinsp;\u0026plusmn;\u0026thinsp;0.17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.36\u0026thinsp;\u0026plusmn;\u0026thinsp;0.11\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eF value\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.51\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e16.68\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e16.24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.86\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.51\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.601\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.164\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.60\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003csup\u003e*\u003c/sup\u003eP\u0026thinsp;\u0026lt;\u0026thinsp;0.05 compared with drug treatment; \u003csup\u003e\u0026dagger;\u003c/sup\u003eP\u0026thinsp;\u0026lt;\u0026thinsp;0.05 compared with UAE treatment.\u003c/p\u003e\u003cp\u003ePSV, Peak Systolic Velocity; EDV, the End Diastolic Velocity; PI, the Pulsatility Index; RI, the Resistance Index; UAE, uterine artery embolization\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\u003ch2\u003e2.3 Binary logistic regression analysis for predicting the need for UAE hemostasis\u003c/h2\u003e\u003cp\u003eUsing the need for UAE hemostasis as the dependent variable, univariate and multivariate logistic regression analyses revealed PSV to be a significantly effective predictor of the need for UAE hemostasis (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The likelihood of needing UAE hemostasis increased by 0.065 for every 1 cm/s increase in prediction, whereas age, gestational age, uterine volume, lesion size (expressed as longitudinal diameter), EDV, PI, and RI were not able to be effective indicators for predicting the need for UAE hemostasis (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05), as shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eResults of the univariate and multiple logistic regression\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable indicators\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eUnivariate logistic regression analysis\u003c/p\u003e\u003cp\u003eOR(95%CI) \u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003eMultifactor logistic regression analysis\u003c/p\u003e\u003cp\u003eOR(95%CI) \u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eage\u0026thinsp;\u0026gt;\u0026thinsp;32 (years)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.720(0.267\u0026ndash;1.939)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.516\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026mdash;\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026mdash;\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePregnancy\u0026thinsp;\u0026ge;\u0026thinsp;3 (times)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1.062(0.402\u0026ndash;2.811)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.875\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026mdash;\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026mdash;\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003euterine volume(cm\u003csup\u003e3\u003c/sup\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1.003(0.993\u0026ndash;1.012)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.584\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026mdash;\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026mdash;\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003elesion length(mm)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1.017(0.982\u0026ndash;1.054)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.341\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026mdash;\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026mdash;\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePSV(cm/s)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1.060(1.029\u0026ndash;1.092)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.065(1.030\u0026ndash;1.100)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEDV(cm/s)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1.082(1.037\u0026ndash;1.129)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.058(0.978\u0026ndash;1.143)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.160\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePI\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.511(0.026\u0026ndash;10.194)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.660\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026mdash;\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026mdash;\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRI\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.320(0.003\u0026ndash;40.136)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.644\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026mdash;\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026mdash;\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003e2.4 Predictive value of PSV for the need for UAE hemostasis\u003c/h2\u003e\u003cp\u003eFrom the above, it can be seen that PSV is an effective predictor of the need for UAE hemostasis, and the higher the PSV, the greater the likelihood of needing UAE hemostasis. The ROC curve was plotted to observe the predictive value of PSV, and the results showed that PSV had the highest accuracy in distinguishing the need for UAE hemostasis at 61.50 cm/s, with a sensitivity of 72.70%, a specificity of 96.90%, and an AUC of 0.818. For details, please see Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eAVMs are caused by abnormal traffic between arteries and veins \u003csup\u003e[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e, AVMs documented in the literature are most common in the brain, whereas peripheral AVMs that occur in isolation tend to occur in the uterus, liver, kidneys, and joints. Uterine AVMs are classified as either congenital or acquired, with acquired uterine AVMs being the more common in clinical practice, usually caused by pregnancy, miscarriage, diagnostic or therapeutic curettage, neoplasia, endometriosis, and gestational trophoblastic disease, with a history of uterine trauma being an important reference to differentiate between the two. The ultrasound detection rate of uterine AVM is increasing year by year, which may be related to the increased awareness of uterine AVM among sonographers and improved instrumentation. Typical two-dimensional ultrasound shows varying degrees of uterine enlargement, with curved tubular echogenic structures found mostly in the myometrium\u003csup\u003e[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/sup\u003e. Color Doppler shows a mosaic of colorful blood flow signals with different orientations, and spectral Doppler ultrasound shows a high-speed, low-resistance arterial flow spectrum and arterial-like changes in the venous blood flow spectrum. UAE is often indicated in patients with high clinical suspicion of uterine AVM, in whom the diagnosis is not clear on conventional imaging, in whom bleeding significantly reaches or exceeds the amount of menstruation and even appears to be in shock, or in whom bleeding fails to improve after medication, and whose efficacy has been widely recognized by domestic and international literature\u003csup\u003e[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/sup\u003e, with a success rate of 71% to 93%\u003csup\u003e[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/sup\u003e。\u003c/p\u003e\u003cp\u003eA consensus has been reached in several studies at home and abroad \u003csup\u003e[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/sup\u003e that blood flow parameters measured by color Doppler are informative for the selection of treatment modalities, with expectant treatment being used when the lesion is small or the PSV is \u0026lt;\u0026thinsp;40 cm/s, pharmacological treatment is used when the lesion is large when the PSV is 40\u0026ndash;60 cm/s, and embolization or surgery is used when the PSV is \u0026gt;\u0026thinsp;60\u0026ndash;70 cm/s. The PSV of all patients in this study ranged from 13 to 170 cm/s. The blood flow parameters of different treatment modalities were retrospectively collected, and the results were consistent with the principle of selecting treatment modalities based on blood flow parameters proposed in the previous study. This individualized treatment strategy based on objective blood flow parameters helps to optimize resource allocation and reduce unnecessary medical interventions while ensuring that high-risk patients receive timely and effective treatment. To determine a critical cut-off value to differentiate between potentially safe and potentially dangerous vascular malformations, this study analyzed age, gestational age, PSV, uterine volume, and lesion size based on logistic regression equations and found that PSV was a significantly effective predictor of the need for hemostasis by UAE (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), with a predicted increase in the risk of the need for embolization by 0.065 for each increase of 1 cm/s, and PSV was found to be most accurate in distinguishing the need for UAE at 61.50 cm/s, a finding that provides a quantitative basis for clinical practice. At the same time, clinical treatment decisions should take multiple factors into account to avoid relying solely on ultrasound parameters leading to over-intervention or under-treatment, and to ensure that patients receive the most appropriate treatment for their condition and needs.\u003c/p\u003e\u003cp\u003eIn conclusion, uterine AVM is a rare but fatal bleeding disorder that is not easy to diagnose. Transvaginal grey-scale and color Doppler ultrasound are becoming the preferred methods of examination because they are non-invasive, easy to perform, and highly accurate. PSV has a predictive value in distinguishing low-risk from high-risk hemorrhage, which can help to avoid rupture of the lesion by blind curettage of unknown etiology, which may lead to massive uterine hemorrhage. Ultrasonographers should improve their knowledge of uterine AVM and be familiar with its ultrasound features so that they can detect suspicious lesions in time in their daily work and provide clinicians with diagnostic clues and suggestions on treatment modalities to avoid delays.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eCompeting Interest\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors report no conflicts of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contribution\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConceptualization, Writing\u0026nbsp;\u0026minus;\u0026nbsp;original draft, Writing\u0026nbsp;\u0026minus;review \u0026amp; editing (ZiTing Lin). Data curation, Writing\u0026minus;review \u0026amp; editing (JunFeng Hong). Resources, Data curation, Investigation, Visualization (ZuLing LI, LiXian Lin, Fei Xu).Funding acquisition, Writing\u0026nbsp;\u0026minus;review \u0026amp; editing, Supervision (Li Jiang, FengMei Wang). All authors read and approved the final manuscript. All authors approved the final version of the article, including the authorship list.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCorresponding author\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCorrespondence to FengMei Wang.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was supported by the Projects of 900TH Hospital of the Joint Logistic Support Force (grant numbers 2022MS37).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors have contributed significantly, and all authors agree with the content of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics Committee\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe confirm that the study was conducted in accordance with relevant guidelines and regulations. This study was approved by the medical ethics committee of 900TH Hospital of Joint Logistics Support Force, with a waiver of informed consent for participants.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of Data and Materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and analysed during the current study are available from the corresponding author on reasonable request.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eGiurazza F, Corvino F, Silvestre M et al. Uterine Arteriovenous Malformations[J]. Seminars in Ultrasound, CT and MRI, 2021, 42(1): 37\u0026ndash;45.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHuang MW, Muradali D, Thurston WA, et al. Uterine arteriovenous malformations: gray-scale and Doppler US features with MR imaging correlation.[J]. Radiology. 1998;206(1):115\u0026ndash;23.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAbu Musa A, Hata T, Hata K, et al. Pelvic arteriovenous malformation diagnosed by color flow Doppler imaging[J]. Am J Roentgenol. 1989;152(6):1311\u0026ndash;2.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTimor-Tritsch IE, Haynes MC, Monteagudo A et al. Ultrasound diagnosis and management of acquired uterine enhanced myometrial vascularity/arteriovenous malformations[J]. American Journal of Obstetrics and Gynecology, 2016, 214(6): 731.e1-731.e10.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eYazawa H, Soeda S, Hiraiwa T, et al. Prospective Evaluation of the Incidence of Uterine Vascular Malformations Developing After Abortion or Delivery[J]. J Minim Invasive Gynecol. 2013;20(3):360\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRuiz Labarta FJ, Pintado Recarte MP, Gonz\u0026aacute;lez Leyte M, et al. Uterine Artery Embolization of Uterine Arteriovenous Malformation: A Systematic Review of Success Rate, Complications, and Posterior Pregnancy Outcomes[J]. J Personalized Med. 2022;12(7):1098.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBarral PA, Saeed-Kilani M, Tradi F, et al. Transcatheter arterial embolization with ethylene vinyl alcohol copolymer (Onyx) for the treatment of hemorrhage due to uterine arteriovenous malformations[J]. Diagn Interv Imaging. 2017;98(5):415\u0026ndash;21.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLevy-Zaubermann Y, Capmas P, Legendre G, et al. Laparoscopic Management of Uterine Arteriovenous Malformation Via Occlusion of Internal Iliac Arteries[J]. J Minim Invasive Gynecol. 2012;19(6):785\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKelly SM, Belli AM, Campbell S. Arteriovenous malformation of the uterus associated with secondary postpartum hemorrhage[J]. Ultrasound Obstet Gynecol. 2003;21(6):602\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGallagher N, Cincotta M, Keblawi H, et al. Uterine arteriovenous malformation leading to postpartum hemorrhage: A case report[J]. Case Rep Women\u0026rsquo;s Health. 2020;28:e00260.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMaleux G, Timmerman D, Heye S, et al. Acquired uterine vascular malformations: radiological and clinical outcome after transcatheter embolotherapy[J]. Eur Radiol. 2006;16(2):299\u0026ndash;306.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePeitsidis P, Manolakos E, Tsekoura V, et al. Uterine arteriovenous malformations induced after diagnostic curettage: a systematic review[J]. Arch Gynecol Obstet. 2011;284(5):1137\u0026ndash;51.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTimmerman D, Wauters J, Van Calenbergh S, et al. Color Doppler imaging is a valuable tool for the diagnosis and management of uterine vascular malformations[J]. Ultrasound Obstet Gynecol. 2003;21(6):570\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-imaging","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmim","sideBox":"Learn more about [BMC Medical Imaging](http://bmcmedimaging.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmim/default.aspx","title":"BMC Medical Imaging","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"uterine arteriovenous malformation, vaginal bleeding, ultrasound","lastPublishedDoi":"10.21203/rs.3.rs-7896726/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7896726/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjective\u003c/h2\u003e\u003cp\u003eTo analyze the predictive value of ultrasound parameters in selecting clinical treatment options for patients with uterine arteriovenous malformation (AVM).\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eData and ultrasound parameters of patients with clinically diagnosed uterine AVM who attended the 900TH Hospital of the Joint Logistic Support Force from January 2015 to December 2023 were collected retrospectively. According to the difference in clinical treatment protocols, the differences in lesion length and ultrasound parameters such as PSV, EDV, PI, and RI were analyzed in the expectant observation group, the drug treatment group, and the UAE treatment group. All patients were also divided into UAE-treated and non-UAE-treated groups according to whether or not uterine artery embolization (UAE) was performed, and effective indicators that could predict the need for embolization for hemostasis were screened, and their predictive efficacy was judged by the univariate and multiple logistic regression analyses and plotting the working characteristic curves (ROCs) of the subjects.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eFor patients with different treatment protocols, it was found that the mean PSV and EDV values were higher in cases with UAE hemostasis than those with pharmacological hemostasis and expectant treatment (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001); the mean PSV and EDV values were higher in cases with pharmacological hemostasis than those with expectant treatment (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001); and there was no significant difference in the values of lesion length, PI, and RI (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05). After univariate and multiple logistic regression analyses, it was shown that peak systolic blood flow velocity (PSV) was a significantly effective predictor of the need for UAE hemostasis (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), with higher PSV being associated with a higher probability of needing UAE hemostasis. For every 1 cm/s increase in prediction, the likelihood of using UAE for hemostasis increased by 0.065. In addition, the highest accuracy in distinguishing the need for UAE for hemostasis was achieved when the PSV was 61.50 cm/s, with a sensitivity of 72.70%, a specificity of 96.90%, and an AUC of 0.818.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eBlood flow parameters of ultrasound are valuable in the selection of treatment options for uterine AVM. We found that the mean PSV and EDV values of patients with UAE hemostasis were higher than those treated with non-UAE, and PSV was a significantly effective predictor of the need for UAE hemostasis.\u003c/p\u003e","manuscriptTitle":"The value of ultrasound parameters in predicting treatment modalities for uterine arteriovenous malformations","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-02 14:53:29","doi":"10.21203/rs.3.rs-7896726/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"85328884321338926978695093809439810024","date":"2026-05-15T16:15:01+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"41314289070652596019035008335242673579","date":"2026-05-15T10:35:10+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-29T04:55:00+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"261938951793442992740002090555151619616","date":"2025-11-28T15:29:05+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-11-28T15:09:42+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-11-25T09:45:52+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-11-05T08:38:10+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-11-04T11:41:04+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Medical Imaging","date":"2025-11-04T11:36:57+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-imaging","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmim","sideBox":"Learn more about [BMC Medical Imaging](http://bmcmedimaging.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmim/default.aspx","title":"BMC Medical Imaging","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"e441952c-21aa-4f2a-8506-e6c46778cd70","owner":[],"postedDate":"December 2nd, 2025","published":true,"recentEditorialEvents":[{"type":"reviewerAgreed","content":"85328884321338926978695093809439810024","date":"2026-05-15T16:15:01+00:00","index":83,"fulltext":""},{"type":"reviewerAgreed","content":"41314289070652596019035008335242673579","date":"2026-05-15T10:35:10+00:00","index":82,"fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-12-02T14:53:29+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-02 14:53:29","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7896726","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7896726","identity":"rs-7896726","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}