The effectiveness of uterine wall and liver elasticity and liver enzyme ratios in understanding the etiopathology of cystic endometrial hyperplasia-pyometra complex in dogs.

This study aims to quantitatively evaluate the elasticity of the uterine wall and liver in dogs diagnosed with cystic endometrial hyperplasia-pyometra (CEH-P) complex and clinically healthy dogs in the luteal stage using two-dimensional shear wave elastography (2D-SWE), and to determine the relationship among the obtained elastographic parameters and clinical findings, hematological-biochemical data, Doppler ultrasonography findings expressing uterine hemodynamics, and possible prognostic indicators. The study included 49 intact female dogs, divided into two groups based on clinical examination: the control group (Group C; n = 15), consisting of healthy diestrus dogs, and the study group (Group P; n = 34), consisting of dogs with CEH-P complex. All bitches underwent abdominal ultrasonography (B-mod ultrasonography, Doppler ultrasonography, 2D-SWE). Reduced resistance pattern and notches in uterine artery waveforms were observed in Group P. Hepatic elasticity was also evaluated to assess the effects of CEH-P on the liver. Both uterine and liver elasticity values were significantly higher in Group P compared to Group C (p < 0.001), with high sensitivity and specificity values in ROC analysis. Hematology and 2D-SWE were evaluated together for accurate diagnosis of liver injury. The alanine aminotransferase/alkaline phosphatase (ALT/ALP) ratio showed high sensitivity in detecting liver injury caused by CEH-P complex in dogs. It was concluded that 2D-SWE is a non-invasive tool to evaluate elasticity changes in the uterine wall in cases of canine CEH-P. It is also useful for determining the systemic effects of CEH-P on the liver by measuring the liver stiffness.