B. Soggiu

OC11.01: Prevalence of deep endometriosis in patients of a second level ultrasound laboratory and tissue US characterization of nodules using VOCAL

Objectives: To generate physical fetal models using images obtained by 3-dimensional ultrasound (3DUS), magnetic resonance (MR) and computed tomography (CT) to guide additive manufacturing (AM) technology. Methods: Images from 45 fetuses, including 4 sets of twins, were used. Twenty-three fetuses were normal and evaluated only by 3DUS. Twenty-two cases had complications such as conjoined twins; tumors; aneuploidy; skeletal; central nervous system; facial or thoracic defects. Scans were performed using high-resolution 3DUS. In cases of abnormalities, MR and CT were performed on the same day as 3DUS. The images obtained with 3DUS, MR or CT, were exported to a workstation in Digital Imaging and Communications in Medicine format. A single observer performed slice-by-slice manual segmentation using a digital high definition screen. Software that converts medical images into numerical models was used to construct virtual 3D models, which were physically realised using AM technologies (SLA Viper, Objet Connex 350, ZCorp 510 or FDM Vantage). Results: The main outcomes presented were the possibility to create 3D virtual and physical models from 3DUS, MRI or CT both separately and also in various combinations. AM systems allow the conversion of a 3D virtual model to a physical model in a fast, easy and dimensionally accurate process. They were remarkably similar to the postnatal appearance of the aborted fetus or newborn baby. Conclusions: This study introduced the innovative use of AM models into fetal researches. The results suggest a new possibility for educational purposes or better interaction between parents and their unborn child during pregnancy. Normal fetus (29 weeks): Virtual and physical model built in a powder-based system.

OP11.01: Standardization of three dimensional ultrasonographic evaluation for the assessment of deep infiltrating endometriosis

Objectives: 3D power Doppler angiography (3DPD) is used to quantify the vascularity of an organ. Analysis of a stored dataset can be reliable but few studies have considered the reliability of data acquisition. Our aim was to investigate the intraand interobserver reproducibility of serial acquisition of 3DPD data of the whole placenta from women at 12 and 20 weeks gestation. We hypothesised a high level of agreement would exist. Methods: 20 low risk women with an uncomplicated, viable singleton pregnancy were scanned (Voluson 730 Expert) at two gestational age groups: 12+0 to 13+6 and 19+0 to 21+6 weeks. 3DPD whole placental datasets were acquired by two observers: the 1st made two acquisitions and the 2nd a single acquisition resulting in 3 datasets per patient and 120 overall. These were analysed by a single observer who used VOCAL (A plane, 9 degree steps) to define the VI, FI and VFI. The reliability of these measurements was assessed by intraclass correlation coefficients (ICC + 95% CI) and Bland-Altman plots. The presence of systematic bias within and between observers was also analysed. Results: Mean BMI was 24 (SD 5) in each group. Interobserver ICC was highest for the VI 0.81 (0.59–0.92) and VFI 0.76 (0.48–0.90). ICC for FI showed only moderate correlation at 0.55 (0.18–0.79). Bland Altman plots showed the FI to be the most reliable vascular index however at ±15% (expressed as a % of the mean) and ±17% at 12 weeks and ±9% and ±10% at 20 weeks for intraobserver and interobserver differences respectively. Intraand inter-observer differences were greater for VI at ±40% and ±70% respectively at 20 weeks. There was no bias between datasets. Conclusions: This study demonstrates that 3D can be used to reliably acquire power Doppler data from the whole placenta at 12 and 20 weeks gestation. Previous studies had only addressed the reliability of data analysis. Prospective studies are now required to identify if 3DPD is sensitive enough to identify patients with early-onset placental dysfunction.

The Ovarian Endometrioma: Clinical Setting and Ultrasound Findings

Ovarian endometrioma is defined as a pseudocyst arising from growth of ectopic endometrial tissue. The typical features of endometriomas are diffuse low-level internal echoes (“ground glass”) in the absence of particular neoplastic features and with a clear demarcation from ovarian parenchyma. Several studies report very high values of specificity with values of sensitivity usually ranging from 87 to 77 %.

OP29.09: Accuracy and reproducibility of ultrasonography for the diagnosis of ovarian cancer in operators with different degrees of experience

according to the IOTA protocol. A proper counselling on a low ovarian cancer risk was given and an adequate informed consent was obtained. Sonographic follow-up was proposed at 3 and 9 months, than yearly. Surgery was proposed in case of changes of ovarian cyst volume (>50%) and/or sonographic parameters at TVS-CD. Demographic, medical, sonographic and pathologic data were recorded. Results: 98 post-menopausal patients with 106 ovarian cysts were enrolled. Median age (IR) was 69 years (59–74). Median years after menopause (IR) were 18 (8–24). Median BMI (IR) was 26 kg/m2 (24–29). Mean parity (±sd) was 2 ± 1.8 women reported bilateral cysts. 53 cysts were unilocular, 53 multilocular. Median cyst diameter (IR) of unilocular and multilocular ovarian cysts was 50 mm (34–56). At a median follow-up period of 36 months, surgery was performed in 28 cases: 14 patients required immediate removal, 5 drop-out, 9 volume changes. One successfully managed cardiac arrest occurred during laparoscopic procedure. No malignant lesions were reported at histology. Conclusions: Sonographic follow-up might be a useful option in the clinical management of incidental unilocular >5 cm and multilocular <7 cm ovarian cysts in post-menopausal women. Larger and longer multicentres studies with strict sonographic parameters are needed to support this potentially safe conservative management.

OP29.06: Perception error and levels of certainty in diagnosing ovarian cancer in operators with different degree of experience

Objectives: To evaluate, sonographic, power-Doppler features and histological findings in cases of small unilocular-solid cyst in a normal-size ovary. Methods: All consecutive women with small ovarian unilocularsolid cyst in normal-size ovary detected by transvaginal ultrasound, were included in the study. Patients had either follow-up ultrasound examination every three months or underwent surgical removal of the cyst. CA 125 was also evaluated. Histological findings were reviewed. Results: A total of 45 cases were identified. The median age of the patients was 48 years (range 25–77). CA 125 was elevated (>35 UI/mL) in 6/45 (13%) cases. The median size of the cyst was 18 mm (range 11–30). The vascularization was present in 20/45 (44%) cases. 15/45 (33%) women received followup ultrasound examination every three month. 30/45 (67%) undervent laparoscopic removal of the cyst. Hystological diagnosis of malignancy (three carcinoma, and six borderline tumors) was recorded in 9/45 (20%) cases and of benign lesion in 21/45 (47%). Conclusions: These data suggest that the presence of a papillary projection is more important than the size of the cyst. Small unilocular solid cysts even in a normal-size ovary have substantial risk of malignancy.