B. Szabolcs

Adenomyosis: Three-dimensional sonographic findings of the junctional zone and correlation with histology

To correlate with histopathological features the adenomyosis‐induced morphological alterations of the outer myometrium and the inner myometrium (‘junctional zone’, JZ) detectable on two‐ (2D) and three‐dimensional (3D) transvaginal ultrasound imaging (TVS), and to evaluate their diagnostic accuracy for adenomyosis.

Preoperative sonographic features of borderline ovarian tumors

To determine the sonographic findings that distinguish borderline ovarian tumors (BOT) from both benign and invasive malignant tumors, thus allowing conservative treatment and laparoscopic management of these tumors.

Automated sonographic tubal patency evaluation with three‐dimensional coded contrast imaging (CCI) during hysterosalpingo‐contrast sonography (HyCoSy)

Evaluation of tubal status is one of the initial steps in the diagnostic work-up of infertile women. Hysterosalpingo- contrast sonography (HyCoSy), currently performed as part of the infertility work-up to assess tubal patency by transvaginal ultrasound (TVS) 1 , is based on the introduction of fluid into the uterine cavity and Fallopian tubes. To evaluate the Fallopian tubes, a sonographic enhancing positive-contrast medium may be used. Air, albumin with micro air bubbles, and galactose with micro air bubbles have been studied. These positive- contrast agents outline the course of the Fallopian tubes, producingahyperechoicappearance.Themostsimpleand inexpensive positive-contrast medium is saline solution mixed with air. When this solution is shaken, it generates as uspension of air bubbles that is easily identif ied sonographically when injected into the uterine cavity and Fallopian tubes 2-4 with spillage around the ovaries. However, while two-dimensional (2D) TVS HyCoSy with saline solution mixed with air appears to be an accurate and inexpensive screening tool to assess tubal patency, it is highly observer-dependent and is accurate only in the hands of experienced investigators 2-5 . In addition,

Contrast-Tuned Imaging and Second-Generation Contrast Agent SonoVue: A New Ultrasound Approach to Evaluation of Tubal Patency

STUDY OBJECTIVE To determine whether transvaginal hysterosalpingo-contrast sonography (HyCoSy) with a new dedicated contrast-enhanced ultrasound technique, can contribute to accurate diagnosis of tubal occlusion. DESIGN Prospective observational study (Canadian Task Force classification II-2). SETTING University hospital. PATIENTS Two-hundred twelve patients with primary or secondary infertility. INTERVENTIONS All patients underwent transvaginal HyCoSy. If the tubes showed no evidence of patency after injection of air-saline solution, a solution with sulphur hexafluoride bubbles (SonoVue) was injected into the uterine cavity and tubes while contrast-tuned imaging (CnTI) was applied. Patients with tubal occlusion underwent laparoscopic chromoperturbation. MEASUREMENTS AND MAIN RESULTS Of the 212 patients who underwent tubal insufflation with air-saline solution, 52 demonstrated tubal occlusion, bilateral in 21 patients and unilateral in 31 patients, for a total of 73 suspected occluded tubes. At the HyCoSy test with SonoVue and CnTI, only 47 tubes seemed to be occluded, and in the other 26 tubes, passage of SonoVue was observed. HyCoSy with Sono Vue demonstrated high concordance for tubal obstruction with the laparoscopic dye test (94%). CONCLUSIONS HyCoSy with SonoVue and CnTi is a low acoustic pressure technique in which bubbles are not immediately destroyed and can be detected for several minutes. This enables the signal sent to the equipment to be filtered from the echoes emanating from other tissues. Therefore, excluding the fundamental image, the bubbles are clearly observed, with no visualization of pelvic tissues and organs. This allows easier evaluation of tubal patency, provides a more accurate assessment of tubal occlusion, and enables better visualization of the tubal course.

Automated three-dimensional coded contrast imaging hysterosalpingo-contrast sonography: feasibility in office tubal patency testing.

To evaluate the feasibility of transvaginal hysterosalpingo‐contrast sonography (HyCoSy) with new automated three‐dimensional coded contrast imaging (3D‐CCI) software in the evaluation of tubal patency and visualization of tubal course.

Laparoscopic approach to dermoid cysts: Combined surgical technique and ultrasonographic evaluation of residual functioning ovarian tissue

STUDY OBJECTIVE To estimate how and if laparoscopic removal of ovarian dermoid cysts is a tissue-sparing procedure. DESIGN Prospective study (Canadian Task Force classification II-2). SETTING University-associated hospital. PATIENTS Fifty-five women. INTERVENTION Laparoscopic removal of ovarian dermoid cysts by a combination of hydrodissection and blunt dissection, and transvaginal sonographic (TVS) evaluation of residual ovarian tissue. MEASUREMENTS AND MAIN RESULTS Within 1 week before surgery all recruited patients underwent TVS evaluation of ovarian volume, size, and morphology of dermoid cysts and measurement of surrounding ovarian cortex. Mean cyst diameter was 5.5 +/- 2.2 cm (range 2.1-15.0 cm). Within 6 to 12 months after laparoscopic excision, TVS measurements of residual ovarian tissues were obtained. Ovarian residual cortex surrounding the cyst was not visible at TVS in 24 ovaries, whereas in 56 ovaries residual tissue volume was greater than 3 cm3 after laparoscopic excision. CONCLUSION We propose laparoscopic removal of dermoid cysts by combining hydrodissection and blunt dissection with maximum tissue sparing, even when the cyst seems to fill the ovary and no surrounding ovarian cortex can be seen on ultrasound.

Ultrasound‐assisted laparoscopic cryomyolysis: two‐ and three‐dimensional findings before, during and after treatment

To investigate the role of two‐ and three‐dimensional (2D and 3D) ultrasound and power Doppler before, during and after surgery in monitoring the effects of uterine fibroid laparoscopic cryomyolysis.

OP11.05: Three‐dimensional sonographic assement of tubal patency with gel foam: hysterosalpingo‐foam sonography (HyFoSy)

and higher serum estradiol (E), progesterone (P) and hCG levels and miscarriage rates would be inversely related to these parameters. Methods: Power calculations suggested a sample size of 100: 128 women were prospectively recruited. Blood was drawn for P, E and hCG levels and TV USS (Voluson E8) scan performed to acquire 3D power Doppler data of the uterus and pulsed wave Doppler studies of uterine arteries. VOCAL used to define endometrium and subendometrium and the values corrected for depth by standardising against iliac vessels (sVI, sFI, sVFI). This was repeated after 7 days (ET+7). Stats analysis using ANOVA, logistic regression and ROC analysis. Results: 106 women included. 60 (56.6%) women conceived; 15 (25%) miscarried in the first trimester. All parameters changed significantly from ET to ET+7. Whilst there was no significant difference in endometrial morphometry or standardised subendometrial vascular indices, mean uterine artery PSV and serum E, P and hCG levels were significantly higher in women who conceived at ET+7. All 3 serum markers were predictive of pregnancy with AUC of 0.84 (95% CI 0.73–0.92), 0.76 (95% CI 0.64–0.85) and 0.96 (95% CI 0.90–0.99) for E, P and hCG. The best threshold was hCG 5IU: sensitivity 71%, specificity 98% for pregnancy. No sig difference in any parameter between women who miscarried and those who had live birth (P > 0.05). Conclusions: Mean uterine artery PSV and serum estradiol, progesterone and hCG a week post ET are significantly higher in women who conceive after IVF. hCG levels were most predictive of conception. No serum or ultrasound marker could predict which of these ended in miscarriage.

P48.02: Sonographic diagnosis of bladder endometriosis

the pregnancy after multidisciplinary consultation including genetic counseling. At 38 weeks gestational age, the patient delivered a 2956 g male neonate with Apgar scores of 6–9 at 5 and 10 minutes, respectively. In the neonatal physical examinations found penis length of few mm with left cryptorchidism. Neonatal testosterone concentration was 3 ng/mL. HCG treatment was started and circumcision was delayed. This case is unique in the very early diagnosis of severe micropenis.

OC19.04: Sonographic evaluation of posterior deep pelvic endometriosis: endovaginal-, transrectal- and vaginosonography to assess the extension of the disease: Oral communication abstracts

‘‘If only we could see what is really going on in there’’ has been one of reproductive biology’s great wishes. Ultrasonography has provided us with a tool for visualizing many aspects of human reproduction that we could only dream about a few short years ago. One of the most useful aspects of ovarian imaging would be the ability to predict the probability of conception based upon a simple, noninvasive examination. Although this wish is not currently available, it might not be as far from practical application as we might think. The current focus of attention in ovarian imaging in infertility therapy is directed at three distinct areas of inquiry. They are 1) assessment of the ‘‘ovarian reserve’’, 2) prediction of the ovarian response to exogenous superstimulation and 3) correlation of follicle imaging characteristics and oocyte quality. There is no consensus on a test for ovarian reserve that might allow an accurate prediction of the remaining reproductive lifespan for individual women. The methods now vary from the assessment of age and various hormone levels on a standardized day of the menstrual cycle, response to different hormonal challenge tests and estimates of ovarian volume and antral follicle counts. A difficulty with the imaging based portions of these assessments are that the number of antral follicles in the ovaries varies dramatically over the menstrual cycle, we do not yet know how to determine prospectively the ovarian follicular wave pattern that a women may express and that there does yet appear to be a standardized means of determining the number of follicles in different diameter categories. Currently accepted estimates of the number of follicles detectable with ultrasonography for estimation of ovarian reserve range from 8 to 12; however, recent data from detailed studies may be interpreted to mean that 18 to 32 follicles may be anticipated on Day 3.