Berit Gull

Terms, definitions and measurements to describe the sonographic features of the endometrium and intrauterine lesions: a consensus opinion from the International Endometrial Tumor Analysis (IETA) group

The IETA (International Endometrial Tumor Analysis group) statement is a consensus statement on terms, definitions and measurements that may be used to describe the sonographic features of the endometrium and uterine cavity on gray‐scale sonography, color flow imaging and sonohysterography. The relationship between the ultrasound features described and the presence or absence of pathology is not known. However, the IETA terms and definitions may form the basis for prospective studies to predict the risk of different endometrial pathologies based on their ultrasound appearance. Copyright

Factors influencing the presence of uterine cavity fluid in a random sample of asymptomatic postmenopausal women

AIMS To assess possible endometrial pathology and other factors influencing the presence of uterine cavity fluid in postmenopausal women. STUDY DESIGN A random sample of 559 asymptomatic postmenopausal women, recruited from the total population, were examined by transvaginal sonography (TVS) for the presence of uterine cavity fluid. Women with uterine cavity fluid who had an endometrial thickness of > or = 8 mm (including fluid) were admitted for hysteroscopy and a dilatation and curettage (D & C), and those with <8 mm underwent a new TVS examination one year later. A medical history, including details regarding previous minor gynecological surgery, was taken from the women and from an age-matched control-group of women from the same population. RESULTS Uterine cavity fluid was found in 8.9% (50/559) of the women. In four women with an endometrium measuring > or = 8 mm, curettage revealed polyps in three women and atrophy with a pyometra in one woman. At the one-year follow-up, 22 women who originally had an endometrial thickness<8 mm had an endometrial thickness of<5 mm; 11 women had no cavity fluid and in the remaining 11 the cavity fluid had decreased. In 17 women, endometrial thickness measured > or = 5 mm and subsequent histology showed 11 endometrial biopsies with atrophy, four endometrial polyps and two cervical polyps. The prevalence of uterine cavity fluid increased with increasing age (p<0.0001) and was increased in smokers (p<0.013) but was unaltered by the presence or absence of hormone replacement therapy (HRT). CONCLUSION There were no indications that uterine cavity fluid was associated with malignancy. The prevalence of uterine cavity fluid increased with increasing age and was higher in smokers. We could not demonstrate an increased prevalence of fluid in HRT-users.

Ovarian morphology assessed by magnetic resonance imaging in women with and without polycystic ovary syndrome and associations with antimüllerian hormone, free testosterone, and glucose disposal rate

OBJECTIVE To characterize ovarian morphology and perfusion by magnetic resonance imaging (MRI) in women with and without polycystic ovary syndrome (PCOS) and to investigate associations with antimüllerian hormone (AMH), free T, and glucose disposal rate (GDR). DESIGN Explorative cross-sectional study. SETTING University hospital. PATIENT(S) Fifty-eight women with PCOS and 31 controls from the general population. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Antral follicle count (AFC), ovarian/stromal volume, perfusion, AMH, free T, and GDR. RESULT(S) Antral follicles of 1-3 and 4-6 mm, but not 7-9 mm, were more numerous, and total AFC (1-9 mm) was higher in women with PCOS. Ovarian volume was larger in women with PCOS. AMH and free T were higher and GDR was lower in women with PCOS. All values were more deranged in classic compared with nonclassic PCOS. There was a positive correlation between AMH and AFC, 1-3 mm (r = 0.81), and between AMH and total AFC (r = 0.87). In receiver operating characteristic analyses, the area under the curve was 0.89 for total AFC, 0.86 for AMH, and 0.90 for free T. PCOS was independently associated with AFC and free T but not with AMH or GDR when adjusted for age and body mass index. CONCLUSION(S) Counting antral follicles down to 1 mm in size by MRI yielded higher AFCs than previously reported. AFC, AMH, and free T discriminated with high accuracy between women with PCOS and controls, but AMH was not independently associated with PCOS. CLINICAL TRIAL REGISTRATION NUMBER NCT00484705.

Ovarian volume and antral follicle count assessed by MRI and transvaginal ultrasonography: a methodological study

Background Ultrasonographic measurements of ovarian volume and antral follicle count are of clinical importance as diagnostic features of polycystic ovarian syndrome (PCOS), and as a parameter in estimation of ovarian follicular reserve in infertility care. Purpose To compare two-dimensional (2D)/three-dimensional (3D) transvaginal ultrasonography (TVUS) and magnetic resonance imaging (MRI) for estimation of ovarian volume and antral follicle count, and to assess reproducibility and inter-observer agreement of MRI measurements. Material and Methods Volumes of 172 ovaries in 99 women aged 21–37 years were calculated (length x width x height x 0.523) with conventional 2D TVUS and 2D MRI. Semi-automatic estimates of ovarian volumes were obtained by 3D MRI. Antral follicles were counted manually on 2D MRI and automatically by 3D TVUS (SonoAVC), and stratified according to follicle size. Results Mean ovarian volume assessed by 2D TVUS (13.1 ± 6.4 mL) was larger than assessed by 2D MRI (9.6 ± 4.1) and 3D MRI (11.4 ± 4.5) (P < 0.001). Total follicle count was higher by 2D MRI than by 3D TVUS, mean difference 14.3 ± 16.2 follicles (P < 0.001). In the smallest size interval of 1–3 mm the mean difference was 22.2 ± 17.6 (P < 0.001). Intra- and inter-observer absolute agreement assessment for MRI measurements of ovarian volume and total follicle count showed ICC coefficients >0.77. Conclusion 2D MRI reveals more antral follicles, especially of small size, than 3D TVUS. Ovarian volume estimation by MRI provides smaller volumes than by the reference standard 2D TVUS. Ovarian volume estimation by 3D MRI, allowing independence of non-ellipsoid ovarian shape measurement errors, provides volumes closer to 2D TVUS values than does 2D MRI. Reproducibility and inter-observer agreement of 2D MRI measurements of ovarian volume and total follicle count are good.

Uterine morphology and peristalsis in women with polycystic ovary syndrome.

Background Polycystic ovary syndrome (PCOS) is associated with chronic oligo-anovulation and high circulating sex hormone levels. Women with PCOS have an increased risk of developing endometrial cancer. In anovulatory women with PCOS a positive relationship between endometrial thickness and endometrial hyperplasia has been observed. Uterine peristalsis, which has been suggested to be of importance for female fertility, has not previously been studied in PCOS. Purpose To assess whether women with PCOS have altered endometrial thickness, uterine wall morphology, and peristalsis. Material and Methods In this prospective case-control study 55 women with PCOS (mean age, 29.5 years+4.5 SD) and 28 controls (27.6+3.2) were examined using magnetic resonance imaging (MRI), assessing thickness of endometrium, junctional zone (JZ), and myometrium, and evaluating the occurrence, frequency (waves/min), strength (amplitude), pattern, and direction of peristalsis. Uterine morphology was also assessed by transvaginal ultrasonography (TVUS). Results The endometrium was thinner in PCOS with oligo-amenorrhea compared to controls, also after adjustments for age and BMI (adjusted P = 0.043). There was no difference in thickness of the JZ or the myometrium in cases versus controls. Uterine peristalsis was less commonly observed in women with PCOS than in controls (adjusted P = 0.014). Conclusion There were no differences in myometrial morphology between PCOS and controls, but the endometrium was thinner in PCOS with oligo-amenorrhea. Based on cine MRI, uterine peristalsis was less common in PCOS than in controls.

Serum anti-Müllerian hormone and ovarian morphology assessed by magnetic resonance imaging in response to acupuncture and exercise in women with polycystic ovary syndrome: secondary analyses of a randomized controlled trial

To investigate whether electro‐acupuncture or physical exercise influence serum anti‐Müllerian hormone (AMH), antral follicle count (AFC) or ovarian volume in women with polycystic ovary syndrome (PCOS).

Sertoli-Leydig cell tumour in a postmenopausal woman showing all facets of the insulin resistance syndrome (IRS)

Sertoli-Leydig cell tumours are rare sex stromal tumours with an incidence of <0.5% of all ovarian tumours. Most frequently this tumour occurs in young women with a history of amenorrhoea, hirsutism and lowered pitch. Here, we report on a woman with IRS, postmenopausal virilization and increased testosterone levels due to a Sertoli-Leydig cell tumour. This is the first case to suggest an association between IRS and Sertoli-Leydig cell tumours. Furthermore, we highlight the difficulties in detecting this ovarian tumour with sonography.

Factors associated with endometrial thickness and uterine size in a random sample of postmenopausal women

Objective:  To investigate factors possibly associated with endometrial thickness and uterine size in a random sample of postmenopausal women.

Spontaneous twin pregnancy with live births after cryopreservation and re-implantation of ovarian tissue

Methods A 27-year-old, 1-parous patient suffered from Hodgkin’s lymphoma in 2011. Pre-operative transvaginal sonography (TVS) revealed a normal uterus, the left side ovary with a unilocular cyst of 50 × 70 mm and the right ovary with 8 antral follicles. Laparoscopic stripping of left ovarian cyst and right-sided oophorectomy was performed with subsequent standard OTC of 15 cortical strips [5] before six chemotherapy treatments with BEACOPP (bleomicin, etoposide, adryamicin, cyclophosphamide, oncovin, procarbazine, prednisolone). Histology showed benign mucinous cystadenoma. After chemotherapy, patient experienced amenorrhea and climacteric symptoms that were treated by hormonal replacement therapy (HRT). HRT was ceased in October 2013 due to benign cysts in the breast, and the patient developed oligomenorrhea. Hormonal status after chemotherapy is presented in Fig. 1a. Patient was considered free of disease and tried to conceive for 1 year. In March 2015, TVS showed cyst on the left ovary and laparoscopic

OC143: Long‐term follow‐up for women with postmenopausal bleeding who have normal ultrasound scans—is ultrasound alone sufficient to manage these patients?

ultrasound examination contributes to a correct diagnosis of endometrial malignancy: the higher the color content of the endometrium the higher the risk of cancer. Multivariate logistic regression models including clinical variables (e.g., age, use of HRT, body mass index), gray scale ultrasound findings, and Doppler findings can be used to calculate the individual risk of malignancy. The clinical value of mathematical models has not been determined.