C. Amoroso

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.

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.

OP16.04: Adenomyosis: three dimensional sonographic findings of the junctional zone in infertile patients

Objectives: The uterine junctional zone (JZ) seems to play an integral part in the implantation process. The coronal section of the uterus obtained by three dimensional (3D) transvaginal sonographic (TVS) permits an accurate evaluation of the JZ. An alteration in the JZ shows a high diagnostic accuracy for adenomyosis. The aim of this study is to assess the 3D TVS detectable morphological alterations of the JZ in infertile patients. Methods: We retrospectively evaluated JZ on the uterine coronal section obtained by 3D volume acquisition in infertile patients scheduled for HyCoSy. All patients underwent a HyCoSy, in the early proliferative phase, followed by a detailed TVS scan and 3D volume acquisition of the entire uterus. On the volume and multiplanar planes we evaluated: uterine diameters and volume, endometrial thickness, min JZ and max JZ thickness, alteration of the JZ, presence of myometrial cystic areas, asymmetry of myometrial wall, presence of myometrial hyperechoic areas and striations. A JZmax > 5 mm, or a JZmax-JZmin > 5, and presence of other TVS signs, were considered diagnostic for adenomyosis and were correlated with the cause of infertility when known. Results: Of the 123 infertile patients included in this study 81 had primary and 42 secondary infertility. 48 patients had a JZmax > 5 mm with a mean age of 37.8 ± 4.2 yrs significantly higher than those with JZmax ≤ 5 mm (35.6 ± 3.2 yrs). Patients with secondary infertility showed mean values of JZmax (6.4 ± 1.1 vs. 5.2 ± 1.2 mm) and JZmax-JZmin (3.8 ± 0.9 vs. 2.9 ± 1.2 mm) which was significantly greater than in patients with primary infertility. Other myometrial sonographic features of adenomyosis were found in 27 (56%) of 48 patients with JZ max > 5 mm and in only 3 of 75 (4%) with JZ max ≤ 5 mm. Conclusions: The coronal section of the uterus obtained by 3D TVS permits an accurate evaluation of the JZ on the coronal section. Non invasive assessment of JZ prior to conception may turn out to be useful in identifying those women affected by initial grade of adenomyosis.

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.

OC10.01: Rectal deep endometriosis: transrectal approach with transvaginal probe to assess the infiltration of rectal mucosa

Objectives: Pulsed tissue Doppler is a technique to record fetal myocardial wall movements with extremely high temporal resolution. Applicable measurements of cardiac performance indexes as TD-Tei Index or mechanical atrioventricular conduction times require knowledge of the exact length of cardiac time intervals as short as 30–50 ms. This requires meticulously fine tuning of the ultrasound parameters and high performance ultrasound equipment.The effect of two different ultrasound machines used to record fetal cardiac tissue Doppler traces on the results was analysed. Methods: Fetal cardiac tissue Doppler traces where obtained on 176 patients, who attended our institute for routine ultrasound scanning for fetal abnormalities or routine assessment of fetal growth. Ultrasound equipment used was either: Philips IU22, vision 2009 (P) or General Electrics E8, BT08 (G). Td-Tei index, the corresponding z-scores, medians and variance where compared. Results: Mean TD-Tei Index was 0.597 (P) and 0.587 (G) variance of TD-Tei Index was 0.009 and 0.008 mean Z-score of TD-Tei Index was 0.167 and −0.115 variance of Z-score of TD-Tei Index was 0.984 and 0.826 mean isovolaemic contraction time was 50.54 and 51.17 variance of isovolaemic contraction time was 116.4 and 109.3 mean isovolaemic relaxation time was 48.28 and 52.12 variance of isovolaemic relaxation time was 70.68 and 93.54 Conclusions: There where only minor differences in the means for fetal cardiac time intervals and their corresponding indices. In the variance of parameters measured with the two different ultrasound systems there were also no significant differences. The used equipment in our setup did not influence the results.

OC11.04: Three dimensional evaluation of adenomyosis: correlation of sonographic findings to histology

Methods: Observational cohort study of 804 patients. Two consecutive cohorts of 402 women undergoing SIS or GIS at the department Bleeding Clinic were included. Patients characteristics, ultrasound features, technical failure rates and final diagnosis (based on endometrial sampling, hysteroscopy and/or surgery) were compared. Pathology was defined as hyperplasia, polyps, intracavity myomas and carcinoma. Results: Mean age was 50.7 years (SD 12) and 50.2 years (SD 11.6) in the SIS and GIS group (NS). In the SIS group 12.7% were nulliparous and 53% premenopausal versus 17.4% and 57.2% in the GIS group (NS). Technical failure rate was 5.0% for SIS versus 1.9% for GIS (difference between proportions 0.03; CI [0.0054-0.0588]). Failure due to inadequate distension was 1.5% versus 0.3% for SIS and GIS (difference between proportions 0.01; CI [−0.02 0.03]). Pathology was diagnosed in 180 (49%) patients of the SIS group versus 147 (40.2%) of the GIS group (difference between proportions 0.09; CI [0.02-0.16]). The LR+ and LR− of a lesion during contrast sonography was 4.03 and 0.28 for SIS and 3.9 and 0.19 for GIS, respectively (NS). The sensitivity was 77.8% and 85.0%, respectively (NS). The negative predictive value was 79.1% for SIS and 88.6% for GIS (difference between proportions 0.095; CI [0.02-0.17]). Conclusions: The technical failure rate, partly due to unstable filling of the uterine cavity and transcervical backflow, was less for GIS. The diagnostic accuracy of GIS was comparable with SIS. We conclude that GIS is a feasible and accurate alternative for SIS in the evaluation of periand postmenopausal women with abnormal bleeding.

OP05.01: Three‐dimensional Coded Contrast Imaging: a new ultrasound approach to evaluate tubal patency

recruitment was completed. Multiplanar mode was used for volume reconstruction by 2 examiners who did not know the 2D NT measurements. 3D NT values in each position (random or neutral) were compared to those obtained with 2D ultrasound. We compared percentages of concordance between 2D and 3D using Fisher’s exact test. According to inter-observer variability described in the literature, we accepted a variation between NT of 0.40 mm. Then, we determined the Spearman correlation coefficients between 2D and 3D for the 2 examiners for each fetal position. Results: The concordance between 2D and 3D was superior when the acquisition was made in ‘‘neutral position’’ compared to ‘‘random position’’; 87% versus 77.7% for the first examiner (P = 0.25) and 97% versus 66.7% for the second one (P < 0.05). When the acquisition was made in ‘‘neutral position’’, correlation coefficients between 2D and 3D were 0.75 and 0.56 for the two examiners versus 0.43 and 0.46 for ‘‘random position’’. Conclusions: In order to obtain valid 3D NT measurements, we found 3D volume acquisition to be more reliable when fetus is in neutral midsagittal position. However, further investigation with larger sample of patients, is needed before 3D NT measurement is included in a first trimester Down syndrome screening program.

OC023: Sonographic evaluation of deep pelvic endometriosis: Endovaginal‐, transrectal‐ and vaginosonography to assess the extension of the disease

S. Guerriero1, L. Savelli2, F. P. G. Leone3, A. A. Lissoni4, A. C. Testa5, T. Bourne6, L. Valentin7, D. Timmerman8, C. Van Holsbeke9 1Department of Obstetrics and Gynaecology, University of Cagliari, Cagliari, Italy, 2Reproductive Medicine Unit, Department of Obstetrics and Gynecology, Bologna, Italy, 3DSC L. Sacco, Università di Milano, Milan, Italy, 4Clinica Ostetrica e Ginecologica, Ospedale S. Gerardo, Università di Milano Bicocca, Monza, Italy, 5Instituto di Clinica Ostetrica e Ginecologica, Universita Cattolica del Sacro Cuore, Rome, Italy, 6Department of Obstetrics and Gynecology, St George’s Hospital, London, United Kingdom, 7Department of Obstetrics and Gynecology, Malmö University Hospital, Lund University, Malmö, Sweden, 8University Hospitals Leuven, Leuven, Belgium, 9Ziekenhuis Oost-Limburg, Genk, Belgium

OC148: Adenomyosis: sonographic findings before and after insertion of levonorgestrel intrauterine system

correlation between lung volumes, MG, LBC, birth weight and delivery week was investigated. Results: The lung volume was different between preterm and term fetuses (104.8 ± 42.8 and 140.6 ± 27.3, P = 0.016). It also increased longitudinally throughout gestation between 26 and 40 weeks (from 31.7 to 221.9). MG was not statistically significantly different between groups (20.3 ± 18.6 in preterm fetuses and 18.4 ± 21.2 in term fetuses, P = 0.39). Lung area was lower in preterm fetuses than in term fetuses (29.1 ± 7.03 and 46.5 ± 8.8, P = 0.02). LBC was lower in preterm fetuses than in term fetuses (59 000 ± 51 000 and 121 000 ± 89 000, P = 0.012). Lung volume had a strong and significant positive correlation with gestational week (r = 0.431, P = 0.02) and 5-min Apgar score (r = 0.570, P = 0.002). Conclusions: Fetal lung volume measurement with VOCAL may be a reliable technique in the assessment of fetal lung maturity.