Emílio Francisco Marussi

Ultrasound criteria and CA 125 as predictive variables of ovarian cancer in women with adnexal tumors

To evaluate the capacity to predict malignancy in women with adnexal tumors using CA 125 measurement and ultrasound criteria.

Variation in the amniotic fluid index following moderate physical activity in water during pregnancy

Background. To evaluate changes in the amniotic fluid index (AFI) in low‐risk pregnant women before and after physical activity in water. Methods. This was a prospective trial with a before‐after approach. Women carried out moderate physical activity for 50 min, 3 times a week, while partially immersed in a swimming pool at 30°C. Women with 2 or more previous cesarean sections, with a high‐risk pregnancy or medical contra‐indications for physical activity were excluded. They were evaluated weekly by ultrasonography, from 20 weeks of pregnancy until delivery, to evaluate AFI before and after physical activity in water. A second observer also performed the AFI measurements, in order to establish inter‐observer variability. Analysis was performed using Students t‐test or Wilcoxon tests. The linear correlation coefficient was used to assess inter‐observer variability. Results. A total of 25 pregnant women, 19–36 years of age, participated in the study between May 2003 and December 2004. A total of 232 ultrasonographic evaluations of AFI were carried out, a mean of 9.28 examinations per woman. Statistically significant increases in AFI were found following immersion at almost every week of pregnancy. The increase in AFI post‐immersion compared to pre‐immersion values ranged from 8.8 to 21.5%. There was good inter‐observer agreement. The correlation coefficient for the inter‐observer variability was 0.78 for pre‐immersion measurements, and 0.70 for post‐immersion measurements. Conclusions. Physical activity in water appears to significantly increase AFI. Since this is a non‐invasive therapy, we speculate that its clinical application may have significant value.

Curva dos valores normais de peso fetal estimado por ultra-sonografia segundo a idade gestacional

Este trabalho teve por objetivo avaliar a evolucao do peso fetal estimado em gestacoes normais de 20 a 42 semanas. Quanto ao desenho e metodos empregados na pesquisa, realizou-se estudo descritivo de um universo constituido por 2.874 gestantes normais da cidade de Campinas, efetuando-se exame ultra-sonografico obstetrico de rotina com medida da biometria fetal e utilizando-se, para o calculo do peso fetal, a formula de Hadlock et al. (1991). Calcularam-se os valores dos percentis 10, 50 e 90 do peso fetal, por idade gestacional, com construcao de curva posteriormente alisada mediante ajuste polinomial de 2o grau. Como resultado, obteve-se que o valor do percentil 50 foi de 368 gramas na 20a semana, 1.512 gramas na 30a semana, atingindo 3.417 gramas na 42a semana. Constatou-se ter havido ganho medio de 200 gramas de peso por semana, de 27 a 38 semanas, a partir de quando o incremento diminuiu. Concluiu-se que a disponibilidade de curva brasileira do peso fetal estimado normal permitira o diagnostico pre-natal de seus desvios pela ultra-sonografia.OBJECTIVE: to evaluate the evolution of estimated fetal weight in normal pregnancies in Campinas, Brazil, between 20 to 42 weeks. DESIGN AND METHODS: A descriptive study was performed, including 2,874 normal pregnant women studied through routine obstetric ultrasound with fetal biometry, using the Hadlock (1991) formula for fetal weight estimation. Data were evaluated by fitting a curve with the 10th, 50th, and 90th percentiles of fetal weight for gestational age, subsequently submitted to a smoothing procedure by quadratic polynomial adjustment. RESULTS: the 50th percentile was 368g at 20th week, 1,512g at 30th, and 3,417g at 42nd week. There was a mean weight increase of 200g per week from the 27th to 38th week, when the gain decreased. CONCLUSIONS: The availability of a Brazilian curve of normal estimated fetal weight will allow for prenatal ultrasound diagnosis of deviations.

Evolution of cystic and adnexal tumors identified by echography

The authors present their experience in detecting volume and echostructure alterations of the ovary in 14 525 women examined echographically and clinically. They analyzed 499 adnexal tumors and observed after clinical follow‐up and echography that 60.6% of the cystic‐septa tumors had involuted spontaneously. Percentage of spontaneous resolution was higher in small‐diameter tumors, avoiding unnecessary surgery.

Birth‐weight prediction by two‐ and three‐dimensional ultrasound imaging

To compare the accuracies of birth‐weight predicting models derived from two‐dimensional (2D) ultrasound parameters and from total fetal thigh volumes measured by three‐dimensional (3D) ultrasound imaging; and to compare the performances of these formulae with those of previously published equations.

Simple rules for ultrasonographic subcategorization of BI-RADS ® -US 4 breast masses

OBJECTIVESnTo evaluate an objective method for ultrasonographic (US) subcategorization of BI-RADS(®)-US 4 breast masses based on clear and simple rules in order for woman to benefit from a more complete and homogeneous breast mass analysis.nnnMETHODSnIn this cross-sectional study, we selected 330 women, with 339 US breast masses, classified as BI-RADS(®)-US 4. Three physicians experienced in breast imaging independently reviewed all US images, assessing mass shape, margins, orientation, echo texture and vascularity. These experts further subdivided the masses into subcategories 4a, 4b and 4c, according to simple US rules. Inter-observer agreement was calculated for US features categories and for final subcategory assessment. We also estimated the positive predictive value (PPV) for BI-RADS(®)-US subcategories 4a, 4b and 4c assigned by each of the three observers.nnnRESULTSnPathological examination of all masses confirmed 144 (42%) malignant and 195 (58%) benign tumors. Moderate agreement was obtained for mass shape, margins, vascularity and for final BI-RADS(®)-US 4 subcategory. Substantial agreement was obtained for the description of mass orientation and echo texture. The PPV for subcategories 4a, 4b and 4c were, 17%, 45% and 85%, respectively, for the first observer and 20%, 38% and 79% and 17%, 40% and 85% for the other two observers.nnnCONCLUSIONnStandardization of a US subcategorization of BI-RADS(®)-US 4 breast masses seems to be feasible, with substantial inter-observer agreement and progressive increase in the PPV in the subcategories 4a, 4b and 4c, provided that clear and simple classification rules are defined.

Sonographic measurement of the umbilical cord area and the diameters of its vessels during pregnancy

The objective was to determine the cross-sectional area of the umbilical cord, its diameter and the diameter of its vessels to establish a reference curve for these parameters during pregnancy, through a prospective cross-sectional study, including 2,310 low-risk pregnancies between 12 and 40 weeks’ gestation. Means and standard deviations (SDs), plus the 10th, 50th and 90th percentiles for each measurement were calculated using polynomial regression analysis. Mann–Whitney, Kruskal–Wallis and Wilcoxon tests were used for statistical analysis. These parameters increased significantly with gestational age. The area of the cord also varied significantly with parity. Their new reference curves for low risk pregnancies were calculated using polynomial regression, and an almost linear increase in values was found up to 32 weeks of pregnancy, tending to stabilise from then onwards. The regression equation of the umbilical cord area according to gestational age (GA) was: –1.417 + 0.3026*GA–0.008*GA2 + 0.000007*GA3 and the degree of adjustment (R2) was 0.89.

Intervalos de referência longitudinais de parâmetros doplervelocimétricos materno-fetais

PURPOSEnTo create longitudinal reference intervals for pulsatility index (PI) of the umbilical (UA), middle cerebral (MCA), uterine (UtA) arteries and ductus venosus (DV) in a Brazilian cohort.nnnMETHODSnA longitudinal observational study performed from February 2010 to May 2012. Low risk pregnancies were scanned fortnightly from 18 to 40 weeks for the measurements of PI of the UA, MCA, DV and UtA. Linear mixed models were used for the elaboration of longitudinal reference intervals (5th, 50th and 95th percentiles) of these measurements. PI obtained for the placental and abdominal portions of the umbilical artery were compared by the t-test for independent samples. Two-sided p values of less than 0.05 were considered statistically significant.nnnRESULTSnA total of 164 patients underwent 1,242 scans. There was significant decrease in PI values of all vessels studied with gestational age (GA). From the 18(th) to the 40(th) week of pregnancy, the median PI values of UA (abdominal and placental ends of the cord), MCA, DV and the mean PI of the UtA ranged from 1.19 to 0.74, 1.33 to 0.78, 1.56 to 1.39, 0.58 to 0.41, and 0.98 to 0.66, respectively. The following equations were obtained for the prediction of the medians: PI-UA=1.5602786 - (0.020623 x GA); Logarithm of the PI-MCA=0.8149111 - (0.004168 x GA) - [0.02543 x (GA - 28.7756)²]; Logarithm of the PI-DV=-0.26691- (0.015414 x GA); PI-UtA = 1.2362403 - (0.014392 x GA). There was a significant difference between the PI-UA obtained at the abdominal and placental ends of the umbilical cord (p<0.001).nnnCONCLUSIONSnLongitudinal reference intervals for the main gestational Doppler parameters were obtained in a Brazilian cohort. These intervals could be more adequate for the follow-up of maternal-fetal hemodynamic modifications in normal and abnormal pregnancies, a fact that still requires further validation.

Fetal thigh volumetry by three-dimensional ultrasound: comparison between multiplanar and VOCAL techniques.

To evaluate the agreement between multiplanar and Virtual Organ Computer‐aided AnaLysis (VOCAL™) techniques for the measurement of total fetal thigh volume and to assess the repeatability and reproducibility of measurements performed using these methods; to derive birth weight‐predicting models for both methods and to compare their accuracies.

Detection of Ovarian Sertoli-Leydig Cell Tumors Exclusively by Color Doppler Sonography

ertoli-Leydig cell tumors account for less than 0.5% of all ovarian cancers. Here we report the case of a 64-year-old patient who had previously undergone left oophorectomy. She underwent a pelvic scan because of lower abdominal pain. Transvaginal sonography showed a right ovary with normal gray scale images. Color Doppler sonography showed intense blood flow inside the gonad, with a low resistive index. After laparoscopic removal of this ovary, histologic examination revealed an intermediately differentiated Sertoli-Leydig cell tumor. Our findings suggest that intensely vascularized ovaries in postmenopausal patients should be closely followed, and histologic evaluation should be considered if these characteristics persist, even in normal-sized gonads.