H. Marret

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

Intravenous contrast ultrasound examination using contrast‐tuned imaging (CnTI™) and the contrast medium SonoVue® for discrimination between benign and malignant adnexal masses with solid components

To determine whether intravenous contrast ultrasound examination is superior to gray‐scale or power Doppler ultrasound for discrimination between benign and malignant adnexal masses with complex ultrasound morphology.

Power Doppler vascularity index for predicting malignancy of adnexal masses.

To assess the performance of a power Doppler vascularity index in the preoperative diagnosis of ovarian malignancy.

OP07.10: Focused ultrasound surgery for conservative fibroids treatment

range 21–64). Both examinations were performed the same day and the ultrasound always before the OHSC. The on-site ultrasound opinions and the post-processing ultrasound diagnoses of saved 3Dvolumes were matched with the OHSC findings. Equipment used was a Medison Accuvix XQ (Medison Co, Ltd, Seoul, Korea) with a 3D transvaginal probe, the post-processing we made by the 3DXI Viewer (Medison). The referral diagnoses for OHSC were infertility (n = 36, 50.70%), bleeding disorder (n = 21, 29.58%), fibroid/polyp (n = 9, 12.68%), repeated pregnancy loss (RPL)/ uterine anomaly (n = 5, 7.04%). Results: The on-site GS ultrasound opinions were negative in 34 (47.89%) patients in contrast to the 32 (45.07%) negative OHSC results. Post-processing and further analysis of the digitally saved 3D-volumes detected lesions in seven additional cases (3 polyps and 4 uterine malformations). Overall, ultrasound failed to detect lesions of four patients (5.63%). However, the ultrasonography detected seven additional uterine pathologies, like intramural fibroids which were not visualized by hysteroscopy. In this study the GS ultrasound had a specificity of 88.89% and sensitivity of 73.58%, while the addition of the off-patient analysis of the 3D volume increased the specificity to 88.89% and a sensitivity to 90.70% in the detection of focal intrauterine lesions. Conclusions: Focal intrauterine lesions such as submucosal fibroids, polyps are often found in the background of common gynecologic disorders such infertility, bleeding disorders and RPL. Although hysteroscopy is regarded as gold standard in the diagnosis, analysis of the 3D ultrasound volume can reach the diagnostic level of hysteroscopy and offers an effective non-invasive diagnostic approach.

OC19.03: Contrast-enhanced sonography in the preoperative diagnosis of ovarian tumors considered difficult to classify by ultrasound examiners

Methods: 109 women with adnexal masses underwent transvaginal gray scale and 3D power Doppler ultrasound examination using a GE Voluson 730 Expert system. After 12–18 months the volumes were analysed twice by two independent experienced sonologists who used IOTA terms and definitions to describe the mass. The assessors also had to classify the mass as benign or malignant using pattern recognition and to suggest a likely histological diagnosis. The time between the two assessments by the same sonologist was 1 to 6 months. Results: There were 90 benign, 8 borderline and 11 malignant adnexal masses. There were no systematic differences in measurement results within or between observers. Differences in measurement results did not change with the magnitude of the measurements. Intra-observer agreement in terms of Kappa value was 0.90 (agreement 92%) for specific histological diagnosis, 0.90 (96%) for malignancy, 0.84 (88%) for type of mass, 0.79 (85%) for tumor size (categorized), 0.71 (86%) for irregular walls and 0.58 (72%) for number of papillary projections. Kappa values for inter-observer agreement were 0.78 (85%) for specific histological diagnosis, 0.81 (93%) for malignancy, 0.76 (83%) for type of mass, 0.89 (92%) for tumor size, 0.53 (80%) for irregular walls and 0.35 (60%) for number of papillary projections. Conclusions: Intraand inter-observer agreement was good with regard to size and type of mass, specific histological diagnosis, and malignancy. Inter-observer agreement was poorest for irregularity and the number of papillary projections. This study shows that repeated analyses of 3D ultrasound volumes of adnexal masses by the same or different observers may yield different results, but that the diagnosis suggested using pattern recognition will often be the same.

OP07.05: Utility of contrast‐enhanced ultrasound in the monitoring of magnetic resonance guided focused ultrasound ablation in patients with uterine fibroids

using gelatin sponge pledgets. In our case the AVM recurred due to recruitment of vessels from the ovarian arteries. The patient responded well to a second intervention with embolization of both ovarian arteries using poly-vinyl alcohol particles and two platinum microcoils on the left side. At six weeks after the procedure the patient reported a normal menses with no irregular uterine bleeding. Transvaginal twodimensional ultrasound confirmed that the mass has decreased, leaving only a small hypoechoic area in the left uterus wall. Two years after the first intervention the third and fourth embolization was performed due to hypermenorrhagia. The patient remains well with normal menses now. We demonstrate here the value of three-dimensional sonography in the diagnosis of AVM and the use of reembolization as an effective therapeutic option when conservative treatment with uterine preservation is desired

OC164: Ultrasound contrast examination to discriminate benign and malignant adnexal masses

A. C. Testa1, D. Timmerman2, E. Fruscella1, C. Van Holsbeke2, L. Savelli3, E. Ferrazzi4, F.P.G. Leone4, H. Marret5, C. Exacoustos6, G. De Placido7, D. Bokor8, G. Ferrandina1, V. Van Belle9, L. Valentin10 1Università Cattolica del Sacro Cuore, Rome, Italy, 2University Hospitals, Leuven, Belgium, 3Reproductive Medicine Unit, Bologna, Italy, 4DSC L. Sacco Università di Milano, Milano, Italy, 5Unité INSERM CHU Bretonneau, Tours, France, 6University of Tor Vergata, Rome, Italy, 7University of Naples, Naples, Italy, 8Bracco S.p.A., Milano, Italy, 9Dept Electrical Engineering (ESAT-SCD), Katholieke Universiteit Leuven, Leuven, Belgium, 10University Hospital, Malmo, Sweden

OC208: Ultrasonographer experience vs. power Doppler index for ovarian tumor discrimination

Objectives: Ovarian causes of virilization include polycystic ovary syndrome (PCOS), androgen-secreting neoplasms and ovarian stromal hyperthecosis (SH). The ultrasound features of the first two causes have been described, but there is little published data regarding the ultrasound appearance of ovarian stromal hyperthecosis. The primary purpose of this study was to describe the sonographic features of ovarian SH. Methods: A computerized search of our institution’s pathology and imaging databases from 1996 to 2006 was performed to identify patients with histologically proven SH who had a pelvic ultrasound scan before surgery. The ultrasound images were reviewed to categorize the ultrasound findings. Associated pathological findings in the ovaries and uterus were also noted. Results: Sixteen ovaries with SH, in 12 patients with mean age 59.6 (range, 36–83) years, were identified. SH was bilateral in four, unilateral in six and of uncertain laterality in two patients who only had a unilateral oophorectomy. Ultrasound findings in the 16 ovaries with SH were: two normal, seven not seen, three enlarged but otherwise normal, one with a hemorrhagic cyst (resolved by surgery) and otherwise normal, one with a probable solid mass (nodular SH), and two with polycystic ovaries (both SH and PCOS by histology). Three of the 12 patients (25%) also had endometrial carcinoma. Five of the 12 patients (42%) also had an ovarian fibrothecoma. Conclusions: Ovarian SH does not have recognizable ultrasound findings in most patients. A minority of affected ovaries appear enlarged but otherwise normal, a solid mass may infrequently be visible, and PCOS changes may coexist with SH. A possible association of SH with endometrial carcinoma was noted, and has been reported previously. A possible association of SH with fibrothecoma was also noted, which to our knowledge has not been reported previously.

OC196: The contribution of CNTI-SonoVue in the classification of adnexal masses as benign or malignant: a multicenter study

I concentration. Cardiac troponin I (cTnI) is a specific marker of myocardial injury in adults and children. Perinatal asphyxia can cause cardiac dysfunction. Methods: Some 161 samples among fetuses from pathological pregnancies were collected. Twenty-two had an elevated level of cTnI (above 0.1 ng/mL). Disorders in pregnancy, date of gestation, Doppler flow velocimetry in the ductus venosus (DV) and umbilical artery (AU) and vein (DV), mode of delivery, Apgar score and respiratory status after birth were evaluated. cTnI was determined on a dimension clinical chemistry system. Results: There were 22 newborns with a raised level of TnI: seven (31.8%) with SGA, five (22.2%) with fetal cardiac problems (arrhythmia, structural and functional abnormalities), nine (40.9%) with abnormal biophysical test results (abnormal Doppler velocimetry, computerized cardiotocography, biophysical profile score) and six (27.2%) whose mothers who had disorders (diabetes mellitus, hypertension). Results are shown in the table. Median gestational age at delivery was 36.6 (range, 27–43) weeks. Seventeen (77.2%) patients had a Cesarean section. The range of TnI blood concentration was 0.11–6.66 ng/mL in this group. Five (22.7%) had umbilical pH below 7.25. Conclusions: A high level of cTnI was associated with several disorders that could have led to fetal asphyxia. More detailed fetal heart examination is necessary to prove that fetal asphyxia had an impact on heart function.

OC118: Use of sonovue for myoma embolization monitoring

Objectives: To assess the diagnostic accuracy of TVUS and SHG in the preoperative staging of submucous fibroids. Methods: Forty-eight women with submucous fibroids diagnosed on TVUS were assessed with SHG within 30 days from surgical treatment. Fibroids were staged according to the angle between the fibroid margins and the endometrium: G0, < 20◦; G1, 20–90◦; G2 > 90◦. Results were compared with findings at operative hysteroscopy or on pathological examination of the uterus. Results: TVUS allowed staging of the fibroid in 18/48 cases (38%). SHG changed staging in 3 out of these 18 cases (17%). In those 30 women where TVUS did not allow staging of the fibroid, SHG was successful in 26. Overall, SHG was considered diagnostic in 44/48 cases (92%). In all of these 44, the accuracy of staging was confirmed. In 4 cases, SHG was considered non diagnostic due to technical difficulties in obtaining sufficient distension of the endometrial cavity. No patient experienced severe pain, vasovagal reactions or infection. Conclusion: SHG performs better than simple TVUS in the preoperative staging of submucous fibroids. SHG showed complete concordance with hysteroscopic and pathological findings.