M. E. Romanini

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.

Maternal Diastolic Dysfunction and Left Ventricular Geometry in Gestational Hypertension

Abstract—The objective of this study was to evaluate diastolic parameters and left ventricular geometry in gestational hypertension. Twenty-one consecutive pregnant women with gestational hypertension and 21 normotensive women matched for age and gestational age were enrolled in the third trimester of gestation. Echocardiographic and uterine color Doppler evaluations were performed. Systolic, diastolic, and mean blood pressure, total vascular resistance (TVR), and uterine resistance index were higher in hypertensive women than in control subjects (P <0.01). Left atrial function and cardiac output were significantly lower in gestational hypertension (P <0.01). Patients with gestational hypertension had longer left ventricular isovolumetric relaxation time (IVRT) (P <0.0001); lower velocity-time integral of the A wave (P <0.05) and of the diastolic pulmonary vein flow (P <0.05); and higher velocity-time integral of the reverse pulmonary vein flow (P <0.05). Systolic fraction of the pulmonary vein flow was higher in women with gestational hypertension than in control subjects (P <0.01); the difference in duration of pulmonary vein flow and A wave was closer to 0 in gestational hypertension (P <0.0001). Altered left ventricular geometry was found in 100% of hypertensive patients and in 19.05% of normotensive patients (P <0.001). IVRT, left ventricular end-systolic volume, atrial function, and uterine resistance index were directly related to TVR (P <0.01); deceleration time of the E wave showed a quadratic correlation with TVR (P <0.01). Gestational hypertension is characterized by an altered cardiac geometric pattern of concentric hypertrophy. The altered geometric pattern assessed during gestational hypertension is associated, in our study, with depressed systolic function, high TVR, altered diastolic function, and left atrial dysfunction. Deceleration time of the E wave, IVRT, and left atrial fractional area change, found in concomitance with the highest TVR, may be useful in the evaluation of cardiac function and hemodynamics present in pregnancy-induced hypertension.

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.

Single inherited thrombophilias and adverse pregnancy outcomes

Introduction:  Inherited thrombophilia is believed to be a multiple gene disease with more than one defect. We aimed to determine the association between single thrombophilic patterns and a variety of pregnancy diseases.

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.

Could birthweight prediction models be improved by adding fetal subcutaneous tissue thickness

Aim:  The aims of the study were to: (i) compare the accuracy of standard ultrasonic algorithms in the estimation of fetal weight and; (ii) test two new algorithms in order to improve the global performance of birthweight prediction by adding fetal subcutaneous tissue thickness.

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.

OC059: Recurrent miscarriage: Three dimensional power Doppler evaluation of endometrial and subendometrial volume and vascularity and correlation to uterine arteries blood flow

Objectives: To evaluate the relationship between uterine arteries blood flow and endometrial and subendometrial volume and vascularity using three-dimensional (3D) power Doppler untrasonography in patients with recurrent miscarriage (RM). Methods: 40 women with unexplained RM were included in the study. All patients underwent an accurate screening in order to exclude all the etiological RM factors. Three-D ultrasound examination with power Doppler was performed in all cases in the midluteal phase of the cycle by Voluson 730 pro GE machine. Twenty patients showed increased resistance to uterine arteries blood flow whereas in 20 cases normal resistances were found. Endometrial and subendometrial volume, vascularization index (VI), flow index (VI) and vascularization flow index (VFI) were calculated using the VOCAL (Virtual Organ Computer-aided AnaLysis) software. Results: Endometrial and subendometrial volume and VI were found significantly lower in patients with increased resistance to uterine arteries blood flow. No statistically significant correlations between uterine arteries PI, endometrial and subendometrial FI and VFI were observed. Nonetheless, patients with increased resistances to uterine arteries blood flow showed lower 3D vascularization indices. Conclusions: 3D power Doppler ultrasonography study of uterine perfusion seems to reflect the actual blood flow to the subendometrium and endometrium. This technique represents a unique tool to examine the blood supply towards the endometrial and subendometrial regions providing the opportunity to identify women with RM in which appropriate therapeutic protocols may effectively improve the possibility for successfully pregnancy.

OC259: Low malignant potential ovarian tumors: role of sonographic diagnostic criteria

removed – there were no cases of malignancy. In a study of 55,278 pregnancy terminations, there were 2 cases of malignancy. We have prospectively evaluated 3000 consecutive women who presented to the Early Pregnancy Unit. The prevalence of ovarian cysts was 5.3%. These women were managed expectantly and followed until resolution of the ovarian cyst occurred, intervention was required or the pregnancy concluded. 72.2% resolved spontaneously, 23.6% persisted and 4.2% required intervention – there were no cases of malignancy. Only 0.13% (1.3/1000) of all women in this longitudinal study required acute intervention. We concluded that examining the ovaries in the first trimester is of no value. Expectant management is advocated, at least until the pregnancy is beyond 14 weeks’ gestation. If symptomatic, simple ovarian cysts diagnosed during pregnancy can be successfully and safely treated with sonographic guided cyst aspiration. Adnexal masses can be accurately classified according to TVS. However in the few cases when the nature of the cyst is in question, one must balance the risks to the pregnancy from intervention versus the risk of malignancy.