M. Mabille

Real‐time transvaginal elastosonography of uterine fibroids

Uterine fibroids are the most frequently occurring benign tumors originating in the uterus, and are usually round or partially rounded in shape (Figure 1). Although they are composed of the same smooth-muscle fibers as the uterine wall, they are many times more dense than is normal myometrium. This characteristic is frequently responsible for the poor visualization of fibroids on transvaginal ultrasonography, due to strong acoustic shadowing.

Imaging of the fetal bony pelvis by computed tomography in a case of bladder exstrophy

We describe the findings on computed tomography (CT) in a prenatally diagnosed case of bladder exstrophy, and compare them with the findings on two‐ and three‐dimensional sonography. The CT data of the affected fetus were compared with the CT findings of 14 fetuses with normal bony pelvises. The CT images showed differences in the structure of the bony pelvis in the case of bladder exstrophy, with a wide gap between the iliopubic and ischiopubic rami and a widening of the iliac bones. CT scanning was useful in confirming the sonographic diagnosis of bladder exstrophy, and it may also be helpful for planning early surgery following delivery. Copyright

OC14.02: Three dimensional imaging of fetal skeletal dysplasia: comparison of 2D, 3D ultrasound and helical computed tomography

genitourinary malformations (7%); 15 gastrointestinal anomalies (6%) and 71 miscellaneous (26%). In 244 (89%) both ultrasound and MRI findings were in agreement with postnatal diagnoses. MRI changed the US diagnosis in 16 (5,8%) cases. Relevant additional information were provided in 7 (2,5%) cases: 3 central nervous system anomalies; 3 thoracic defects; 1 abdominal malformations. Ultrasound was more accurate than MRI in 4 (1,4%) cases: 1 case of placenta previa; 1 exomphalos; 1 CCAM in a twin pregnancy; 1 hypoplasia of corpus callosum. In 9 (3,2%) cases, the diagnoses at both US and MR imaging were not correlated with postnatal outcome. Conclusions: Prenatal US remains the primary fetal imaging modality. Prenatal diagnosis of even complex malformations was accurate in over 90% of cases. In a few selected patients in our experience, particularly in late pregnancy, MRI may however add relevant information.

OP30.13: Transvaginal real time elastosonography for uterine fibroids diagnosis and mapping

appeared very similar. The final histologic diagnosis was extrauterine undifferentiated endometrioid stromal sarcoma close to co-existing deep endometriosis in the rectovaginal septum and myometrium (adenomyosis). Subsequent radiotherapy was administered. Seven months after the initial surgery the patient is in good health. Conclusion(s): Malignant transformation of deep endometriosis should be considered in the differential diagnosis of pelvic lesions even in a patient without a history of endometriosis but sudden onset of pelvic pain and ultrasonographic signs of deep endometriosis. However, currently it is not possible to predict malignant transformation by ultrasonography. This is why multiple laparoscopic biopsies and regular follow-up by ultrasound is warranted.

P05.03: Antenatal neuronal fiber tracking with diffusion tensor MRI in humans

The primary aim of this study was to calculate, based on a mathematically modelled decision tree the cost effectiveness of the RM as an intervention for improving fetal medicine specialist’s decisions. Methods: 106 cases of fCNS were prospectively followed up until either termination of pregnancy (TOP) or postnatal follow up (PF). All of them underwent dedicated ultrasonographic (US) assessment and MR, at least once during prenatal evaluation. Neurological postnatal outcome and anatomo-pathology records were registered as gold standards. Positive and negative likelihood ratios (LR) were calculated for four specific regions: posterior fosa (PF), ventricular zone (VZ), cortex and subcortical region (CSC) and middle line (ML). After refinement of univariate analysis, a discriminative likelihood ratio (LR) was calculated for every region and technique, based on direct and indirect cost and calculated post-test probability a Markov’s chain was designed to modelate the real effectiveness of each test. Results: Table 1 summarizes LR results for region and technique, based on post test probabilities and costs, the probability of improving diagnosis with MR before 22 weeks is 15% for PF, 18,5% for VZ, 11% for CSC, 23% for ML, once modified the model for gestational age, the probability at 33 weeks increases to 53%, 78%, 65% and 42% respectively.

RP-WS-40 Imagerie tridimensionnelle de l’os fœtal par scanner 64 detecteurs

Objectifs Illustrer l’interet du scanner 64 detecteurs dans l’etude de l’os fœtal, au cours de pathologies diverses, et en particulier dans les osteochondrodysplasies. Souligner les avantages et les limites de la technique. Comparer les resultats avec ceux de l’imagerie echographique bidimensionnelle et tridimensionnelle. Materiels et methodes Entre novembre 2005 et aout 2008,62 patientes, de terme compris entre 17 et 37 semaines d’amenorrhee, ont ete adressees pour scanner fœtal apres depistage echographique. Les indications principales etaient : RCIU avec os longs courts (15 patientes), anomalies faciales (15 patientes). Les examens ont tous ete realises sur un appareil 64 detecteurs General Electric (Lightspeed VCT). Les parametres techniques ont ete choisis pour ne pas depasser une dose estimee au fœtus de 3 mGy : 100Kv, 100 mA. L’examen est realise sans sedation maternelle, en une apnee courte (environ 5 s). Les resultats ont ete compares a l’anatomopathologie en cas d’interrruption medicale de grossesse, a l’examen pediatrique post natal en cas de grossesse menee a son terme. Resultats Parmi les 62 patientes, une pathologie osseuse a ete retrouvee dans 53 cas, principalement crânio-faciale (12 cas) et rachidienne (10 cas), avec une superiorite du scanner sur l’echographie bidimensionnelle, voire tridimensionnelle pour les termes tardifs (> 32 SA). Neuf osteochondrodysplasies ont ete etudiees : parmi elles, le scanner a modifie le diagnostic echographique dans 6 cas avec confirmation anatomopathologique ou pediatrique. Le scanner etait normal pour tous les RCIU avec os longs courts sans autre point d’appel echographique. Conclusion Le scanner 64 detecteurs apparait etre un outil utile et complementaire a l’echographie, meme tridimensionnelle, pour l’analyse de l’os fœtal, en particulier pour l’etude du pole cephalique et du rachis, en dehors de l’indication classique des maladies osseuses constitutionnelles.

P33.11: Prenatal diagnosis of a rare skeletal dysplasia by ultrasound and scan tomography : atelosteogenesis III (AO III). Correlation with autopsy

Skeletal dysplasias are a heterogeneous group of bone growth disorders with different fetal outcomes. Prenatal sonographic examination is an excellent method for discovering fetal skeletal dysplasias. However, it is not always possible to differentiate TD from others skeletal dysplasias by ultrasonography alone and molecular genetic analysis of the fibroblast growth factor receptor 3 (fgfr3) gene is useful for prenatal diagnosis of TD. Therefore definitive diagnosis should always be accomplished by a comprehensive postnatal evaluation, including clinical, radiological, pathological, biochemical and molecular genetic examination. Thanatophoric dysplasia (TD) is the most common form of platyspondylic lethal skeletal dysplasias and TD 1 is characterized by short limbs, a narrow thoracic cage, straight femora, with or without a cloverleaf skull. In this report, one fetus with TD 1 was diagnosed by 3D ultrasound and MRI in the second trimester, and molecular analyses of the fgfr3 gene confirmed the postnatal diagnosis.

P33.05: Study of the fetal bony pelvis by computed tomography in bladder exstrophy: about one case

Objectives: To report the interest of CT imaging, associated with three-dimensional ultrasonography and MRI, in a case of bladder exstrophy. Material and Methods: We compared the three imaging modalities abilities to predict the pathology of one case of proved classical bladder exstrophy. Furthermore, CT data were compared with 15 normal fetal bony pelvis at different stages of the pregnancy. Results: Three-dimensional ultrasound using surfacing mode, proved to be accurate in facial fetal abnormalities, allowed an accurate description of fetal genitalia in our case of bladder exstrophy; nevertheless, further studies are necessary to confirm these preliminary results. CT imaging in this case was the best modality to predict fetal bony pelvis; we found a wide pubic diastasis, an external rotation of iliac wings and a pubic rami opening when compared with control fetuses, as reported in previous studies for neonates and ex vivo fetuses. Conslusion: As proved for born infants and dead fetuses, CT scan can describe abnormalities of fetal bony pelvis, in utero, allowing precise and early surgery.

P26.01: Prenatal diagnosis of a patent urachus cyst associated with umbilical cord pseudocyst using 3D, 4D ultrasound and fetal magnetic resonance imaging

F. Fuchs1, O. Picone1, M. Mabille2, A. L. Delezoide3, R. Frydman1, M. V. Senat1 1Service de Gynecologie-Obstetrique et Medecine de la Reproduction, Hopital Antoine Beclere, Universite Paris-Sud, Clamart, France, 2Service de Radiologie. Assistance Publique Hopitaux de Paris, Universite Paris Sud., France, 3Service d’Anatomopathologie, Assistance Publique Hopitaux de Paris, Universite Paris Sud., France