M. Paszkowski

P31.01: Ascites index—a new method of ultrasound evaluation of ascites volume in patients with ovarian cancer

Objectives: Ascites is often observed in malignant diseases, and is then associated with a poor prognosis. In 30–54% cases of ascites ovarian cancer is the primary tumor. Effective palliation of symptoms caused by the pressure of ascites is difficult to achieve. Assessment of the volume of ascites is necessary in monitoring the progress of the disease and in selecting appropriate methods of treatment. The aim of this study was to introduce Ascites Index (AsI), a simple to use ultrasound method of evaluating the volume of ascites. Methods: Six patients with ovarian cancer and ascites were included in the study. All patients were admitted to the hospital because of respiratory dysfunction (dyspnea) due to increasing ascites. Ultrasound measurements of the volume of ascites were performed in the external quadrants of the abdomen – in the vicinity of the liver, spleen and bilaterally above the inguinal ligament. Pockets of free fluid were measured in millimeters, perpendicularly to the tangents of each quadrant of the abdomen. The obtained values were totalled, creating the Ascites Index (AsI), similary to the amniotic fluid index. Abdominal puncture was performed in 4 cases, and exploratory laparotomy in 2 cases. AsI values acquired before and after these procedures were subsequently compared. Results: Initial AsI values ranged from 196 to 316 mm (mean 233 mm, SD 47.0). To avoid complications a maximum of 2000 ml of ascitic fluid was collected. After abdominal puncture AsI values were decreased to 89–183 mm (mean 129 mm; SD 42.5). During exploratory laparotomy 4500–5000 ml of fluid was obtained, and after the procedure the index was decreased to 6–19 mm (mean 12.5 mm; SD 9.2). Conclusions: The proposed Ascites Index seems to by a promising tool in estimating ascites volume. It is simple to implement and may be estimated using basic ultrasound equipment even in outpatient clinic. AsI may be useful in monitoring ascites, predicting dyspnea and assessing the effect of abdominal puncture.

EP22.11: Use of “elasto strain ratio” in the assessment of the cervical internal os stiffness in asymptomatic, low-risk pregnant women: preliminary study

Methods: 16 normotensive pregnant women between 24 and 40 weeks gestation with low-risk pregnancy were recruited for this study. The Samsung HS 70A ultrasound system and linear probe (L3-12A) were used by a single operator to identify a longitudinal section of the right carotid artery. A cine loop was recorded while participants were in the semi-recumbent position. CIMT was calculated using an in-built computer semi-automated programme. Measurements were repeated in each participant and the average difference was calculated. Identifying the carotid artery, obtaining a cine loop and automatically calculating IMT typically took less than a minute. No discomfort was reported by the participants. Results: Maternal CIMT values were obtained in all participants. CIMT values ranged from 0.26mm to 0.96mm. The mean difference between repeated CIMT values was 0.007mm. In our cohort CIMT did not change with increasing gestation. Conclusions: This novel semi-automated technique was able to obtain CIMT values in pregnant women rapidly. This technique can be used by a novice operator with limited technical skills and has good reproducibility. This technique may be applicable as a non-invasive bedside test for CIMT in pregnant women between 24-40 weeks gestation.

EP32.04: Usefulness of elastography in the assessment of Caesarean scar defects in women qualified for surgical scar correction

for the analysis using 4 different methods: VOCAL, SonoAVC general, SonoAVC follicle, and three-diameters. We compared the inter-observer reliability/agreement of the 4 methods. The average values of two observers were used for the comparisons with VOCAL. Results: We evaluated 40 participants. The main results are reported on table 1. Conclusions: VOCAL provide the most reliable results but SonoAVC general might be considered for clinical practice as it has good inter-observer reproducibility and good agreement with VOCAL. SonoAVC general has other potential advantages as it allows dividing the total volume, which could add to the evaluation of uterine anomalies. The small volume underestimation has probably little clinical impact and might be explained by not accounting the catheter as part of the endometrial cavity volume.

P13.21: “Beret” sign in differentiating between anencephaly and exencephaly during ultrasound at the first and the second trimester

landmarks for a standardized and reproducible measurement of BPD and HC. Methods: A 3D volume of 21 fetuses was acquired either transvaginaly or transabdominaly by a single operator using the same machine. The volumes were treated offline with the 3D static mode to measure different BPD and HC at different levels. We analyzed first 3 axial sections, from up to down: (i) an axial section passing through the lateral ventricles (ii) one passing through the third ventricle, the thalami and the cerebral fissures of Bichat (defined as the reference plane) (iii) one passing through the posterior cerebral fossa. We studied then a coronal section passing through the posterior fossa and an oblique section between the reference plane and the coronal section. These biometric data were converted into Z-scores. A BlandAltman analysis was used to assess the level of agreement between the reference plane and the 4 deviant planes. Results: The results of the Bland-Altman analysis are shown in the table. The 4 deviant planes do not consistently provide similar measures with respect to the reference plane. Conclusions: The study put into relief the necessity of standardizing the measurement of the BPD and HC to increase the sensitivity of a screening test for neural tube defects. We suggest to measure the BPD and the HC in the reference plane.

P15.07: Does the initial volume of intramural fibroids affect the decrease of fibroid volumes after uterine artery embolization?

and uterine and 10 mm shell myometrial 3D-PDA indices VI (vascularization index), FI (flow index) and VFI (vascularization flow index) were calculated. Signal attenuation in 3D-PDA was evaluated by categorizing the patients into two subgroups according to the distance to the center of the endometrium. The results were compared with a complete surgical staging. Results: A deep myometrial invasion was present in 23 patients. Of the color Doppler indices, the uterine artery RI and PI were statistically significantly lower in the group with deep invasion (P = 0.014 and 0.013, respectively). The uterine and myometrial 3D-PDA indices VI and VFI were statistically significantly higher in the group with deep invasion (P = 0.014 and 0.014; P = 0.013 and 0.022, respectively). No correlation was found between any of the measured indices and the presence of metastases. The subgroup analysis indicated that the uterine and myometrial VI was affected by distance, being statistically significantly higher in the group closer to the probe (P = 0.021 and 0.012, respectively). The multivariable analysis left the mean uterine artery RI as the only independent factor for the presence of deep invasion (OR 0.0003, 95%CI 0.00008–0.143, P = 0.010). Conclusions: The uterine artery RI correlates with the presence of deep invasion in endometrial carcinoma. 3D-PDA has potential in the preoperative assessment of endometrial carcinoma, but signal attenuation may bias the results.

P07.08: Ultrasound evaluation of the uterine fibroids volume changes after uterine arteries embolization

layers represented by basal endometrial and was considered normal between 4 and 8 mm. Patients with endometrial abnormal elevated thickness (26 cases) were treated with didrogesteron 30 mg b.d. for 3 days and then 20 mg b.d for another 7 days. In these cases, the preventing treatment was conducted in a discontinuous manner, with 20 mg didrogesteron b.d., ten days, starting with the 15th day of the cycle, for 3 months. Patients with endometrial atrophy (11 cases) were treated with combined oral contraceptive containing 30 μg etinilestradiol and 150 μg levonorgestrel, 2–3 pills b.d. until the bleeding ceased followed by 1 pill b.d. for completing 21 days of therapy. In these cases the preventive treatment was done in the same discontinuous manner, with didrogesteron. Results: In both groups the bleeding ceased after a medium of 3, 6 days of treatment. One patient with endometrial hyperplasia needed after 6 days of treatment uterine haemostatic curettage. Four patients in the first group and one in the second have experienced in the following six months after completing preventive therapy bleeding recurrences. In these cases was applied the same treatment and no relapse was encountered another six months. Conclusions: The endometrial thickness ultrasound evaluation is a valuable criterion for the treatment of juvenile uterine functional bleeding. Hormonal therapy in such cases is highly efficient in bleeding cessation. Prevention of the illness’s receive needs in 16% of cases am additional treatment until maturation of the hypothalamushypophysis-ovarian axe is established.

P27.08: Can we rely on transvaginal ultrasonography in the detection of endometrial polyps? A comparison of transvaginal ultrasonography, hysteroscopy and pathology reports.

applied with slices of 2.2 mm, including 15 images for reviewing. Statistical analysis included contingency tables and reliability tests. Results: 10 cases of HBD and 10 of women without HBD (controls) were included in this study. Volumes could be captured in all cases. The average examination time was 5 minutes. The overall performance of the operators for 2D approach and TUI in the detection of IUD placement were: sensitivity 70%–100%; specificity 90%–100%; PPV 87%–100%; NPV 75%–90%. ROC curve analysis showed a better performance for TUI than the 2D approach: area under the curve of 0.95 vs 0.8. Reliability analysis showed a high correlation between operators (C.alpha = 0.95, p < 0.01). Conclusion: TUI technique is a sensitive and reliable method for the assessment of HBD. It is an easy method for in situ exploration, and may help to increase the detection rate of non copper-related devices.

P20.09: The impact of low maternal plasma glucose level after glucose challenge test on fetal growth

Introduction: Intrauterine growth restriction (IUGR) is a major cause of perinatal morbidity and mortality. IUGR is characterized by the presence of a fetus with a weight lower than the 10th centile for gestational age estimated by ultrasound examination or a delivery of a neonate with a birth weight lower than 2.5 kg at term. The causes of IUGR are divided into fetal, placental and maternal ones. Maternal anemia, malnutrition, infections (rubella, cytomegalovirus), toxic substances (alcohol, smoking) may affect fetal growth. Objectives: The aim of the study was to determine the relationship between the low maternal plasma glucose level after glucose challenge test (GCT) and fetal growth restriction. Material and Methods: The studied population consisted of 141 pregnant women with a singleton gestation. The women underwent the GCT between the 24th and 27th week of pregnancy. In all patients ultrasound examination was performed between 20th and 24th week of gestation and the estimated fetal weight (EFW) was evaluated. Low maternal plasma glucose level after GCT was defined as less than 100mg/dL. Patients with glucose level higher than 140mg/dL after GCT were excluded from the study. The data obtained from the remaining women (n = 134) were compared with the fetal birth weight measured after delivery. The Yates’ chi-square test was used to perform statistical calculation. Results: The frequency of IUGR in the studied population was 12.6% (17/134). Conclusion: The study showed that in women with the plasma glucose levels lower than 100 mg/dL after GCT the frequency of IUGR was significantly higher than in those with normal results of GCT.

P34.01: Usefulness of three‐dimensional sonographic evaluation of maternal hydronephrosis volume as a diagnostic tool in urinary tract infection during pregnancy

can result in considerable morbidity and mortality. Undiagnosed; a choledochal cyst can lead to development of serious complications such as hepatic fibrosis, pancreatitis, cholangitis, and liver failure in infants. Prenatal diagnosis, postnatal ultrasound evaluation and early surgical treatment can reduce the development of serious complications. We report a case of a choledochal cyst diagnosed prenatally by ultrasound. A 24 year old woman, gravida2, para1, presented at 29 weeks gestation to our hospital for a routine ultrasound evaluation. Ultrasound examination revealed a singleton fetus with normal amniotic fluid volume and measurements consistent with 29 weeks. Assessment of the fetal abdomen demonstrated an ovoid shaped well defined anechoic mass measuring 1.2 × 1.2 cm. in the right upper quadrant, located medially and communicating with the gall bladder. The postnatal ultrasound confirmed the diagnosis and it was classified as Type 1 choledochal cyst.

P27.12: Three‐dimensional sonographic evaluation estimation of maternal hydronephrosis volume and its association with urinary tract infection

because of contractions was performed at 32/6 weeks of gestation. A viable 1840 g female infant with Apgar scores of 8, 8 and 9 and umbilical artery pH 7.32 was delivered. At the time of delivery, approximately 600 mL of fresh blood gushed from the uterine incision before amniotomy. The total estimated blood loss from the surgery was 500 mL. The mother had an unremarkable postoperative course and was discharged in stable condition on postpartum day 8. The neoanate was admitted to the neonatal intensive care unit for prematurity and respiratory distress syndrome.