Masayuki Ohno

Does three‐dimensional power Doppler ultrasound improve the diagnostic accuracy for the prediction of adnexal malignancy?

Objective:  The aim of the present study was to investigate the diagnostic accuracy of three‐dimensional power Doppler ultrasound (3DPD) in the differentiation between benign and malignant adnexal masses and evaluate 3DPD for assessing malignancy in comparison with two‐dimensional transvaginal gray‐scale sonography (2DTVS), magnetic resonance imaging (MRI) and positron emission tomography (PET).

Positron emission tomography with the glucose analog [18F]-fluoro-2-deoxy-D-glucose for evaluating pelvic lymph node metastasis in uterine corpus cancer: Comparison with CT and MRI findings

Objective:  The aims of this study were to investigate the ability of positron emission tomography (PET) with the glucose analog [18F]‐fluoro‐2‐deoxy‐D‐glucose (FDG) to detect pelvic lymph node metastasis of uterine corpus cancer and to perform a retrospective comparison with computed tomography (CT) and magnetic resonance imaging (MRI) findings.

A case of non-Hodgkin’s lymphoma of the ovary: Usefulness of18F-FDG PET for staging and assessment of the therapeutic response

Primary ovarian lymphoma as the initial manifestation is rare. A 27-year-old woman presented to our hospital with the symptoms of lower abdominal fullness and pollakisuria. CT scan and MRI revealed bilateral ovarian tumors, which showed heterogeneous masses.18F-FDG PET revealed strong uptake by the abdominal masses, and the maximum standardized uptake value (SUVmax) was 12.5. Abnormal uptake was not shown by other regions. An exploratory laparotomy was performed. Histological findings revealed diffuse large B-cell lymphoma. The clinical stage was IV according to the Ann Arbor system. International prognostic index (IPI) was 3 (high-intermediate risk). Chemotherapy was administered consisting of three courses of an R-CHOP regimen, and18F-FDG PET and CT scan revealed no signs of involvement 3 months after initiation of the chemotherapy.18F-FDG PET was a useful method for staging and assessment of the therapeutic response in primary ovarian lymphoma.

Nuchal Translucency Thickness and Fetal Cardiac Flow Velocity in Normal Fetuses at 11–13 Weeks of Gestation

Objective: To investigate the relationship between nuchal translucency thickness and cardiac flow velocity in normal fetuses at 11–13 weeks of gestation. Subjects and Methods: Eighteen normal pregnancies were prospectively studied with transvaginal sonography and pulsed and color Doppler ultrasound. Flow velocities at the fetal atrioventricular valves (mitral and tricuspid valve) and outflow tract levels (ascending aorta and pulmonary artery), and at the descending aorta were recorded. Nuchal translucency thickness was also measured. Results: Mitral peak velocity during early diastolic filling correlated with gestational age. Mitral peak velocities during early diastolic filling and atrial contraction, tricuspid peak velocity during early diastolic filling, ascending aorta peak velocity, and pulmonary artery peak velocity correlated well with nuchal translucency thickness. There was an inverse correlation between umbilical artery pulsatility index and gestational age. Conclusions: These results suggest that the increase of nuchal translucency thickness in normal fetuses at 11–13 weeks of gestation may be the consequence of changes in fetal cardiac functions.

Three-dimensional power Doppler sonographic features of uterine vascular malformation.

Pelvic arteriovenous malformations (AVMs) are uncommon lesions of frequently unknown cause. Congenital AVMs are considered to be undifferentiated vascular structures resulting from arrest of embryonic development at various stages1,2. Acquired AVMs are usually caused by neoplasms, trophoblastic disease or trauma, and procedures such as curettage and uterine surgery have been implicated3–5. These malformations are characterized by their slow growth with a period of latency before becoming symptomatic. They may produce local or systemic effects, including vaginal bleeding, abdominal pain, urinary symptoms, and high-output congestive heart failure. Many methods have been used to diagnose pelvic AVMs. Angiography, which is the gold standard for diagnosis, has the advantage of demonstrating the feeding arteries and draining veins of the AVM6. However, angiography is an invasive procedure, and should be reserved for cases in which surgical intervention or therapeutic embolization of the lesion is planned such as those with persistent and severe uterine hemorrhage7–9. Recently, color and power Doppler sonography has provided a valuable, non-invasive method for the definitive diagnosis of AVM10,11. We present our initial experience with applying three-dimensional sonography in the diagnosis of uterine vascular malformation. A 27-year-old Japanese woman, gravida 3 para 2, was referred to our outpatient department because of persistent high serum β-human chorionic gonadotropin (β-hCG) levels. Gray-scale sonography (GE Voluson 730 Expert, Yokogawa, Tokyo, Japan) revealed an ill-defined mildly echogenic lesion with multiple small hypoechoic spaces on the right side of the uterus. Twodimensional color and power Doppler flow imaging showed a hypervascular lesion with turbulent flow, with a peak velocity of 80.3 cm/s and low pulsatility index of 0.445. The clinical diagnosis of invasive mole was made, and five courses of chemotherapy with Etoposide were administered. After 3 courses of chemotherapy, the serum β-hCG levels normalized. Six months after chemotherapy, three-dimensional power Doppler sonography clearly showed an aneurysm-like structure typical of uterine vascular malformation including its feeding vessels and drainage within the right mesosalpinx (Figure 1). The diagnosis of uterine vascular malformation was confirmed by magnetic resonance angiography. The patient had no manifestation of clinical symptoms. The aneurysm-like structure of the uterine vascular malformation was still evident 17 months after the initial examination. The typical color Doppler sonographic pattern of an AVM is ‘chaotic’ flow characterized by a turbulent flow velocity waveform. The ‘chaotic’ or turbulent flow results from the area being filled with numerous individual velocity vectors randomly occurring in all directions. The diagnosis of AVM might be made from these findings on color Doppler ultrasound but confirmation of the diagnosis is usually achieved by angiography12. There has been only one report on the three-dimensional power Doppler sonographic diagnosis of AVM of the mesosalpinx12. In our case, the aneurysm-like structure of the uterine vascular malformation with its feeding vessels and drainage within the right mesosalpinx was shown beautifully by means of three-dimensional power Doppler sonography. Moreover, it could be observed from any angle, which enables a much easier and quicker understanding of the spatial relationships of the vessels involved12. As surgical manipulation for uterine or pelvic AVM may sometimes result in hemorrhage or even death, conservative management by means of serial observations, may be preferable8,12. Timmerman et al.10 reported that conservative management is possible in more than two-thirds of patients presenting with uterine vascular malformation diagnosed by color Doppler sonography, and that peak systolic velocity values appear to be useful in distinguishing lowfrom highrisk patients. Peak systolic velocities of ≥ 83 cm/s were associated with higher probabilities of further treatment such as embolization whereas no vascular malformation with a peak systolic velocity value

Reciprocal Effects of Tamoxifen on Hormonal Cytology in Postmenopausal Women

OBJECTIVE To evaluate the estrogenic effect of tamoxifen (TAM) therapy in postmenopausal women. STUDY DESIGN The subjects were 26 postmenopausal women. The maturation index (MI), maturation value (MV) and karyopyknotic index (KPI) were evaluated based on hormonal cytology. Endometrial cytologic examinations and transvaginal ultrasonography were also performed. RESULTS Of the 26 patients, 16 had low estrogenic activity from the viewpoint of hormonal cytology before TAM administration. During administration, their mean MV rose significantly, from 25.8 +/- 17.7 to 68.8 +/- 13.2, (mean +/- SD) and their mean KPI rose from 9.0 +/- 8.3 to 47.1 +/- 23.1. In contrast, among the 10 patients with high estrogenic activity, mean MV and KPI decreased from 62.9 +/- 8.4 and 27.2 +/- 16.9 to 58.4 +/- 7.7 and 17.7 +/- 16.1, respectively, with TAM administration. Mean endometrial thickness increased more significantly with TAM administration in the low estrogenic activity group than in the high estrogenic activity group. CONCLUSION TAM had a reciprocal effect; no additional estrogenic effect was seen in patients with high estrogenic activity. Conversely, an estrogenic effect was seen in those with low estrogenic activity. An individualized gynecologic evaluation based on hormonal cytology is useful in selecting patients who will be more susceptible to TAM-induced endometrial abnormality.

Three-Dimensional Sonographic Features of Nuchal Edema

Objective: To describe the three-dimensional (3D) sonographic features of nuchal edema in the early second trimester of pregnancy. Methods: From 16 to 22 weeks of gestation 5 cases with nuchal edema were studied using transabdominal 3D sonography. Results: Nuchal edema could be easily imaged with both two-dimensional and 3D sonography; however, visualization of the continuity and curvature of structures was more easily accomplished with 3D sonography. Before 20 weeks of gestation, the skin has a transparent structure, so the bony structures are clearly identified. 3D sonography allowed visualization of nuchal edema in all three dimensions at the same time, providing an improved overview and a more clearly defined demonstration of the adjusted anatomical planes. Conclusion: These results suggest that 3D sonography provides a novel means of visualizing nuchal edema in utero.

Antenatal three-dimensional sonographic features of early amnion rupture sequence

Background: Early amnion rupture sequence is rare, and its antenatal three-dimensional sonographic features have not been reported.Case: A 24-year-old japanese woman, gravida 1, para 0, was referred to our sonography clinic during her 16th week of gestation because of multiple fetal anomalies. Three-dimensional sonography clearly showed scalp adhesion, skull defect, abdominal wall disruption, amputation of the right hand, kyphoscoliosis, and clubfeet. Delivery was induced at 17 weeks of gestation. Autopsy showed a 166 gram male fetus and confirmed the prenatal diagnosis of early amnion rupture sequence.Conclusion: Three-dimensional sonography provides further information for sonographers. This includes unique identification of the displayed anatomic plane, realistic and reliable depiction of multiple fetal anomalies, and visualization of complex fetal anomalies.

Laparoscopy-Assisted Intrapelvic Sonography with a High-Frequency, Real-Time Miniature Transducer to Assess the Ovary: A Preliminary Report

Objective: Our purpose was to evaluate the normal and pathologic internal textures of the ovary using laparoscopy-assisted intrapelvic sonography (LAIPS) with a specially developed 20-MHz flexible catheter-based high-resolution real-time miniature (2.4 mm in outer diameter) ultrasound transducer in patients with gynecologic disorders and infertile women. Methods: 30 women (19 patients with gynecologic disorders and normal menstrual cycles (2 adenomyoses, 1 cervical cancer, 5 fibromyomas, 5 simple ovarian cysts, 1 endometriosis, 3 benign cystic teratomas, and 2 endometriomas), and 11 patients with infertility including 4 with polycystic ovarian syndrome, PCOS) were studied by intrapelvic sonography using a high-frequency real-time miniature transducer with pelvic saline effusion and laparoscopy. Results: In the normal ovary in the mid-follicular phase, follicles were depicted more distinctly than with transvaginal sonography (TVS). In the late-follicular phase, cumulus oophorus formations were visualized in 6 of 9 patients (54.5%), but were not clear using TVS. In the luteal phase, the corpus luteum was noted in 9 of 12 patients (75%) by both TVS and LAIPS. In patients with PCOS, the thickened capsule of the ovary was distinguished clearly especially in the peripheral type, in which numerous small cysts were aligned in the subcapsular region of the ovary, whereas it could not be detected by TVS. In all 4 cases with PCOS (8 ovaries), the ovarian capsular thickness could be measured by means of LAIPS. In subjects with benign cystic teratoma, minimal high echoic lesions were depicted. In subjects with endometrioma, a diffuse coarse-granular internal texture was visualized. However, depiction of internal structures in large pathologic ovarian lesions was markedly limited because of the shallow scanning range of the high-frequency transducer. Conclusion: LAIPS with a high-frequency real-time miniature transducer might be a useful diagnostic modality to evaluate the normal physiologic textures of the ovary, as well as those with PCOS.

Frequency of positive peritoneal cytology during laparotomy, especially in clinical stage I adenocarcinoma of the endometrium.

1984～1993年の10年間に香川医科大学附属病院で治療された子宮体癌68例中, 術中腹膜細胞診施行例は47例であり, うち5例 (10.6%) が陽性であった. これを臨床進行期1期のみについてみると, 腹膜細胞診陽性例は41例中4例 (9.8%) であった. ただし, この中には手術進行期分類IIIの1例が含まれていた. 腹膜細胞診陽性例は, 腺扁平上皮癌, 未分化腺癌や推計学的有意差はなかったものの子宮筋層浸潤の深いものとの関連が示唆された. 腹膜細胞診陽性5例中1例は, 細胞形態学的に悪性細胞と判別できたものの子宮体癌由来と診断することは難しい細胞像を呈していた.術前に子宮鏡診を施行した46例中, わずか4例のみが腹膜細胞診陽性であった.