S. Monda

Non‐surgical management of live ectopic pregnancy with ultrasound‐guided local injection: a case series

To describe a series of consecutive cases of live ectopic pregnancies managed with ultrasound‐guided local injection of methotrexate (MTX) or potassium chloride (KCl).

Spherical Tissue Sampling in 3-Dimensional Power Doppler Angiography : A New Approach for Evaluation of Ovarian Tumors

The purpose of this study was to evaluate the usefulness of virtual spherical tissue sampling using 3‐dimensional (3D) ultrasound power Doppler angiography to enhance differentiation between normal and pathologic ovaries.

An ethnic predilection for fetal echogenic intracardiac focus identified during targeted midtrimester ultrasound examination: A retrospective review

BackgroundEchogenic intracardiac focus (EIF) has been identified as a common ultrasound finding in association with fetal aneuploidy. Little is known about the association of this soft marker aneuploidy in various ethnic groups. Although it is commonly thought Asians in general have a higher incidence of EIF, it is unknown whether this also applies to Japanese as a subpopulation. The purpose of this study is to determine the antenatal incidence and postnatal significance of EIF observed during sonography in Japanese patients.MethodsA cohort of Japanese patients who underwent ultrasound screening from 1997 to 1999 in the ultrasound unit at the New York University School of Medicine was identified. Variables included age, gestational age, serum markers, and the presence or absence of aneuploidy. Patients with first degree paternal or maternal Japanese ancestry were included for analysis. Examinations were performed between 14 and 24 weeks gestation. The prevalence of EIF was calculated. The control group was based on previously published data in the U.S (7.3% prevalence).ResultsA total of 154 subjects were identified, 148 were available for final analysis. Twenty-two fetuses had an EIF, 19 (86.4%) left-sided, 3 (13.6%) right-sided. Seventeen patients had other sonographic markers associated with aneuploidy. The mean maternal age at diagnosis was 30.7 ± 3.9 years and the mean gestational age was 19.8 ± 1.6 weeks. The prevalence of EIF was 14.8%. Compared to published population prevalence, there was a statistically significant difference (p < 0.005). No abnormal karyotypes were found.ConclusionAsians of Japanese origin may have a higher prevalence of echogenic intracardiac foci, thus affecting the positive predictive value of this sonographic marker for aneuploidy.

Cystadenofibromas: Can transvaginal ultrasound appearance reduce some surgical interventions?

Cystadenofibromas are benign ovarian neoplasms. Their most typical features on sonography (US) are unilocular cysts with small, shadowing hyperechoic, solid papillae without internal vascularity. In the past, they were virtually always surgically removed to exclude malignancy. This study was undertaken to review the sonographic appearances of benign cystadenomas.

OC25.03: Ultrasound appearance of cystadenofibroma: can we reduce surgical intervention?

Objectives: Transvaginal ultrasound has greatly improved our understanding of ovarian neoplasms. Transvaginal ultrasound has had a very high negative predictive value for excluding ovarian malignancy in cases of unilocular cysts and or minimal septations. Solid components and/or mural nodules have been felt to be a more ominous sonographic finding. Cystadenofibromas are benign ovarian neoplasms that originate from the surface epithelium as well as underlying cortical connective tissue of the ovary. Sonographically they often have solid areas that appear to be papillations coming off the cyst wall (‘‘mural nodules’’) and thus are almost always surgically removed to exclude malignancy. This study was undertaken to determine if any consistent finding of cystadenofibroma could be discerned thereby increasing the negative predictive value of transvaginal ultrasound and color flow Doppler in identifying them as benign. Material and methods: Over a 6 year period 58 cases of pathologically proven cystadenofibromas were identified from our hospital’s pathology database. Of these 32 had transvaginal ultrasound with color flow Doppler performed in our imaging facility. The images were analyzed for size, presence of features beyond simple cystic appearance, and presence or absence of blood flow. Results: 22 of the tumors presented as unilocular cystic structures with one or more solid mural nodules projecting from the cyst wall. None of these displayed any discernable blood flow within the solid area. Ten were multi loculated with multiple solid areas and did not follow this more typical classic appearance. Conclusion: Not all cystadenofribromas will look the same on transvaginal ultrasound and color flow Doppler. The majority(69% in our series) presented as unilocular cysts with a small solid non vascular projection from the cyst wall. This particular presentation was virtually pathognomonic and when present seemed to have reliability for benign cystadenofribroma that approached 100% in this small series. Further study is clearly necessary.

OP17.05: Spherical virtual tissue sampling with different size samples in 3D power Doppler angiography for evaluation of ovarian cancers

Objectives: Mature cystic teratomas (MCT) or Dermoid cysts of the ovary account for approximately 25% of all ovarian tumours. The wide range of tissue types found in these tumours give rise to a highly varied appearance on ultrasound examination. The aim of this study was to assess the frequency of different morphological features in order to improve the accuracy of ultrasound diagnosis and aid in management planning. Methods: Our gynaecology ultrasound database and the histopathology department were retrospectively searched for MTCs. All women with a histological diagnosis of MCT and preoperative ultrasound images were included in the study. The images were reviewed by a single observer who recorded the presence and extent of common and rare features of MCTs. Results: A total of 133 cysts were found in 117 women. 15/117 (12.8%) had bilateral MCTs. Hyperechoic cyst contents consistent with sebum were present in 94.7% of cysts. Other common ultrasound features included hair (91.7%), acoustic shadowing (83.5%), and healthy ovarian tissue seen at one edge of the cyst (‘‘the ovarian crescent sign’’) 75.9%. The amount of sebum within the cyst was significantly higher in older women and it was inversely proportional to the size of the cyst (P < 0.05). Conclusions: Sebum and hair are present in more than 90% of MCTs, which facilitates a correct pre-operative diagnosis on ultrasound scan. The amount of sebum within the cyst can be used to estimate the potential of the cyst to grow and require surgical intervention in the future.

OP16.08: Virtual 3D power Doppler angiographic spherical tissue sampling for evaluation of ovarian pathology

Methods: Digitally stored B-mode sonographic images, from a random sample of 98 women with an adnexal mass submitted to surgery after B-mode transvaginal sonography, were evaluated by five different examiners with different degree of experience. Masses in which the echo features were highly characteristic of a given pathology, such as endometrioma, cystic teratoma, hemorrhagic cyst, hydrosalpinx, benign mucinous cystoadenoma, serous cyst, and peritoneal cysts were categorized as benign. Any cystic mass containing excrescences, thick septations, multiple irregular septations or solid mass (thick wall, thick septations, thick papillary projections, solid areas or mostly solid component) in which the echo architecture was not highly suggestive of benign histology was categorized as malignant. Intraobserver and interobserver agreement according to the level of experience was assessed by calculating the kappa index. Results: Of the 98 cases randomly selected, definitive histologic diagnoses were as follows: 70 (71%) benign and 28 (29%) malignant masses. Intraobserver agreement was good or very good for all examiners with different degrees of experience (kappa = 0.72–1). Interobserver agreement was good for all expert operators (kappa = 0.69–0.75). Interobserver agreement between experts and highly experienced operators was moderate or good (kappa = 0.51–0.63). Interobserver agreement between moderately experienced operators and experts was fair to moderate (kappa = 0.29–0.46). Interobserver agreement between moderately and highly experienced operators was fair (kappa = 0.33). Conclusions: Our results indicate that typical malignant patterns are very highly reproducible even in moderately experienced examiners. More experience was associated with better interobserver agreement.

OP03.12: The six‐year experience of a single practice with central nervous system anomalies

Agenesis of the corpus callosum (ACC) and septo-optic dysplasia (SOD) are congenital abnormalities of the midline structures of the brain in which the cavum septum pellucidum (CSP) is absent. Indeed absence of the cavum septum pellucidum is a useful clue to the diagnosis of these conditions. We present six cases, three examples of agenesis of the corpus callosum and three of septooptic dyplasia where structures resembling a CSP were seen. This led to some confusion in the diagnosis in certain cases. Case 1 – A diabetic patient was scanned at 20 weeks gestation, a structure resembling a CSP was seen however the configuration of the ventricles was consistent with ACC. MRI scanning confirmed ACC. Case 2 – A detailed scan at 20 weeks demonstrated a CSP and apparently normal intracranial anatomy. the pregnancy continued uneventfully to term. Following delivery the baby was found to have ACC. Case 3 – Routine scanning at 20 weeks demonstrated median facial clefting. Subsequent detailed scanning revealed multiple abnormalities including ACC. Scans of the brain however showed a structure resembling a CSP. Case 4 – This patient was referred for detailed scanning at 22 weeks following a diagnosis of SOD. The scan confirmed the diagnosis but demonstrated a structure identical to a CSP. Case 5 – This patient was referred for detailed scanning at 28 weeks after scans for growth suggested abnormal anterior horns of the lateral ventricles. Detailed scanning showed a structure similar to a CSP but fusion of the anterior horns. MRI scans confirmed SOD. Case 6 – Routine scanning at 20 weeks detected a unilateral hydronephrosis. detailed scanning revealed SOD but also demonstrated a structure consistent with a CSP. We conclude that in agenesis of the corpus callosum and septo-optic dysplasia, cavum septum pellucidum mimics may be present. Evaluation of the ventricular configuration however is more important than the presence or absence of a CSP and will usually reveal the diagnosis.