S. Piras

Three-Dimensional Quantification of Tumor Vascularity as a Tertiary Test After B-Mode and Power Doppler Evaluation for Detection of Ovarian Cancer

The purpose of this study was to investigate the role of 3‐dimensional (3D) quantification of tumor vascularity in the differential diagnosis of pelvic indeterminate masses with a solid appearance or unilocular or multilocular cysts with a solid component showing central vascularization on 2‐dimensional power Doppler sonography.

Serial ultrasonographic evaluation of a decidualized endometrioma in pregnancy.

results in the production of collagen and elastin with fibroelastic thickening of the endocardium, which leads to myocardial dysfunction. In the literature, endocardial fibroelastosis has generally been reported in young children or in secondand thirdtrimester fetuses. However, the condition is likely to develop earlier in pregnancy, as we have shown, and as was also demonstrated by Rustico et al.5 who reported a case of endocardial fibroelastosis with aortic stenosis at 14.5 weeks’ gestation. Our observation stresses the importance of first-trimester ultrasound examination, which can allow early termination for lethal diseases. Nevertheless, the benefits of such early systematic screening for heart diseases have to be weighed against the negative aspects6. When severe abnormalities are noticed so early it is likely that spontaneous miscarriage will ensue and parents should have the choice of continuing the pregnancy until it reaches its natural end.

Diagnosis of paraovarian cysts using transvaginal sonography combined with CA 125 determination

transfused peri-operatively. The postoperative recovery was uneventful and she attended for the removal of the cervical suture 5 days later. Ten months later she attended for another scan, which showed a 7-week viable recurrent Cesarean-scar pregnancy. The pregnancy was removed by suction curettage without complications. Six months later she attended again with a 4-week Cesarean-scar ectopic, which was also removed surgically without complications. Three months following her third Cesarean-scar ectopic a laparotomy was performed to repair the uterine-scar defect. The deficient scar was completely excised and the uterine wall was then closed in three layers including the visceral peritoneum. Her postoperative recovery was uneventful and she was discharged a week later. On histological examination, the excised uterine scar tissue contained an old suture remnant and it showed evidence of chronic inflammation and fibrosis. A followup scan 2 months after laparotomy revealed a well-healed uterine scar with no evidence of residual myometrial defect (Figures 1 and 2). Eight months after the operation she had a biochemical pregnancy, which was not detectable on the scan. Following this she had two pregnancies, which were both located normally within the uterine cavity. Although the pregnancies initially contained embryos with evidence of cardiac activity, they both miscarried spontaneously at 7 and 8 weeks’ gestation, respectively. Until this case, there have been only two previous reports of recurrent Cesarean-scar pregnancies in the world literature3,4. This low prevalence of recurrent scar pregnancies indicates that implantation into the scar is more likely to be a chance event, rather than the result of a particular affinity of a pregnancy for implanting into the scar. It is possible that the risk of scar implantation may be proportional to the size of the anterior uterine wall defect. The patient described in this report had a particularly large defect on the scan, which supports this hypothesis. Our case report also shows that laparotomy and repair of a uterine defect may be successful in preventing

OC11.01: Prevalence of deep endometriosis in patients of a second level ultrasound laboratory and tissue US characterization of nodules using VOCAL

Objectives: To generate physical fetal models using images obtained by 3-dimensional ultrasound (3DUS), magnetic resonance (MR) and computed tomography (CT) to guide additive manufacturing (AM) technology. Methods: Images from 45 fetuses, including 4 sets of twins, were used. Twenty-three fetuses were normal and evaluated only by 3DUS. Twenty-two cases had complications such as conjoined twins; tumors; aneuploidy; skeletal; central nervous system; facial or thoracic defects. Scans were performed using high-resolution 3DUS. In cases of abnormalities, MR and CT were performed on the same day as 3DUS. The images obtained with 3DUS, MR or CT, were exported to a workstation in Digital Imaging and Communications in Medicine format. A single observer performed slice-by-slice manual segmentation using a digital high definition screen. Software that converts medical images into numerical models was used to construct virtual 3D models, which were physically realised using AM technologies (SLA Viper, Objet Connex 350, ZCorp 510 or FDM Vantage). Results: The main outcomes presented were the possibility to create 3D virtual and physical models from 3DUS, MRI or CT both separately and also in various combinations. AM systems allow the conversion of a 3D virtual model to a physical model in a fast, easy and dimensionally accurate process. They were remarkably similar to the postnatal appearance of the aborted fetus or newborn baby. Conclusions: This study introduced the innovative use of AM models into fetal researches. The results suggest a new possibility for educational purposes or better interaction between parents and their unborn child during pregnancy. Normal fetus (29 weeks): Virtual and physical model built in a powder-based system.

OC176: Three‐dimensional (3D) quantification of tumor vascularity as third step after B‐mode and power Doppler evaluation for detection of ovarian cancer

gadolinium injection. For the myometrial invasion, we used the FIGO classification: 1a (without myometrial invasion), 1b (< 50% myometrial invasion), 1c (> 50% myometrial invasion). Results: The pathological analysis showed that 15% of women were stage 1a, 31%, stage 1b and 54%, stage 1c. As far as the myometrial involvement is concerned, the sonographic report was correct in 9 out of 13 patients (69%). The MRI conclusion was concordant with the histology in 9 patients out of 11 (82%). The sonography found more overestimations, but recognized all stage 1c diseases. The MRI gave one overestimation and one underestimation, but was inaccessible for two patients (no place). Conclusion: In the extension staging of an early endometrial carcinoma, the endovaginal sonography, with all its potentialities, seems to be promising, as it seems to give nearly equivalent results has the MRI, with a lower cost and an easier access. This preliminary study stimulates us to extend the study on a larger scale.

OC07: Diagnosis of location of deep infiltrating endometriosis by transvaginal tenderness‐guided ultrasonography

variables could improve ultrasound prediction of fetal macrosomia over prediction which relies on the commonly used formulas for the sonographic estimation of fetal weight. Methods: The δ SVM algorithm was used for binary classification between two categories of weight estimation: > 4000 g and < 4000 g. Clinical and sononographic input variables of 100 pregnancies suspected of having LGA fetuses were tested. Results: Thirteen of 38 features were selected as contributing variables that distinguish birth weights of below 4000 g and of 4000 g and above. Considering 4000 g as a cut-off weight the pattern recognition algorithm predicted macrosomia with a sensitivity of 81%, specificity of 73%, positive predictive value of 81% and negative predictive value of 73%. The comparative figures according to the combined criteria based on two commonly used formulae generated from regression analysis were 88.1%, 34%, 65.8% and 66.7%. Conclusions: The δ SVM algorithm provides a prediction of LGA fetuses comparable to that of other commonly used formulae generated from regression analysis. The better specificity and better positive predictive value suggest potential value for this method and further accumulation of data may improve the reliability of this approach.

OC24: The role of magnetic resonance imaging and transvaginal ultrasonography in patients with an adnexal mass and chronic pelvic pain or infertility

Objectives: Previously we showed that sonovaginography is an accurate ultrasonographic tool in the assessment of rectovaginal endometriosis. The aim of this study was to compare the diagnostic accuracy of sonovaginography and NMR in the diagnosis of rectovaginal endometriosis. Methods: This was a longitudinal prospective study in which 28 women with rectovaginal endometriosis suspected from the medical history and/or pelvic examination were enrolled. The study group underwent transvaginal ultrasonography and sonovaginography was performed in the same session as follows: an assistant inserted a Foley catheter into the vagina and an ultrasound probe covered with a specific balloon to swell the vagina. The balloon was filled with water (mean 40 mL) and soon after 60–180 mL saline solution was inserted through the Foley catheter to fill the vagina in order to create an acoustic window through the vagina to detect rectovaginal lesions. Within a mean of 30 days after the examination patients were scheduled for pelvic NMR. Once all the diagnostic tests had been performed, patients underwent laparoscopic surgery to enucleate the endometriotic lesion, which was sent for pathological examination. Results: Twenty-three (82.1%) patients had rectovaginal endometriotic lesions. The sensitivity of sonovaginography was 91.7%, specificity 75%, PPV 95.6% and NPV 60%; the area under the receiver-operating characteristic (ROC) curve was 0.87. In comparison, NMR had a sensitivity of 73.9%, specificity 60%, PPV 89.5% and NPV 33.3%, with an area under the ROC curve of 0.67. The procedure was well tolerated with a median visual analogue scale score of 2 (range, 0–8). Conclusions: Sonovaginography is a well tolerated procedure, with higher accuracy than NMR in the detection of rectovaginal endometriosis.

OC198: Sonohistology: the use of simple findings to predict the histological diagnosis in more than 900 adnexal masses evaluated by a single center

I concentration. Cardiac troponin I (cTnI) is a specific marker of myocardial injury in adults and children. Perinatal asphyxia can cause cardiac dysfunction. Methods: Some 161 samples among fetuses from pathological pregnancies were collected. Twenty-two had an elevated level of cTnI (above 0.1 ng/mL). Disorders in pregnancy, date of gestation, Doppler flow velocimetry in the ductus venosus (DV) and umbilical artery (AU) and vein (DV), mode of delivery, Apgar score and respiratory status after birth were evaluated. cTnI was determined on a dimension clinical chemistry system. Results: There were 22 newborns with a raised level of TnI: seven (31.8%) with SGA, five (22.2%) with fetal cardiac problems (arrhythmia, structural and functional abnormalities), nine (40.9%) with abnormal biophysical test results (abnormal Doppler velocimetry, computerized cardiotocography, biophysical profile score) and six (27.2%) whose mothers who had disorders (diabetes mellitus, hypertension). Results are shown in the table. Median gestational age at delivery was 36.6 (range, 27–43) weeks. Seventeen (77.2%) patients had a Cesarean section. The range of TnI blood concentration was 0.11–6.66 ng/mL in this group. Five (22.7%) had umbilical pH below 7.25. Conclusions: A high level of cTnI was associated with several disorders that could have led to fetal asphyxia. More detailed fetal heart examination is necessary to prove that fetal asphyxia had an impact on heart function.

OP22.02: The use of simple ultrasonographic findings makes accurate differential diagnosis of adnexal masses unrelated to the increase of experience of the operators

Objective: To evaluate the ultrasound features of tuberculosis in the female genital system. Methods: Fourty female patients with histologic diagnosis were included in this study. Among them, eighteen were TB and 22 were ovarian cancer. The pelvic sonogram was performed with gray-scale and color Doppler techniques. Serum CA-125 of the patients’ were obtained. Results: Multiple hyperechoic foci of 0.5–2.5 cm were found in the chorion of uterus and ovaries in 82% of TB patients and 12% in ovarian cancer patients. Miliary nodules were found on peritoneal in 64% TB patients and 16% in ovarian cancer patients. Visualization of the ovaries was limited in 33% TB patients with solid or complex pelvic masses. Bilateral ovary enlargement was seen in 67% TB patients. Ascites was found in 66% TB patients and in 78% ovarian cancer. Omental thickening was found in 77.8% ovarian cancer and 11% in TB. Color flow signals were detected in 12% TB mass that involved ovaries and in 91% ovarian cancer mass. Serum CA125 level were high in TB and ovarian cancer patients. Conclusion: The genital system tuberculosis should be suspected when multiple small nodules were found on uterus and ovary in young women.

OC170: Power Doppler‐based triage for adnexal masses to provide the most appropriate surgical approach

pathologies, useful signs, clinical pitfalls and classification problems will be presented. We conclude that the subjective assessment of ultrasound images and ultrasound based algorithms are effective in distinguishing between malignant and benign adnexal masses. However, different centers have different patient populations and different ways of using gray scale and color Doppler ultrasonography. Therefore, there is still a need for efforts to standardize ultrasound based procedures and the recording of descriptive, diagnostic end-points. IOTA Steering Committee: Dirk Timmerman (Leuven, Belgium); Lil Valentin (Malmo, Sweden); Tom Bourne (London, U.K.); Sabine Van Huffel (Leuven, Belgium); William P. Collins (London, U.K.); Ignace Vergote (Leuven, Belgium)