T. Ghi

ISUOG practice guidelines: performance of first-trimester fetal ultrasound scan.

The International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) is a scientific organization that encourages safe clinical practice and high-quality teaching and research related to diagnostic imaging in women’s healthcare. The ISUOG Clinical Standards Committee (CSC) has a remit to develop Practice Guidelines and Consensus Statements that provide healthcare practitioners with a consensus-based approach for diagnostic imaging. They are intended to reflect what is considered by ISUOG to be the best practice at the time at which they are issued. Although ISUOG has made every effort to ensure that Guidelines are accurate when issued, neither the Society nor any of its employees or members accept any liability for the consequences of any inaccurate or misleading data, opinions or statements issued by the CSC. The ISUOG CSC documents are not intended to establish a legal standard of care because interpretation of the evidence that underpins the Guidelines may be influenced by individual circumstances, local protocol and available resources. Approved Guidelines can be distributed freely with the permission of ISUOG (info@isuog.org).

Accuracy of three-dimensional ultrasound in diagnosis and classification of congenital uterine anomalies

OBJECTIVE To assess the accuracy of three-dimensional (3D) ultrasound in the diagnosis of congenital uterine anomalies. DESIGN Prospective study. SETTING University hospital. PATIENT(S) Nulliparae with three or more consecutive miscarriages. INTERVENTION(S) All women underwent 3D transvaginal ultrasound study of the uterine cavity. MAIN OUTCOME MEASURE(S) Women with negative ultrasound findings subsequently underwent office hysteroscopy, whereas a combined laparoscopic-hysteroscopic assessment was performed in cases of suspected Müllerian anomaly. RESULT(S) A specific Müllerian malformation was sonographically diagnosed in 54 women of the 284 included in the study group. All negative ultrasound findings were confirmed at office hysteroscopy. Among the women with abnormal ultrasound findings, the presence of a Müllerian anomaly was endoscopically confirmed in all. Concordance between ultrasound and endoscopy around the type of anomaly was verified in 52 cases, including all those with septate uterus and two out of three with bicornuate uterus. CONCLUSION(S) Volume transvaginal ultrasound appears to be extremely accurate for the diagnosis and classification of congenital uterine anomalies and may conveniently become the only mandatory step in the assessment of the uterine cavity in patients with a history of recurrent miscarriage.

Diagnosis of station and rotation of the fetal head in the second stage of labor with intrapartum translabial ultrasound

To investigate the ability of intrapartum translabial sonography to diagnose fetal station in the second stage of labor.

Outcome of antenatally diagnosed intracranial hemorrhage: case series and review of the literature

Prenatal diagnosis of intracranial hemorrhage (ICH) has been widely reported. Hemorrhages may occur either within the cerebral ventricles, subdural space or infratentorial fossa. The aim of this study was to determine the sonographic criteria for the diagnosis of fetal ICH, the role of in utero magnetic resonance imaging (MRI) and the outcome of this condition.

Diagnosis of midline anomalies of the fetal brain with the three‐dimensional median view

To investigate the effectiveness of a simplified approach to the evaluation of the midline structures of the fetal brain using three‐dimensional (3D) ultrasound.

Prenatal diagnosis of open and closed spina bifida

To identify criteria useful for differentiating closed from open spina bifida antenatally.

Prenatal diagnosis and outcome of fetal posterior fossa fluid collections

To evaluate the accuracy of fetal imaging in differentiating between diagnoses involving posterior fossa fluid collections and to investigate the postnatal outcome of affected infants.

Cervical and hysteroscopic injection for identification of sentinel lymph node in endometrial cancer

OBJECTIVES The aims of our study were to evaluate the possibility of identifying the sentinel lymph node (SLN) in patients with endometrial cancer (EC) and to directly compare two injection techniques, cervical and hysteroscopic injection. METHODS Fifty-four patients with endometrial carcinoma, clinical stages I and II, were submitted to complete surgical staging through laparoscopy, as recommended by FIGO in 1988. For the mapping procedure the patients were divided into two groups of injection: the cervical injection group and hysteroscopic injection group. Technetium (Tc) 99m radiocolloid was used as tracer. RESULTS Intraoperative detection rate of SLN was 70% in cervical group and 65% in the hysteroscopic group (p=n.s.). In the cervical group, all patients had SLN in the pelvis only and the mean SLN removed was 18 (range 2-26). In the hysteroscopic group, all patients had SNLs in the pelvis and two patients had SLN both in the pelvis and above the bifurcation of the aorta. Mean pelvic SLN removed was 20 (range 8-42). CONCLUSIONS Our data shows that it is possible to identify the SLN in tumours of the endometrium. Both cervical and hysteroscopic techniques are feasible but the hysteroscopic procedure might represent the only method able to highlight the complete lymphatic drainage of the uterus as suggested by the presence of paraaortic positive SLN only in this group.

Three‐dimensional ultrasound examination of the fetal central nervous system

The technique used to obtain an ultrasound volume is adequately described by three elements: (1) the section that is used to start the acquisition of the volume (referred to in the following as the ‘start’ scan); (2) the angle of rotation of the mechanical sweep of the motorized probe; and (3) the quality of the acquisition that can be varied by the operator and depends on the number of sections obtained during the acquisition. Both the angle of rotation and the quality of the volume influence the acquisition time and, when this is too long, the probability of movement artifacts increases. Tailoring the size and quality of the volumes to the specific diagnostic requirements is important because it increases the efficiency of the scan. In the following we provide information for each of the applications discussed. The modalities for the analysis of ultrasound volumes have been described in depth previously4,16,17. The multiplanar mode is most frequently used for assessment of the fetal CNS6,10,13,14. With this mode of display, the plane parallel to the acquisition plane or ‘start’ appears in the upper left corner of the screen and is identified with the letter A; the plane perpendicular to A but parallel to the ultrasound beam is identified with the letter B and appears in the upper right corner. The plane that is both perpendicular to the ‘start’ scan and the ultrasound beam is defined as C, and is frequently referred to as the coronal plane17 (Figure 1). The terminology may sound confusing at times. As discussed later, when dealing with the fetal brain, the coronal plane of the volume typically demonstrates a sagittal or axial section of the fetal head13. Although 3D ultrasound imaging can be used in many ways to evaluate the fetal (CNS), we have found that in practice there are mainly two useful applications: the multiplanar analysis of volumes obtained with an axial approach6,13 and the multiplanar analysis of volumes obtained from a sagittal or coronal approach12,14. 3D ultrasound examination can assist in evaluation of the spine18 and is particularly helpful in early neurosonographic studies1–3,5,19. It may also be used to improve the quality of two-dimensional (2D) images. These aspects are described separately below.

Effect of Long‐Term Testosterone Administration on the Endometrium of Female‐to‐Male (FtM) Transsexuals

INTRODUCTION Long term safety of testosterone (T) administration in women is still unknown. In particular few and discordant data exists on the effects of T on the endometrium. AIM The aim of this study was to investigate the effects of long-term T treatment on endometrium histology and proliferation in female to male transsexual subjects (FtM). We compared these endometria with those of young women in the proliferative phase (PM) of the cycle and with those of post menopausal women (M). METHOD Endometrial samples from 27 FtM treated with T (intramuscular injection of 100 mg Testoviron Depot /10 days for at least one year), 30 M undergoing vaginal hysterectomy, and 13 PM undergoing hysteroscopy for infertility problems were collected. Endometrial proliferation was evaluated on the basis of histopathology and expression of the proliferation marker Ki-67. Both M and PM women had not received any hormonal treatment for at least one year. MAIN OUTCOME MEASURE Circulating total testosterone (TT), estradiol (E), progesterone (P), insulin and glucose levels were measured in FtM and PM subjects. RESULTS FtM had received T for 33.6 +/- 21.3 months (mean +/- SD). In FtM subjects, histological analysis found inactive endometrium similar to the atrophic menopausal endometrium. The expression of Ki-67 in the glands, stroma and glands and stroma together was significantly (p < 0.0005) lower in FtM than in PM women and was similar in the FtM and M groups. Small polyps were detected in 5 of the 27 FtM subjects. CONCLUSIONS In conclusion our data suggest that exogenous T administration does not stimulate endometrial proliferation in FtM transsexuals and indeed may have atrophic effects.