bluuebunny/crossref_metadata_2025 huggingface dataset:
WS09‐04Ultrasound diagnosis of adnexal masses: computer modelling
Authors: Alcázar J. L.
Published: March 2003

The differential diagnosis of adnexal masses still represents a challenge. The main goal is to determine whether a given mass is malignant or benign, in order to establish the best therapautical approach. When a clinician face to a woman diagnosed as having an adnexal tumor several parameters may be used to determine the nature of the mass, such as patient's age, menopausal status, clinical complaints, physical examination, tumor's sonographic and Doppler features and serum tumor markers. When these data are collected may be difficult to interpret them all together and the clinician has to rely in one or two of them to predict the diagnosis and to decide the management strategy, guided many times by own experience or strict protocols.

A possible solution to this question may be the use of computer modelling. This means the use of statistical or mathematical models developed, using computer aid, to predict adnexal malignancy.

Currently, there are two methods that may be used: Multiple Logistic Regression Analysis (MLRA) and Artificial Neural Networks (ANN).

Both techniques allow to calculate the probability of a particular event has occurred, in this case a mass to be malignant or benign.

By computer modelling, actual independent predictors parameters are identified and may be used combined and simultaneously to predict malignancy. Each method has advantages and disadvantages, being MLRA the statistical technique of choice and ANN a potential newer alternative to MLRA.

Several studies have been published using one or both technique to predict adnexal malignancy. The results of these studies are encouraging showing a high diagnostic performance. All studies comparing MLRA to ANN showed the latter seems to be superior. However, it should be taken into account that most of these models have not tested prospectively.
WS09‐06What does contrast media add to three dimensional power Doppler evaluation of adnexal masses?
Authors: Šparac V. , Kupešić S. , Kurjak A.
Published: March 2003

Aim

To investigate the potential usefulness of contrast enhanced three‐dimensional (3D) power Doppler sonography in the differentiation of benign and malignant adnexal lesions.

Methods

A total of 31 patients with complex adnexal lesions of uncertain malignancy at transvaginal B mode and/or color Doppler sonography were prospectively evaluated with three‐dimensional power Doppler sonography before and after injection of the contrast agent. Presence of a penetrating pattern and a mixed penetrating and peripheral pattern suggested adnexal malignancy.

The results were compared with histopathology.

Results

There were 10 cases of ovarian malignancy and 21 benign adnexal lesions. Of the 10 ovarian cancers, 6 (60%) showed vascular distribution suggestive of malignancy at nonenhanced 3D power Doppler sonography. After injection of contrast agent, a penetrating vascular pattern and/or a mixed penetrating and peripheral pattern were detected in all cases of ovarian malignancy with two benign lesions (fibroma and cystadenofibroma) which were misdiagnosed as malignant. The use of a contrast agent with three‐dimensional power Doppler sonography showed diagnostic efficiency (96.7%) that was superior to nonenhanced 3D power Doppler sonography (93.5%).

Conclusion

Contrast enhanced 3D power Doppler sonography provides better visualizatoin of tumor vascularity in complex adnexal masses. If used together with 3D morphological ultrasound assessment, enhanced 3D power Doppler imaging might precisely discriminate benign from malignant adnexal lesions.
WS09‐08Sonographic and clinical characteristics of struma ovarii
Authors: Zalel Y. , Seidman D. S. , Oren M. , Achiron R. , Gotleib W. , Mashiach S. , Goldenberg M.
Published: March 2003

Background

To evaluate the preoperative clinical, laboratory and sonographic characteristics of struma ovarii.

Method

A retrospective review of gynecologic patients operated for mature cystic teratoma over a 10‐year period, identified 16 cases of struma ovarii. These cases were the subject of this study and were compared to 32 cases of ovarian dermoid cysts.

Results

The incidence of struma ovarii among all cases of dermoid cysts was 4.8%. Most patients were menopausal, the mean lesion diameter was 57.3 mm, occurred more frequently (68.8%) in the right adnexa and presented with normal CA‐125 level. Blood flow signals were detected from the center of the lesions in all cases. Rare cases presented with elevated tumor marker and low‐resistance blood flow. In dermoid cycsts, blood flow had a higher resistive index. In addition, no blood flow could be detected from the center of the echogenic lesion in dermoid (P < 0.0001).

Conclusion

It is difficult to distinguish between struma ovarii and dermoid cysts, based on their sonographic appearance. Nevertheless, Doppler flow may aid in the preoperative diagnosis of struma ovarii. Blood flow signals, detected from the center of the echogenic lesions and low resistance to flow may be more common in struma ovarii.
WS10: Chromosomopathies WS10‐01Pathophysiology of increased nuchal translucency‐abnormalities of the extracellular matrix
Authors: Von Kaisenberg C.S. , Jonat W. , Brand‐Saberi B. , Farzaneh F. , Nicolaides K.H.
Published: March 2003

Objective

In about 80% of fetuses with trisomies, Turner syndrome, and in fetuses with skeletal abnormalities, genetic syndromes, structural abnormalities and cardiac defects, there is increased collection of fluid in the neck region. This can be visualized sonographically at 11–14 weeks of gestation as increased nuchal translucency thickness. The pathophysiology of this common phenotypic expression of different chromosomal abnormalities is uncertain, but there is some evidence that the underlying mechanism may be altered composition of extracellular matrix components and/or cardiac failure.

Methods

We performed a number of studies investigating nuchal skin tissue for various extracellular matrix components and cardiac heart failure using molecular techniques. We used northern blotting, immunohistochemistry, electron‐microscopy and in situ hybridization.

Results

Studies investigating the heart found increased levels of mRNA for ANP and BNP, and reduced levels of Calcium ATPase, whereas transcript levels for GATA‐4 were unchanged. Studies investigating components of the extracellular matrix in nuchal skin of trisomic fetuses found overexpression of ecm genes in trisomies (collagen type VI, collagen type IV, laminin) or an altered ratio of genes between normals and abnormals (collagen type VI).

Conclusions

The present data provide some evidence, that chromosomally abnormal fetuses with increased nuchal translucency at 12–14 week may suffer from an altered extracellular matrix of the heart and skin or transient heart failure.
WS11‐02Collaborative management of three‐dimensional ultrasound between medical centers, physicians and patients
Authors: Nelson T. R. , Pretorius D. H.
Published: March 2003

To purpose of this project was to evaluate the feasibility of performing off‐line sonographic examinations over the internet using 3DUS data. To accomplish this we performed complete OB, pelvic, cardiac and abdominal studies following AIUM guidelines in 100 patients with 2DUS/3DUS methods including multiple volumes. Physicians performed a ‘virtual re‐scan’ of the patient using 3DUS data that was compared retrospectively to the 2DUS diagnosis. Our overall results showed that both abnormal and normal findings were identified for both 2DUS and 3DUS studies. Outcome depended on sonographer training, image quality and patient motion. There were few false negative/positive results with either 2DUS or 3DUS studies. Proper training was essential to acquire sufficient volumes for a complete study and for complete patient evaluation. In conclusion, off‐line virtual evaluation of patients is feasible using 3DUS data but has different technical requirements for acquisition and review than 2DUS studies. Proper training of sonographers, well defined scanning protocols and acquisition of sufficient volume data are essential to obtain diagnostic studies.
WS12‐04Fetal hemodynamics and growth restriction
Authors: Clerici G. , Di Renzo G. C.
Published: March 2003

Intrauterine growth restriction (IUGR) is a common symptom of many possible maternal‐fetal pathologies and/or the expression of a genetic alteration; by far, the most common etiology is related to chronic fetal hypoxemia. Fetal hypoxemia may be the result of different feto‐maternal pathophysiological processes which can produce completely different fetal hemodynamic modifications, not only in relation to the quality but particularly in relation to the chronology of the hemodynamic events. However, fetal hypoxia is mostly due to placental vascular insufficiency and it is important to point‐out that fetal hypoxemia‐acidemia is part of the terminal pathway starting from placental functional and structural alterations, through fetal IUGR, leading to intrauterine fetal death. Doppler evaluation of fetal arterial districts is important for the diagnosis of the fetal hemodynamic adaptation to the hypoxemia. Our observations suggest that, in the evaluation of fetal hemodynamics, it is important to consider also the intracardiac and the venous hemodynamics, focusing the study on the evaluation of the output tracts, the atrio‐ventricular flow and on vessels like the ductus venosus, inferior vena cava, umbilical vein. Keeping the time of the hemodynamic alterations in these vessels and/or districts, which are characteristic signs of the incipient heart failure, may be one of the key for the solution for one of the main obstetrical problem: the diagnosis of fetal decompensation phase.
WS12‐07Fetal venous and arterial circulation in hypoxic IUGR. From adaptation to decompensation
Authors: Ville Y.
Published: March 2003

Objective

To evaluate the changes in flow velocity waveforms in the mid‐cerebral artery and in the transverse cerebral sinus in growth restricted fetuses and to correlate these changes between them and with (1) flow velocity waveforms in the ductus venosus and (2) changes in computerized analysis of fetal cardiotocogram.

Design

Fetuses between 22 and 37 weeks' gestation with an estimated fetal weight below the 5th centile were included in this prospective longitudinal study. Doppler measurements in the umbilical artery, descending aorta, middle cerebral artery, transverse cerebral sinus and ductus venosus were recorded. Fetal heart rate was analyzed by a computer system according to the Dawes‐Redman criteria.

Results

Blood flow within the midcerebral artery and that in the cerebral transverse sinus follow a mirror image distribution. Arterial redistribution is already present when alteration in the venous cerebral circulation develops.

We measured a significant correlation between pulsatility index in the transverse cerebral sinus and in the ductus venosus over the study period and at delivery. There was a negative correlation between these indices and short and long‐term variability of the fetal heart rate. There was a parallel increase in pulsatility in the ductus venosus and the transverse cerebral sinus. These changes were inversely correlated with fetal heart rate variability and preceded fetal distress.

Conclusion

Cerebral venous blood flow in IUGR fetuses may be a useful additional investigation to (1) understand better the mechanism of cerebral redistribution in hypoxemic IUGR and (2) to discriminate between fetal adaptation and fetal decompensation in chronic hypoxemia.
WS14‐03Fetal extremities – three‐dimentional approach
Authors: Kos M.
Published: March 2003

Background

To assess particular features of fetal extremities evaluation using three‐dimensional ultrasound.

Methods

Total of 276 patients were selected from our routine outpatient clinic or sent for supervision from other clinics because of a suspected fetal anomaly. Patients were examined during a three year period (Jan1997‐Dec1999). Pre‐selected patients were examined with standard 2‐D ultasonic devices, and their gestation age ranged between 12 and 40 weeks. 3‐D ultrasound devices were Combison 530D and Voluson 530D MT (Kretztechnik, Zipf, Austria) with a 3–5 MHz annular array transducer for three dimensional volume scanning.

Results

In 28/276 patients the initial diagnosis was suspected by 2‐D sonography at entry in the study. In 18/28 suspected cases diagnosis was determined after examination by 3‐D sonography (15/28 clubfoot, 3/28 other limb anomalies). The diagnosis of clubfoot was confirmed In 17/28 cases after delivery or termination of pregnancy, meaning that 2/18 cases of clubfoot were not detected using ultrasonography. In all of 3 other cases the sonographic diagnoses of hand contractures and micromelia were confirmed after termination of pregnancy.

Conclusion

3‐D sonography accurately visualized angular and structural limb anomalies. In two cases of severe oligohydramnios we missed clubfoot by 3‐D sonography.
F12Diagnosis of ovarian cancer with ultrasound, serum CA125 and logistic regression
Authors: Lawrence A. C. , Aslam N. , Wolfer B. , Elson C. J. , Jurkovic D.
Published: March 2003

Background

The aim of this study was to compare the accuracy of a logistic regression model for the diagnosis of ovarian malignancy to subjective assessment made by experienced ultrasonographers at the time of the scan.

Method

All patients undergoing surgery for known adnexal masses were assessed preoperatively using transvaginal ultrasound and serum CA125 measurements. A number of demographic, morphological and Doppler parameters necessary for the regression analysis were recorded. The risk of malignancy was then calculated using a previously published multivariate regression model. Independently to these calculations, an attempt was made to establish the histological diagnosis based on subjective assessment of ultrasound findings by experienced operators.

Results

A total of 161 patients had surgery for adnexal masses between August 1997 and June 2000. Of these, 115 had benign masses, 9 borderline and 37 malignant. The multivariate logistical regression model diagnosed ovarian malignancy with a sensitivity of 68.9% and specificity of 79.7%. The subjective assessment of the malignancy gave a sensitivity of 92.7% with a specificity of 78.2%. The calculated likelihood ratios were 3.4 and 4.3, respectively.

Comment

Multivariate logistic regression model is less accurate than subjective assessment by experienced observers in the diagnosis of ovarian cancer.
F122Fetal cardiology considering fetal intervention, and animal model of fetal pacing and fetal cariopulmonary bypass
Authors: Chiba Y. , Kawamata K. , Bando K. , Kawahira Y.
Published: March 2003

Background

Two hundred two cases of structural heart diseases were diagnosed prenatally, and 23 cases of complete AV block were delivered. However, their mortality has not been decreased. We have to discuss the possibility of fetal interventions for heart diseases.

Methods

The mortality of fetal heart diseases diagnosed prenatally were discussed. Resent new findings of fetal cardiology considering fetal mortality and the possibility of fetal interventions were discussed. Animal experiments for fetal cardiac interventions were performed.

Results

The total mortality of fetal structural heart diseases was 60.2%. The mortality of hydropic heart diseases was 92%. The mortality of hypoplastic left heart syndrome was 100%, that of Ebstein's anomaly was 88%, and that of pulmonary valve atresia or stenosis was 64%. The total mortality of complete AV block was 30.4%. That of hydropic complete AV block was 50%. Fifteen cases of complete AV block were performed implantation of pacemaker after birth. The youngest case was 32 weeks delivered, the birth weight of which was 1906g. The procedure of fetal intervention should be simple. They will be aortic valvotomy, pulmonary valvotomy, enlargement of foramen ovale, and fetal pacing. Considering fetal or neonatal interventions for pulmonary atresia or critical stenosis, the findings of sinusoidal communication is essential. According to the good resolution of ultrasonic equipment, details of sinusoidal communication can be diagnosed. We have started group study to select cases to be considered cardiac interventions for fetuses and to develop surgical technique by support of japanese ministry of health and Welfare. We performed the implantation of pacemaker to fetal ram and experiments of fetal cardiopulmonary bypass.
Ectopic pregnancy F16Natural course of ectopic pregnancy evaluated by transvaginal sonography
Authors: Okitsu O. , Nakasaka H. , Mimura T.
Published: March 2003

Backgorund

Some of the cases with ectopic pregnancy (EP) may have spontaneous resolution without any treatment. Our aim of this study was to survey natural course of EP with serial sonographic assessment.

Method

All patients with EP from 1995 to 2000 were recruited. Inclusion criteria were 1. Positive hCG test, 2. Adnexal mass, suggestive of EP depicted by transvaginal sonography, 3. No fetal activity, 4. Pelvic fluid less than 300 mL, 5. Minimal symptoms, 6. Conservative management might be profitable to the patients, and 7 Informed consent. Under Hospitalization, the patients underwent at least one sonographic examination per day. When the amount of intraperitoneal hemorrhage proved to be increasing during the follow‐up, surgical treatment was performed.

Results

Of 34 cases with ectopic pregnancy, 13 cases with tubal pregnancy had emergency laparotomy immediately after admission. One case with cervical pregnancy was treated with methotrexate. Other 20 cases were enrolled in this study. Of the cases, 10 had laparotomy because of increasing intraperitoneal hemorrhage and/or worsening symptoms. In other 10 cases, spontaneous regression of the mass and decline of hCG level were confirmed. They could be discharged without any surgical treatment.

Conclusion

Expectant management was successful in 10 (50.0%) of the patients, in which natural course of EP was followed by transvaginal sonography.
F21Recurrent non inmune hydrops fetalis in parents with shared HLA DR and DQ
Authors: Pérez Fernández R. , De León J. A. , Pintado P. , Orera M. , Carbone J. , Ortiz L.
Published: March 2003

Introduction

Non immune hydrops fetalis (NIHF) is defined as the extra cellular accumulation of fluid in tissues and serous cavities, without evidence of circulating antibodies against red blood cell antigens. NIHF is the result of a heterogeneous group of conditions including cardiovascular, pulmonary, chromosomal, haematology, infectious disorders and deposit disease.

A 34‐year‐old pregnant woman with obstetrical history of two prior perinatal deaths between 29th and 30th weeks of gestation, all associated with foetal hydrops. In the prior pregnancy we made a exhaustive study of the foetal blood, obtained by cordocentesis, and the parents' blood. This study included haematology, infectious serology, hormonal and immune disorders and it was detected a shared HLA DR and DQ. In the current pregnancy, the foetus has developed hydrops at the 20th week of gestation which has been diagnosticated by ultrasound. Once again the results of the research has been normal and we have tried to correct the hypoproteinemia with albumen infusion by cordocentesis. The following up has showed the increase of the hydrops concluding with cardiovascular failure and foetal death.

Discussion

The mortality rate of recurrent NIHF is over the 80% of the cases and depends on the ethiology. The epidemiological studies had demonstrated the association between abortions and parents who shared HLA DR and DQ but the association with recurrent NIHF is not a proved fact.

The diagnosis of hydrop fetalis is by ultrasound on detection of skin thickness greater than 5 mm with fluid accumulation in at least one of the serous cavities. It is also necessary to obtain a detailed ultrasound scan for structural defects, echocardiography and Doppler blood flow studies of mayor foetal vessels. Ultrasound is an important tool used in the following up of NIHF and it makes possible the use of the cordocentesis therapy in some cases.
F27A correlation of the uterine and ovarian perfusion with parity of women having a history of recurrent spontaneous abortions
Authors: Jirous J. , Diejomaoh M. , Al‐Othman S. , Al‐Abdulhado F. , Al‐Xmarzouk N. , Sugathan T.
Published: March 2003

Background

To explore a relationship between the incidence of recurrent spontaneous abortions (RSA) and values of Doppler indices characterizing the uterine and ovarian perfusion in women with history of Primary and secondary RSA.

Method

A prospective study was carried out in which color Doppler transvaginal ultrasonography was used to estimate the endometrial thickness (ETH), the uterine pulsatility index (UTAP) and the intraovarian arterial resistance index (IOARI) on the 21st day of a regular 28‐day menstrual cycle in a control group of 19 healthy fertile nonpregnant parous women and 81 cases of nonpregnant women having a history of RSA.

Results

A highly significant difference (P < 0.001) was observed between UTAPI and IOARI values of control group and women with primary RSA. The same results were obtained for secondary RSA women who had some more 3 abortions. No difference was found for ETH values in control and study groups.

Conclusion

Our study has demonstrated the presence of a significantly decreased uterine and ovarian perfusion in nonpregnant women with primary RSA and secondary RSA if more than 3 abortions occurred. The significance of this result in the management of RSA requires further study. There was no difference between UTAPI and IOARI values in the control group and secondary RSA women with only 3 abortion.
F33Application of early sonographic markers of Down syndrome to pregnancies achieved by assisted reproduction techniques
Authors: Lara C. , Bellver J. , Iberico G. , Remohí J. , Pellicer A. , Serra‐Serra V.
Published: March 2003

Background

Biochemical markers need to be adjusted in pregnancies following assisted reproduction techniques (ART) for proper interpretation of second trimester Down syndrome screening results. However, little information is available on the application of first trimester sonographic markers of Down syndrome to ART pregnancies.

Methods

The crown‐rump length (CRL), nuchal translucency (NT), fetal heart rate (FHR), femur length (FL) and humerus length (HL) were measured transvaginally in 301 normal fetuses (159 singletons and 142 twins) between 10 and 14 weeks gestation. A control group of naturally conceived fetuses (n = 91) was compared to those obtained after intrauterine insemination (n = 35), in vitro fertilization (IVF) (n = 35), intracytoplasmic sperm injection (ICSI) (n = 47), combined IVF‐ICSI (n = 25) and ovum donation (n = 68). Adjustment for gestational age was performed by dividing the sonographic measurement by the CRL in each fetus.

Results

Naturally conceived fetuses showed similar NT/CRL, FHR/CRL, FL/CRL and HL/CRL ratios than ART fetuses (P = NS). No differences were observed either between the various ART pregnancies (P = NS).

Conclusion

Our preliminary results suggest that no adjustments are needed for the application of early sonographic markers of Down syndrome to pregnancies achieved by ART.
F42Doppler assessment of the intervillous blood flow before and after selective twin reduction in the reduced twin placenta
Authors: Antsaklis A. , Miliu‐Paulescu D. , Doublis D. , Daskalakis G. , Theodhosi G.
Published: March 2003

Background

The aim of this study was to compare the Doppler parameters (PI, RI) from the intervillous blood flow of the reduced twin placenta before and after the selective twin reduction.

Method

We studied 21 patients with triplets (trichorionic triamniotic) who underwent selective twin reduction (to twin pregnancy) at 10 weeks gestation from the last menstrual period. The intervillous blood flow of the reduced twin placenta was studied using pulsed color Doppler before and 10 days after the selective reduction. The arterial waveform signals were assessed by resistance index and pulsatility index.

Results

Arterial blood flow signals isolated from the intervillous space before the selective reduction did not show significant difference in RI (0.35 ± 0.03) and PI (0.78 ± 0.04) comparing with the values obtained 10 days after the reduction (RI 0.36 ± 0.03 and PI 0.73 ± 0.02).

Conclusions

The impedance to flow did not show significant difference after a relatively short period from the embryos death.
F47The flow redistribution toward the brain: beneficial and adverse effects on the fetal outcome in htypertensive pregnancies
Authors: Salihagic A. , Tobal N. , Perrotin F. , Imily V. , Lansac J. , Arbeille P.
Published: March 2003

Objective

To predict fetal outcome (abnormal FHR to cerebral lesion) from the degree and the duration of the hypoxia.

Method

Pregnancies complicated with hypertension and IUGR were submitted to a daily umbilical and cerebral Doppler from first day of admission until delivery. The umbilical (URI), and cerebral (CRI) resistance indices, cerebral‐umbilical ratio (C/U = CRI/URI), and the hypoxia index (HI) were calculated. The HI expresses as the maximum C/U change between admission day and delivery day (in percentage of C/U at admission, or in percentage of C/U cut‐off limit (= 1) if C/U admission < 1) multiplied by number of days of observation.

Results

68 pregnancies investigated (age: 25 ± 5 years, primipar: 35%, admission date: 30.8 ± 2.5 weeks, delivery at 33.2 ± 2.8, mean weight: 2300 ± 457g. The combination (HI > 200 and C/U < 1) was associated with abnormal FHR in 75% cases, whereas 1 or 2 of these parameter normal was associated with normal FHR in 85% cases (PPV 75% – NPV 85%). The minimal C/U and the HI during the period of observation allowed to predict abnormal FHR at delivery. On 5 pregnancies the period of hypoxia extended over 10–20 days (C/U << 1, HI >> 200), the fetuses died or were handicaped at delivery. The daily cerebral index recording showed a loss of fluctuation from one day to another, which could correspond to a deterioration of the cerebral regulation (vasoplegia). We suggest that the loss of fluctuation could be considered as the last limit before the cerebral lesion have serious chances to develop. In these 5 cases the fetal heart rate abnormalities appeared several days after this limit was passed.
F48Vasoconstrictor effect of the proximal segment of the fetal middle cerebral artery after an external partial occlusion of the umbilical vein (vasoconstrictor reflex)
Authors: López Ramón y Cajal C.
Published: March 2003

Background

We studied the repercussion of the nuchal cords on the proximal segment of the middle cerebral artery (pMCA) (segment with a rich innervation).

Method

We performed an external partial occlusion of the umbilical vein (through maternal abdominal wall) during 1–2 s to stimulate the baroreflex (pressure test or PT). We performed 76 PT in 36 fetuses. The pMCA was studied sonographically before, during and after the PT through pulsed Doppler and color Doppler energy (CDE).

Results

During the PT we observed stop the whole of the umbilical vein flow while maintaining the flow of the umbilical arteries. We observe a vasoconstrictor effect on the pMCA using CDE. This effect reflected a moderate‐severe segmental stenosis in the pMCA, however, flow in the remaining MCA was maintained. Sometimes, the effect vasoconstrictor produced a reverse flow on the pMCA to pulsed Doppler study. Post occlusion a cerebral vasodilatation took place, although in occasions an increased vascular tone persisted. Some fetal movements also could produce a similar effect in the pMCA (spontaneous PT).

Conclusion

The PT produces an effect vasoconstrictor in the pMCA. Variations of this reflex can be the origin of some perinatal motor injury of intrauterine origin.
F58Anatomical variation of the fetal venous system
Authors: Hofstaetter C. , Hansmann M.
Published: March 2003

Objective

This report presents our experience in the prenatal diagnosis of anomalies of fetal veins using high‐resolution and color Doppler ultrasound.

Design

In an observatorial study 15 cases of abnormalities of the umbilical, portal, hepatic and caval venous system have been diagnosed at our division over the past 5 years. The abnormality, the underlying embryologic disorder and the outcome of the pregnancy are presented.

Results

In group A, 8 fetuses had an abnormal course of the umbilical vein with a patent (n = 3) or absent (n = 5) ductus venosus. No portal veins and absent or abnormal hepatic veins were visualized. Six fetuses (75%) did not have an associated malformation and have survived. Two pregnancies were terminated or ended in fetal demise. In group B, 7 fetuses with an abnormal caval system had a left (n = 5) and right (n = 2) atrial isomerism with a cardiac defect in 6 cases (86%). The pregnancies ended in 4 terminations of pregnancy and two infant deaths. Only an infant with a left atrial isomerism and a normal heart has survived.

Conclusion

In a targeted fetal scan the course of the venous system should be carefully examined using color Doppler. Any suspicious finding should be followed by a detailed assessment of the specifity of this abnormality considering the embryological development as well as the associated malformations.
F66Learning ultrasound‐guided invasive procedures in fetal medicine: the learning curve with an automated system
Authors: Nizard J. , Ville Y.
Published: March 2003

Background

Learning ultrasound‐guided invasive procedures in fetal medicine can be done either on training models or directly on patients. Amniocenteses, cordocentesis, and chorionic villous sampling are associated with more complications at the beginning of the learning curve. It is therefore essential to optimise the teaching and reduce the length of the learning curve. We studied the learning curves of 8 inexperienced registrars in ObGyn with and without the use of a new electronic guidance system.

Method

8 medical students performed 100 invasive procedures (cordocentesis) using a specially designed training model. Four students used the ultrasound‐assisted free hand technique and four students used the same technique but assisted by the electronic guidance system. We studied the overall duration of the procedure and the proportion of this time the student is in control of the needle (the entire needle is visualised on the ultrasound screen).

Results

The new electronic guidance system reduces the learning curve of ultrasound‐assisted invasive procedures on training models, but increases the length of the procedure.

Conclusion

The new electronic guidance system can help teaching junior doctors in ultrasound‐assisted invasive procedures in fetal medicine.
F70Evaluation of adnexal masses with three‐dimensional ultrasound
Authors: Simic M. , Kopjar M. , Zadro M. , Viskovic T. , Knezovic N. , Maricic I. , Alvir I.
Published: March 2003

Study objective

To evaluate the use of 3D ultrasound in preoperative preparation for the laparoscopic operation of adnexal masses.

Methods

In last two years we have started with 3D ultrasound in preoperative evaluation of adnexal masses. Over that period we have had 187 adnexal masses evaluated with 3D ultrasound.

Results

At the period of first two years since we have performed 3D ultrasound we have had 14 tecofibroma ovarii, 2 Brener tumours, 10 cystadenoma, 14 ovarian carcinoma in different stages, 9 teratomas, 21 dermoid cysts, 62 endometrioid cysts and 55 simplex cysts of the ovary.

All of those finding were confirmed at the time of operation (frozen section). Two dermoid cysts were estimated on ultrasound as a malignant disease of the ovary and frozen section finding was benign cystic teratoma.

Conclusion

Since we started to perform 3D ultrasound in estimation of adnexal masses before surgery (mostly laparoscopy) we have found that adnexal masses with 3D ultrasound verification of intracystic papilla for the patient in fertile period greater than 1.0 cm and for postmenopausal patient greater than 0.5 cm can be of clinical value in early diagnosis of ovarian carcinoma and appropriate therapy.
F82Detailed three‐dimensional fetal echocardiography facilitated by an internet link
Authors: Michailidis G.D. , Simpson J.M. , Karidas C. , Economides D.L.
Published: March 2003

Objectives

To assess whether a complete virtual cardiologic examination can be achieved in stored three‐dimensional volumes of the fetal heart, transmitted to a tertiary fetal cardiology centre via the Internet.

Methods

Twenty‐one sequential normal singleton pregnancies. 1–4 cardiac volumes were acquired using a Kretz Voluson 530D scanner. The volumes were sent via the internet to a fetal cardiologist. A detailed fetal cardiac examination, was attempted using the 3D volumetric dataset.

Results

The mean gestational age was 24 weeks and 3 days. A complete heart examination was accomplished in 81% (95%C.I. 58% to 94%) of cases. The four‐chamber view, and the right ventricle outflow tract were seen in all cases. The ‘three vessel’ view was seen in 91% of the cases, while the left ventricle outflow, long axis view of the aortic arch, SVC/IVC and pulmonary veins in 81% of the cases. The mean time of volume acquisition was 10 min (SD: 2 min) and it was mainly influenced by fetal movements and the transfer time to the main computer. The mean examination time by the fetal cardiologist was 17.8 min (SD 6 min).

Conclusion

These preliminary results demonstrate that 3D virtual examination of the heart is possible. Although there are limitations such as the lack of flow and functional information, complete ascertainment of the main cardiac connections was possible in the majority of cases. The use of an internet link has major implications, particularly in situations where the scanning centre is geographically remote from the cardiological centre.
Prenatal diagnosis F92Fetal biometry from 10 to 14 weeks of gestation
Authors: Chatzipapas I. , Spathopoulos Y. , Whitlow B. , Lazanakis M. , Kadir R. , Verdin S. , Economides D.
Published: March 2003

Background

To determine fetal biometrical reference ranges from 10 to 14 weeks' gestation.

Methods

A prospective cross‐sectional study in a University Department of Obstetrics and Gynaecology, London. Four hundred and seventy women from an unselected population underwent a detailed assessment of fetal anatomy at 10+°−14+6 weeks' of gestation (confirmed by crown‐rump length) using transabdominal sonography (TAS), and transvaginal sonography (TVS) (35.3%: 166/470) when necessary. Biparietal diameter (BPD), occipito‐frontal diameter (OFD), head circumference, humerus (HU), abdominal circumference (AC), femur (FL) and foot lengths (FL) were measured and charts for centiles derived using regression analysis and a model of best fit constructed. HC/AC, BPD/OFD, BPD/FL and BPD/FL ratios were derived for each gestational age. Differences in measurements of BPD, HL and FL using TAS and TVS were examined in 39 cases using regression and t‐test analyses.

Results

Centiles (2.5th, 5th, 50th, 95th, 97.5th) were derived for each biometrical parameter. New charts and tables for each biometrical parameter are presented and compared with previously published data. As expected all parameters increased with gestational age. However the BPD/FL ratio decreased significantly at 10–13 weeks and the BPD/OFD and HC/AC ratio did not change. There was no significant difference between TAS and TVS measurements of BPD (T = 0.18, P = 0.86, R2 = 0.846), FL (T = −0.03, P = 0.98, R2 = 0.764) and HL (T = 0.17, P = 0.87, R2 = 0.633), therefore the results were combined.

Conclusion

We have constructed new reference ranges for biparietal diameter (BPD), occipito‐frontal diameter (OFD), head circumference (HC), humerus (HU), abdominal circumference (AC), femur (FL) and foot lengths (Fo) from 10+° to 14+6 weeks gestation. These data may be useful in the diagnosis of skeletal dysplasias and chromosomal abnormalities in early pregnancy.
F93Feasibility of the second trimester fetal ultrasound examination in an unselected population at 18, 20 or 22 weeks of pregnancy: a randomized trial
Authors: Schwärzler P. , Ville Y.
Published: March 2003

Objective

The purpose of this study was to investigate whether of three gestational ages (18, 20 and 22 weeks) any one was associated with a significant advantage in terms of identification of abnormalities, or need for further ultrasound assessment.

Subjects and methods

1206 women were randomised into 3 mutually exclusive groups: group 1 at 18–18 + 6 weeks, group 2 at 20–20 + 6 weeks and group 3 at 22–22 + 6 weeks. The main end‐points were (i) need for rescan of all or part of the fetal anatomy, (ii) fetal outcome, (iii) placental localisation and (iv) incidence of notches in the uterine artery waveform.

Results

There was a significantly higher percentage of completed scans in group 2 (90%) and 3 (88%) than in group 1 (76%, P < 0.001), but no significant difference between those scanned at 20 and at 22 weeks. This was associated with a higher incidence of noncephalic presentation in group 1 (46%) than in the other two groups (36%, P < 0.001). Significant differences in completing the assessment of the thorax, heart, spine and skeleton were also observed. The incidence of low lying placenta and of abnormal uterine artery Doppler screening were also higher at 18 weeks than at 20 and 22 weeks (P < 0.001 for both variables), with no difference being seen between groups 2 and 3. The number of fetal anomalies detected in the three groups were, respectively, 3, 2 and 2, and did not differ significantly between the groups.

Conclusions

This study suggests that among an unselected pregnant population, second trimester ultrasound screening is easier to perform and less likely to require an additional scan appointment at 20 −22 weeks than at 18 weeks.
F95Cerebral tissue and vessels growth, during normal pregnancies
Authors: Perrotin F. , Landre F. , Paillet C. , Philippot M. , Lansac J. , Janky E. , Arbeille P.H.
Published: March 2003

The objective was to study the kinetic of development of the main cerebral structures and vessels from 20 to 39 weeks.

Method

30 normal pregnancies were included into the study. The conventionnal parameters used for fetal growth assessment were measured: biparietal and, abdomen diameters, skull and abdomen transverse cross section area, femur length. In addition the transverse cross section of the main intracranial structures were measured: Thalami, cerebral ventricles, cerebral peduncles, cerebellum. The diameter of the middle cerebral artery and the flow velocity were also measured at the same rate. These parameters were measured every 3 weeks from 20 to 40 weeks. The fetal weight was evaluated from a simple index checked at delivery against the fetal actual fetal. All these parameters were displayed against time in order to study and compare the kinetic of their progression during normal pregnancies.
Continuing participation supports ultrasound screening for ovarian cancer
Authors: Pavlik E.J. , Johnson Ii T.L. , Depriest P.D. , Andrykowski M.A. , Kryscio R.J. , Van Nagell J.R.
Published: March 2003

The effect of ovarian cancer screening on survival is enabled by women who continue to actively participate in screening. In this report, factors that affect participation are examined. Participants included 13 963 Kentucky women who received 56 392 screens accounting for a 46 113 screening year experience. Background, health history and reasons for participating in transvaginal sonographic screening were collected via a self‐reported questionnaire. Screening participants were characterized as >50 years old, mostly married, well educated, medically insured, health conscious women, living in the vicinity of the screening centre or 51–150 miles away. Approximately 70% of the participants can be considered active in the study based upon a screening visit during the 1997–1998 2‐year period. The probabilities of a return screen at 1, 2, 5 and 7.5 years were 77.8%, 72.0%, 58.7% and 50.6%, respectively. A total of 96% of return visits occurred within 2 years, with 33.7% having intervals of <1 year. Perceived family history was not observed to affect continuation. However, abnormal findings were associated with a shortened participation. These high levels of continuation in ultrasound screening indicate that women take this disease seriously and demonstrate that this disease is of consequence to them. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology
Preoperative diagnosis of the primary Fallopian tube carcinoma by three‐dimensional static and power Doppler sonography
Authors: Kurjak A. , Kupesic S. , Jacobs I.
Published: March 2003

Objective To investigate whether three‐dimensional static and power Doppler ultrasound improves the diagnosis of primary Fallopian tube carcinoma.

Methods During a 2‐year period five cases of primary Fallopian tube carcinoma were selected from a cohort of 520 patients with a previous scan suggestive of an adnexal tumor.

Results Tubal malignancy occurred in patients between 49 and 64 years, with presenting symptoms such as pain, vaginal bleeding and leukorrhea. CA 125 was elevated in three cases of tubal carcinoma with stages II and III, while in two patients with stage I, CA 125 was within the normal limits. Two‐dimensional ultrasound demonstrated sausage shaped cystic masses with papillary projections in two patients and a complex adnexal mass in one patient. Three‐dimensional ultrasound revealed sausage shaped cystic and/or complex masses with papillary projections in all five cases of tubal malignancy. In one patient preoperative 3‐D ultrasound correctly predicted bilateral tumors, while 2‐D transvaginal sonography found only unilateral changes. Additional 3‐D power Doppler examination depicted vascular geometry typical for malignant tumor vessels such as arteriovenous shunts, microaneurysms, tumoral lakes, blind ends and dichotomous branching in each of the cases with Fallopian tube carcinoma.

Conclusions Three‐dimensional ultrasound allows precise depiction of tubal wall irregularities such as papillary protrusions and pseudosepta. Improved understanding of anatomical relationships may aid in distinguishing ovarian from tubal pathology. Multiple sections of the tubal sausage like structures enable determination of local tumor spread and capsule infiltration. Study of the vascular architecture in cases of Fallopian tube malignancy is further enhanced using 3‐D power Doppler imaging.
Endometrial thickness and histological abnormalities in women on hormonal replacement therapy: a transvaginal ultrasound/hysteroscopic study
Authors: Omodei U. , Ferrazzia E. , Ruggeri C. , Palai N. , Fallo L. , Dordoni D. , Peruginoa G.
Published: March 2003

Objectives

The aim of this study was to assess if endometrial thickness could be used to select postmenopausal women on hormonal replacement therapy (HRT) at increased risk for endometrial abnormalities. The secondary aim was to assess if endometrial abnormalities were more likely to occur in patients with increased endometrial thickness or in patients with unexpected bleeding.

Methods

Bi‐endometrial thickness was measured by transvaginal ultrasound (TVS) in postmenopausal patients on sequential or combined HRT regimens. Women following a sequential regimen underwent TVS examination immediately after their withdrawal bleed, always between 5 and 10 days after the last progesterone tablet. A hysteroscopy with endometrial biopsy was performed within 5 days after the TVS examination, when endometrial thickness was ≥ 4 mm, or when unscheduled bleeding was observed.

Results

A total of 190 women were recruited. In 138 women on sequential regimens, the mean value of endometrial thickness was 3.6 mm ± 1.5, and in 52 women on combined regimens it was 3.2 mm ± 1.8 (P = n.s.) Twenty‐eight patients (15%) had an endometrial thickness > 4 mm, 35 patients (18.4%) reported unexpected bleeding. The percentage of abnormal endometrial findings (9%; three of 35) in patients selected for unscheduled bleeding was significantly lower than the percentage of abnormal findings in patients selected for hysteroscopy for endometrial thickness > 4 mm (36%; 10 of 28) (P < 0.01). All patients with unexpected bleeding and endometrial thickness ≤ 4 mm (24 cases) were found to have an atrophic endometrium.

Conclusions

Endometrial thickness in patients on sequential HRT, measured soon after withdrawal bleeding, is not significantly different from thickness measured in patients on combined HRT. Patients on HRT with an endometrial thickness of > 4 mm could be considered for histological sampling. The prevalence of abnormal endometrial findings in patients with a thick endometrium is significantly higher than the prevalence observed in patients with unexpected bleeding. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology
The bright edge of the endometrial polyp
Authors: Caspi B. , Appelman Z. , Goldchmit R. , Ashkenazi M. , Haruvy Y. , Hagay Z.
Published: March 2003

Objective

To evaluate the accuracy of sonographic detection of endometrial polyps using a new ultrasound marker denoted ‘the bright edge of the polyp’.

Methods

The ultrasound scans of the uterus were examined for the presence of the bright edge in two groups of women. The first, a retrospective group, included 40 women in whom both a histological diagnosis of endometrial polyps and sonographic scans were available for evaluation. The second, a prospective group, included 80 women scheduled for operative hysteroscopy because of endometrial irregularities detected by sonography. In this group the hysteroscopical and histological results of the removed endometrial tissue were correlated with the sonographic diagnosis.

Results

In the retrospective group, the bright edge marker, indicative of the presence of a polyp, was detected in 30 out of 40 scans available for evaluation. In the prospective group this marker was detected in 60 women out of 80. Endometrial polyps were confirmed in 56 of these 60 women. In three cases a submucosal myoma was found and in one case the histology showed simple cystic hyperplasia. Two polyps were found in 20 cases where the bright edge had not been detected. This marker has a sensitivity of 96%, specificity of 82%, positive predictive value of 93%, and negative predictive value of 90% in this group at high risk for endometrial abnormalities.

Conclusion

The bright edge of the polyp is an accurate sonographic marker for the detection of endometrial polyps in women with endometrial irregularities demonstrated on ultrasound. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology
Prenatal diagnosis of an aortico‐left ventricular tunnel
Authors: Grab D. , Paulus W. E. , Terinde R. , Lang D.
Published: March 2003

Aortico‐left ventricular tunnel is a rare abnormal communication between the ascending aorta and the left ventricle. Early diagnosis and prompt surgical repair prevent congestive heart failure or consecutive valvular insufficiency. However, in utero diagnosis of this heart malformation has been rarely described and none of those children survived. We report on a case of aortico‐left ventricular tunnel detected at 32 weeks'gestation with a favourable outcome after surgical repair at three months of age. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology