bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparison of Lerner score, Doppler ultrasound examination, and their combination for discrimination between benign and malignant adnexal masses
Authors: Valentin L. 
Published: March 2003

Objective To determine whether the combined use of Lerner’s morphologic score and color Doppler ultrasound examination results in better discrimination of benign and malignant adnexal masses than the use of Lerner’s score alone or Doppler variables alone.
Design One hundred and seventy‐three consecutive women with a pelvic mass judged clinically to be of adnexal origin underwent preoperative ultrasound examination including color and spectral Doppler techniques. One hundred and forty‐nine tumors were benign and 24 malignant. The sensitivity and false‐positive rate with regard to malignancy were calculated for Lerner’s score, six Doppler variables and combinations of Lerner’s score and Doppler variables. Previously defined gray scale and Doppler criteria of malignancy were used and tested prospectively. The best method was defined as that detecting most malignancies with the lowest false‐positive rate.
Results Lerner’s score had a sensitivity of 92% and a false‐positive rate of 36%. The best Doppler variable—time‐averaged maximum velocity—had similar diagnostic properties with a sensitivity of 100% and a false‐positive rate of 41%. Combining Lerner’s score with Doppler measurement of time‐averaged maximum velocity—i.e. requiring both Lerner’s score and time‐averaged maximum velocity to indicate malignancy for a malignant diagnosis to be made—had a sensitivity of 92% and a false‐positive rate of 19%.
Conclusions The combined use of Lerner’s score and measurement of time‐averaged maximum velocity is a better method for discrimination of benign and malignant adnexal masses than the use of Lerner’s score alone or Doppler ultrasound examination alone. The clinical value of the combined method needs to be cross‐validated prospectively in a new series of tumors.
Acute bowel perforation in a fetus with gastroschisis
Authors: Haberman S. , Burgess T. , Klass L. , Cohn B. D. , Minkoff H. L. 
Published: March 2003

AbstractGastroschisis is a congenital anomaly with a reported incidence of 1 in 10 000 live births. Although prenatal diagnosis is more common with the widespread use of biochemical markers and obstetric ultrasound, the role of ultrasound in the identification of the fetus that might need early intervention has not been established.Acute bowel perforation was diagnosed by ultrasound at 34 weeks gestation in a fetus with gastroschisis. An immediate Cesarean section was performed, followed by repair with primary closure. The neonatal outcome was favorable. The post‐partum findings, including bowel pathology, confirmed the antenatal diagnosis.Acute bowel perforation can be diagnosed antenatally. Immediate intervention, before further bowel injury occurs, might enhance the ability of the surgeon to perform primary closure and obtain a favorable outcome. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology
Errors in the measurement of endometrial depth using transvaginal sonography in postmenopausal women on tamoxifen: random error is reduced using saline instillation sonography
Authors: Ballard P. , Tetlow R. , Richmond I. , Killick S. , Purdie D.W. 
Published: March 2003

AbstractObjectiveThe endometrium in women on tamoxifen is often made irregular by small cysts. The aim of this study was to assess the accuracy and precision of the measurement of endometrial depth by transvaginal sonography.MethodsThe endometrial depth from endometrial biopsies obtained with the resectoscope in 15 women receiving tamoxifen was compared to the endometrial depth measured by TVS. The inter‐observer variability was measured in 58 women.ResultsIn those biopsies of sufficient quality to allow a measurement, the corresponding depth measurement obtained by ultrasound was up to 3 mm greater than the histological measurement. The interobserver variability for the measurement of endometrial depth using TVS was assessed in 58 postmenopausal women on tamoxifen. The interobserver variability deteriorated as the mean endometrial depth increased, probably because the increase in depth resulted from greater morphological changes within the endometrium such as cyst formation which resulted in an irregular endometrial/myometrial boundary. This may, however, be improved by performing saline instillation sonography. In a prospective study of 10 postmenopausal women, the interobserver variability was significantly greater during tamoxifen treatment compared to pretreatment.ConclusionsOn the basis of the above, if uterine surveillance using TVS were to be offered to postmenopausal women on tamoxifen, then the procedure should be augmented by saline instillation sonography if the endometrial depth is > 4 mm, as this will improve the measurement precision and also identify intrauterine pathology. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology
Human fetal pulmonary artery velocimetry: repeatability and normal values with emphasis on middle and distal pulmonary vessels
Authors: Laudy J. A. M. , De Ridder M. A. J. , Wladimiroff J. W. 
Published: March 2003

AbstractObjectivesTo establish the nature and gestational age dependency of flow velocity waveforms from fetal middle and distal arterial pulmonary branches in the second half of normal pregnancy and to determine repeatability and inter–relationship of flow velocity waveform recordings from proximal, middle and distal arterial pulmonary branches.DesignCross‐sectional study.Subjects/methodsA total of 111 singleton normal pregnancies between 20 and 40 weeks of gestation were studied using a color‐coded Doppler ultrasound system. Pulmonary waveforms were obtained at the level of the fetal cardiac four‐chamber view. Repeatability was tested from two recordings at 15 min time‐intervals in 25 separate normal pregnancies.ResultsAcceptable repeatability of flow velocity waveforms from fetal arterial pulmonary branches was established with coefficients of variation below 15%. The nature of middle arterial pulmonary flow velocity waveforms was similar to that of proximal waveforms and showed a gestational age‐related change for diastolic velocity parameters, peak systolic/peak diastolic ratio and pulsatility index. The distal arterial pulmonary branch displayed a monophasic forward flow velocity profile throughout the cardiac cycle. All velocity parameters of the distal branch remained unchanged with advancing gestation, with the exception of the pulsatility index. Significant inter–pulmonary changes were found for all pulmonary arterial waveform parameters.ConclusionsAlteration in pulmonary vascular resistance may play a role in gestational age‐related changes, whereas changes in vessel branching/diameter and in the distance between the heart and more distal arterial pulmonary vessels may cause inter–pulmonary differences. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology
In‐utero diagnosis of mucopolysaccharidosis type VII in a fetus with an enlarged nuchal translucency
Authors: Den Hollander N. S. , Kleijer W. J. , Schoonderwaldt E. M. , Los F. J. , Wladimiroff J. W. , Niermeijer M. F. 
Published: March 2003

AbstractMucopolysaccharidosis type VII was diagnosed prenatally during the first pregnancy of a Turkish consanguineous couple, following diagnostic work‐up of an increased nuchal translucency detected by ultrasound at 13 weeks of gestation. Mucopolysaccharidosis type VII (MPS VII) or Sly syndrome is a rare autosomal recessive lysosomal storage disease, caused by the deficiency of the enzyme β‐glucuronidase. The most severe form of MPS VII manifests itself by non‐immune fetal hydrops. Tests for the diagnosis of metabolic disorders, especially lysosomal diseases, are essential when the major causes of hydrops fetalis have been excluded. The presence of a β‐glucosidase deficiency, Gaucher's disease, in the infant of the patient's sister emphasizes the importance of a complete family history in consanguineous couples and the risk for several recessive diseases in some families. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology
Prenatal diagnosis of congenital Wilms' tumor (nephroblastoma) presenting as fetal hydrops
Authors: Vadeyar S. , Ramsay M. , James D. , O'Neill D. 
Published: March 2003

AbstractWe describe a case of congenital nephroblastoma (Wilms' tumor) presenting at 28 weeks of gestation with fetal hydrops and polyhydramnios. Prenatal diagnosis was made by biopsy. An emergency Cesarean section was performed due to deterioration in the cardiotocograph. A post‐mortem examination confirmed the diagnosis of congenital nephroblastoma. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology
Thermocoagulation for selective reduction of conjoined twins at 12 weeks of gestation
Authors: Lam Y. H. , Lee C. P. , Tang M. H. Y. , Lau E. 
Published: March 2003

AbstractConjoined twins occur rarely. Most of the prenatally diagnosed cases are terminated either because of extensive organ sharing or because of the presence of major structural abnormalities. We present a case of omphalopagus conjoined twins diagnosed at 10 weeks of gestation with selective reduction performed at 12 weeks. The twins were conjoined at the umbilicus with vascular communication demonstrated at the conjunction. Twin A was normal but twin B was growth restricted and hydropic. Thermocoagulation of twin B was performed at 12 weeks by passing an insulated electric wire through a 18‐gauge needle placed close to the fetal heart. Reassessment at 15 weeks showed that twin A was growing normally with a small dead twin B attached at its umbilicus. Twin B was subsequently sloughed off from this attachment and could be seen lying free in the amniotic cavity at 17 weeks. Twin A was delivered at term and was healthy. A small scar could be seen just above the umbilical cord insertion. This case represents the first antenatal example of selective reduction of conjoined twins by thermocoagulation. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology
Coronary artery blood flow visualization signifies hemodynamic deterioration in growth‐restricted fetuses
Authors: Baschat A. A. , Gembruch U. , Gortner L. , Reiss I. , Weiner C. P. , Harman C. R. 
Published: March 2003

AbstractObjectiveTo determine the relationship between fetal coronary blood flow (CBF) visualization in intrauterine growth restriction (IUGR), longitudinal changes in arterial and venous flow velocity waveforms and perinatal outcome.MethodsA total of 48 IUGR fetuses (abdominal circumference below the 5th percentile for gestational age) with absent or reversed umbilical artery (UA) end‐diastolic velocity (AREDV) were examined longitudinally by echocardiography attempting CBF visualization at each examination. Doppler evaluation of the middle cerebral artery, inferior vena cava (IVC), ductus venosus (DV) and umbilical vein (UV) was performed at each examination. Doppler measurements were correct for gestational age by conversion into Z‐ (Δ‐). Doppler results and outcome from fetuses in which CBF was visualized (group 1, n = 20) and those in which CBF was never visualized (group 2, n = 28) were compared. Outcome parameters analyzed included Apgar scores, cord arterial blood gases, perinatal mortality, respiratory distress, bronchopulmonary dysplasia, intraventricular hemorrhage, necrotizing enterocolitis and postpartum circulatory failure requiring pressor support.ResultsThere was no difference in Doppler indices between groups at study entry. CBF visualization coincides with a significant increase of UA‐, IVC‐ and DV Δ‐indices. The greatest rate of change was observed for indices in the ductus venosus which occurred in the 24 h preceding CBF visualization. Group 1 fetuses required earlier delivery (median 27 + 4, vs. median 30 + 0), had lower birthweight (682 ± 305 g vs. 936 ± 416 g), lower cord pH (7.21 ± 0.1 vs. 7.27 ± 0.06) and cord pO2 (13 ± 4.5 vs. 24.1 ± 13.5 mmHg) compared to group 2 (all values P < 0.05). Mortality was similar (group 1 = 6/20, 30% group 2 = 6/28, 21.4%).ConclusionsIn IUGR, fetuses with AREDV and centralization are at high risk for hypoxemia, acidemia and adverse outcome. CBF visualization coincides with deteriorating venous flows. Operator dependence of CBF visualization and the strong association with abnormal venous flow stresses the importance of venous Doppler surveillance in these fetuses. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology
Quantification of the diastolic notch in Doppler ultrasound screening of uterine arteries
Authors: Aardema M. W. , De Wolf B. T. H. M. , Saro M. C. S. , Oosterhof H. , Fidler V. , Aarnoudse J. G. 
Published: March 2003

AbstractObjectiveTo investigate a new method of quantification of the diastolic notch of the flow velocity waveforms of uterine arteries in the prediction of hypertensive disorders of pregnancy.MethodsPulsed‐wave Doppler was used to obtain flow velocity waveforms (FVWs) from the uterine arteries at 21–22 weeks of gestation from 531 nulliparous women and 94 multiparous women at high risk. From the FVWs, both the pulsatility index (PI) and the notch index (NI) were calculated and the predictive values for both indices were compared using logistic regression analysis for mild and severe early onset hypertensive pregnancy complications.ResultsBoth the PI and the NI were poor predictors for mild gestational hypertension and pre‐eclampsia; predictive values for severe early onset disease, however, were much better. Logistic regression analysis showed the NI has no additional value compared with the PI in the prediction of either mild or severe disease.ConclusionThe NI offers the possibility to quantify the diastolic notch in uterine artery analysis. Compared to the PI, this does not lead to better predictive values for hypertensive disorders of pregnancy. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology
The development of the fetal penis—an in utero sonographic evaluation
Authors: Zalel Y. , Pinhas‐Hamiel O. , Lipitz S. , Mashiach S. , Achiron R. 
Published: March 2003

AbstractObjectiveTo establish a nomogram for fetal penile length during gestation.DesignA prospective, cross‐sectional study of normal singleton pregnancies.SubjectsFour hundred and nineteen male fetuses between 14 and 38 weeks were studied.MethodsMeasurements of fetal penis length were performed by high resolution transvaginal ultrasonography between 14 and 17 weeks of gestation, and by transabdominal ultrasonography beyond 18 weeks of gestation.ResultsAdequate penile length measurements were obtained in all 419 fetuses. Penile length as a function of gestational age was expressed by the regression equation: (square root) penile length (mm) = 0.277 + 0.121 × gestational age (weeks). The correlation coefficient, r = 0.967 was found to be highly statistically significant (P < 0.0001). The normal mean and the 90% prediction limits were defined. During the study period, we identified three fetuses with abnormalities involving penile development. Using the above reference data range, it has been shown that their penile length was below the lower limit.ConclusionsThe present data provide a normal range of fetal penile length from early stages of gestation that may allow intrauterine assessment of the development of the male external genitalia. Copyright © 2001 International Society of Ultrasound in Obstetrics and Gynecology
Ductus venosus studies in fetuses at high risk for chromosomal or heart abnormalities: relationship with nuchal translucency measurement and fetal outcome
Authors: Bilardo C. M. , Müller M. A. , Zikulnig L. , Schipper M. , Hecher K. 
Published: March 2003

AbstractObjectiveTo investigate, in a high‐risk group of fetuses, the role of ductus venosus Doppler velocimetry as a prognostic factor, in addition to nuchal translucency measurement, for predicting chromosomal anomalies and, where the karyotype was normal, for predicting fetal outcome.MethodsNuchal translucency was measured and ductus venosus pulsatility index and late diastolic flow (a‐wave) were recorded in 186 fetuses at a median gestational age of 12.6 weeks (range, 10–17). Fetal karyotype, the presence of structural anomalies, pregnancy outcome, neonatal examination at birth and postnatal follow up were the outcome values.ResultsNuchal translucency measurement was increased in 112 fetuses. The outcome of pregnancy was normal in 130 fetuses. Fifty‐six fetuses had an adverse outcome (46 chromosomal anomalies, three intrauterine deaths, six structural anomalies and one developmental disorder). The sensitivity of an abnormal ductus venosus pulsatility index or of absent or reversed flow during the a‐wave was 65% for chromosomal anomalies and 68% for an adverse outcome. The specificity was 79%. There was a significant correlation between nuchal translucency and ductus venosus pulsatility index. In chromosomally normal fetuses with an enlarged nuchal translucency an abnormal ductus venosus flow was associated with a nearly nine‐fold increase in adverse outcome (odds ratio 11.7).ConclusionDuctus venosus Doppler velocimetry can be used in addition to nuchal translucency measurement as a predictor of chromosomal anomalies. However, as the ductus venosus blood flow pattern is correlated with nuchal translucency measurement it cannot be used as an independent variable to reduce the indication for fetal karyotyping. Ductus venosus Doppler velocimetry may have a role in the counseling of parents in the case of an enlarged nuchal translucency and normal karyotype by identifying those fetuses in need of an intensive follow up due to an increased risk of adverse outcome. Copyright © 2001 International Society of Ultrasound in Obstetrics and Gynecology
Prenatal sonographic diagnosis of vasa previa: ultrasound findings and obstetric outcome in ten cases
Authors: Catanzarite V. , Maida C. , Thomas W. , Mendoza A. , Stanco L. , Piacquadio K. M. 
Published: March 2003

AbstractObjectiveTo assess the specificity of sonographic diagnosis of vasa previa and pregnancy outcome in sonographically diagnosed cases.MethodsWe prospectively collected cases of vasa previa diagnosed by color Doppler sonography. Delivery by elective Cesarean section after demonstration of fetal pulmonary maturity and prior to the onset of labor was recommended unless obstetric complications supervened. Data regarding maternal obstetric courses and newborn status were collected.ResultsEleven cases of vasa previa without placenta previa were diagnosed among 33 208 women over an 8‐year period. Ten patients had confirmation of the diagnosis by the delivering obstetrician and/or placental examination, giving a specificity of diagnosis of 91%. Among the 10 patients with confirmed vasa previa, two were delivered at 31.5 and 35.5 weeks' gestation prior to demonstration of lung maturity, and the remainder were delivered at 34–37.5 weeks, after lung maturity. All infants had normal Apgar scores and survived. One baby had Scimitar syndrome, which was not suspected from sonography.ConclusionsThe specificity of sonographic diagnosis of vasa previa at our center was 91%. Antenatal diagnosis permitted us to prevent the catastrophic outcomes commonly associated with vasa previa. Copyright © 2001 International Society of Ultrasound in Obstetrics and Gynecology
Does acute hypoxia cause fetal arterial blood flow redistribution?
Authors: Krampl E. , Chalubinski K. , Schatten C. , Husslein P. 
Published: March 2003

AbstractChronic fetal hypoxia in fetal growth restriction due to impaired placentation is associated with centralization of blood flow to the vital organs, such as brain, heart and adrenal glands, in order to maintain oxygenation. There is a correlation between fetal hypoxemia and low impedance to blood flow in the middle cerebral artery. However, there is no association between abnormal flow velocity waveforms and fetal distress in an unselected population, and this reported case also suggests that Doppler ultrasound is of no value in identifying acute fetal distress. Copyright © 2001 International Society of Ultrasound in Obstetrics and Gynecology
Reproducibility of pulsed Doppler measurements of the maternal renal circulation in normal pregnancies and those with pregnancy‐induced hypertension
Authors: Nakai A. , Miyake H. , Oya A. , Asakura H. , Koshino T. , Araki T. 
Published: March 2003

AbstractObjectiveTo assess the inter‐ and intraobserver reproducibilities of pulsed Doppler measurements of the maternal renal circulation in normal pregnancies and those affected by pregnancy‐induced hypertension.Materials and methodsColor and pulsed Doppler ultrasound was used to measure acceleration time and resistance index in the renal segmental and interlobar arteries. For the investigation of interobserver reproducibility, two sonographers performed measurements blindly in six normal pregnant women and 14 women with pregnancy‐induced hypertension between 28 and 36 weeks' gestation. A second group of 10 patients between 30 and 35 weeks' gestation were examined by one sonographer to assess the level of intraobserver reproducibility of measurements. For each patient in this group, the flow waveform was measured three times in succession. Calculations of the intraclass correlation coefficient Ri were used to determine the level of reproducibility.ResultsThe interobserver Ri and intraobserver Ri for acceleration time in the segmental artery were 0.95 and 0.96 and for the interlobar artery they were 0.97 and 0.98, respectively. For the resistance index, these values were 0.01 and 0.01 in the segmental artery and 0.52 and 0.29 in the interlobar artery.ConclusionBoth the inter‐ and intraobserver reproducibility of acceleration time measurements in the renal segmental and interlobar arteries were clinically acceptable but the equivalent reproducibilities of resistance index measurements were poor. Copyright © 2002 ISUOG
Detection of central pelvic recurrent disease with transvaginal color Doppler ultrasound in women treated for gynecological malignancy
Authors: Testa A. C. , Ciampelli M. , Mastromarino C. , Lopez R. , Zannoni G. F. , Mancuso S. , Scambia G. 
Published: March 2003

AbstractObjectiveTo evaluate color Doppler characteristics of small recurrent tumors detected within the central pelvis in follow‐up patients treated for gynecological malignancy.Patients and methodsA prospective study was performed on 340 patients who were being monitored following treatment for gynecological malignancies. A selected group of 27 patients, with small pelvic masses located in the central region of the pelvis, underwent a color Doppler examination. A subjective assessment of the vascularization (vascular score), the lowest resistance index (RI), the highest peak velocity (PSV) and the highest time averaged maximum velocity (TAMXV) of the vessels detected within the lesion were analyzed.ResultsIn 16 patients the pelvic mass was found to be benign while in 11 patients a malignant recurrence was diagnosed. Gray‐scale examination could not differentiate between benign and malignant lesions. The color score of tumor recurrences was significantly higher in comparison to that in benign lesions (color score 3 in 54% vs. 0%, P < 0.005). The malignant lesions showed significantly lower mean values of RI and significantly higher mean values of PSV and TAMXV when compared with benign lesions (0.39 ± 0.09 vs. 0.81 ± 0.22, P < 0.0001; 19.3 ± 4.7 vs. 10.5 ± 5.6 cm/s, P < 0.0001; 8.9 ± 3.7 vs. 4.3 ± 2.7 cm/s, P < 0.005).ConclusionsColor Doppler analysis added to transvaginal gray‐scale ultrasonography seems to be a helpful tool in the diagnosis of recurrent tumors in the central region of the pelvis. Copyright © 2002 ISUOG