Extended transvaginal sonography in deep infiltrating endometriosis: use of bowel preparation and an acoustic window with intravaginal gel: preliminary results.

OBJECTIVES: The purpose of this study was to assess the diagnostic performance of extended transvaginal sonography for diagnosing deep infiltrating endometriosis. METHODS: A prospective study was conducted comprising 51 women (mean age, 32.9 years; range, 23-43 years) with suspected deep infiltrating endometriosis based on clinical symptoms. All women underwent extended transvaginal sonography, which included assessment of 2 pelvic compartments (anterior compartment: bladder and distal ureters; and posterior compartment: posterior vaginal fornix, retrocervical area, pouch of Douglas, and rectosigmoid). The sliding sign for detecting pouch of Douglas obliteration was also assessed. All patients received bowel preparation before sonographic examinations. A single examiner performed all examinations. All women underwent laparoscopic surgery, and histologic confirmation of endometriosis was done. The sensitivity, specificity, positive likelihood ratio (LR+) and negative likelihood ratio (LR-) were calculated. RESULTS: Some women had more than 1 lesion, giving a total of 55 histologically confirmed lesions (rectosigmoid, n = 13; vagina, n = 5; retrocervical, n = 32; bladder, n = 5). The sensitivity, specificity, and LR+ for rectosigmoid involvement were 100%, 93%, and 14.0, respectively. The sensitivity, specificity, LR+, and LR- for vaginal involvement were 60%, 98%, 30.0, and 0.41. The sensitivity, specificity, LR+, and LR- for retrocervical involvement were 84%, 96%, 19.4, and 0.16. The sensitivity, specificity, and LR- for bladder involvement were 20%, 100%, and 0.80. The sensitivity, specificity, LR+, and LR- of the sliding sign for diagnosing pouch of Douglas obliteration were 89%, 92%, 10.7, and 0.12. CONCLUSIONS: Except for bladder involvement, extended transvaginal sonography has good diagnostic performance for deep infiltrating endometriosis.

Gynecologic Imaging and Reporting Data System for classifying adnexal masses.

INTRODUCTION: To perform a systematic review and meta-analysis of the diagnostic performance of the so-called Gynecologic Imaging and Report Data System (GI-RADS) for classifying adnexal masses. EVIDENCE ACQUISITION: A search for studies reporting about the use of GI-RADS system for classifying adnexal masses from January 2009 to December 2021 was performed in Medline (Pubmed), Google Scholar, Scopus, Cochrane, and Web of Science databases. Pooled sensitivity, specificity, positive and negative likelihood ratios and diagnostic odd ratio (DOR) were calculated. Studies' quality was evaluated using QUADAS-2. EVIDENCE SYNTHESIS: We identified 510 citations. Ultimately, 26 studies comprising 7350 masses were included. Mean prevalence of ovarian malignancy was 26%. The risk of bias was high in eight studies for domain "patient selection" and low for "index test," "reference test" domains for all studies. Overall, pooled estimated sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio and DOR of GI-RADS system for classifying adnexal masses were 94% (95% confidence interval [CI]=91-96%), 90% (95% CI=87-92%), 9.1 (95% CI=7.0-11.9), and 0.07 (95% CI=0.05-0.11), and 132 (95% CI=78-221), respectively. Heterogeneity was high for both sensitivity and specificity. Meta-regression showed that multiple observers and study's design explained this heterogeneity among studies. CONCLUSIONS: GI-RADS system has a good diagnostic performance for classifying adnexal masses.

Gynecologic imaging reporting and data system: a new proposal for classifying adnexal masses on the basis of sonographic findings.

OBJECTIVE: The purpose of this study was to describe a new reporting system called the Gynecologic Imaging Reporting and Data System (GI-RADS) for reporting findings in adnexal masses based on transvaginal sonography. METHODS: A total of 171 women (mean age, 39 years; range, 16-77 years) suspected of having an adnexal mass were evaluated by transvaginal sonography before treatment. Pattern recognition analysis and color Doppler blood flow location were used for determining the presumptive diagnosis. Then the GI-RADS was used, with the following classifications: GI-RADS 1, definitively benign; GI-RADS 2, very probably benign; GI-RADS 3, probably benign; GI-RADS 4, probably malignant; and GI-RADS 5, very probably malignant. Patients with GI-RADS 1 and 2 tumors were treated expectantly. All GI-RADS 3, 4, and 5 tumors were removed surgically, and a definitive histologic diagnosis was obtained. The GI-RADS classification was compared with final histologic diagnosis. RESULTS: A total of 187 masses were evaluated. The prevalence rate for malignant tumors was 13.4%. Overall GI-RADS classification rates were as follows: GI-RADS 1, 4 cases (2.1%); GI-RADS 2, 52 cases (27.8%); GI-RADS 3, 90 cases (48.1%); GI-RADS 4, 13 cases (7%); and GI-RADS 5, 28 cases (15%). The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 92%, 97%, 85%, 99%, and 96%, respectively. CONCLUSIONS: Our proposed reporting system showed good diagnostic performance. It is simple and could facilitate communication between sonographers/sonologists and clinicians.

Quiste ovárico fetal: manejo invasivo / Fetal ovaric cyst: invasiveness managment

Se presenta el caso de un feto portador de un quiste ovárico de gran volumen, en una madre con diabetes gestacional. A las 29 y media semanas se punciona el quiste extrayéndose 500 cm3. El embarazo se interrumpe a las 33 y media semanas por la presencia de una Colestasia Intrahepática del Embarazo (CIE)

Diagnostico prenatal de malformaciones fetales mediante el uso de ecografia materna. / Prenatal diagnosis of fetal malformations by the use of maternal echography

Se presentan 15 R.N. con malformaciones congenitas sospechadas mediante ecografias realizadas a la madre por indicacion obstetrica en el 3er. trimestre del embarazo. Se hallaron 9 malformaciones fetales quisticas (6 del tracto urinario, 2 obstrucciones del tracto gastrointestinal, 1 hernia diafragmatica) y 7 alteraciones de la silueta fetal (4 onfaloceles, 1 gastrosquisis y 2 teratomas sacrococcigeos). El hallazgo de estas anomalias debe ser estudiado por un equipo que incluya obstreta, neonatologo y cirujano pediatra para una mejor interpretacion diagnostica. Este equipo manejara adecuadamente el embarazo y el parto para conseguir un mejor exito en el tratamiento de la malformacion del recien nacido. La ecografia materna debe ser el primer examen medico en la vida del nino

Derivación ventrículo amniótica en un feto hidrocefálico / Ventriculo-amniotic derivation in fetal hydrocephalus

Se presenta el caso de un feto de 27 semanas de gestación, al cual se le implanta un catéter derivativo ventrículo-amniótico por presentar hidrocefalia. La intervención, técnicamente satisfactoria, consiguió la descompresión del encéfalo, lográndose una reducción sostenida del DBP. Once días después se produjo parto prematuro. A los 17 días de vida se implantó una derivación ventrículo-peritoneal definitiva. Se analizan algunos problemas técnicos en el manejo de estos casos y se plantean los requisitos que consideramos cumplir para su realización