Pelvic floor biometry in asymptomatic primiparous women compared with nulliparous women: a single-center study in Southern China.

OBJECTIVE: This study aimed to investigate pelvic floor biometry of asymptomatic primiparous women compared with nulliparous women by using four-dimensional transperineal ultrasound (4D TPUS). METHODS: From July 2015 to February 2017, 722 women were enrolled and divided into the nulliparous group (n = 292), the vaginal delivery group (n = 272), and the elective cesarean section group (n = 158). The ultrasound parameters of 4D TPUS were compared among the groups. RESULTS: The vaginal delivery group had a significantly greater bladder neck descent (η2 = 0.04), retrovesical angles on Valsalva maneuver (η2 = 0.01), urethral rotation (η2 = 0.01), levator hiatus area on Valsalva maneuver (η2 = 0.02), urethral inclination angle (η2 = 0.02), and funneling of the proximal urethra (η2 = 0.11) than the other two groups. Comparison of the two modes of delivery (vaginal delivery and cesarean section) also showed significant differences in the above-mentioned ultrasound parameters. CONCLUSION: There are significant differences in pelvic floor biometry between asymptomatic primiparous women and nulliparous women, as well as between women with vaginal delivery and those with elective cesarean section.

Evaluation of the microcirculatory disturbance of biliary ischemia after liver transplantation with contrast-enhanced ultrasound: preliminary experience.

The aim of this study was to determine the efficacy of contrast-enhanced ultrasound for depicting the perfusion of hilar bile ducts in ischemic-type biliary lesions after orthotopic liver transplantation. Thirteen transplant recipients with ischemic-type biliary lesions and 12 patients without ischemic-type biliary lesions underwent ultrasound examinations after the injection of 1.5 mL of an intravenous contrast agent. The enhancement of the hilar bile duct wall in the arterial, portal venous, and late phases was qualitatively graded as higher, equal, lower, or none with respect to that of the adjacent liver parenchyma. No or low contrast enhancement was seen in 10 of 13 patients (76.90%) with biliary ischemia, whereas increased contrast enhancement with respect to the normal liver parenchyma was found in all 12 patients without biliary ischemia. The difference in the enhancement patterns between the 2 groups was significant (P = 0.0001). In conclusion, contrast-enhanced ultrasound is a new imaging modality to depict perfusion of the hilar bile duct. No or low contrast enhancement of the bile duct wall in the arterial phase may reflect the microcirculatory disturbance of biliary ischemia and may contribute to its early diagnosis.

The use of contrast-enhanced ultrasound in uterine leiomyomas.

BACKGROUND: Ultrasound (US) is a popular method in the diagnosis and treatment of uterine leiomyomas, but the lack of accuracy greatly limits its application. Recently, microbubble enhancement technique affords direct depiction of tumor neovascularity and establishes a more precise vascular map of the tumor. This study was undertaken to describe the distribution patterns of SonoVue, a second-generation contrast agent, in the microcirculation of uterine leiomyomas, and to investigate the potential use of contrast-enhanced ultrasound (CEUS) in the characterization and treatment of uterine leiomyomas. METHODS: Ninety-six patients with uterine leiomyomas were enrolled in this study. The CEUS was performed using cadence pulse sequencing technique (CPS) and SonoVue. Enhancement patterns of different lesions were observed. The diagnostic accuracy of CEUS was compared with that of conventional ultrasound. RESULTS: After contrast injection, vessels of macro- and micro-circulation of the myoma first appeared, followed by the normal myometrium and finally the endometrium. During the washout phase, the myoma exhibited homogeneous enhancement followed by apparent hypoenhancement. The margin of the tumor was depicted clearly. There was no agent perfusion in the benign degenerative or necrotic area. However in sarcomas degeneration, the feeding vessels appeared markedly earlier than those in myometrium. In addition, the tumor exhibited heterogeneous hyperenhancment with no agent perfusion in the center and no membraniform sign was observed in the late phase. In subserous and submucous leiomyomas, the feeding arteries in the pedicle arising from the uterine could be seen. In this study, the diagnostic accuracy of CEUS and conventional US for uterine leiomyomas was 96.7% (160/165) and 82.4% (136/165) respectively. CONCLUSIONS: CEUS can provide a precise description of the leiomyomas vascularization. The specific enhancement pattern may be helpful for the characterization, treatment choice and therapeutic monitoring of leiomyomas.