Comparison of the diagnostic efficiency between the O-RADS US risk stratification system and doctors' subjective judgment.

BACKGROUND: This study aimed to compare the diagnostic efficiency of Ovarian-Adnexal Reporting and Data System (O-RADS) and doctors' subjective judgment in diagnosing the malignancy risk of adnexal masses. METHODS: This was an analysis of 616 adnexal masses between 2017 and 2020. The clinical findings, preoperative ultrasound images, and pathological diagnosis were recorded. Each adnexal mass was evaluated by doctors' subjective judgment and O-RADS by two senior doctors and two junior doctors. A mass with an O-RADS grade of 1 to 3 was a benign tumor, and a mass with an O-RADS grade of 4-5 was a malignant tumor. All outcomes were compared with the pathological diagnosis. RESULTS: Of the 616 adnexal masses, 469 (76.1%) were benign, and 147 (23.9%) were malignant. There was no difference between the area under the curve of O-RADS and the subjective judgment for junior doctors (0.83 (95% CI: 0.79-0.87) vs. 0.79 (95% CI: 0.76-0.83), p = 0.0888). The areas under the curve of O-RADS and subjective judgment were equal for senior doctors (0.86 (95% CI: 0.83-0.89) vs. 0.86 (95% CI: 0.83-0.90), p = 0.8904). O-RADS had much higher sensitivity than the subjective judgment in detecting malignant tumors for junior doctors (84.4% vs. 70.1%) and senior doctors (91.2% vs. 81.0%). In the subgroup analysis for detecting the main benign lesions of the mature cystic teratoma and ovarian endometriosic cyst, the junior doctors' diagnostic accuracy was obviously worse than the senior doctors' on using O-RADS. CONCLUSIONS: O-RADS had excellent performance in predicting malignant adnexal masses. It could compensate for the lack of experience of junior doctors to a certain extent. Better performance in discriminating various benign lesions should be expected with some complement.

Assessing Obstetric Anal Sphincter Injuries: A Comparison of Exoanal and Endoanal Ultrasound.

OBJECTIVES: To explore the differences in assessing obstetric anal sphincter injuries (OASI) between transperineal ultrasound (TPUS) and endoanal ultrasound (EAUS) and test relationships between ultrasound findings and anal incontinence (AI) symptoms. METHODS: A group of 196 women with a history of vaginal delivery was recruited. OASI was detected in a set of 5 slices by EAUS and 8 slices by TPUS. OASI grading was performed on TPUS rules and EAUS rules. A "significant sphincter defect" was diagnosed by TPUS and EAUS using "2/3 rules." Symptoms of AI were determined using the St Mark's Incontinence Score (SMIS). Ultrasound findings were compared between the two methods and correlated with symptoms. RESULTS: Of 196 women, 29 (14.8%) suffered from AI with a mean SMIS of 12.1 ± 4.5, and 70 (35.7%) women with a mean age of 57 years had suspected OASI on imaging. Twenty-one (10.7%) "significant defects" were diagnosed by TPUS and 24 (12.2%) by EAUS. OASI Grades on TPUS had good agreement with EAUS rules (k = 0.70, P < .001). Logistic regression analysis showed that OASI Grade on imaging and "significant sphincter defects" seen on both forms of imaging were associated with AI symptoms. The odds ratio was 46 and 38 for "significant defects" on TPUS and EAUS, and 14 and 7 for OASI 3b+ on TPUS and EAUS in predicting AI, respectively. CONCLUSIONS: "Significant defects" diagnosed by EAUS or TPUS and OASI Grade 3b+ predict AI symptoms. The diagnostic performance of endoanal and exoanal ultrasound (EAUS and TPUS) appear to be very similar.

Visualized Urethral Mobility Profile During Urine Leakage in Supine and Standing Positions.

OBJECTIVES: To describe the urethral course and position during urine leakage based on the visualized urethral mobility profile (UMP) and to explore the differences between supine and standing positions. METHOD: This was a prospective study of 100 women with SUI and 100 control women who underwent a cough stress test (CST) with transperineal ultrasound (TPUS) in supine and standing positions. In the mid-sagittal plane, the UMP software automatically placed six equidistant points from the bladder neck (point 1) to the external urethral meatus (point 6). It determined the x and y coordinates of the points relative to the symphysis pubis. The distance between the points and symphysis pubis (dist. 1 to 6) was calculated using the formula SQRT (x2 + y2). The visualized UMP was created by reproducing the six points on a bitmap. RESULTS: Valid UMP data of 78 control women and 90 women with SUI were analyzed. In the two positions, distances 1 to 6 were significantly greater in the SUI group than the continent group (all p < 0.05). During Valsalva, the distance between the mid-urethra (dist. 3 and 4) and the symphysis was significantly increased (all p < 0.001) in the SUI group. The visualized UMP showed a similar upper-urethral course in the two groups. The gap between the mid-urethra (points 3 and 4) and symphysis was wider in the SUI group. CONCLUSION: The visualized UMP in supine and standing positions showed no difference in the bladder neck and upper urethral stability between incontinent and continent women, but mid-urethral stability was weaker in SUI.

Comparison of diagnostic efficiency between IOTA LR2 model and doctors' experiences. / IOTA LR2模型与医师经验诊断效能的比较.

OBJECTIVES: International Ovarian Tumor Analysis (IOTA) working group proposed a logistic regression (IOTA LR2) model. It is served as a risk prediction model for benign and malignant adnexal tumors. This study aims to compare the diagnostic efficiency between the IOTA LR2 model and doctors' subjective assessment on diagnosing benign and malignant adnexal mass. METHODS: The ultrasonographic images of 616 adnexal masses were retrospectively analyzed by the senior doctors' group and the junior doctors' group using the IOTA LR2 model and subjective assessment. The postoperative pathological diagnosis was used as the gold standard to compare the diagnostic efficiency of the 2 methods. RESULTS: The area under the curves of subjective assessment and IOTA LR2 model for diagnosing malignant adnexal masses were 0.86 and 0.90 for the senior doctors' group and 0.79 and 0.88 for the junior doctors' group, respectively. The sensitivity and specificity of subjective assessment for diagnosing the malignant adnexal masses were 81.0% and 91.3% for the senior doctors' group and 70.1% and 88.7% for the junior doctors' group, respectively. The sensitivity and specificity of the IOTA LR2 model for diagnosing the malignant adnexal masses were 79.6% and 88.1% for the senior doctors' group, and 79.6% and 81.7% for the junior doctors' group, respectively.There were no significant difference in the sensitivities between the senior doctors' group and junior doctors' group using the IOTA LR2 model and the senior doctors' group using subjective assessment (both P>0.05). CONCLUSIONS: The diagnostic efficiency of the IOTA LR2 model is equal to the senior doctors' experiences. This model can help junior doctors to reduce the missed diagnosis of malignant adnexal masses.

A comparison of the diagnostic performance of the O-RADS, RMI4, IOTA LR2, and IOTA SR systems by senior and junior doctors.

PURPOSE: This study compared the diagnostic performance of the Ovarian-Adnexal Reporting and Data System (O-RADS), the Risk of Malignancy Index 4 (RMI4), the International Ovarian of Tumor Analysis Logistic Regression Model 2 (IOTA LR2), and the IOTA Simple Rules (IOTA SR) in predicting the malignancy of adnexal masses (AMs). METHODS: This retrospective study included 575 women with AMs between 2017 and 2020. All clinical messages, ultrasound images, and pathological findings were collected. Two senior doctors (group I) and two junior doctors (group II) used the four systems to classify AMs. The postoperative pathological diagnosis was used as the gold standard to evaluate the diagnostic efficiency. A receiver operating characteristic curve was used to test the diagnostic performance. The interrater agreement between the two groups was tested using kappa values. RESULTS: Of all 592 AMs, 447 (75.5%) were benign, 123 (20.8%) were malignant, and 22 (3.7%) were borderline. The intergroup consistency test yielded kappa values of 0.71, 0.92, 0.68, and 0.77 for the O-RADS, RMI4, IOTA LR2, and IOTA SR, respectively. To predict malignant lesions, the areas under the curve of the O-RADS, RMI4, IOTA LR2, and IOTA SR systems were 0.90, 0.89, 0.90, and 0.86 for group I and 0.89, 0.87, 0.88, and 0.84 for group II, respectively. The O-RADS had the highest sensitivity (91.0% in group I and 84.8% in group II). CONCLUSION: The four diagnostic systems could compensate for junior doctors' inexperience in predicting malignant adnexal lesions. The O-RADS performed best and showed the highest sensitivity.

The Visualized Urethral Mobility Profile in Stress Urinary Incontinence Described by Four-Dimensional Transperineal Ultrasound.

OBJECTIVES: To describe the urethral mobility during urine leaking in stress urinary incontinence (SUI) by transperineal ultrasound (TPUS) with urethral mobility profile (UMP) analysis. METHODS: This was a prospective study of 380 women who had a cough stress test (CST) with TPUS. UMP software automatically placed six equidistant points from the bladder neck (Point 1) to the external urethral meatus (Point 6) and determined their x and y coordinates relative to the symphysis pubis. Urethral mobility vector of Points 1-6 (Vectors 1-6) and the distance between the six points and the symphysis (Dist. 1-6) were calculated and compared between the two groups. The visualized UMP was created by reproducing the positions of the six points at rest and on Valsalva. RESULTS: Valid data of 188 women with SUI and 174 continent women were analyzed. The mean age of all 362 women was 49.3 years. Mean body mass index in the SUI group was significantly increased (23.8 vs 22.2 kg/m2 , P < .001). During CST, Vectors 1-6 and Dist. 2-6 were significantly increased (all P < .005) in the SUI group. The UMP showed the mid-urethral rotated down around the symphysis pubis. The upper urethral profile in the two groups was similar. But the gap between the mid-urethra and the symphysis was wider in the SUI group. CONCLUSIONS: The visualized UMP illustrated the mid-urethral hypermobility in SUI by showing a wider gap due to the unstable connection between the mid-urethra and the symphysis pubis.

Urethral configuration and mobility during urine leaking described using real-time transperineal ultrasonography.

PURPOSE: The aim of this study was to explore differences in the bladder neck configuration and segmental urethral mobility during the cough stress test (CST) in the supine and standing positions between women with and without stress urinary incontinence (SUI). METHODS: This prospective study included 100 control women and 100 incontinent women who had a CST with transperineal ultrasonography. The bladder neck configuration and urethral mobility were described in terms of urethral funneling, bladder neck descent (BND), retrovesical angle (RVA), urethral rotation angle, and urethral mobility at six points along the urethra (vectors 1 to 6). The two groups' ultrasound findings in the two positions were compared. RESULTS: Valid data were collected from 78 control women and 90 women with SUI. Significant differences were found in age and body mass index between the two groups (P<0.01). Urethral funneling was found in 33 women (36.7%) with SUI and five continent women (6.4%) and altered little in the standing position. In the standing position, the mean RVA significantly increased (160° to 179°, P<0.001) in the SUI group; The mean vector of points 1 to 6 significantly increased in the control group (all P<0.001). The RVA, BND, and vectors 1 to 4 were significantly greater (all P≤0.01) in women with SUI than without, in both positions. CONCLUSION: Urethral funneling was an intrinsic anatomical characteristic relative to SUI. Weak upper- and mid-urethral support and an unstable connection between the trigone and proximal urethra were the anatomical signs of SUI.

The Association of Hiatal Dimensions and Urethral Mobility With Stress Urinary Incontinence.

OBJECTIVES: To investigate the association of hiatal area (HA), bladder neck mobility, and urethral mobility during the cough stress test (CST) with stress urinary incontinence (SUI). METHODS: This was a prospective study of 110 continent and 190 incontinent women using transperineal ultrasound. HA, bladder neck mobility, and the mobility of six points along the urethra (Vectors 1-6) were measured. The cohort was randomly divided at a ratio of 2:1 into a training cohort and a validation cohort. The correlations of HA with bladder neck mobility, urethral mobility, and SUI were tested. The predictive model was yielded by fisher linear discriminant analysis and receiver operating characteristics to assess the parameters' ability to predict SUI. RESULTS: Valid data were collected from 177 incontinent women and 105 continent women. Significant differences were identified in HA, body mass index (BMI), funneling, bladder neck mobility, and Vectors 1-6 between them. HA was positively correlated to bladder neck mobility. In the training cohort, bladder neck position on Valsalva, Vectors 3, and BMI had the area under curves of 0.74, 0.69, and 0.66 (all P < 0.001); Funneling and Vector 3 had odds ratios of 18.96 and 3.65 (all P < 0.001), for predicting SUI. The predictive model incorporating funneling, Vectors 3, and BMI provided the best performance in predicting SUI in both cohorts. CONCLUSION: The larger the HA was, the higher the bladder neck mobility. However, it was mid-urethral mobility rather than bladder neck mobility that performed best at predicting SUI.

The learning curve and difficult points of the O-RADS ultrasound risk stratification system in 54 trainees.

PURPOSE: This study aimed to evaluate the learning curve and explore the difficult points of the Ovarian-Adnexal Reporting and Data System (O-RADS) ultrasound risk stratification system. METHODS: One hundred adnexal masses (AMs) were randomly selected for five tests as training data. Two experienced trainers had an inter-rater agreement of 0.95 for the O-RADS scores. Fifty-four trainees (26 level I practitioners [group 1], 17 level II practitioners [group 2], and 11 experienced level II practitioners [group 3]) attended the training. Every trainee received assessment and feedback after 20 scored cases. The outcomes of the five tests were compared among the three groups using repeated-measurements analysis of variance. RESULTS: Of the 100 AMs, 52 were pathologically benign and 48 were malignant; the O-RADS scores were 2, 3, 4, and 5 in 22, 11, 48, and 19 AMs, respectively. The between-subjects effects test showed no significant differences between groups 1, 2, and 3 for the five tests (P=0.501). For each group, the differences among the five tests were significant (P<0.001, P=0.006, and P=0.044 for groups 1, 2, and 3, respectively). Test 2 was the worst. In 23 cases, more than 40% of trainees gave incorrect answers, which mainly related to classic benign lesions, the color flow score, and solid-appearing masses. CONCLUSION: After training, junior doctors at different levels can reach a coincident O-RADS ultrasound risk stratification. The difficulties primarily related to subjective judgments of classic benign lesions, the color flow score, and solid-appearing masses. More experience is needed to improve the applicability of the system.

Ultrasound Findings and O-RADS Malignancy Risk Stratification of Ovarian Collision Tumors.

OBJECTIVES: To describe the ultrasonographic signs of ovarian collision tumors and evaluate the malignancy risk using the O-RADS system. METHODS: This was a retrospective analysis of 25 ovarian collision tumors from 8739 patients between May 2010 and January 2020. All clinical characteristics, ultrasound images, and histological findings were collected and analyzed. Using the O-RADS lexicon descriptors, the O-RADS score was determined by two senior doctors. Lesions with O-RADS scores of 1 to 3 were classified as benign tumors, and lesions with O-RADS scores of 4 to 5 were classified as malignant tumors. RESULTS: The mean age of the 25 patients was 30.4 years. Histological findings showed that all tumors were a combination of mature cystic teratomas and cystadenomas/cystadenocarcinomas. There were 11 benign tumors of O-RADS 2 or 3, including 3 uniocular cysts, 3 dermoid cysts, and 5 dermoid cysts with an anechoic fluid cavity. There were 12 benign tumors of O-RADS 4, including 3 uniocular-multilocular cysts with solid components, 2 multilocular cysts with irregular walls, and 8 multilocular cysts with dermoid sacs. One borderline tumor of O-RADS 4 was a multilocular cyst with irregular septation. One malignant tumor of O-RADS 5 was a multilocular cystic tumor with solid components and ascites. CONCLUSIONS: The most common ovarian collision tumor was the coexistence of a mature cystic teratoma and a cystadenoma. The O-RADS system was able to sensitively detect malignant tumors in this series. A typical dermoid cyst with an anechoic cavity or a multilocular cyst with a dermoid sac may signify a benign collision tumor.

Doppler evaluation of the posterior cerebral artery in fetuses with transposition of great arteries.

Objective To observe Doppler ultrasound changes in the two segments of the posterior cerebral artery (PCA) in fetuses with transposition of the great arteries (TGA). Methods The peak systolic velocity (PSV), end-diastolic velocity (EDV), pulsatility index (PI), and velocity-time integral (VTI) of the two segments of PCA (the first segment: PCAS1, the second segment: PCAS2) and of the middle cerebral artery (MCA) were compared in TGA fetuses and normal fetuses. The abnormality rate between the PCAS1-PI and MCA-PI was compared in TGA fetuses. Results The PCAS1-PI and MCA-PI were smaller in the TGA fetuses than in the controls (all P < 0.05), but the PCAS2-PI was unchanged (P > 0.05). The MCA-VTI, PCAS1-VTI, and PCAS2-VTI were larger in the TGA fetuses (all P < 0.05). In the TGA fetuses, the abnormality rate of the PCAS1-PI was significantly higher than that of the MCA-PI (P < 0.05). Conclusion In fetuses with TGA, there were hemodynamic differences between the two segments of the posterior cerebral arteries. Moreover, PCAS1 exhibited signs of vasodilatation more obviously than did the MCA in fetuses with TGA.

Real-time assessment of the behaviour of the bladder neck and proximal urethra during urine leaking in the cough stress test (CST) in supine and standing positions using transperineal ultrasound.

INTRODUCTION AND HYPOTHESIS: The objective was to describe the behaviour of the bladder neck and proximal urethra during urine leaking in the cough stress test (CST) in supine and standing positions using transperineal ultrasound (TPUS). METHOD: We carried out prospective data collection and a retrospective data analysis of 102 women with stress urinary incontinence (SUI) who had a positive CST with TPUS in the supine and/or standing position. On TPUS, the behaviour of the bladder neck and proximal urethra was described by the urethral length, urethral funnelling, bladder neck descent (BND), retrovesical angle (RVA) and urethral rotation angle (URA). Differences between the ultrasound findings in the two positions were evaluated. RESULTS: In the 102 women, the mean age was 48 years and mean BMI was 23.8 kg/m2. On TPUS, urine leakage was detected in the supine or standing position in 102 women and in both positions in 81. Between the two positions, significant differences were found in the URA and RVA. In the standing position, the median RVA of 166° was significantly larger than that of 133° in the supine position (p < 0.001), and the median URA of 35° was significantly smaller than that of 64° in the supine position (p < 0.001). CONCLUSIONS: TPUS in both positions can be used to detect the real-time behaviour of the bladder neck and urethra in the CST. In the standing position, less rotation and more straightening of the bladder neck and proximal urethra occurred during urine leakage.

A Preliminary Study on Quantitative Quality Measurements of the Urethral Rhabdosphincter Muscle by Supersonic Shear Wave Imaging in Women With Stress Urinary Incontinence.

OBJECTIVES: To quantitatively assess the quality of the urethral rhabdosphincter muscle by measuring its shear wave velocity (Vs ) and calculating the Young modulus (E) with supersonic shear wave imaging (SSI). METHODS: This was a prospective study of 43 women with SUI and 52 female control participants who underwent a transperineal US examination with SSI. Supersonic shear wave imaging was performed at rest with a linear transducer and a specialized-preset procedure. The stability and validity of the shear waves were automatically assessed by the SSI procedure. The SSI images were visualized in a color-coded elastographic image. In the postprocessing analysis, the ventral part of the urethral rhabdosphincter muscle was manually outlined. The mean Vs and the mean E of the muscle were measured by the SSI procedure. The relationship between the mean Vs , mean E, and SUI was evaluated. RESULTS: The SSI examination was successfully performed in 40 patients with SUI (93.0%) and 40 female control participants (76.9%). No significant differences between the groups in age, body mass index, and parity were identified. For the SUI and control groups, the mean Vs values were 2.54 and 2.73 m/s, respectively, and the mean E values were was 19.7 and 22.7kPa. Significant correlations were found between SUI and the mean Vs as well as the mean E (Spearman correlation coefficients, -0.41 and -0.43; P < .05). CONCLUSIONS: The mechanical properties of the urethral sphincter can be quantitatively assessed by SSI. The stiffness of the urethral rhabdosphincter muscle was significantly lower in women with SUI.

Cerebral blood flow dynamic in foetuses with hypoplastic left heart syndrome: Incremental value of the first segment of the anterior cerebral artery over the middle cerebral artery?

OBJECTIVE: To investigate the blood flow Doppler parameters of the anterior cerebral artery (ACA) in foetuses with hypoplastic left heart syndrome (HLHS). METHODS: Doppler parameters (peak systolic velocity [PSV], end-diastolic velocity [EDV], time-averaged maximum velocity [TAMXV] and pulsatility index [PI]) and biometric parameters were measured in two anatomical segments of the ACA (S1 and S2) and in the middle cerebral artery (MCA) in 35 HLHS foetuses and 73 gestational age-matched normal foetuses. Correlations between the cerebral artery PIs and head circumference (HC) were assessed. RESULTS: Both EDV and TAMXV of the ACA and MCA in the HLHS group were significantly higher than in the normal group (P < .05). The PI of the ACA and MCA in the HLHS group were significantly lower than in the normal group (P < .05). ACAS1PI and ACAS2PI in the HLHS foetuses with retrograde blood flow in the aortic isthmus (AoI) were significantly lower than those of HLHS foetuses without retrograde blood flow in the AoI (P < .05). ACAS2PI was significantly lower than ACAS1PI in the HLHS foetuses with retrograde blood flow in the AoI (P = .047). The abnormal rates of ACAS1 and ACAS2 were significantly higher than that of the MCA (P < .05) in the HLHS group. The HC and biparietal diameter were significantly lower in the HLHS group than in the control group (P < .05). HC was correlated with the PIs of ACAS1, ACAS2 and the MCA in the HLHS group (P < .05). CONCLUSION: A redistribution of foetal cerebral blood flow appeared in HLHS, and the measurement of ACA PI might provide early information on brain hypoxia.

[Ischemic postconditioning improves longitudinal contractile function of the reperfused myocardium in patients with anterior wall acute myocardial infarction].

OBJECTIVE: To investigate whether ischemic postconditioning (IPTC) can promote the recovery of left ventricular impaired regional or global longitudinal systolic function.
 Methods: The trial was divided into a percutaneous coronary intervention (PCI) group, an PCI+IPTC group and a control group. Thirty-two patients with anterior acute anterior wall ST-segment elevation myocardial infarction (STEMI) underwent the first emergency PCI in the PCI group, 28 patients with anterior acute STEMI underwent the combination of PCI and IPTC in the PCI+IPTC group, while 30 patients underwent coronary angiography in the control group. Two-dimensional dynamic echocardiography was collected before operation, 0.5 h, 1 day, 3 days, 1 week, 1 month and 6 months after operation, respectively. The longitudinal strain parameters at different time points were analyzed and compared in the 3 groups.
 Results: The regional longitudinal strain of infracted segments in the PCI+IPTC group after the operation within 1 week was higher than that in the PCI group (P<0.05). The left ventricular global longitudinal strain in the PCI+IPTC group seemed to be higher than that in PCI group after the operation within 1 week, but there was not statistically difference (P>0.05). There was no significant difference in the long-term regional and global longitudinal strains of left ventricle between the PCI+IPTC group and the PCI group (both P>0.05).
 Conclusion: The IPTC can improve the short-term longitudinal systolic function of the reperfused myocardium in patients with acute anterior wall STEMI after PCI.

[Blood flow parameters in fetal anterior cerebral artery during the second and third trimester of gestation].

OBJECTIVE: To investigate hemodynamic parameters in 2 anatomical segments (S1 and S2) of anterior cerebral artery (ACA) in normal pregnancy during the second and third trimester of gestation.
 Methods: The peak systolic velocity (PSV), end diastolic velocity (EDV), time-average maximum velocity (TAMAXV), peak systolic velocity/end diastolic velocity (S/D), resistance index (RI), and pulsation index (PI) in S1 and S2 of fetal anterior cerebral artery (ACA) in 288 normal pregnant women were detected by power Doppler and pulsed Doppler. Multiple regression models were fitted to estimate the relation between Doppler variables and gestational age. The differences of hemodynamic parameters between ACAS1 and ACAS2 were compared.
 Results: The PSV, EDV, and TAMAXV of ACAS1 and ACAS2 were positively correlated with the weeks of pregnancy (P<0.001), all fitted with the cubic curve. The S/D, PI, and RI values of ACAS1 and ACAS2 were not correlated with gestational ages (P>0.05). The PSV, TAMAXV, S/D, PI, and RI of ACAS1 were significantly higher than those of ACAS2, while EDV in ACAS1 was lower than that in ACAS2 (P<0.05).
 Conclusion: The velocity parameters (PSV, EDV, TAMAXV) of the 2 anatomical segments (ACAS1 and ACAS2) are increased with the increase of gestational age in normal pregnant fetus during the second and third trimester of gestation, and the resistance parameters (S/D, PI, RI) are not significantly correlated with gestational age. Distribution of blood flow is different in the blood supply territory between ACAS1 and ACAS2.

[Blood flow parameters of posterior cerebral artery in normal pregnancy during middle and late stage].

OBJECTIVE: To study the blood flow parameters for 2 anatomical segments of posterior cerebral artery (PCA) in normal singleton fetal.
 Methods: The blood flow velocity parameters peak systolic velocity (PSV), end diastolic velocity (EDV), time-average maximum velocity (TAMAXV), velocity time integral (VTI) and resistance parameters systolic peak velocity and end diastolic velocity ratio (S/D), pulsatility index (PI), resistance index (RI) for 2 anatomical segments in PCA were recorded. The first segment of the PCA (PCAS1) was recorded between the origin of PCA and the proximal part of the posterior communicating artery. The second segment of the PCA (PCAS2) was recorded at the distal part of the posterior communicating artery. The blood parameters in both PCAS1 and PCAS2 were analyzed by using Pearson correlation and multiple curves fitting with gestational age (GA). Paired student's t test was performed to compare the difference in blood parameter between PCAS1 and PCAS2.
 Results: The blood flow velocity parameters in both PCAS1 and PCAS2 were increased with the GA (P<0.0001), with the best fitted curves of Quadratic curve (P<0.0001). There were no correlations between resistance parameters in PCA and GA (P>0.05). Resistance parameters in PCAS1 were higher than those in PCAS2 (P<0.05).
 Conclusion: The blood flow velocity parameters in both PCAS1 and PCAS2 are increased with GA. The resistance parameters in both PCAS1 and PCAS2 do not change with GA. Study on the velocities and resistance in these 3 arterial branches provides a more comprehensive evaluation on the process of brain circulation.

Evaluating Z Scores to Quantify Levator Hiatal Distensibility by 3-Dimensional Ultrasonography in Nulliparas and Women With Pelvic Organ Prolapse.

OBJECTIVES: To use Z scores to quantify hiatal distensibility and to test the performance of Z scores for levator hiatal areas in predicting substantial pelvic organ prolapse (POP). METHODS: We undertook a retrospective study of the data from 145 nulliparas and 166 patients with POP who had a clinical POP examination with 3-dimensional translabial ultrasonography. Z scores were used to normalize levator hiatal areas of nulliparas. The Z score model for the hiatal area was built by the formula Z score = (measured value - predicted mean value)/predicted standard deviation and was used to evaluate hiatal ballooning in women with POP. RESULTS: Valid data were gathered from 134 nulliparas and 159 patients with POP. POP stage 1 was found in 46 women, stage 2 in 62, stage 3 in 43, and stage 4 in 8. We built the Z score model as follows: Z-Av = (measured value - 17.15)/3.11, where Av represented the minimal levator hiatal area on the maximum Valsalva maneuver. The levator hiatal area was strongly related to the POP stage (P < .001). On a receiver operating characteristic curve analysis, the cutoff of Z-Av was 1 for POP stage 2 or higher (sensitivity, 77%; specificity, 60%) and substantial POP on ultrasonography (sensitivity, 84%; specificity, 75%). CONCLUSIONS: Hiatal distensibility can be exactly evaluated by Z-Av. A Z-Av value of less than 1.0 was defined as a "normal hiatal expansion," 1 to 3 as "mild ballooning," 3 to 5 as "moderate ballooning," 5 to 7 as "marked ballooning," and 7 or greater as "severe ballooning."

Time-course Study on Left Ventricular Function in a Rabbit Model of Ischemia-reperfusion Injury With Morphine Preconditioning.

AIMS: To analyze the left ventricular longitudinal function in a rabbit model of myocardial ischemia reperfusion with morphine preconditioning through strain rate imaging and to evaluate the effect of morphine preconditioning. METHODS: A myocardial ischemia-reperfusion model was induced by occlusion and recanalization of the coronary artery in 40 male New Zealand white rabbits, which were divided into a sham group, morphine group, and vehicle control group. Routine echocardiography data were recorded 1 day before and within 28 days after the operation. Dynamic images were also collected and analyzed off-line using Doppler tissue imaging software. RESULTS: On the first day after the operation, the global and regional systolic functions of the left ventricle in the morphine and vehicle control groups were lower than those in the sham group. After ischemia reperfusion, some of the values of the above-mentioned parameters decreased over time, which was more obvious in the vehicle control group at each examined time point. CONCLUSIONS: The current study revealed that detection of changes in regional myocardial function after myocardial ischemia reperfusion by strain rate imaging is objective and accurate. In addition, our results indicated that morphine preconditioning significantly attenuates myocardial ischemia-reperfusion injury in rabbits.

[Noninvasive evaluation of renal allograft fibrosis by virtual touch tissues quantification].

OBJECTIVE: To explore the value of virtual touch tissue quantification (VTQ) in the diagnosis of renal allograft fibrosis and analyze its advantages and limitations. METHODS: The renal allografts of 54 patients with renal allograft biopsies or nephrectomy were assessed by Virtual Touch quantification of Siemens-Acuson S2000. RESULTS: Stiffness of renal allograft was significantly correlated to the value of VTQ (Spearman r=0.796, P<0.05). CONCLUSION: VTQ is a new technique in the assessment of renal allograft fibrosis.