HDLive ultrasound images of ovarian dermoid cysts: diagnostic accuracy.

OBJECTIVE: To demonstrate that the use of 3D/4D HDLive increases the image quality in the diagnosis of benign cystic ovarian teratomas. MATERIALS AND METHODS: 3D/HDLive ultrasound (US) was used in 31 cases of suspected ovarian cystic teratoma using vaginal 2D US. The following pathognomonic images of mature cystic teratomas were considered for diagnosis: 1) a cystic, unilocular lesion with a densely echogenic tubercle (Rokitansky nodule); 2) a diffuse or partially echogenic mass usually demonstrating sound attenuation; 3) fluid-fluid/fat-fluid levels; 4) dermoid mesh with hyperechogenic calcifications indicating the presence of bone, teeth, or other ectodermally-derived structure; 5) multiple mobile spherical structures (fat globules). RESULTS: Dermoids present a wide spectrum of images depending on the predominant tissue type. In the vast majority of cases there are dense echogenic structures that correspond to complex masses of fatty tissue, sebum, hair, epithelial remnants, along with cartilage or bone. If we catalogue all the images together, the pathognomonic of dermoid are: 1) cystic or solid cystic lesions with a Rokitansky nodule, with bone, teeth or cartilage (six cases, 22.2%); 2) a solid mass with or without attenuation that corresponds with pure sebum (five cases, 18.5%); 3) a diffuse mass with fine bands that correspond with hair inside sebum (four cases, 12.9%) and that may form meshes or plugs corresponding with a mixture of fat, sebum, and hair (three cases, 11.5%). CONCLUSIONS: HDLive U.S. provides some images of exceptional quality that enhance the definition of the structures of these tumors (fat, hair, cartilage, bone, etc.) compared to 2D/3D/4D.

Semi-automatic Sono T measurement of nuchal translucency.

A prospective study of 63 singleton pregnancies between 11 + 0 and 13 + 6 weeks gestation underwent semi-automatic nuchal translucency (NT) measurement and were compared with two-dimensional ultrasonography (2D US). Inter-observer variation and the repeatability were evaluated. Sono T automatically achieves mid-sagittal plane views and measures the maximum NT thickness. Measurements have less inter-observer variation (CI = -0.13, -0.04) when compared with 2D measurements (CI = -0.45, 0.28). It is reproducible and comparable to conventional 2D US technique for NT measurement. However, incorporating Sono T into routine practice requires further program refinements in order to reduce erroneous NT measurements.

Prenatal diagnosis of sacrococcygeal teratomas by two- and three-dimensional ultrasound.

We suspected two fetuses of having sacrococcygeal teratomas following initial two-dimensional ultrasound scanning at 18 and 22 weeks' gestation. The fetuses were then scanned with three-dimensional multiplanar surface and three-dimensional orthogonal planar ultrasound to establish a definitive diagnosis. Although we made a presumptive diagnosis in both cases after initial two-dimensional scanning, with three-dimensional ultrasound we were better able to define the degree of involvement of the sacrum and other pelvic structures of prognostic importance.

Fetus acardius: two- and three-dimensional ultrasonographic diagnoses.

OBJECTIVE: To determine whether ultrasonographic detection of acardiac fetuses and diagnostic accuracy of related malformations improve with complementary use of two-dimensional ultrasonography, three-dimensional ultrasonography, and Doppler scanning. METHODS: Three pregnant women with multifetal gestations who were found to have discordant fetuses on initial two-dimensional ultrasonographic scanning were subsequently scanned with three-dimensional ultrasonography and color Doppler ultrasonography. RESULTS: Although the possibility of acardiac fetuses was entertained in all cases after two-dimensional ultrasonographic scanning, the diagnosis was confirmed, and the accuracy and extent of fetal malformations were established with three-dimensional ultrasonography and color Doppler scanning. Two of the women had twin gestations, and the third woman had a triplet gestation. Among the women with twin gestations, 1 donor twin had no abnormalities, and the other donor twin had a diagnosis of arthrogryposis and gastroschisis. The woman with triplets had 1 acardiac fetus; the donor fetus was anencephalic; and the third fetus had alobar holoprosencephaly. CONCLUSIONS: Complementary use of two-dimensional ultrasonography, three-dimensional ultrasonography, and color Doppler scanning improves diagnostic accuracy and the ability to evaluate the extent and severity of organ compromise in pregnancies complicated by acardiac fetuses.

Two- and three-dimensional ultrasound in malformations of the medullary canal: report of four cases.

A comparison between two-dimensional (2D), and three-dimensional (3D) ultrasonography was made in four fetuses diagnosed with neural tube defect (NTD) in the first half of pregnancy. 3D ultrasonography (orthogonal and multiplanar systems) proved to be an excellent complement to 2D, particularly when using orthogonal planes. When using the 3D multiplanar surface imaging system, excellent images of the malformations can be rapidly obtained.

Abdominal wall defects: two- versus three-dimensional ultrasonographic diagnosis.

We diagnosed 12 cases of abdominal wall defects. The cases diagnosed occurred in 6 fetuses with omphalocele, 3 with gastroschisis, 2 with prune-belly syndrome, and 1 with pentalogy of Cantrell. Except for 1 case of gastroschisis first diagnosed on the basis of three-dimensional ultrasonography at 14 weeks' gestation, all cases were first detected by two-dimensional transabdominal ultrasonography and then reevaluated with three-dimensional ultrasonography using multiplanar and orthogonal plane modes. Although the original diagnosis was accurate on the basis of two-dimensional ultrasonography in 11 of 12 cases, additional information was obtained by three-dimensional scanning in all cases. Our experience suggests that in cases in which abdominal wall defects are first detected by two-dimensional ultrasonographic scanning, the additional information gained by complementary three-dimensional ultrasonographic scanning can be useful for more-efficient counseling and postnatal therapeutic planning.

Thanatophoric dysplasia: ultrasound diagnosis.

Six pregnant women with singleton fetuses were referred to our Prenatal Diagnostic Centers because of an initial diagnosis of intrauterine growth restriction (n = 4) or short femoral length (n = 2). We first examined the patients with two-dimensional (2D) ultrasonography (US), and then with three-dimensional (3D) US, and arrived at a definitive diagnosis of thanatophoric dysplasia. Although in experienced hands a diagnosis of thanatophoric dysplasia can be made with 2D US before the 24th week of gestation, our experience suggests that 3D US is a valuable complement to 2D US for the evaluation of fetuses with skeletal dysplasias.

Concerns regarding the Centers for Disease Control's published guidelines for pelvic inflammatory disease.

The International-Infectious Disease Society for Obstetrics and Gynecology-USA (I-IDSOG-USA) has concerns about the most recently published Centers for Disease Control and Prevention (CDC) guidelines for pelvic inflammatory disease (PID). I-IDSOG-USA advocates the following changes when the guidelines are revised. We recommend the use of the term "upper genital tract infection" (UGTI), followed by the designation of the etiologic agent, instead of the currently employed term, "pelvic inflammatory disease," or PID. In diagnoses, there should be greater emphasis on signs and symptoms related to subclinical or occult UGTI. Therapeutic recommendation for the treatment of UGTI should be documented for various stages of this diverse disease entity. There should be greater emphasis on hospitalization for infected nulligravida teenagers. This permits monitoring of antibiotic treatment and provides a site for medical educational efforts to teach this medically underserved segment of our society how to protect their future fertility, their health, and their lives.

Polycystic ovarian syndrome: assessment with color Doppler angiography and three-dimensional ultrasonography.

We conducted a three-dimensional ultrasonographic evaluation of the size and structure of the ovaries of women who had clinical and biochemical findings suggestive of polycystic ovary syndrome. We carried out a comparative color Doppler frequency and color Doppler amplitude study of the vascular patterns of these ovaries. This study involved 65 women of reproductive age with polycystic ovary syndrome and 25 eumenorrheic women who were not taking hormonal contraceptives and who had a body mass index below 25 kg/m2. Compared to controls, women with polycystic ovary syndrome had larger ovaries and thicker stroma, increased impedance in the uterine arteries, increased stromal vascularity with decreased impedance that persisted throughout the menstrual cycle, and a lack of luteal conversion.

Early diagnosis of conjoined twins using two-dimensional color Doppler and three-dimensional ultrasound.

Transvaginal three-dimensional (3-D) and color Doppler ultrasound were used to establish a first-trimester definitive diagnosis and classification of thoracoomphalopagus conjoined twins following two-dimensional (2-D) transabdominal and transvaginal scans that indicated twin gestation of uncertain classification. Color Doppler in combination with 3-D ultrasound can be a useful complement to 2-D ultrasound to confirm early diagnosis and determine the extent of organ sharing and definitive classification of conjoined twins.

Ultrasonography as a screening tool for paravaginal defects in women with stress incontinence: a pilot study.

The aim of the study was to determine whether transabdominal ultrasonography can accurately identify paravaginal defects associated with genuine stress urinary incontinence. Sixteen women were diagnosed with genuine stress urinary incontinence (GSUI) following clinical evaluation, urethroscopy and urodynamic studies. They were then evaluated by transabdominal sonography and a full bladder and immediately following micturition. The ultrasound studies were also carried out in 8 women (5 nulliparous and 3 primiparous) who had no signs or symptoms of urinary incontinence. Paravaginal defects were detected in the 16 women with GSUI: 9 had unilateral defects and 7 had bilateral defects. Only right-sided defects were identified in women with unilateral lesions. Paravaginal defects were confirmed in all symptomatic women at the time of surgery, and corresponded with the defects identified with transabdominal ultrasound. Mild unilateral paravaginal defects were identified in 2 continent parous women. Five nulliparous women and 1 primiparous control had no ultrasound evidence of paravaginal defects. A transabdominal, transverse, suprapubic ultrasound scan with a full bladder is a promising screening technique for the diagnosis of paravaginal defect in women with GSUI. Transabdominal suprapubic longitudinal sections are not useful for the identification of paravaginal defects.

Preoperative contrast ultrasonographic diagnosis of patent urachal sinus.

A patent urachal sinus, as well as other congenital urachal anomalies, may be at risk of injury during laparoscopy. Leakage of fluid at the midline site of trocar entry is the usual postoperative sign of injury to a patent urachal sinus. Pre-operative diagnosis of this anomaly can prevent injury during laparoscopy. We describe a contrast ultrasound technique for diagnosis of patent urachal sinus.

First-trimester neck abnormalities: three-dimensional evaluation.

In order to study the first trimester ultrasonographic differences between nuchal translucency and hygroma colli, we rescanned 25 fetuses (13 with nuchal translucency and 12 with hygroma colli) using transvaginal and three-dimensional ultrasonography, after obtaining a fetal karyotype report. Our objective was to test the premise that the different physiopathologic mechanisms of both processes would be reflected in detectable sonographic differences. Our retrospective analysis showed that the most striking ultrasonographic difference was the presence of bullae as well as greater irregularity, extent, and amplitude of the membrane in cases of hygroma colli. Fetuses with simple nuchal translucency had a more homogeneous linear membrane. Although detailed analysis was impossible in 30% of cases, we found three-dimensional ultrasonography to be a useful technique for establishing the differences between these two entities.

Method for diagnosing paravaginal defects using contrast ultrasonographic technique.

Thirty women with pelvic relaxation and genuine stress urinary incontinence were evaluated with a contrast ultrasonography technique developed for the diagnosis of paravaginal defects. Control subjects were continent women with vaginal prolapse and nulliparous asymptomatic women. Seventeen incontinent patients had unilateral right-sided paravaginal defects and 13 had bilateral paravaginal defects. All continent controls with vaginal prolapse had bilateral paravaginal defects. None of the nulliparous controls had paravaginal defects. The contrast ultrasonographic technique also was found to be useful for postoperative evaluation and documentation of the anatomic results achieved after laparoscopic paravaginal repair.

Three-dimensional hysterosonography for the study of endometrial tumors: comparison with conventional transvaginal sonography, hysterosalpingography, and hysteroscopy.

We studied endometrial thickness and homogeneity in 36 patients with postmenopausal bleeding using three-dimensional ultrasound following distention of the uterine cavity with a sterile saline solution (3D-SHSG). Results with 3D-SHSG were compared with findings using transvaginal sonography, transvaginal sonohysterography, transvaginal color Doppler, and hysteroscopy. Sixteen patients (including three on tamoxifen) were undergoing hormone therapy at the time when they were studied. Visualization of the uterine cavity and of endometrial thickness was better with 3D-SHSG than with any of the other ultrasound techniques. The results with 3D-SHSG corresponded to the findings observed with hysteroscopy. Three-dimensional SHSG seems to improve ultrasound determination of myometrial and cervical invasion in cases of endometrial adenocarcinoma.

Control of intrauterine device insertion with three-dimensional ultrasound: is it the future?

A comparative study was designed to determine whether three-dimensional transvaginal sonography (3D-TVS) offered advantages over two-dimensional transvaginal sonography (2D-TVS) for the identification and location of IUDs in 66 asymptomatic women. Hysteroscopy was performed in cases in which there was a discrepancy between the information obtained by both methods (n = 14). In eight cases (12.2%) the IUD was misidentified with 2D-TVS. In six cases (9.1%) it was not possible to identify the device model with 2D-TVS. In two cases (3.0%) 2D-TVS failed to identify the position of the device. In contrast, all IUDs were identified and located accurately with 3D-TVS.