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1.
Zhonghua Zhong Liu Za Zhi ; 41(11): 878-880, 2019 Nov 23.
Artigo em Chinês | MEDLINE | ID: mdl-31770859

RESUMO

Objective: To investigate the characteristics of magnetic resonance imaging (MRI) of minimal deviation adenocarcinoma (MDA) of cervix, and improve the diagnostic accuracy of MDA. Methods: The imaging data of eight cases of MDA was retrospectively collected, including tumor size, tumor location, tumor components, signal characteristics, enhancement characteristics and invasive extent. Results: The maximum diameter of tumor was (4.36±1.46) cm. Six tumors were mixed solid and cystic and two were predominantly solid. Six were diffusion limited on diffusion-weighted imaging, and two were not diffusion limited. On multi-phase dynamic contrast-enhanced scan, the enhancement curve of solid components of the tumor showed a plateau-like pattern in three cases and a slow-rising pattern in five cases. Tumors were confined to the cervical canal in three cases, infiltrated to cervical stroma > 1/2 depth in seven cases, and ≤ 1/2 depth in one case. There were four cases of uterine invasion, four cases of vaginal fornix invasion, four cases of bilateral ovarian metastasis and one case of lymph node metastasis. Conclusions: Patients suffering from large amount of vaginal discharge had cervical lesions on MRI showing polycystic and solid component enhancement should be alert to MDA. Deep-seated cervical biopsy and even conization is conducive to early diagnosis, treatment and improvement of prognosis.


Assuntos
Adenocarcinoma/diagnóstico por imagem , Neoplasias do Colo do Útero/diagnóstico por imagem , Adenocarcinoma/patologia , Colo do Útero/diagnóstico por imagem , Colo do Útero/patologia , Feminino , Humanos , Imagem por Ressonância Magnética , Estudos Retrospectivos , Neoplasias do Colo do Útero/patologia
2.
Cochrane Database Syst Rev ; 9: CD007235, 2019 09 25.
Artigo em Inglês | MEDLINE | ID: mdl-31553800

RESUMO

BACKGROUND: Measurement of cervical length by ultrasound is predictive of preterm birth (PTB). There are three methods of ultrasound cervical assessment: transvaginal (TVU), transabdominal (TAU), and transperineal (TPU, also called translabial). Cervical length measured by TVU is a relatively new screening test, and has been associated with better prediction of PTB than previously available tests. It is unclear if cervical length measured by ultrasound is effective for preventing PTB. This is an update of a review last published in 2013. OBJECTIVES: To assess the effectiveness of antenatal management based on transvaginal, transabdominal, and transperineal (also called translabial) ultrasound screening of cervical length for preventing preterm birth. SEARCH METHODS: For this update, we searched the Cochrane Pregnancy and Childbirth's Trials Register, ClinicalTrials.gov, and the WHO International Clinical Trials Registry Platform (ICTRP) to 30 August 2018; reviewed the reference lists of all articles, and contacted experts in the field for additional and ongoing trials. SELECTION CRITERIA: We included published and unpublished randomised controlled trials (RCT) including pregnant women between the gestational ages of 14 to 32 weeks, for whom the cervical length was screened for risk of PTB with TVU, TAU, or TPU. This review focused on studies based on knowledge versus no knowledge of cervical length results, or ultrasound versus no ultrasound for cervical length. We excluded studies based on interventions (e.g. progesterone, cerclage) for short cervical length. DATA COLLECTION AND ANALYSIS: We followed standard Cochrane methods. MAIN RESULTS: We included seven RCTs (N = 923): one examined asymptomatic women with twin pregnancies; four included women with singleton pregnancies and symptoms of preterm labour (PTL); one included women with singleton pregnancies and symptoms of preterm premature rupture of membranes (PPROM); and one included asymptomatic singletons. All trials used TVU for screening.We assessed the risk of bias of the included studies as mixed, and the quality of the evidence for primary outcomes as very low for all populations.For asymptomatic women with twin pregnancies, it is uncertain whether knowledge of TVU-measured cervical length compared to no knowledge reduces PTB at less than 34 weeks (risk ratio (RR) 0.62, 95% confidence intervals (CI) 0.30 to 1.25; 1 study, 125 participants) because the quality of the evidence is very low. The results were also inconclusive for preterm birth at 36, 32, or 30 weeks; gestational age at birth, and other maternal and perinatal outcomes.Four trials examined knowledge of TVU-measured cervical length of singletons with symptoms of PTL versus no knowledge. We are uncertain of the effects because of inconclusive results and very low-quality evidence for: preterm births at less than 37 weeks (average RR 0.59, 95% CI 0.26 to 1.32; 2 studies, 242 participants; I² = 66%; Tau² = 0.23). Birth occurred about four days later in the knowledge groups (mean difference (MD) 0.64 weeks, 95% CI 0.03 to 1.25; 3 trials, 290 women). The results were inconclusive for the other outcomes for which there were available data: PTB at less than 34 or 28 weeks; birthweight less than 2500 g; perinatal death; maternal hospitalisation; tocolysis; and steroids for fetal lung maturity.The trial of singletons with PPROM (N = 92) evaluated safety of using TVU to measure cervical length in this population as its primary outcome, not its effect on management. The results were inconclusive for incidence of maternal and neonatal infections between the TVU and no ultrasound groups.In the trial of asymptomatic singletons (N = 296), in which women either received TVU or not, the results were inconclusive for preterm birth at less than 37 weeks (RR 1.27, 95% CI 0.61 to 2.61; I² = 0%), gestational age at birth, and other perinatal and maternal outcomes.We downgraded evidence for limitations in study design, inconsistency between the trials, and imprecision, due to small sample size and wide confidence intervals crossing the line of no effect.No trial compared the effect of knowledge of the CL with no knowledge of CL in other populations, such as asymptomatic women with singleton pregnancies, or symptomatic women with twin pregnancies. AUTHORS' CONCLUSIONS: There are limited data on the effects of knowing the cervical length, measured by ultrasound, for preventing preterm births, which preclude us from drawing any conclusions for women with asymptomatic twin or singleton pregnancies, singleton pregnancies with PPROM, or other populations and clinical scenarios.Limited evidence suggests that knowledge of transvaginal ultrasound-measured cervical length, used to inform the management of women with singleton pregnancies and symptoms of preterm labour, appears to prolong pregnancy by about four days over women in the no knowledge groups.Future studies could look at specific populations separately (e.g. singleton versus twins; symptoms versus no symptoms of PTL), report on all pertinent maternal and perinatal outcomes, and include cost-effectiveness analyses. Most importantly, future studies should include a clear protocol for management of women based on TVU-measured cervical length.


Assuntos
Medida do Comprimento Cervical/métodos , Colo do Útero/diagnóstico por imagem , Trabalho de Parto Prematuro/prevenção & controle , Nascimento Prematuro/prevenção & controle , Feminino , Humanos , Gravidez , Gravidez Múltipla , Gravidez de Gêmeos , Nascimento Prematuro/diagnóstico por imagem , Ensaios Clínicos Controlados Aleatórios como Assunto
3.
Semin Ultrasound CT MR ; 40(4): 280-286, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31375168

RESUMO

Cervical carcinoma remains a common gynecologic malignancy. Physical examination has historically served as the predominant tool for staging and assessment, in part due to lack of availability of additional diagnostic resources in many parts of the world. Cross-sectional imaging in the evaluation of cervical cancer has become standard of care in developed countries, and has recently been incorporated into the official staging classification of the International Federation of Gynecology and Obstetrics. This article will describe the use of computed tomography, magnetic resonance imaging, and positron emission tomography/computed tomography and positron emission tomography/magnetic resonance imaging in cervical cancer patients, review optimal techniques for MR evaluation of the cervix, and describe key aspects of staging and management of cervical carcinoma.


Assuntos
Diagnóstico por Imagem/métodos , Neoplasias do Colo do Útero/diagnóstico por imagem , Neoplasias do Colo do Útero/patologia , Colo do Útero/diagnóstico por imagem , Colo do Útero/patologia , Feminino , Humanos , Imagem por Ressonância Magnética , Imagem Multimodal , Estadiamento de Neoplasias , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Tomografia por Emissão de Pósitrons , Gravidez , Tomografia Computadorizada por Raios X
4.
Eur J Radiol ; 118: 147-152, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31439234

RESUMO

PURPOSE: To identify parametrial infiltration (PMI) in cervical cancer with voxel-based segmentation of integrated PET/MRI images. METHOD: This retrospective study enrolled 79 cervical cancer patients confirmed by pathology (FIGO stage IB to IIB) who underwent 18F-FDG PET/MRI prior to surgery. Region of interest (ROI) at the largest tumor level was delineated on the T2W-MR image, and the ROI was applied to PET image of the corresponding layer. Then, these images were postprocessed with segmentation and gray level calculations in the parauterine area. RESULTS: In total, 37 patients (46.8%) had postoperative pathology-confirmed PMI, and 42 patients (53.2%) showed no PMI. There was a moderate correlation between pathological results and the gray level values of each region (rs > 0.5, P < 0.001). According to FIGO stage, as the cervical lesions became more malignant, the gray level values gradually increased. The diagnostic results of MRI and PET/MRI were in good agreement (kappa = 0.693, P < 0.001); the accuracy (78.5%), sensitivity (64.9%) and NPV (74.5%) of PET/MRI were slightly higher than those of MRI (74.7%,59.5%,71.2%, respectively), with no statistically significant difference (P = 1.000). The diagnostic results of MRI and PET/MRI+gray level values were generally consistent (kappa = 0.475, P < 0.001); the accuracy (87.3%), sensitivity(83.8%) and NPV(86.4%) of PET/MRI+gray level values were higher than those of MRI, with statistically significant differences (all P values < 0.05). CONCLUSIONS: It is feasible to evaluate PMI based on PET/T2W-MRI voxel segmentation and to obtain quantitative and visual indicators. PET/MRI and gray level values considered together can also improve the accuracy, sensitivity and NPV of PMI diagnosis.


Assuntos
Fluordesoxiglucose F18 , Imagem por Ressonância Magnética/métodos , Imagem Multimodal/métodos , Tomografia por Emissão de Pósitrons/métodos , Neoplasias do Colo do Útero/diagnóstico por imagem , Neoplasias do Colo do Útero/patologia , Adulto , Idoso , Colo do Útero/diagnóstico por imagem , Colo do Útero/patologia , Feminino , Humanos , Pessoa de Meia-Idade , Invasividade Neoplásica , Compostos Radiofarmacêuticos , Reprodutibilidade dos Testes , Estudos Retrospectivos , Adulto Jovem
5.
Georgian Med News ; (290): 32-37, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31322511

RESUMO

The aim of the study was to improve the diagnosis of structural changes in all parts of the cervix depending on the preferential localization of the inflammatory process - in the ectocervix, endocervix, and also in the stroma in women with ectopia (pseudoerosis) of the vaginal part of the cervix. The study included women of predominantly early and middle reproductive age, as these women have inflammatory processes more often than in menopause. To perform the work, a transvaginal imaging method was used, which allowed us to see the smallest structures (up to 0.5-1.0 mm) of the cervix. We have previously developed a technique for visualizing the external part of the cervix and obtained a patent of Ukraine. The results of the ultrasound were compared with laboratory data, colposcopy and cervicoscopy. Traditionally, the diagnosis of cervicitis was made on the basis of clinical symptoms, smear results to determine the presence and type of pathogen. Endoscopic methods allowed visualization of only the mucous membrane of the cervical canal and external part of the cervix. The deep layers of the ectocervix, endocervix and cervical stroma can only be visualized using high-frequency ultrasound in a transvaginal way. According to the results of the study, it was possible to determine the preferential localization of the inflammatory process, to determine the nature of changes in different layers of the cervix. These changes were expressed in the presence of calcifications and cystic cavities of various sizes (1-6 mm), an increase or decrease in echogenicity, the degree of heterogeneity of the structure of the ecto-, endocervix and stroma.


Assuntos
Colo do Útero/diagnóstico por imagem , Colo do Útero/patologia , Ultrassonografia/métodos , Cervicite Uterina/etiologia , Vagina/diagnóstico por imagem , Adulto , Colposcopia , Feminino , Humanos , Pessoa de Meia-Idade , Ucrânia , Cervicite Uterina/patologia
6.
Medicine (Baltimore) ; 98(29): e16449, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31335700

RESUMO

BACKGROUND: The aim of the study was to evaluate the diagnostic accuracy of cervical elastography in predicting preterm delivery (PTD). METHODS: We searched the PubMed, EMBASE, and Cochrane databases to identify relevant studies that applied ultrasound (US) elastography to assess cervical stiffness and predict PTD. All the studies were published before December 11, 2018, and only studies published in English were collected. The cervical length (CL) was considered a comparator, and the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool was applied to assess the quality of the included studies. Summary receiver operating characteristic (SROC) modeling was performed to evaluate the diagnostic performance of cervical elastography in predicting PTD. Subgroup analyses were also performed. RESULTS: Seven studies, including 1488 pregnant women, were included in this meta-analysis. Cervical elastography showed a summary sensitivity of 0.84 [95% confidence interval (CI): 0.68, 0.93], a specificity of 0.82 (95% CI: 0.63, 0.93), a diagnostic odds ratio of 25 (95% CI: 7, 93), and an area under the curve (AUC) of SROC of 0.90 (95% CI: 0.87-0.93). CL measurement showed that the AUC of SROC was 0.60 (95% CI: 0.56-0.64). The results of subgroup analysis showed that the summary sensitivity and specificity were different in the QUADAS-2 score subgroups. CONCLUSION: Cervical elastography is a promising and reliable method to predict PTD. Cervical elastography showed better diagnostic performance to predict PTD than CL measurement.


Assuntos
Colo do Útero , Técnicas de Imagem por Elasticidade/métodos , Nascimento Prematuro/diagnóstico , Colo do Útero/diagnóstico por imagem , Colo do Útero/fisiopatologia , Precisão da Medição Dimensional , Feminino , Humanos , Valor Preditivo dos Testes , Gravidez
7.
Gynecol Obstet Fertil Senol ; 47(7-8): 562-567, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31280032

RESUMO

OBJECTIVES: Evaluate an educational program based on "CLEAR" (Cervical Length Education and Review) in the teaching of measuring sonographic cervical length to residents in gynecology and obstetrics. METHODS: This is a prospective cohort study in a tertiary care center between May and November 2017. The residents were asked to collect 5 cervical length images from patients suspected with threatened preterm labor. A theoretical session on cervix measurement image criteria based on "CLEAR" program was taught to all residents. Then, they had to collect 5 new cervical length images. All the images were reviewed by two experienced reviewers, blinded to the resident and whether the image was obtained before or after the theoretical session and based on 8 criteria. RESULTS: Ten residents participated to the study. The mean total score CLEAR was significantly higher post-intervention: 6.6±0.9 vs. 4.3±2.1, positive difference of 2.3±2.3 (P<0.001). Improvement was most significant with the junior residents: 3.6 pre vs. 6.5 post-intervention. CONCLUSION: Educational program based on CLEAR criteria allowed to improve the competence of residents in measuring sonographic cervical length, although this can also be correlated with the progression of residents during the semester. It could be implemented systematically with the aim of CLEAR certification to standardize the teaching of residents in gynecology and obstetrics.


Assuntos
Colo do Útero/diagnóstico por imagem , Ginecologia/educação , Internato e Residência , Trabalho de Parto Prematuro/diagnóstico por imagem , Obstetrícia/educação , Ultrassonografia Pré-Natal , Estudos de Coortes , Feminino , França , Idade Gestacional , Humanos , Gravidez , Estudos Prospectivos
8.
Sensors (Basel) ; 19(15)2019 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-31344796

RESUMO

A torsional wave (TW) sensor prototype was employed to quantify stiffness of the cervix in pregnant women. A cross-sectional study in a total of 18 women between 16 weeks and 35 weeks + 5 days of gestation was performed. The potential of TW technique to assess cervical ripening was evaluated by the measurement of stiffness related to gestational age and cervical length. Statistically significant correlations were found between cervical stiffness and gestational age ( R 2 = 0.370 , p = 0.0074 , using 1 kHz waves and R 2 = 0.445 , p = 0.0250 , using 1.5 kHz waves). A uniform decrease in stiffness of the cervical tissue was confirmed to happen during the complete gestation. There was no significant correlation between stiffness and cervical length. A stronger association between gestational age and cervical stiffness was found compared to gestational age and cervical length correlation. As a conclusion, TW technique is a feasible approach to objectively quantify the decrease of cervical stiffness related to gestational age. Further research is required to evaluate the application of TW technique in obstetric evaluations, such as prediction of preterm delivery and labor induction failure.


Assuntos
Colo do Útero/diagnóstico por imagem , Técnicas de Imagem por Elasticidade/métodos , Anormalidade Torcional/diagnóstico por imagem , Adulto , Maturidade Cervical/fisiologia , Colo do Útero/fisiopatologia , Estudos Transversais , Elasticidade , Feminino , Idade Gestacional , Humanos , Trabalho de Parto Induzido , Gravidez , Anormalidade Torcional/fisiopatologia
9.
Sensors (Basel) ; 19(15)2019 Jul 25.
Artigo em Inglês | MEDLINE | ID: mdl-31349721

RESUMO

The reconstruction of viscous properties of soft tissues, and more specifically, of cervical tissue is a challenging problem. In this paper, a new method is proposed to reconstruct the viscoelastic parameters of cervical tissue-mimicking phantoms by a Torsional Wave Elastography (TWE) technique. The reconstruction method, based on a Probabilistic Inverse Problem (PIP) approach, is presented and experimentally validated against Shear Wave Elastography (SWE). The anatomy of the cervical tissue has been mimicked by means of a two-layer gelatine phantom that simulates the epithelial and connective layers. Five ad hoc oil-in-gelatine phantoms were fabricated at different proportion to test the new reconstruction technique. The PIP approach was used for reconstructing the Kelvin-Voigt (KV) viscoelastic parameters by comparing the measurements obtained from the TWE technique with the synthetic signals from a Finite Difference Time Domain (FDTD) KV wave propagation model. Additionally, SWE tests were realized in order to characterize the viscoelastic properties of each batch of gelatine. Finally, validation was carried out by comparing the KV parameters inferred from the PIP with those reconstructed from the shear wave dispersion curve obtained from the SWE measurements. In order to test the degree of agreement between both techniques, a Student's T-test and a Pearson's correlation study were performed. The results indicate that the proposed method is able to reconstruct the KV viscoelastic properties of the cervical tissue, for both the epithelial and connective layers, as well as the thickness of the first layer with acceptable accuracy.


Assuntos
Colo do Útero/diagnóstico por imagem , Técnicas de Imagem por Elasticidade/métodos , Imagens de Fantasmas , Viscosidade , Adulto , Fenômenos Biomecânicos , Colo do Útero/fisiologia , Elasticidade , Feminino , Gelatina/química , Humanos , Gravidez
10.
J Clin Ultrasound ; 47(7): 389-393, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31245845

RESUMO

PURPOSE: To investigate the correlation between cervical length measurements using transvaginal and transperineal approaches at 16-24 weeks of gestation. METHODS: The prospective study recruited 110 singleton pregnant women. All the measurements were performed by one operator who was blinded to the results of both approaches. Cervical length was first measured by transvaginal sonography (TVUS) then transperineal sonography (TPUS). The transvaginal approach was used as the reference measurement. Patient preference regarding the sonographic approaches was evaluated using questionnaire. RESULTS: Cervical length was successfully measured by TVUS in all cases. TPUS was successful in 108/110 participants. There was high correlation between the results of TVUS and TPUS (Pearson's correlation coefficient was .94; 95% CI .9 to .95. Lin's concordance correlation coefficient was .94; 95% CI .92-.96). The estimated difference in cervical length measured using TVUS and TPUS was .2 mm. The 95% tolerance interval for paired observation was -1.8 to 2.3 mm. The interobserver coefficient of TPUS measurement was .98 (95% CI .92-.99). TPUS was rated as resulting in mild or no discomfort and was preferred by most women. CONCLUSION: TVUS and TPUS techniques showed high correlation in cervical length measurement with high interobserver reliability. More patients preferred TPUS. TPUS should be considered as an alternative method of cervical length measurement.


Assuntos
Medida do Comprimento Cervical/métodos , Colo do Útero/diagnóstico por imagem , Adolescente , Adulto , Feminino , Humanos , Gravidez , Estudos Prospectivos , Reprodutibilidade dos Testes , Inquéritos e Questionários , Adulto Jovem
11.
Zhonghua Fu Chan Ke Za Zhi ; 54(5): 318-323, 2019 May 25.
Artigo em Chinês | MEDLINE | ID: mdl-31154713

RESUMO

Objective: To investigate the predictive value of cervical length (CL) measured by transvaginal ultrasound for preterm birth <32 weeks, <34 weeks in twin pregnancies in the second and the third trimester of pregnancy. Methods: A total of 490 twin pregnant women with CL measured by transvaginal ultrasound during the second trimester of pregnancy (20-24 weeks) and the third trimester of pregnancy (28-32 weeks) delivered in Peking University Third Hospital, and Tongzhou Maternal and Child Health Hospital from January 2014 to December 2017 were collected, and 161 cases out of which were measured by CL during both the second trimester and the third trimester of pregnancy. Based on the measured gestational weeks, 427 cases were in the second trimester group and 224 cases in the third trimester group. The predictive value of CL for preterm birth was evaluated by calculating the optimal cut-off point with sensitivity and specificity. Logistic regression analysis was used to assess the relationship between CL and preterm birth after adjusting for confounding factors (age of pregnant women, chorionic status, mulipara, assisted reproductive pregnancy and pre-pregnancy body mass index). Results: (1) The median CL of pregnant women in the second trimester group and the third trimester group were 36 mm (33-40 mm) and 28 mm (18-33 mm) respectively. In the second trimester group, 151 cases (35.4%, 151/427) were preterm birth and 276 cases (64.6%, 276/427) were full-term birth; the median CL of preterm and full-term pregnant women were 34 mm (30-37 mm) and 37 mm (34-40 mm), respectively, with significant difference (P<0.01). In the third trimester group, 100 cases (44.6%, 100/224) were preterm birth and 124 cases (55.4%, 124/224) were full-term birth; the median CL of preterm and full-term pregnant women were 22 mm (15-30 mm) and 31 mm (23-34 mm), respectively, with significant difference (P<0.01). (2) Prediction of preterm birth <32 weeks and <34 weeks was performed with CL in the second trimester group. The area under the receiver-operating characteristics curve were 0.78 (95%CI: 0.70-0.86) and 0.71 (95%CI: 0.64-0.79), respectively. The optimal cut-off points were 36.5 mm and 33.5 mm, respectively. After adjusting for confounding factors, CL was inversely associated with preterm birth <32 weeks and <34 weeks of gestation. (3) Prediction of preterm birth <32 weeks and <34 weeks were performed with CL in the third trimester group. The area under the receiver-operating characteristics curve were 0.86 (0.75-0.96) and 0.75 (0.67-0.84), respectively. The optimal cut-off points were 17.5 mm and 18.5 mm, respectively. After adjusting for confounding factors, CL was inversely associated with preterm birth at <32 weeks and <34 weeks of gestation. Conclusions: CL measured by transvaginal ultrasound in the second and the third trimester is a good predictor for preterm birth of twin pregnancy. CL≤36.5 mm and ≤33.5 mm at 20-24 weeks of gestation could predict preterm birth <32 weeks and <34 weeks respectively. CL≤17.5 mm and ≤18.5 mm at 28-32 weeks of gestation could predict preterm birth <32 weeks and <34 weeks respectively.


Assuntos
Medida do Comprimento Cervical/métodos , Colo do Útero/diagnóstico por imagem , Gravidez de Gêmeos , Nascimento Prematuro , Ultrassonografia Pré-Natal/métodos , Criança , Feminino , Humanos , Recém-Nascido , Valor Preditivo dos Testes , Gravidez , Segundo Trimestre da Gravidez , Terceiro Trimestre da Gravidez , Sensibilidade e Especificidade , Ultrassonografia
12.
Eur Radiol ; 29(12): 6741-6749, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31134366

RESUMO

BACKGROUND: We designed a deep learning model for assessing 18F-FDG PET/CT for early prediction of local and distant failures for patients with locally advanced cervical cancer. METHODS: All 142 patients with cervical cancer underwent 18F-FDG PET/CT for pretreatment staging and received allocated treatment. To augment the amount of image data, each tumor was represented as 11 slice sets each of which contains 3 2D orthogonal slices to acquire a total of 1562 slice sets. In each round of k-fold cross-validation, a well-trained proposed model and a slice-based optimal threshold were derived from a training set and used to classify each slice set in the test set into the categories of with or without local or distant failure. The classification results of each tumor were aggregated to summarize a tumor-based prediction result. RESULTS: In total, 21 and 26 patients experienced local and distant failures, respectively. Regarding local recurrence, the tumor-based prediction result summarized from all test sets demonstrated that the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 71%, 93%, 63%, 95%, and 89%, respectively. The corresponding values for distant metastasis were 77%, 90%, 63%, 95%, and 87%, respectively. CONCLUSION: This is the first study to use deep learning model for assessing 18F-FDG PET/CT images which is capable of predicting treatment outcomes in cervical cancer patients. KEY POINTS: • This is the first study to use deep learning model for assessing 18 F-FDG PET/CT images which is capable of predicting treatment outcomes in cervical cancer patients. • All 142 patients with cervical cancer underwent 18 F-FDG PET/CT for pretreatment staging and received allocated treatment. To augment the amount of image data, each tumor was represented as 11 slice sets each of which contains 3 2D orthogonal slices to acquire a total of 1562 slice sets. • For local recurrence, all test sets demonstrated that the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 71%, 93%, 63%, 95%, and 89%, respectively. The corresponding values for distant metastasis were 77%, 90%, 63%, 95%, and 87%, respectively.


Assuntos
Quimiorradioterapia/métodos , Aprendizado Profundo , Fluordesoxiglucose F18 , Recidiva Local de Neoplasia/diagnóstico por imagem , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/métodos , Neoplasias do Colo do Útero/diagnóstico por imagem , Neoplasias do Colo do Útero/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Colo do Útero/diagnóstico por imagem , Colo do Útero/patologia , Estudos de Coortes , Feminino , Humanos , Pessoa de Meia-Idade , Prognóstico , Compostos Radiofarmacêuticos , Recidiva , Estudos Retrospectivos , Sensibilidade e Especificidade , Resultado do Tratamento , Neoplasias do Colo do Útero/patologia
13.
Magn Reson Imaging ; 61: 9-15, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31071471

RESUMO

PURPOSE: To explore the possibility of using amide proton transfer-weighted imaging (APTWI) for the identification and diagnosis of cervical squamous carcinoma (CSC), cervical adenocarcinoma (CA) and different levels of CSC. MATERIALS AND METHODS: Seventy-six patients with newly diagnosed uterine cervical cancer (UCC) were studied prior to treatment, including 20 with poorly differentiated (Grade 3) CSC, 23 with moderately differentiated (Grade 2) CSC, 17 with well-differentiated (Grade 1) CSC, and 16 with CA (13 with poorly differentiated (Grade 3) CA and 3 with moderately differentiated (Grade 2) CA). Differences in the magnetization transfer ratio at 3.5 ppm (MTRasym (3.5 ppm)) were identified between CSC and CA and between high-level (Grade 3) CSC and low-level (Grade 2 and Grade 1) CSC, as well as among all three grades of CSC differentiation. Receiver operating characteristic (ROC) curve analysis was used to evaluate the diagnostic thresholds and performance of the parameters. Spearman correlation analysis was used to examine the correlation between the MTRasym (3.5 ppm) and histological grade. RESULTS: The MTRasym (3.5 ppm) in CA was higher than that in CSC (P = 0.001). The MTRasym (3.5 ppm) in high-level CSC was higher than that in low-level CSC (P = 0.001). The MTRasym (3.5 ppm) was positively correlated with the grade of CSC differentiation (r = 0.498, P = 0.001). The MTRasym (3.5 ppm) in Grade 3 CSC was higher than that in Grade 2 and Grade 1 CSC (P = 0.02/0.01). No significant difference in the MTRasym (3.5 ppm) was found between Grade 2 CSC and Grade 1 CSC (P = 0.173). The area under the ROC curve (AUC) for the MTRasym (3.5 ppm) in distinguishing CSC and CA was 0.779, with a cut-off, sensitivity, and specificity of 2.97%, 60.0% and 82.5%, respectively. The AUC for distinguishing high-/low-level CSC was 0.756, with a cut-off, sensitivity, and specificity of 3.29%, 68.8% and 83.3%, respectively. CONCLUSION: APTWI may be a useful technique for the identification and diagnosis of CSC, CA and different levels of CSC, which may have an important impact on clinical strategies for treating patients with UCC.


Assuntos
Adenocarcinoma/diagnóstico por imagem , Adenocarcinoma/patologia , Carcinoma de Células Escamosas/diagnóstico por imagem , Carcinoma de Células Escamosas/patologia , Imagem por Ressonância Magnética/métodos , Neoplasias do Colo do Útero/diagnóstico por imagem , Neoplasias do Colo do Útero/patologia , Idoso , Amidas , Colo do Útero/diagnóstico por imagem , Colo do Útero/patologia , Diagnóstico Diferencial , Feminino , Humanos , Pessoa de Meia-Idade , Gradação de Tumores , Prótons , Curva ROC , Sensibilidade e Especificidade
14.
Obstet Gynecol Clin North Am ; 46(2): 367-378, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31056137

RESUMO

Diagnostic ultrasound is a powerful tool in obstetrics/gynecology. It has multiple applications, but for every use there are potential pitfalls that can have significant deleterious effects. Guidelines and certifications have been implemented to enhance the safety of this technique.


Assuntos
Ginecologia/métodos , Obstetrícia/métodos , Ultrassonografia Pré-Natal , Ultrassonografia , Colo do Útero/diagnóstico por imagem , Feminino , Desenvolvimento Fetal , Doenças Fetais/diagnóstico por imagem , Feto/anormalidades , Feto/diagnóstico por imagem , Idade Gestacional , Humanos , Erros Médicos , Placenta/diagnóstico por imagem , Gravidez , Complicações na Gravidez/diagnóstico por imagem , Gravidez Múltipla , Nascimento Prematuro/diagnóstico por imagem
15.
J Obstet Gynaecol ; 39(8): 1057-1064, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31046494

RESUMO

The Manipal Cervical Scoring System is an accurate and objective sonographic score that predicts the outcome of induced labour. The aim of the current study was to compare the performance of the Manipal Cervical Scoring System against the Bishop Score. A prospective study was conducted on 105 women underwent labour induction in Ain Shams University Hospital, Cairo, Egypt. Both scores were assessed pre-induction. Successful induction occurred in 78.09% of the cases. The area under the ROC curve (AUC) was of 0.940 (95% CI = 0.876 to 0.977; p value <.0001) for the Manipal Score and 0.863 (95% CI = 0.783-0.923; p value <.0001) for the Bishop Score. The Manipal Score >5 had a sensitivity of 91.5% and a specificity of 91.3%. While the Bishop score >4 had a sensitivity of 98.8% and specificity of 69.6% to predict the outcome of induced labour. The Manipal Cervical Scoring system is a better objective tool to predict the outcome of labour induction compared to the Bishop Score. However, other female and fetal characteristics, including body mass index (BMI) at gestation, gestational weight gain, occiput position and parity should be taken into consideration when performing labour induction. Impact statement What is already known on this subject? The ultimate fate of 20% of women having an induction of labour (IOL) is a Caesarean delivery. Thus, predicting the possible response to IOL before starting induction could guide clinicians to determine the efficacy of starting and/or continuing the induction process and in counselling women regarding the possible response to IOL. The main predictor for IOL outcome is based on the pre-induction cervical status which has been traditionally assessed by the Bishop Score. However, the Bishop Score remains subjective, thereby, associated with high rates of bias and several studies have demonstrated its poor predictive value for the outcome of induction. What do the results of this study add? Proposed use of ultrasound parameters that are equivalent to Bishop Score will be objective, reliable and reproducible method. It allows for patient re-evaluation by other obstetricians without the need for re-examination (thus decreasing exposing the patient to pain and anxiety). What are the implications of these findings for clinical practice and/or further research? According to WHO and FIGO, oral misoprostol (25 µg, 2-hourly) is recommended for induction of labour. This helps to decrease the discomfort of repeated vaginal examination and increases the women satisfaction with labour process, especially in women at higher risk of infection. Thus evaluating cervical status using an ultrasound cervical scoring system can similarly increase women's satisfaction with labour process. Our goal in the upcoming trial is to perform RCT comparing ultrasound versus Bishop in women undergoing IOL using oral misopristol regarding measures of satisfaction during labour in the parturient women.


Assuntos
Colo do Útero/diagnóstico por imagem , Trabalho de Parto Induzido , Ultrassonografia Pré-Natal/métodos , Adolescente , Adulto , Egito , Feminino , Humanos , Trabalho de Parto Induzido/estatística & dados numéricos , Trabalho de Parto , Gravidez , Estudos Prospectivos , Curva ROC , Sensibilidade e Especificidade , Resultado do Tratamento , Adulto Jovem
18.
Ultrasound Med Biol ; 45(6): 1466-1474, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30979594

RESUMO

Clinical prediction and especially prevention of abnormal birth timing, particularly pre-term, is poor. The cervix plays a key role in birth timing; it first serves as a rigid barrier to protect the developing fetus, then becomes the pathway to delivery of that fetus. Imaging biomarkers to define this remodeling process could provide insights to improve prediction of birth timing and elucidate novel targets for preventive therapies. Quantitative ultrasound (QUS) approaches that appear promising for this purpose include shear wave speed (SWS) estimation to quantify softness, as well as parameters based on backscattered power, such as the mean backscattered power difference (mBSPD) and specific attenuation coefficient (SAC), to quantify the organization of tissue microstructure. Invasive studies in rodents demonstrated that as pregnancy advances, cervical microstructure disorganizes as tissue softness and compliance increase. Our non-invasive studies in pregnant women and rhesus macaques suggested that QUS can detect these microstructural changes in vivo. Our previous study in the same cohort showed a progressive decline in SWS during pregnancy, consistent with increasing tissue softness, and we hypothesized that backscatter parameters would also decrease, consistent with increasing microstructural disorganization. In this study, we analyzed the mBSPD and SAC in the cervices of rhesus macaques (n = 18). We found that both mBSPD and SAC decreased throughout pregnancy (p < 0.001 for both parameters) and that the former appears to be a more reliable biomarker. In summary, biomarkers that can characterize tissue microstructural organization are promising for comprehensive characterization of cervical remodeling in pregnancy.


Assuntos
Colo do Útero/diagnóstico por imagem , Macaca mulatta , Processamento de Sinais Assistido por Computador , Ultrassonografia/métodos , Animais , Biomarcadores , Estudos de Avaliação como Assunto , Feminino , Gravidez
19.
J Chin Med Assoc ; 82(1): 50-54, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30839404

RESUMO

BACKGROUND: Preterm labor is one of major obstetric challenges and can be predicted by cervical length at mid-trimester. In some settings, transvaginal ultrasound is not available and the screening and prevention of preterm labor will be suboptimal. We hope to find a correlation between other marker i.e. lower uterine wall thickness measured by transabdominal ultrasonography and cervical length measured by transvaginal ultrasonography in Thai pregnant women during 16-32 weeks of gestation. METHODS: This study was a cross-sectional study. 166 singleton pregnant women were invited to participate in the study between June 2015 and December 2015. Transabdominal ultrasonography was performed to measure the lower uterine wall thickness and transvaginal ultrasonography was performed to measure the cervical length. The Spearman's rank correlation was used to evaluate the correlation between the two parameters. The inter-observer variation was assessed by using Bland-Altman plot. The outcomes of all pregnancies were followed and only those who delivered at term were included for the calculation of normal value of lower uterine wall thickness. RESULTS: There was a highly positive correlation between lower uterine wall thickness and cervical length (rs = 0.767, n = 166, p < 0.001). For those who had short cervical length (defined as less than 30 mm) at GA 16-24 weeks (n = 10), the mean corresponding lower uterine wall thickness was 4.4 mm (SD 0.50). The inter-observer variation of the measurement of lower uterine wall thickness and cervical length were small. The lower uterine wall thickness tended to be slightly thinner when the gestation advanced. (mean 5.4 mm at 16-20 weeks and 5.1 mm at 28-32 weeks). CONCLUSION: There was a highly positive correlation between lower uterine wall thickness measured by transabdominal ultrasonography and cervical length measured by transvaginal ultrasonography in Thai pregnant women.


Assuntos
Colo do Útero/anatomia & histologia , Ultrassonografia/métodos , Útero/anatomia & histologia , Adolescente , Adulto , Colo do Útero/diagnóstico por imagem , Estudos Transversais , Feminino , Humanos , Gravidez , Útero/diagnóstico por imagem , Adulto Jovem
20.
J Korean Med Sci ; 34(9): e68, 2019 Mar 11.
Artigo em Inglês | MEDLINE | ID: mdl-30863266

RESUMO

Background: We investigated whether there is a difference in elastographic parameters between pregnancies with and without spontaneous preterm delivery (sPTD) in women with a short cervix (≤ 25 mm), and examined the ability of elastographic parameters to predict sPTD in those women. Methods: E-CervixTM (WS80A; Samsung Medison, Seoul, Korea) elastography was used to examine the cervical strain. Elastographic parameters were compared between pregnancies with and without sPTD. Diagnostic performance of elastographic parameters to predict sPTD ≤ 37 weeks, both alone and in combination with other parameters, was compared with that of cervical length (CL) using area under receiver operating characteristic curve (AUC) analysis. Results: A total of 130 women were included. Median gestational age (GA) at examination was 24.4 weeks (interquartile range, 21.4-28.9), and the prevalence of sPTD was 20.0% (26/130). Both the elastographic parameters and CL did not show statistical difference between those with and without sPTD. However, when only patients with CL ≥ 1.5 cm (n = 110) were included in the analysis, there was a significant difference between two groups in elasticity contrast index (ECI) within 0.5/1.0/1.5 cm from the cervical canal (P < 0.05) which is one of elastographic parameters generated by E-Cervix. When AUC analysis was performed in women with CL ≥ 1.5 cm, the combination of parameters (CL + pre-pregnancy body mass index + GA at exam + ECI within 0.5/1.0/1.5 cm) showed a significantly higher AUC than CL alone (P < 0.05). Conclusion: An addition of cervical elastography may improve the ability to predict sPTD in women with a short CL between 1.5 and 2.5 cm.


Assuntos
Colo do Útero/fisiologia , Técnicas de Imagem por Elasticidade , Nascimento Prematuro/diagnóstico , Adulto , Área Sob a Curva , Colo do Útero/diagnóstico por imagem , Feminino , Idade Gestacional , Humanos , Gravidez , Nascimento Prematuro/epidemiologia , Prevalência , Estudos Prospectivos , Curva ROC , República da Coreia/epidemiologia
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