RESUMO
To determine if patients with a DC respond similarly to ovarian stimulation when compared to patients without a DC. Infertility patients with a DC that underwent IVF between January 2009 and December 2016 were included. A cystic mass with mixed echogenicity, internal echoes similar to thick bands, fatty-fluid level, or an echogenic tubercle with acoustic shadow (Rokitansky nodule) within two years of the cycle characterized the diagnosis. The z-score compared the standard deviations (SDs) in patients with/without a DC and were compared to a nomogram (expected oocytes minus oocytes obtained divided by the SD), adjusted for age and number of oocytes retrieved, built utilizing cycles from noninfertile female patients. Thirty-nine patients with DC and 7839 patients without DC were identified. The mean number of oocytes (8.6 ± 5.8 vs. 8.5 ± 7.7, p = .43) and MIIs (6.7 ± 4.7 vs. 7.0 ± 6.7, p = .74) retrieved were similar. When cycles with and without a DC were compared to the nomogram (z-score of 0), cycles with a DC presented a z-score for ovarian response of 0.1921 SDs from the mean, and patients without DC presented a z-score of -0.2065 SDs from the mean (similar and less than -1.0). After building a population 'normal' response as a template, patients with and without a DC responded similar to COS.
Assuntos
Cisto Dermoide/diagnóstico por imagem , Fertilização in vitro , Neoplasias Ovarianas/diagnóstico por imagem , Indução da Ovulação , Adulto , Feminino , Humanos , Recuperação de Oócitos , Gravidez , Taxa de Gravidez , Estudos Retrospectivos , UltrassonografiaRESUMO
OBJECTIVES: To estimate intraobserver and interobserver reproducibility for assigning an International Endometrial Tumor Analysis (IETA) group color score for endometrial vascularization on color Doppler imaging. METHODS: Sixty-eight endometrial 3-dimensional volumes from endometrial color Doppler assessments of women with different endometrial disorders were evaluated by 8 different examiners (4 skilled examiners and 4 obstetric and gynecologic trainees). One skilled examiner who did not participate in the assessments selected the 68 volumes from a database to select a balanced number of each IETA score. Each examiner evaluated the 68 endometrial volumes to assign the IETA color score (1, absence of vascularization; 2, low vascularization; 3, moderate vascularization; or 4, abundant vascularization) using tomographic ultrasound imaging. The analysis was repeated 4 weeks later, and interobserver and intraobserver reproducibility was analyzed by calculating the weighted κ index. The second of the measurements made by each observer was used to estimate interobserver reproducibility. RESULTS: The intraobserver reproducibility was very good for all examiners, with a weighted κ index ranging from 0.84 to 0.91. The interobserver reproducibility was good or very good for all estimated comparisons, with a weighted κ index ranging from 0.77 to 0.96, regardless of experience level. CONCLUSIONS: The reproducibility of assigning the IETA color score for assessing endometrial vascularization using 3-dimensional volumes is good or very good regardless of the experience of the examiner.
Assuntos
Velocidade do Fluxo Sanguíneo/fisiologia , Endométrio/diagnóstico por imagem , Endométrio/fisiologia , Interpretação de Imagem Assistida por Computador/normas , Imageamento Tridimensional/normas , Ultrassonografia Doppler em Cores/normas , Adulto , Feminino , Humanos , Internacionalidade , Variações Dependentes do Observador , Tamanho do Órgão , Guias de Prática Clínica como Assunto , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Adulto JovemRESUMO
Objective: To compare the uterine transverse diameter (UTD) in women with normal uteri and women with uterine canalization defects as well as to assess its performance for ruling out such defects. Study Design: Retrospective analysis of prospectively collected data in a series of selected women with primary or secondary infertility. Measurement of UTD and 3D volume acquisition for subsequent off-line analysis was performed in order to identify possible canalization defects. UTD of the normal uterus, measured by 2D ultrasound, was compared to that of arcuate, subseptate, and septate uteri. ROC curve was plotted to determine the best UTD cutoff for differentiating normal from abnormal uteri. Results: A total of 421 women were ultimately evaluated. UTD was significantly larger in women with arcuate (53.3 mm, SD 6.3, p<0.05), subseptate (55.0 mm, SD 6.7, p<0.05), and septate (56.0 mm, SD 4.8, p<0.05) uterus as compared with the normal uterus (45.9 mm, SD 7.1). ROC curve showed that the best UTD cutoff for ruling out the presence of a uterine canalization defect was 45 mm (AUC 0.809, 95% CI 0.7680.849). Conclusion: Measurement of UTD may be a simple and practical method for ruling out a uterine canalization defect in infertile women.
Assuntos
Colo do Útero/anormalidades , Colo do Útero/cirurgia , Infertilidade Feminina/diagnóstico por imagem , Anormalidades Urogenitais/diagnóstico por imagem , Útero/anormalidades , Adulto , Feminino , Humanos , Histeroscopia/métodos , Imageamento Tridimensional , Infertilidade Feminina/cirurgia , Gravidez , Estudos Retrospectivos , Ultrassonografia/métodos , Anormalidades Urogenitais/cirurgia , Útero/diagnóstico por imagem , Útero/cirurgia , Adulto JovemRESUMO
Rudimentary horn pregnancy occurs in 1 in 76,000-150,000 pregnancies and causes uterine rupture in about 80% of cases. The use of three-dimensional transvaginal ultrasound seems to be useful for its early detection. We present a case of an 8-week pregnancy in a rudimentary horn, managed by laparoscopic excision. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound 45:112-115, 2017.
Assuntos
Laparoscopia , Gravidez Cornual/diagnóstico por imagem , Gravidez Cornual/cirurgia , Ultrassonografia Pré-Natal/métodos , Útero/anormalidades , Adulto , Feminino , Humanos , Imageamento Tridimensional , Gravidez , Útero/diagnóstico por imagemRESUMO
OBJECTIVES: We evaluated learning curve cumulative summation (CUSUM) of 3-dimensional (3D) sonography for diagnosis of congenital uterine anomalies and the deviations of the level of trainees' performance at the control-stage CUSUM. METHODS: First-year (R1), second-year (R2), and third-year (R3) residents in obstetrics and gynecology received a training program to learn how to analyze 3D sonographic volumes and to classify congenital uterine anomalies. Each trainee worked on 155 3D sonographic volumes from preselected patients. Their results were evaluated by learning curve CUSUM and standard CUSUM. The time for each volume analysis was calculated for the expert examiner and the trainees. RESULTS: Trainees R1, R2, and R3 reached competence at the 85th, 58th, and 40th evaluations, respectively, with success rates of 80%, 81%, and 85%, and kept the process under control with error levels of less than 4.5% until the end of the test. The trainees significantly reduced the average time of the evaluation per volume (P < .001). CONCLUSIONS: Learning curve CUSUM provided quantitative indicators of the learning evolution of 3D sonography for diagnosis of congenital uterine anomalies by obstetrics and gynecology residents. The training received by the residents was adequate for diagnosis of congenital uterine anomalies using 3D sonography.
Assuntos
Competência Clínica , Ginecologia/educação , Imageamento Tridimensional/métodos , Curva de Aprendizado , Ultrassonografia/métodos , Anormalidades Urogenitais/diagnóstico por imagem , Útero/anormalidades , Feminino , Humanos , Internato e Residência , Estudos Prospectivos , Estudos Retrospectivos , Útero/diagnóstico por imagemRESUMO
OBJECTIVES: The aim of this study was to evaluate the interobserver agreement for diagnosis of deep endometriosis of the rectovaginal septum using introital 3-dimensional (3D) sonography. METHODS: Two experienced observers (observers A and B) performed a retrospective review of stored 3D sonographic volumes from a sample of 84 consecutive patients with a clinical suspicion of endometriosis. Each observer, independently and blinded to each other, evaluated the presence or absence of involvement of the rectovaginal septum. When no lesion was seen, the observers were asked to judge whether the acquisition of the volume was suboptimal for interpretation or whether no lesion on the rectovaginal septum was detectable. One inadequate acquisition case was discarded; a total of 83 cases were evaluated. To calculate the performance of introital 3D sonography, 7 discordant cases were reviewed by a third observer. Interobserver agreement was assessed by calculating the κ index, and the sensitivity, specificity, positive predictive value, and negative predictive value for the 3 observers were also determined. RESULTS: Interobserver agreement was 0.816 (95% confidence interval, 0.69-0.93), representing very good agreement. Sensitivity was 74.1%; specificity, 85.7%; positive predictive value, 71.4%; and negative predictive value, 87.3%. CONCLUSIONS: Our results show that introital 3D sonography for diagnosis of deep endometriosis of the rectovaginal septum is reproducible, with very good interobserver agreement.
Assuntos
Endometriose/diagnóstico por imagem , Endometriose/epidemiologia , Reto/diagnóstico por imagem , Vagina/diagnóstico por imagem , Adulto , Feminino , Humanos , Imageamento Tridimensional , Variações Dependentes do Observador , Prevalência , Reprodutibilidade dos Testes , Fatores de Risco , Sensibilidade e Especificidade , Espanha/epidemiologia , Ultrassonografia , Adulto JovemRESUMO
PURPOSE: To describe the gray-scale and color Doppler ultrasound features of uncommon (<5% prevalence) primary malignant ovarian tumors. METHODS: Retrospective analysis of 98 masses in 89 patients (median age: 50.4 years old, ranging from 15 to 81 years) diagnosed as having an uncommon primary ovarian malignancy. All patients had undergone transvaginal color Doppler ultrasound according to a standardized protocol prior to surgical tumor removal. Ultrasound features analyzed were laterality, presence of ascites, tumor volume, morphologic appearance (unilocular, multilocular, unilocular-solid, multilocular-solid, and solid), and color Doppler score (subjective assessment of the amount of flow as absent, scanty, moderate, or abundant). RESULTS: Pathological diagnoses included uncommon epithelial tumors (n = 59), germ cell tumors (n = 10), sex cord-stromal tumors (n = 11), sarcoma (n = 9), and lymphoma (n = 9). Germ cell tumors presented in younger women (p < 0.001). Germ cell tumors, sex cord-stromal tumors, sarcomas, and lymphomas were significantly more often solid as compared with epithelial malignancies, which appeared more frequently as complex (cystic-solid) tumors (p < 0.001). There were no differences in color Doppler score between the various types of tumors. CONCLUSIONS: Germ cell tumors, sex cord-stromal tumors, sarcomas, and lymphomas tend to appear as unilateral solid tumors. Color Doppler score is not useful for discriminating among uncommon primary ovarian malignancies.
Assuntos
Distribuição de Qui-Quadrado , Neoplasias Ovarianas/diagnóstico por imagem , Ultrassonografia Doppler em Cores , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Análise de Variância , Antígeno Ca-125/análise , Diagnóstico Diferencial , Feminino , Humanos , Itália , Pessoa de Meia-Idade , Neovascularização Patológica/diagnóstico por imagem , Neovascularização Patológica/patologia , Neoplasias Ovarianas/patologia , Estudos Retrospectivos , EspanhaRESUMO
The purpose of this pictorial essay is to describe the diagnostic value of two-dimensional ultrasound (2DUS) and the additional information that three-dimensional ultrasound (3DUS) provides in the assessment of location, type and complications of IUDs.
Assuntos
Ecocardiografia Doppler em Cores , Imageamento Tridimensional , Migração de Dispositivo Intrauterino , Dispositivos Intrauterinos , Útero/diagnóstico por imagem , Feminino , Humanos , Doenças Uterinas/diagnóstico por imagemRESUMO
PURPOSE: The purpose of this study was to investigate the intraobserver and interobserver agreements in the diagnosis of malignant versus benign adnexal masses using two-dimensional ultrasonography (2D US) and three-dimensional ultrasonography (3D US). METHODS: Two experienced sonographers performed a retrospective review of digitally stored 2D images and 3D data from a sample of 41 consecutive patients with a diagnosis of adnexal mass. Each observer independently, and blinded to each other, evaluated the 2D static images of each adnexal mass and then the 3D volumes 1 week later. The observers were required to classify the adnexal lesion as benign or malignant according to pattern recognition analysis. Intraobserver and interobserver agreement were assessed by calculating the kappa index (κ). RESULTS: Intraobserver agreement between 2D US and 3D US for the observer A was 1.00 and for the observer B was 0.69. Interobserver agreement was 0.69 for 2D US and 1.00 for 3D US (p > 0.05) CONCLUSIONS: Although 3D US in the diagnosis of adnexal masses appeared more reproducible than 2D US, the difference was not statistically significant.
Assuntos
Doenças dos Anexos/diagnóstico por imagem , Neoplasias Ovarianas/diagnóstico por imagem , Doenças dos Anexos/patologia , Adulto , Competência Clínica , Diagnóstico Diferencial , Feminino , Humanos , Imageamento Tridimensional , Variações Dependentes do Observador , Neoplasias Ovarianas/patologia , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Estudos Retrospectivos , Ultrassonografia DopplerRESUMO
OBJECTIVE: To assess whether there are differences in ovarian echogenicity and vascularization as assessed by three-dimensional power Doppler angiography (3D-PDA) between women with polycystic ovaries (PCO) and women with normal ovaries (NO). METHODS: Eighty-three women were classified into two groups according to the 2003 Rotterdam consensus criteria. The NO group comprised women (n = 45) with regular menstrual cycles and proven fertility, whereas the PCO group comprised women (n = 38) with oligo-anovulation, clinical and/or biochemical features of hyperandrogenism, and polycystic ovary morphology at two-dimensional ultrasound. All women were evaluated by means of 3D-PDA. The parameters studied in both groups were follicle number per ovary (FNPO), ovarian volume (OV), mean gray value (MG) and three vascular indices: vascularization index (VI), flow index (FI) and vascularization flow index (VFI). RESULTS: The PCO group showed a higher mean OV as well as FNPO. No differences in MG, VI, FI and VFI were found between the groups. CONCLUSIONS: 3D-PDA indices are not useful for discriminating between normal and polycystic ovaries.
Assuntos
Ovário/irrigação sanguínea , Síndrome do Ovário Policístico/diagnóstico por imagem , Adulto , Angiografia , Estudos de Casos e Controles , Feminino , Humanos , Tamanho do Órgão , Ovário/diagnóstico por imagem , Ovário/patologia , Síndrome do Ovário Policístico/patologia , Ultrassonografia Doppler em Cores , Adulto JovemRESUMO
OBJECTIVE: To assess the natural history of benign appearing purely solid ovarian lesions in asymptomatic postmenopausal women. METHODS: Retrospective observational cohort study comprising 99 women (mean age, 58.2 years, ranging from 50 to 77 years) diagnosed as having a purely solid ovarian lesion at transvaginal ultrasound between April 2001 and October 2015. Inclusion criteria were as follows: asymptomatic postmenopausal women with a well-defined purely solid ovarian lesion with International Ovarian Tumor Analysis color score 1 or 2, without ascites and/or signs of carcinomatosis. Clinical, sonographic, biochemical (CA-125), and histologic data (in case of surgery) were retrieved for analysis. Patients who were managed conservatively were assessed by transvaginal sonography every 6 months for a minimum of a year. In case of bilateral lesions we used the largest one for analysis. RESULTS: Five women (5.1%) had bilateral lesions. Mean size of the lesion was 2.9âcm (range, 1.0-7.8âcm). Most lesions were homogeneous (96.0%). Acoustic shadowing was present in 59.6% of cases. International Ovarian Tumor Analysis color score was 1 in 77.8% and 2 in 22.2% of the cases, respectively. Median CA-125 was 10.8âIU/mL (range, 3.0-403.0âIU/mL). Forty-two women underwent surgery after diagnosis (histologic diagnoses were as follows: fibroma (nâ=â26), fibrothecoma (nâ=â5), dermoid (nâ=â3), Brenner tumor (nâ=â3), endometrioma (nâ=â2), thecoma (nâ=â1), primary invasive cancer (nâ=â2). One case of invasive cancer CA-125 was 403.0âIU/mL and in the other case CA-125 was 6.0âIU/mL. They both were stage 1. Fifty-seven women were managed with serial follow-up. With a median follow-up time of 36 months (range, 12-142 months) all these lesions had no change and women remain asymptomatic. Considering all 99 cases the risk of malignancy is 2% (95% CI, 0.1-7.5). CONCLUSIONS: The risk of malignancy of benign appearing purely solid adnexal masses in asymptomatic postmenopausal women is low. Conservative management of these lesions might be an option.
Assuntos
Doenças Ovarianas/diagnóstico , Neoplasias Ovarianas/diagnóstico , Pós-Menopausa , Ultrassonografia , Idoso , Antígeno Ca-125/sangue , Diagnóstico Diferencial , Feminino , Humanos , Pessoa de Meia-Idade , Doenças Ovarianas/patologia , Doenças Ovarianas/cirurgia , Neoplasias Ovarianas/patologia , Neoplasias Ovarianas/cirurgia , Estudos Retrospectivos , Fatores de RiscoRESUMO
OBJECTIVE: To evaluate the reproducibility and accuracy of color Doppler flow location in indeterminate masses after a gray-scale sonography in the diagnosis of ovarian malignancy. METHODS: Digitally stored color Doppler sonographic images from a random sample of 130 women with an indeterminate adnexal mass submitted to surgery were evaluated by six different examiners with different degrees of experience. A mass was graded malignant if flow was shown within the excrescences or solid areas. Intraobserver agreement and interobserver agreement according to the level of experience were assessed by calculating the kappa index. RESULTS: Intraobserver agreement was good for all examiners with different degrees of experience (kappa 0.72-0.89). Interobserver agreement was good to moderate for all operators (kappa 0.48-0.71) irrespective of degree of experience. The accuracy was comparable among different operators. CONCLUSIONS: Our results indicate that color Doppler imaging for detection of adnexal malignancy seems to be a reproducible method even in moderately experienced examiners.
Assuntos
Anexos Uterinos/diagnóstico por imagem , Neoplasias Ovarianas/diagnóstico por imagem , Ultrassonografia Doppler em Cores/métodos , Adulto , Feminino , Humanos , Pessoa de Meia-Idade , Variações Dependentes do Observador , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Sensibilidade e EspecificidadeRESUMO
OBJECTIVE: To evaluate the diagnostic accuracy of introital three-dimensional (3D) transvaginal sonography for preoperative detection of rectovaginal septal endometriosis. DESIGN: Ultrasonographic results were compared with surgical and histologic findings. SETTING: University Department of Obstetrics and Gynecology. PATIENT(S): This prospective study included 39 women with suspected rectovaginal endometriosis. INTERVENTION(S): All patients underwent 3D transvaginal sonography for the evaluation of the rectovaginal septum, before undergoing laparoscopic radical resection of endometriosis. Rectovaginal endometriosis was defined as hypoechoic areas, nodules, or anatomic distortion of this specific location. MAIN OUTCOME MEASURE(S): Sensitivity, specificity, and likelihood ratios (positive or negative) were calculated with 95% confidence intervals (CIs). RESULT(S): Surgery associated with histopathologic evaluation revealed deep endometriosis in the rectovaginal septum in 19 patients. The specificity, sensitivity, positive likelihood ratio, and negative likelihood ratio were 94.7% (95% CI, 78.6%-99.7%), 89.5% (95% CI, 73.3%-94.5%), 17.2 (95% CI, 2.51-115), and 0.11 (95% CI, 0.03-0.41), respectively. CONCLUSION(S): Introital 3D ultrasonography seems to be an effective method for the diagnosis of endometriosis of the rectovaginal septum and should be included in the preoperative evaluation of patients with clinical suspicion of deep endometriosis.
Assuntos
Endometriose/diagnóstico por imagem , Endossonografia/métodos , Imageamento Tridimensional , Doenças Retais/diagnóstico por imagem , Doenças Vaginais/diagnóstico por imagem , Adulto , Endometriose/cirurgia , Feminino , Procedimentos Cirúrgicos em Ginecologia/métodos , Humanos , Imageamento Tridimensional/métodos , Laparoscopia/métodos , Valor Preditivo dos Testes , Doenças Retais/cirurgia , Reto/diagnóstico por imagem , Sensibilidade e Especificidade , Vagina/diagnóstico por imagem , Doenças Vaginais/cirurgiaRESUMO
OBJECTIVE: To describe three-dimensional ultrasonographic features of an ectopic pregnancy in a cesarean scar. DESIGN: Description of a case. SETTING: Case report of one patient. PATIENT(S): A 38-year-old women with three previous cesarean deliveries. INTERVENTION(S): Three-dimensional ultrasonography was performed for diagnosis and treatment. MAIN OUTCOME MEASURE(S): Local administration of methotrexate under ultrasonographic guidance. RESULT(S): Ultrasonographic study revealed a gestational sac in the anterior wall of the uterine isthmus with peritrophoblastic flow. It was treated conservatively and successfully with local methotrexate administration under ultrasonographic guidance. CONCLUSION(S): The early diagnosis of ectopic cesarean scar pregnancy allows the conservative treatment with local administration of methotrexate under ultrasonographic guidance.
Assuntos
Cesárea/efeitos adversos , Cicatriz/diagnóstico por imagem , Gravidez Ectópica/diagnóstico por imagem , Adulto , Feminino , Humanos , Gravidez , Ultrassonografia DopplerRESUMO
BACKGROUND: Traditionally, embryo transfer after IVF has been performed blindly and placing the embryos approximately 1 cm below the fundal endometrial surface. However, it has been suggested that transferring embryos rather lower in the uterine cavity or high in the uterus may improve implantation rates. Nevertheless, there has not yet been a controlled trial to prove this theory. This prospective randomized study investigates the influence of the depth of embryo replacement on the implantation rate after embryo transfer carried out under transabdominal ultrasound guidance. METHODS: A total of 180 consecutive patients undergoing ultrasound-guided embryo transfer were randomized to three study groups according to the distance between the tip of the catheter and the uterine fundus at the moment of the embryo deposition in the lumen of the endometrial cavity: group 1: 10 +/- 1.5 mm; group 2: 15 +/- 1.5 mm; group 3: 20 +/- 1.5 mm. RESULTS: There was equal distribution between all three study groups regarding the main demographic and baseline characteristics of the patients, ovarian response, oocyte retrieval and IVF outcome, as well as the characteristics of embryo transfer and luteal phase support. The position of the catheter tip in relation to the fundal endometrial surface in groups 1 (10.2 +/- 0.9 mm), 2 (14.6 +/- 0.7 mm) and 3 (19.3 +/- 0.8 mm) was significantly different. Implantation rate was significantly higher (P < 0.05) in groups 2 (31.3%) and 3 (33.3%) compared with group 1 (20.6%). CONCLUSIONS: The depth of the embryo replacement into the uterine cavity may influence implantation rates, and thus it should be considered as an additional procedure among factors recently proposed as associated with successful embryo transfer after IVF.