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Choi ES, Lee H, Lee SJ, Jung YM, Kim HY, Lee SM, Lee KA, Seol HJ, Ko HS, Na SH, Kwak DW, Hwang HS, Choi S, Hong SC, Won HS, Kim SY, Kim HJ, Ahn KH. Ultrasonographic assessment of abnormal fetal growth related to uteroplacental-fetal biometrics and Doppler (U-AID) indices: Protocol for multicenter retrospective cohort study trial. PLoS One 2024; 19:e0298060. [PMID: 38359058 PMCID: PMC10868764 DOI: 10.1371/journal.pone.0298060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 01/15/2024] [Indexed: 02/17/2024] Open
Abstract
Fetal growth restriction (FGR) is one of the leading causes of perinatal morbidity and mortality. Many studies have reported an association between FGR and fetal Doppler indices focusing on umbilical artery (UA), middle cerebral artery (MCA), and ductus venosus (DV). The uteroplacental-fetal circulation which affects the fetal growth consists of not only UA, MCA, and DV, but also umbilical vein (UV), placenta and uterus itself. Nevertheless, there is a paucity of large-scale cohort studies that have assessed the association between UV, uterine wall, and placental thickness with perinatal outcomes in FGR, in conjunction with all components of the uteroplacental-fetal circulation. Therefore, this multicenter study will evaluate the association among UV absolute flow, placental thickness, and uterine wall thickness and adverse perinatal outcome in FGR fetuses. This multicenter retrospective cohort study will include singleton pregnant women who undergo at least one routine fetal ultrasound scan during routine antepartum care. Pregnant women with fetuses having structural or chromosomal abnormalities will be excluded. The U-AID indices (UtA, UA, MCA, and UV flow, placental and uterine wall thickness, and estimated fetal body weight) will be measured during each trimester of pregnancy. The study population will be divided into two groups: (1) FGR group (pregnant women with FGR fetuses) and (2) control group (those with normal growth fetus). We will assess the association between U-AID indices and adverse perinatal outcomes in the FGR group and the difference in U-AID indices between the two groups.
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Affiliation(s)
- Eun-Saem Choi
- Department of Obstetrics and Gynecology, Korea University College of Medicine, Korea University Anam Hospital, Seoul, Korea
| | - Hwasun Lee
- Department of Biostatistics, Korea University College of Medicine, Seoul, Korea
| | - Se Jin Lee
- Department of Obstetrics and Gynecology, School of Medicine Kangwon National University, Chuncheon-si, Gangwon-Do, Korea
| | - Young Mi Jung
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Ho Yeon Kim
- Department of Obstetrics and Gynecology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Seung Mi Lee
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Kyung A. Lee
- Department of Obstetrics and Gynecology, Ewha Womans University School of Medicine, Seoul, Korea
| | - Hyun-Joo Seol
- Department of Obstetrics and Gynecology, Kyung Hee University School of Medicine, Seoul, Korea
| | - Hyun Sun Ko
- Department of Obstetrics and Gynecology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sung Hun Na
- Department of Obstetrics and Gynecology, School of Medicine Kangwon National University, Chuncheon-si, Gangwon-Do, Korea
| | - Dong Wook Kwak
- Department of Obstetrics and Gynecology, Ajou University School of Medicine, Suwon, Korea
| | - Han-Sung Hwang
- Department of Obstetrics and Gynecology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Sooran Choi
- Department of Obstetrics and Gynecology, College of Medicine, Inha University, Incheon, Korea
| | - Soon-Cheol Hong
- Department of Obstetrics and Gynecology, Korea University College of Medicine, Korea University Anam Hospital, Seoul, Korea
| | - Hye-Sung Won
- Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Suk Young Kim
- Department of Obstetrics and Gynecology, Gachon University Gil Hospital, Incheon, South Korea
| | - Hai-Joong Kim
- Department of Obstetrics and Gynecology, Kyung Hee University School of Medicine, Seoul, Korea
| | - Ki Hoon Ahn
- Department of Obstetrics and Gynecology, Korea University College of Medicine, Korea University Anam Hospital, Seoul, Korea
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de Souza LRMF, Cardia PP. The role of cine magnetic resonance imaging in the evaluation of uterine contractility in patients with deep infiltrating endometriosis. Radiol Bras 2023; 56:V. [PMID: 37564078 PMCID: PMC10411774 DOI: 10.1590/0100-3984.2023.56.3e1-en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/12/2023] Open
Affiliation(s)
- Luís Ronan Marquez Ferreira de Souza
- Associate Professor of Radiology at the Universidade Federal do Triângulo Mineiro, Coordinator of the Female Pelvic Imaging Sector of the Colégio Brasileiro de Radiologisa e Diagnóstico por Imagem.
| | - Patricia Prando Cardia
- Radiologist and Coordinator of the Program for Medical Residency and Improvement in Radiology at the Hospital Vera Cruz and the Hospital da Pontifícia Universidade Católica de Campinas.
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Zhang M, Bazot M, Tsatoumas M, Munro MG, Reinhold C. MRI of Adenomyosis: Where Are We Today? Can Assoc Radiol J 2023; 74:58-68. [PMID: 35856446 DOI: 10.1177/08465371221114197] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Purpose of Review: The purpose of this review is to (i) summarize the current literature regarding the role of magnetic resonance imaging (MRI) in diagnosing adenomyosis, (ii) examine how to integrate MRI phenotypes with clinical symptomatology and histological findings, (iii) review recent advances including proposed MRI classifications, (iv) discuss challenges and pitfalls of diagnosing adenomyosis, and (v) outline the future role of MRI in promoting a better understanding of the pathogenesis, diagnosis, and treatment options for patients with uterine adenomyosis. Recent Findings: Recent advances and the widespread use of MRI have provided new insights into adenomyosis and the range of imaging phenotypes encountered in this disorder. Summary: Direct and indirect MRI features allow for accurate non-invasive diagnosis of adenomyosis. Adenomyosis is a complex and poorly understood disorder with variable MRI phenotypes that may be correlated with different pathogeneses, clinical presentations, and patient outcomes. MRI is useful for the assessment of the extent of findings, to evaluate for concomitant gynecological conditions, and potentially can help with the selection and implementation of therapeutic options. Nevertheless, important gaps in knowledge remain. This is in part due to the lack of standardized criteria for reporting resulting in heterogeneous and conflicting data in the literature. Thus, there is an urgent need for a unified MRI reporting system incorporating standardized terminology for diagnosing adenomyosis and defining the various phenotypes.
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Affiliation(s)
- Michelle Zhang
- Department of Radiology, 54473McGill University Health Centre, Montreal, QC, Canada.,Montreal Imaging Experts Inc, Montreal, QC, Canada
| | - Marc Bazot
- Department of Radiology, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), 27063Sorbonne Université, Paris, France.,Groupe de Recherche Clinique (GRC-6), Centre Expert en Endométriose (C3E), Assistance Publique des Hôpitaux de Paris, Tenon University Hospital, 27063Sorbonne Université, Paris, France
| | - Maria Tsatoumas
- Department of Radiology, 54473McGill University Health Centre, Montreal, QC, Canada.,Montreal Imaging Experts Inc, Montreal, QC, Canada
| | - Malcolm G Munro
- Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.,Department of Obstetrics and Gynecology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA
| | - Caroline Reinhold
- Department of Radiology, 54473McGill University Health Centre, Montreal, QC, Canada.,Montreal Imaging Experts Inc, Montreal, QC, Canada.,Augmented Intelligence and Precision Health Laboratory of the Research Institute of McGill University Health Center, 54473McGill University, Montreal, QC, Canada
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Modulating Morphological and Redox/Glycative Alterations in the PCOS Uterus: Effects of Carnitines in PCOS Mice. Biomedicines 2023; 11:biomedicines11020374. [PMID: 36830911 PMCID: PMC9953026 DOI: 10.3390/biomedicines11020374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 01/23/2023] [Accepted: 01/23/2023] [Indexed: 01/31/2023] Open
Abstract
(1) Background: Polycystic ovarian syndrome (PCOS) is a common and multifactorial disease affecting reproductive-age women. Although PCOS ovarian and metabolic features have received extensive research, uterine dysfunction has been poorly investigated. This research aims to investigate morphological and molecular alterations in the PCOS uterus and search for modulating effects of different carnitine formulations. (2) Methods: CD1 mice were administered or not with dehydroepiandrosterone (DHEA, 6 mg/100 g body weight) for 20 days, alone or with 0.40 mg L-carnitine (LC) and 0.20 mg acetyl-L-carnitine (ALC) in the presence or absence of 0.08 mg propionyl-L-carnitine (PLC). Uterine horns from the four groups were subjected to histology, immunohistochemistry and immunoblotting analyses to evaluate their morphology, collagen deposition, autophagy and steroidogenesis. Oxidative-/methylglyoxal (MG)-dependent damage was investigated along with the effects on the mitochondria, SIRT1, SOD2, RAGE and GLO1 proteins. (3) Results: The PCOS uterus suffers from tissue and oxidative alterations associated with MG-AGE accumulation. LC-ALC administration alleviated PCOS uterine tissue alterations and molecular damage. The presence of PLC prevented fibrosis and maintained mitochondria content. (4) Conclusions: The present results provide evidence for oxidative and glycative damage as the main factors contributing to PCOS uterine alterations and include the uterus in the spectrum of action of carnitines on the PCOS phenotype.
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MRI of Adenomyosis: Where Are We Today? CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2022. [DOI: 10.1007/s13669-022-00342-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Hosseinzadeh P, Barsky M, Gibbons WE, Blesson CS. Polycystic Ovary Syndrome and the Forgotten Uterus. F&S REVIEWS 2021; 2:11-20. [PMID: 34423324 PMCID: PMC8378802 DOI: 10.1016/j.xfnr.2020.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Polycystic ovary syndrome (PCOS) is a common disorder that affects various facets of fertility. Although the ovarian and metabolic aspects of the disease is well studied, its role in uterine dysfunction is not well understood. Our objective was to review the features of endometrial and uterine aberrations in women with PCOS. A systematic literature search was performed in PubMed, Medline, and the Cochrane Library databases for papers published in English up to March 2020. The following key words were used for the search: polycystic ovary syndrome, poly cystic ovarian disease, polycystic ovaries, PCOS, PCOD, PCO, PCOM, oligoovulation, anovulation, oligomenorrhea, amenorrhea, hyperandrogenism and this was combined with terms; endometrium, infertility, uterus, progesterone resistance, endometrial hyperplasia, pregnancy outcomes, preterm delivery. In this review, we highlight various uterine pathologies that are associated with PCOS and explore its impact on fertility. We also discuss key uterine molecular pathways that are altered in PCOS that may be related to infertility, endometrial hyperplasia and cancer.
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Affiliation(s)
- Pardis Hosseinzadeh
- Division for Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas 77030
| | - Maya Barsky
- Division for Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas 77030
- Family Fertility Center, Texas Children’s Hospital, Houston, Texas 77030
| | - William E. Gibbons
- Division for Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas 77030
- Family Fertility Center, Texas Children’s Hospital, Houston, Texas 77030
| | - Chellakkan S. Blesson
- Division for Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas 77030
- Family Fertility Center, Texas Children’s Hospital, Houston, Texas 77030
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Maruyama S, Imanaka S, Nagayasu M, Kimura M, Kobayashi H. Relationship between adenomyosis and endometriosis; Different phenotypes of a single disease? Eur J Obstet Gynecol Reprod Biol 2020; 253:191-197. [PMID: 32877772 DOI: 10.1016/j.ejogrb.2020.08.019] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 08/10/2020] [Accepted: 08/21/2020] [Indexed: 02/07/2023]
Abstract
Adenomyosis and endometriosis are common gynecological disorders, but their pathophysiology is still under debate. The aim of this review is to discuss whether adenomyosis and endometriosis represent two different entities or different phenotypes of a single disease. We searched PubMed electronic databases published between January 2000 and April 2020. Endometriosis is classified into three phenotypes; superficial peritoneal disease (SUP), ovarian endometrioma (OMA) and deep infiltrating endometriosis (DIE) lesions. Adenomyosis presents several different subtypes, including intrinsic adenomyosis, extrinsic adenomyosis, adenomyosis externa and focal adenomyosis located in the outer myometrium (FAOM). Human uterus is embryologically composed of archimetra, originating from the Müllerian duct, and neometra, arising from the non-Müllerian duct, and adenomyosis and endometriosis are diseases of archimetra. The outer myometrial layer of the uterus is composed of highly differentiated smooth muscle cells (SMCs), while the inner myometrial cells are immature. Inappropriate uterine contractions can cause retrograde menstruation and chronic inflammation in the pelvic cavity, then influencing the development of pelvic endometriosis. Furthermore, hyperperistalsis results in physiological and pathological changes to the endometrial-myometrial junctional barrier, allowing invagination of the normal endometrial tissue into the inner myometrial layer. This can trigger the development of intrinsic adenomyosis. There are insufficient data available to draw conclusions, but extrinsic adenomyosis may result from pelvic endometriosis and FAOM from rectal and bladder DIE/adenomyosis externa. In conclusions, this paper contributes to the debate in the possibility that adenomyosis and endometriosis represent different phenotypes of a single disease.
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Affiliation(s)
- Sachiyo Maruyama
- Department of Obstetrics and Gynecology, Nara Medical University, Kashihara, 634-8522, Japan
| | - Shogo Imanaka
- Department of Obstetrics and Gynecology, Nara Medical University, Kashihara, 634-8522, Japan; Department of Gynecology and Infertility, Ms.Clinic MayOne, Kashihara, 634-0813, Japan
| | - Mika Nagayasu
- Department of Obstetrics and Gynecology, Nara Medical University, Kashihara, 634-8522, Japan
| | - Mai Kimura
- Department of Obstetrics and Gynecology, Nara Medical University, Kashihara, 634-8522, Japan
| | - Hiroshi Kobayashi
- Department of Obstetrics and Gynecology, Nara Medical University, Kashihara, 634-8522, Japan; Department of Gynecology and Infertility, Ms.Clinic MayOne, Kashihara, 634-0813, Japan.
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Konishi I. Diffuse Leiomyomatosis: Complete Myomectomy for Innumerable Small Nodules to Achieve Fertility Sparing and Childbearing. Surg J (N Y) 2020; 6:S50-S57. [PMID: 32399490 PMCID: PMC7214083 DOI: 10.1055/s-0039-1693709] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Diffuse leiomyomatosis is a rare condition among benign smooth muscle neoplasms of the uterus, being defined as innumerable small myomatous nodules that mainly occur in the submucosal area. Young women with this disease suffer from menorrhagia, pains, and infertility. It is essential to perform extensive myomectomy after opening the endometrial cavity by a deep, median, longitudinal incision of the uterine corpus, followed by careful suture and reconstruction of the uterus for fertility spearing and childbearing in young women with this disease. So far, there have been no experiences of the uterine rupture during pregnancy even after such myomectomy, but Caesarean section is recommended for safe delivery.
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Affiliation(s)
- Ikuo Konishi
- National Hospital Organization, Kyoto Medical Center, Kyoto, Japan
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Nakashima A, Komesu I, Sakumoto T, Hamakawa H, Terada Y, Takayama H, Kamiyama S, Higashi M, Ishigaki K, Nakaza A, Ushijima K, Tokunaga Y. Study of uterine kinetics in nonpregnant women using cine-mode magnetic resonance imaging. Reprod Med Biol 2019; 18:370-377. [PMID: 31607797 PMCID: PMC6780040 DOI: 10.1002/rmb2.12295] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 07/26/2019] [Accepted: 07/29/2019] [Indexed: 11/07/2022] Open
Abstract
PURPOSE To evaluate the uterine kinetics in each phase of the menstrual cycle when observed in detail using cine-mode magnetic resonance imaging (MRI) of sagittal and transverse plane images. METHODS Seven volunteers with a history of multiple natural pregnancies and deliveries were enrolled from January 2017 to May 2017. The kinetic parameters (depth, frequency, and direction) of uterine muscle contractions were evaluated in cine-mode MRI. RESULTS Strong contractions from the uterine cornua to cervix were detected during menstruation. In the late follicular phase, the frequency of opposing contractions from the cervix and uterine cornua increased. Immediately before ovulation, contractions from the cervix reached the uterine fundus. After ovulation, opposing contractions returned. These contractions gradually decreased in the mid-luteal phase, while fine contractions from the cervix to the middle of the uterine body were frequently observed until 7 days after ovulation. Few contractions were observed in the implantation phase. CONCLUSIONS Our data suggest that the uterine kinetics change in each phase of the menstrual cycle in accordance with the purpose of the uterus in each phase. Further, cine-mode MRI studies of each phase are needed to assess the relationships between uterine kinetics and infertility.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Kimio Ushijima
- Department of Obstetrics and GynecologyKurume University of MedicineFukuokaJapan
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Qu Y, Xiao Z, Liu L, Lv F, Sheng B, Li J. Uterine Peristalsis Before and After Ultrasound-Guided High-Intensify Focused Ultrasound (USgHIFU) Treatment for Symptomatic Uterine Fibroids. Med Sci Monit 2019; 25:2553-2560. [PMID: 30955023 PMCID: PMC6698095 DOI: 10.12659/msm.913392] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background This study investigated uterine peristalsis before and after ultrasound-guided high-intensify focused ultrasound (USgHIFU) treatment for symptomatic uterine fibroids by cine magnetic resonance imaging (cine MRI). Material/Methods A total of 30 patients with symptomatic uterine fibroids were treated by USgHIFU, who were subjected to cine MRI before and after USgHIFU treatment in the periovulatory phase. The images were analyzed for the existence, direction, and frequency of uterine peristalsis. The effects of uterine volume, the largest fibroid volume and location, and the fibroid number were examined before and after USgHIFU treatment. Results The incidence of uterine peristalsis was significantly increased after USgHIFU treatment. The main direction of uterine peristalsis before and after USgHIFU was cervix-to-fundus. In 12 cases, uterine peristalsis newly emerged after USgHIFU, and the largest fibroid volumes in these 12 cases were significantly smaller than in the remaining 18 cases before and after USgHIFU. The reduction rates of the largest fibroid volume in the 12 cases were significantly higher than in the remaining 18 cases. The largest fibroids were mainly located in the intramural area before and after USgHIFU. Conclusions USgHIFU treatment may contribute to the recovery of uterine peristalsis in patients with symptomatic fibroids, as detected by cine MRI. Uterine peristalsis recovery was related to the largest fibroid volume, especially for intramural fibroids.
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Affiliation(s)
- Yalin Qu
- Department of Radiology, Chongqing Dazu District People's Hospital, Chongqing, China (mainland)
| | - Zhibo Xiao
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China (mainland)
| | - Liuheng Liu
- Department of Radiology, Chongqing Traditional Chinese Medicine Hospital, Chongqing, China (mainland)
| | - Furong Lv
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China (mainland)
| | - Bo Sheng
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China (mainland)
| | - Jia Li
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China (mainland)
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