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Liu Y, Zhou Q, Peng B, Jiang J, Fang L, Weng W, Wang W, Wang S, Zhu X. Automatic Measurement of Endometrial Thickness From Transvaginal Ultrasound Images. Front Bioeng Biotechnol 2022; 10:853845. [PMID: 35425763 PMCID: PMC9001908 DOI: 10.3389/fbioe.2022.853845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 02/21/2022] [Indexed: 11/25/2022] Open
Abstract
Purpose: Endometrial thickness is one of the most important indicators in endometrial disease screening and diagnosis. Herein, we propose a method for automated measurement of endometrial thickness from transvaginal ultrasound images. Methods: Accurate automated measurement of endometrial thickness relies on endometrium segmentation from transvaginal ultrasound images that usually have ambiguous boundaries and heterogeneous textures. Therefore, a two-step method was developed for automated measurement of endometrial thickness. First, a semantic segmentation method was developed based on deep learning, to segment the endometrium from 2D transvaginal ultrasound images. Second, we estimated endometrial thickness from the segmented results, using a largest inscribed circle searching method. Overall, 8,119 images (size: 852 × 1136 pixels) from 467 cases were used to train and validate the proposed method. Results: We achieved an average Dice coefficient of 0.82 for endometrium segmentation using a validation dataset of 1,059 images from 71 cases. With validation using 3,210 images from 214 cases, 89.3% of endometrial thickness errors were within the clinically accepted range of ±2 mm. Conclusion: Endometrial thickness can be automatically and accurately estimated from transvaginal ultrasound images for clinical screening and diagnosis.
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Affiliation(s)
- Yiyang Liu
- Biomedical Information Engineering Lab, The University of Aizu, Aizuwakamatsu, Japan
| | - Qin Zhou
- Department of Obstetrics and Gynecology, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Boyuan Peng
- Biomedical Information Engineering Lab, The University of Aizu, Aizuwakamatsu, Japan
| | - Jingjing Jiang
- Department of Obstetrics and Gynecology, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Li Fang
- Department of Obstetrics and Gynecology, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Weihao Weng
- Biomedical Information Engineering Lab, The University of Aizu, Aizuwakamatsu, Japan
| | - Wenwen Wang
- Department of Obstetrics and Gynecology, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
- *Correspondence: Wenwen Wang, ; Shixuan Wang, ; Xin Zhu,
| | - Shixuan Wang
- Department of Obstetrics and Gynecology, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
- *Correspondence: Wenwen Wang, ; Shixuan Wang, ; Xin Zhu,
| | - Xin Zhu
- Biomedical Information Engineering Lab, The University of Aizu, Aizuwakamatsu, Japan
- *Correspondence: Wenwen Wang, ; Shixuan Wang, ; Xin Zhu,
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Amreen S, Choh NA, Yaseen Y, Lyn Saldanha C, Singh M, Gojwari TA, Shaheen F, Robbani I, Riaz Rasool S. Unravelling the endometrium: a pictorial review of saline infusion sonohysterography in the evaluation of abnormal uterine bleeding. BIONATURA 2019. [DOI: 10.21931/rb/2019.04.01.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
This article describes the diagnosis of causes of abnormal uterine bleeding with experience of the biggest medical institute in Kashmir, India. We work in a low resource setting where unavailabity of hysteroscopy made us acknowledge the accuracy and efficacy of saline infusion sonohysterography in diagnosis of patients with AUB thus helping guide their management.
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Affiliation(s)
- Saika Amreen
- Sher-I-Kashmir Institute of Medical Sciences. Soura. India
| | - Naseer A Choh
- Sher-I-Kashmir Institute of Medical Sciences. Soura. India
| | - Yawar Yaseen
- Sher-I-Kashmir Institute of Medical Sciences. Soura. India
| | | | - Manjeet Singh
- Sher-I-Kashmir Institute of Medical Sciences. Soura. India
| | | | - Feroze Shaheen
- Sher-I-Kashmir Institute of Medical Sciences. Soura. India
| | - Irfan Robbani
- Sher-I-Kashmir Institute of Medical Sciences. Soura. India
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Cogendez E, Eken MK, Bakal N, Gun I, Kaygusuz EI, Karateke A. The role of transvaginal power Doppler ultrasound in the differential diagnosis of benign intrauterine focal lesions. J Med Ultrason (2001) 2015; 42:533-40. [PMID: 26576978 DOI: 10.1007/s10396-015-0628-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 03/25/2015] [Indexed: 11/24/2022]
Abstract
PURPOSE The purpose of this prospective study was to assess the role of power Doppler imaging in the differential diagnosis of benign intrauterine focal lesions such as endometrial polyps and submucous myomas using the characteristics of power Doppler flow mapping. METHODS A total of 480 premenopausal patients with abnormal uterine bleeding were evaluated by transvaginal ultrasonography (TVS) searching for intrauterine pathology. Sixty-four patients with a suspicious focal endometrial lesion received saline infusion sonography (SIS) after TVS. Fifty-eight patients with focal endometrial lesions underwent power Doppler ultrasound (PDUS). Three different vascular flow patterns were defined: Single vessel pattern, multiple vessel pattern, and circular flow pattern. Finally, hysteroscopic resection was performed in all cases, and Doppler flow characteristics were then compared with the final histopathological findings. RESULTS Histopathological results were as follows: endometrial polyp: 40 (69 %), submucous myoma: 18 (31 %). Of the cases with endometrial polyps, 80 % demonstrated a single vessel pattern, 7.5 % a multiple vessel pattern, and 0 % a circular pattern. Vascularization was not observed in 12.5 % of patients with polyps. Of the cases with submucousal myomas, 72.2 % demonstrated a circular flow pattern, 27.8 % a multiple vessel pattern, and none of them showed a single vessel pattern. The sensitivity, specificity, and positive and negative predictive values of the single vessel pattern in diagnosing endometrial polyps were 80, 100, 100, and 69.2 %, respectively; and for the circular pattern in diagnosing submucous myoma, these were 72.2, 100, 100, and 88.9 %, respectively. CONCLUSION Power Doppler blood flow mapping is a useful, practical, and noninvasive diagnostic method for the differential diagnosis of benign intrauterine focal lesions. Especially in cases of recurrent abnormal uterine bleeding, recurrent abortion, and infertility, PDUS can be preferred as a first-line diagnostic method.
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Affiliation(s)
- Ebru Cogendez
- Gynecology Department, Zeynep Kamil Women and Children's Diseases Training and Research Hospital, Istanbul, Turkey.
| | - Meryem Kurek Eken
- Gynecology Department, Zeynep Kamil Women and Children's Diseases Training and Research Hospital, Istanbul, Turkey
| | - Nuray Bakal
- Radiology Department, Zeynep Kamil Women and Children's Diseases Training and Research Hospital, Istanbul, Turkey
| | - Ismet Gun
- Gynecology Department, GATA Haydarpasa Training Hospital, Istanbul, Turkey
| | - Ecmel Isik Kaygusuz
- Pathology Department, Zeynep Kamil Women and Children's Diseases Training and Research Hospital, Istanbul, Turkey
| | - Ates Karateke
- Gynecology Department, Zeynep Kamil Women and Children's Diseases Training and Research Hospital, Istanbul, Turkey
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Bhaduri M, Tomlinson G, Glanc P. Likelihood ratio of sonohysterographic findings for discriminating endometrial polyps from submucosal fibroids. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2014; 33:149-154. [PMID: 24371110 DOI: 10.7863/ultra.33.1.149] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVES The purpose of this study was to determine which combination of sonohysterographic features has the highest likelihood ratios (LRs) in discriminating polyps from submucosal fibroids. METHODS This retrospective study included 200 consecutive patients who underwent both sonohysterography and a procedure resulting in a positive pathologic diagnosis. A reader, masked to the imaging and pathologic findings, independently reviewed the 200 sonograms and recorded the findings using a standardized checklist for sonographic features on sonohysterography. The features assessed included angle, echogenicity, endometrial-myometrial interface, and vascular pattern, among others. The reader chose one final diagnosis from the list of possibilities, which included normal, hyperplasia, polyp, submucosal fibroid, cancer, adhesions, and clots. Sonographic observations were then compared to pathologic findings. RESULTS The LR of 13.4 was achieved for polyps when there was a combination of an intact endometrial-myometrial interface, a single vessel, an acute angle, and homogeneous echogenicity. The highest LR of 27.8 was achieved for submucosal fibroids when the combination of sonographic features included an absent endometrial-myometrial interface, an arborized/multiple vascular pattern, an obtuse angle, and heterogeneous echogenicity. CONCLUSIONS A combination of sonographic findings may provide high LRs for discriminating endometrial polyps from submucosal fibroids.
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Affiliation(s)
- Mousumi Bhaduri
- MBDNB, DABR, Department of Medical Imaging Schulich School of Medicine and Dentistry, University of Western Ontario, London Health Sciences Center-Victoria Hospital, 800 Commissioners Rd E, Room D1-106, London, ON N6A 5W9, Canada.
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Ahmadi F, Javam M. Role of 3D sonohysterography in the investigation of uterine synechiae/asherman's syndrome: pictorial assay. J Med Imaging Radiat Oncol 2013; 58:199-202. [PMID: 24314038 DOI: 10.1111/1754-9485.12137] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Accepted: 10/22/2013] [Indexed: 11/30/2022]
Abstract
Several imaging methods have been applied for evaluation of suspected uterine synechiae; however, sonohysterography is yet recognised as a valid and accurate modality. Performing three-dimensional (3D) imaging along with sonohysterography enables evaluation of the uterus in the coronal plane to detect and grade the adhesions that characterise this condition. Thus, 3D sonohysterography is a minimally invasive and cost-effective tool for investigating suspected synechiae and is particularly useful when the transvaginal sonography findings are normal.
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Affiliation(s)
- Firoozeh Ahmadi
- Department of Reproductive Imaging at Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
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El Sheikh H, Atwa K, Sammour MA. Sonohysterography for evaluation of endometrial abnormalities associated with tamoxifen therapy for breast cancer. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2013. [DOI: 10.1016/j.ejrnm.2013.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Di Spiezio Sardo A, Bettocchi S, Spinelli M, Guida M, Nappi L, Angioni S, Sosa Fernandez LM, Nappi C. Review of new office-based hysteroscopic procedures 2003-2009. J Minim Invasive Gynecol 2010; 17:436-48. [PMID: 20621007 DOI: 10.1016/j.jmig.2010.03.014] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2009] [Revised: 03/09/2010] [Accepted: 03/12/2010] [Indexed: 11/30/2022]
Abstract
Office operative hysteroscopy is a recent technique that enables treatment of uterine pathologic disorders in the ambulatory setting using miniaturized hysteroscopes with mechanical or electric instruments. The available international literature from 1990 to 2002 has clearly demonstrated that such technique enables performance of hysteroscopically directed endometrial biopsy and treatment of uterine adhesions, anatomic disorders, polyps, and small myomas safely and successfully without cervical dilation and the need for anesthesia. This review provides a comprehensive survey of further advancements of office operative hysteroscopy in the treatment of other gynecologic pathologic conditions that have not been included in the schema of treatment indications for office procedures proposed in 2002. A search of MEDLINE, EMBASE, and the Cochrane Database of Systematic Reviews identified articles published from 2003 to 2009. Eighteen articles were identified: 9 on hysteroscopic sterilization; 1 on office-based metroplasty, 8 on office-based treatment of some uncommon gynecologic pathologic conditions (e.g., hematometra, diagnosis and treatment of vaginal lesions, treatment of uterine cystic neoformations, bleeding from the cervical stump, diagnosis and treatment of endocervical ossification, and removal of uterovaginal packing). All performed procedures were carried out safely and successfully in the office setting, with high patient tolerance and minimal discomfort. The success of the procedures has been confirmed by resolution of symptoms and at follow-up ultrasonographic and hysteroscopic examinations. Currently, as a result of technologic advancements and increased operator experience, an increasing number of gynecologic pathologic conditions traditionally treated in the operating room may be treated safely and effectively using office operative hysteroscopy.
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Affiliation(s)
- Attilio Di Spiezio Sardo
- Department of Gynaecology and Obstetrics, and Pathophysiology of Human Reproduction, University of Naples Federico II, Naples, Italy.
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de Ziegler D. Contrast ultrasound: a simple-to-use phase-shifting medium offers saline infusion sonography–like images. Fertil Steril 2009; 92:369-73. [DOI: 10.1016/j.fertnstert.2008.04.032] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2007] [Revised: 04/15/2008] [Accepted: 04/15/2008] [Indexed: 10/21/2022]
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Transvaginal sonography, sonohysterography, and hysteroscopy for investigation of focal intrauterine lesions in women with recurrent postmenopausal bleeding after dilatation & curettage. Arch Gynecol Obstet 2009; 281:637-43. [DOI: 10.1007/s00404-009-1150-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2009] [Accepted: 06/02/2009] [Indexed: 10/20/2022]
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Kitajima K, Imanaka K, Kuwata Y, Hashimoto K, Sugimura K. Magnetic Resonance Imaging of Typical Polypoid Adenomyoma of the Uterus in 8 Patients. J Comput Assist Tomogr 2007; 31:463-8. [PMID: 17538297 DOI: 10.1097/01.rct.0000243447.03116.0c] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To study the magnetic resonance imaging findings of typical polypoid adenomyoma and correlate radiological findings with histopathologic findings. METHODS Magnetic resonance imaging and histopathologic findings were retrospectively reviewed in 8 patients. The size, location, polyp's shape, and signal intensity of magnetic resonance imaging findings were evaluated. RESULTS The polyp's shape of 8 cases is pedunculated in 7 and sessile in 1, and all 8 cases are well circumscribed. Four cases (50%) show an isointense mass relative to the myometrium with small or large hyperintense foci on T1-weighted imaging (T1WI) or T2-weighted imaging (T2WI), reflecting the fascicle of smooth muscle with islands of hemorrhagic endometrial tissue. One case forms a large hemorrhagic cavity, being hyperintense on T1WI and hypointense on T2WI. Three cases (37%) show almost homogeneous isointense or hyperintense mass on T2WI. CONCLUSIONS When there is a well-defined polypoid mass protrusion into the uterine endometrial cavity that is isointense relative to the myometrium with small or large foci of high signal on T1WI or T2WI in a premenopausal woman, typical polypoid adenomyoma can be considered in the differential diagnosis.
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Meng K, Branam JD, Nghiem HV, Carlos RC. The short-term clinical outcomes after saline infusion sonohysterography in women with postmenopausal bleeding. Acad Radiol 2005; 12:136-41. [PMID: 15721589 DOI: 10.1016/j.acra.2004.11.028] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2004] [Revised: 11/08/2004] [Accepted: 11/08/2004] [Indexed: 11/25/2022]
Abstract
RATIONALE AND OBJECTIVE To describe the short-term clinical outcomes of women with postmenopausal bleeding (PMB) who underwent saline-infused sonohysterography (SIS) and the impact of SIS results on clinical management. MATERIALS AND METHODS A retrospective review of the Radiology Information Systems database identified 786 women who underwent SIS between February 1998 and October 2002. Of this group, 144 women (mean age, 60; range, 42-83) presented with PMB. The following clinical data were extracted from the electronic medical record: date of birth, hormone replacement therapy (HRT) status, SIS results, and clinical management before and after the SIS procedure. We categorized post-SIS clinical management into three categories: additional diagnostic or therapeutic procedure performed; HRT change or addition; or no change in clinical management. Between-group comparisons were performed using a chi2 test. RESULTS Of the 144 women with postmenopausal bleeding who underwent SIS, 119 (82.6%) successfully completed the SIS. Eighty women (67.2%) had a positive SIS exam. Abnormalities detected including polyps (n = 42); submucosal fibroids (n = 6); endometrial thickening (n = 8); a combination of 2 or more of the above (n = 7), or other abnormalities (debris, adenomyosis, or indeterminate findings, n = 17). Of the women with a positive SIS exam, 58% received subsequent diagnostic/therapeutic procedures compared to 5% of women who had a negative SIS (P < 0.001). Conversely, 59% of women with a negative SIS had no change in clinical management compared to 17.5% who had a positive SIS (P < 0.001). CONCLUSION The trend in short-term clinical management is to pursue more aggressive subsequent diagnostic or treatment procedures if findings are positive on SIS. A negative SIS exam was associated with more conservative management.
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Affiliation(s)
- Kenneth Meng
- Department of Radiology, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI 48109-0030, USA
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Lee EJ, Han JH, Ryu HS. Polypoid adenomyomas: sonohysterographic and color Doppler findings with histopathologic correlation. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2004; 23:1421-1431. [PMID: 15498906 DOI: 10.7863/jum.2004.23.11.1421] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
OBJECTIVE This study was undertaken to describe the sonographic features of polypoid adenomyomas of the uterus and to determine the diagnostic role of sonohysterography and color Doppler sonography in the evaluation of these lesions. METHODS The sonographic findings for 46 histologically proved cases of polypoid adenomyomas of the uterus, accumulated over 10 years, were reviewed retrospectively. The pathologic diagnoses included typical polypoid adenomyoma (n = 36), atypical polypoid adenomyoma (n = 7), and low-grade adenosarcoma arising in polypoid adenomyoma (n = 3). RESULTS Of 46 total uterine tumors, 31 were in the corpus, 12 were in the fundus, and 3 were in the isthmus. The mean tumor size was 3.5 cm (range, 0.5-9 cm). The tumors were polypoid in 30 cases, pedunculated in 11 cases, and sessile in the remaining 5 cases. Of the pedunculated tumors, 5 protruded into the endocervical canal and 2 had prolapsed into the vagina. Three distinct sonographic patterns were identified with respect to the presence of cystic areas: a solid mass (pattern 1) in 12 cases, a solid mass with cystic areas (pattern 2) in 32 cases, and a predominantly cystic mass (pattern 3) in 2 cases. The characteristic sonographic features of polypoid adenomyomas included heterogeneous or homogeneous isoechogenicity relative to the myometrium, a smooth surface, a poorly defined margin with the underlying myometrium, hemorrhagic foci, posterior shadowing, a single vascular pedicle entering the mass, and associated adenomyosis in the myometrium. CONCLUSIONS Knowledge of the sonographic appearance of polypoid adenomyomas may facilitate diagnosis and may help distinguish these tumors from other polypoid uterine tumors.
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Affiliation(s)
- Eun Ju Lee
- Department of Radiology, Ajou University Medical Center, San 5, Wonchon-dong, Yeongtong-gu, Suwon 443-721, South Korea.
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Guven MA, Bese T, Demirkiran F, Idil M, Mgoyi L. Hydrosonography in screening for intracavitary pathology in infertile women. Int J Gynaecol Obstet 2004; 86:377-83. [PMID: 15325856 DOI: 10.1016/j.ijgo.2004.05.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2004] [Revised: 05/07/2004] [Accepted: 05/10/2004] [Indexed: 11/28/2022]
Abstract
OBJECTIVES We evaluated the value of hydrosonography in screening for intracavitary pathologies in infertile patients. METHODS A total of 93 infertile women with suspected intracavitary lesions on transvaginal ultrasonography (TVS) underwent hydrosonography. Specimens obtained either by dilatation and curettage or hysteroscopic resection were compared with findings on TVS and hydrosonography. RESULTS Pathology confirmed the presence of sonographically diagnosed intracavitary lesions in 40 out of 66 (60%) women. The sensitivity, specificity, positive predictive value, and negative predictive value of TVS for the detection of endometrial cavity lesions were 78%, 38%, 61%, and 59%, respectively. Forty-six out of 71 (65%) women who were found to have intracavitary lesions on hydrosonography were pathologically confirmed. The sensitivity, specificity, positive and negative predictive value of hydrosonography in the detection of endometrial cavity lesions were 90%, 40%, 65%, and 77%, respectively. CONCLUSIONS Hydrosonography is a useful procedure in screening for intracavitary pathologies and allows differentiation of intracavitary, endometrial, and submucosal abnormalities.
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Affiliation(s)
- M A Guven
- Department of Obstetrics and Gynecology, Kahramanmaraş Sütcüimam University, Faculty of Medicine, Kahramanmaras, Turkey.
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Guven MA, Bese T, Demirkiran F. Comparison of hydrosonography and transvaginal ultrasonography in the detection of intracavitary pathologies in women with abnormal uterine bleeding. Int J Gynecol Cancer 2004; 14:57-63. [PMID: 14764030 DOI: 10.1111/j.1048-891x.2004.14105.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND The aim of the study was to compare the accuracy of hydrosonography with that of transvaginal ultrasonography in detection of intracavitary pathologies in patients with history of abnormal uterine bleeding. STUDY DESIGN Prospective, randomized, and unblinded study. MATERIAL AND METHODS A total of 197 women (n = 130 premenopausal and n = 67 postmenopausal) aged between 23 and 71 years (mean age 45.7 +/- 8.9) presenting with a history of abnormal uterine bleeding were included into the study. Hydrosonography was carried out by experienced gynecologists, on the same setting in an outpatient clinic immediately after the performance of transvaginal sonography. The finally obtained surgical-pathologic findings were compared with the results obtained from transvaginal sonography and hydrosonography. Sensitivity, specificity, positive, and negative predictive values were calculated for each procedure. RESULTS The surgical-pathologic examination confirmed normal physiologic endometrium in 50 (48%) of 104 women who were said to have normal endometrium on transvaginal sonography. Seventy (75%) of 93 women diagnosed of intracavitary pathologies on transvaginal sonography were confirmed by surgical-pathologic findings. The sensitivity, specificity, positive predictive value, and negative predictive value of transvaginal sonography in the detection of intracavitary pathology were 56, 68, 75, and 48%, respectively. Surgical-pathologic results revealed intracavitary pathologies in 23 (30%) of 76 women who were said to have normal endometrium on hydrosonography. Among 121 women diagnosed of intracavitary pathologies on hydrosonography, 101 (81%) women were confirmed after histological evaluation of the surgical specimens. The sensitivity, specificity, positive predictive value, and negative predictive value of hydrosonography in the detection of intracavitary pathology were 81, 73, 83, and 70%, respectively. Sensitivity and negative predictive value were significantly higher with hydrosonography. There were five cases of endometrial malignancy in which one of the case of malignancy was on polyp and two cases of endometrial hyperplasia with atypia which were not stated on sonographic results. CONCLUSION Hydrosonography is more accurate than transvaginal ultrasography in the detection of intracavitary pathologies in women with abnormal uterine bleeding.
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Affiliation(s)
- M A Guven
- Department of Obstetrics and Gynecology, Faculty of Medicine, Kahramanmaras Sutcuimam University, Kahramanmaras, Turkey
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Berridge DL, Winter TC. Saline infusion sonohysterography: technique, indications, and imaging findings. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2004; 23:97-115. [PMID: 14756358 DOI: 10.7863/jum.2004.23.1.97] [Citation(s) in RCA: 127] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
OBJECTIVE To review the technique, indications, and common imaging findings regarding saline infusion sonohysterography. METHODS The literature on saline infusion sonohysterography was reviewed. Pertinent images from our institution are presented to illustrate common imaging findings. RESULTS From the literature review, we summarize the various clinical scenarios in which saline infusion sonohysterography is useful and give examples from our clinical practice. CONCLUSIONS Saline infusion sonohysterography is a useful procedure for evaluation of endometrial and subendometrial abnormalities.
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Affiliation(s)
- Debra L Berridge
- Department of Radiology, Abdominal Imaging, University of Wisconsin Hospitals and Clinics, Madison, Wisconsin 53792, USA
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Nass Duce M, Oz U, Ozer C, Yildiz A, Apaydin FD, Cil F. Diagnostic value of sonohysterography in the evaluation of submucosal fibroids and endometrial polyps. Aust N Z J Obstet Gynaecol 2003; 43:448-52. [PMID: 14712949 DOI: 10.1046/j.0004-8666.2003.00129.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
AIMS To evaluate the diagnostic value of sonohysterography in the evaluation of submucosal fibroids and endometrial polyps. METHODS Thirty-two women whose preliminary transvaginal ultrasound suggested endometrial abnormality underwent sonohysterography. The findings were then compared with histopathological results. RESULTS The sonohysterographic diagnosis was fibroid in seven patients, endometrial polyp in 23 patients and simple hyperplasia in two patients. Histopathological findings confirmed our diagnosis in all except three patients with endometrial polyps, who had normal secretory endometrium. Sonohysterography was found to have a sensitivity of 100%, a positive predictive value of 90% and diagnostic accuracy of 90.6%. CONCLUSION Sonohysterography is a useful, minimally invasive and accurate technique to evaluate the pathologies involving endometrium and uterine cavity.
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Affiliation(s)
- Meltem Nass Duce
- Department of Radiology, Faculty of Medicine, Mersin University, Mersin, Turkey.
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Fong K, Causer P, Atri M, Lytwyn A, Kung R. Transvaginal US and hysterosonography in postmenopausal women with breast cancer receiving tamoxifen: correlation with hysteroscopy and pathologic study. Radiographics 2003; 23:137-50; discussion 151-5. [PMID: 12533649 DOI: 10.1148/rg.231025048] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Tamoxifen citrate therapy increases the prevalence of benign and malignant uterine lesions. At transvaginal ultrasonography (US), the finding of a thickened central endometrial complex, with or without cystic changes, is often nonspecific and may be caused by an endometrial polyp, submucosal leiomyoma (fibroid), endometrial hyperplasia, carcinoma, or cystic atrophy. In addition, because of an increased prevalence of adenomyosis or adenomyosis-like changes in women receiving tamoxifen, proper transvaginal US assessment of endometrial thickness and abnormalities is difficult in some women. Hysterosonography, as an adjunct to transvaginal US, allows identification of intracavitary lesions and focal and diffuse endometrial abnormalities and helps determine whether an abnormality is endometrial or subendometrial. Endometrial polyps may be seen at transvaginal US as nonspecific thickening of the endometrial complex, with or without cystic changes. At hysterosonography, they appear as an echogenic mass with smooth margins. Submucosal leiomyomas may protrude into the endometrial cavity, causing false endometrial thickening at transvaginal US. Hysterosonography shows a round structure arising from the myometrium with a thin, overlying endometrium. At transvaginal US, when the endometrium cannot be accurately measured or when there is a nonspecific thickened central endometrial complex, hysterosonography can provide additional information and can help in the triage for hysteroscopic versus nondirected endometrial biopsy. Correlation of transvaginal US and hysterosonographic findings with hysteroscopic and pathologic findings enhances understanding of these changes, as well as the limitations and potential pitfalls of both imaging techniques.
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Affiliation(s)
- Katherine Fong
- Department of Medical Imaging, Sunnybrook and Women's College Health Sciences Centre, University of Toronto, Ontario, Canada
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18
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Jorizzo JR, Chen MYM, Martin D, Dyer RB, Weber TM. Spectrum of endometrial hyperplasia and its mimics on saline hysterosonography. AJR Am J Roentgenol 2002; 179:385-9. [PMID: 12130438 DOI: 10.2214/ajr.179.2.1790385] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Johanna R Jorizzo
- Department of Radiology, Wake Forest University School of Medicine, Winston-Salem, NC 27157-1088, USA
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19
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Abstract
Although ultrasound (US) is the primary imaging modality of choice in the radiologic evaluation of the female patient with acute pelvic pain, the role of computed tomography (CT) in the evaluation of abdominal and pelvic pain continues to expand. CT may be performed if a gynecologic disorder is not initially suspected, if US findings are equivocal, or if the abnormality extends beyond the field of view achievable with the endovaginal probe and further characterization of pelvic disease is required. Many gynecologic disorders that cause acute pelvic pain (eg, uterine disorders, ovarian disorders, endometriosis, pelvic inflammatory disease, postoperative or postpartum complications) demonstrate characteristic CT findings. Familiarity with these CT appearances is important: It will allow the radiologist to guide appropriate treatment of affected patients and may eliminate the need for further imaging evaluation.
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Affiliation(s)
- Genevieve L Bennett
- Department of Radiology, New York University Medical Center, 560 First Ave, Tisch Hospital Rm HW202, New York 10016, USA.
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20
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Risk of Dissemination of Malignant Cells into the Peritoneal Cavity during Sonohysterography and Attendant Risk ofWorsening Prognosis. ACTA ACUST UNITED AC 2002. [DOI: 10.1097/00130747-200205000-00001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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21
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Kraus PA, Boston RJ. Saline infusion sonohysterogram as initial investigation of the endometrium and uterine cavity. Aust N Z J Obstet Gynaecol 2001; 41:433-5. [PMID: 11787920 DOI: 10.1111/j.1479-828x.2001.tb01324.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The results of 54 consecutive saline infusion sonohysterograms (SIS) are presented. Sonohysterogram, in conjunction with Pipelle endometrial sampling, was found to be a reliable and accurate method of initial investigation of the endometrium and uterine cavity with good correlation with other methods of investigation. It was well tolerated in an outpatient setting, saved two out of three of the women from needing a hysteroscopy and curettage, and yielded information beyond that available from hysteroscopy and curettage.
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Affiliation(s)
- P A Kraus
- Kirwan Hospital for Women, Townsville, Queensland, Australia
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22
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Abstract
The pursuit of endometrial histology is often prompted by postmenopausal or dysfunctional endometrial bleeding, a pathologically-thickened central endometrial complex on ultrasound, infertility, or routine screening caused by risk factors for underlying pathology. If a focal endoluminal process is responsible, it can remain undiagnosed when a blind method of biopsy is used. Transvaginal ultrasound coupled with hysterosonography can provide the necessary information to triage these patients to the most appropriate tissue sampling technique and avoid the common problem of a false-negative biopsy result. In many circumstances, a focal process can be more specifically characterized and localized during hysterosonography, information which could also help direct subsequent hysteroscopic biopsy if needed.
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Affiliation(s)
- K M Dudiak
- Department of Radiology, Mayo Medical Center, Rochester, Minnesota 55905, USA.
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23
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Abstract
For most women, pelvic sonography using a transvaginal probe is the imaging modality of choice for evaluating the uterus and adnexae. It is reliable for detecting ovarian cysts and other adnexal masses, and it can often determine if a lesion can be observed on serial examinations or if it requires more urgent attention. Uterine ultrasound is reliable for evaluating both the normal and abnormal endometrium and myometrium. In cases that are technically limited, or in those that are difficult to interpret, a tailored MR imaging examination often can be helpful.
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Affiliation(s)
- F C Laing
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA.
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24
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Affiliation(s)
- J R Jorizzo
- Department of Radiology, Wake Forest University School of Medicine, Medical Center Blvd., Winston-Salem, NC 27157-1088, USA
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