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AIUM Practice Parameter for the Performance of Ultrasound of the Female Pelvis, 2024 Revision. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2024. [PMID: 39158217 DOI: 10.1002/jum.16556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2024] [Accepted: 08/07/2024] [Indexed: 08/20/2024]
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Barrios-López M, Sánchez-Bernal S, Julián Gómez E, Galante MJ, Herrán de la Gala D, González-Sánchez FJ, Fernández-Flórez A, Barba-Arce A, González-Carreró C. Postpartum obstetric complications: a guide for radiologists. Abdom Radiol (NY) 2024:10.1007/s00261-024-04445-y. [PMID: 39088017 DOI: 10.1007/s00261-024-04445-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Revised: 06/03/2024] [Accepted: 06/07/2024] [Indexed: 08/02/2024]
Abstract
The puerperium refers to the 6-8 weeks following delivery, and is a dynamic period in which maternal anatomy and physiology are restored to their prepregnant state. Postpartum complications can be divided into non-obstetric and obstetric. The latter are the topic of this article and can be further classified as infectious, thrombotic, hemorrhagic or cesarean-related. Transvaginal US is often the initial modality in the evaluation of puerperal disorders. CT is probably the most valuable imaging technique when life-threatening conditions are suspected. Pelvic MRI is being increasingly used in cases of inconclusive findings or if further characterization is needed, especially in the setting of postsurgical complications or placental disorders. Diagnostic and interventional radiologists play a pivotal role in the evaluation and management of a variety of puerperal complications. Many of these conditions pose a diagnostic challenge, as imaging findings often overlap with normal postpartum changes, so keeping in mind the patient's clinical information is key.
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Affiliation(s)
- Marta Barrios-López
- Department of Radiology, Hospital Universitario Marqués de Valdecilla, Av Valdecilla S/N, 39008, Santander, Spain.
| | - Sara Sánchez-Bernal
- Department of Radiology, Hospital Clínico Universitario de Salamanca, P San Vicente 182, 37007, Salamanca, Spain
| | - Elena Julián Gómez
- Department of Radiology, Hospital Universitario Marqués de Valdecilla, Av Valdecilla S/N, 39008, Santander, Spain
| | - María José Galante
- Department of Radiology, Hospital Universitario Marqués de Valdecilla, Av Valdecilla S/N, 39008, Santander, Spain
| | - Darío Herrán de la Gala
- Department of Radiology, Hôpital Universitaire Pitié-Salpêtrière, 47-83 Bd de L'Hôpital, 75013, Paris, France
| | | | - Alejandro Fernández-Flórez
- Department of Radiology, Hospital Universitario Marqués de Valdecilla, Av Valdecilla S/N, 39008, Santander, Spain
| | - Ana Barba-Arce
- Department of Radiology, Hospital Universitario Marqués de Valdecilla, Av Valdecilla S/N, 39008, Santander, Spain
| | - Carmen González-Carreró
- Department of Radiology, Hospital Universitario Marqués de Valdecilla, Av Valdecilla S/N, 39008, Santander, Spain
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Zhao Y, You C, Zhou X, Li X, Zhang C, Wu Y, Shen W. The volumetric ADC histogram analysis in differentiating stage IA endometrial carcinoma from endometrial polyp. Br J Radiol 2024; 97:1139-1145. [PMID: 38662891 PMCID: PMC11135793 DOI: 10.1093/bjr/tqae081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 07/06/2023] [Accepted: 04/02/2024] [Indexed: 05/31/2024] Open
Abstract
OBJECTIVE This study aimed to explore the value of apparent diffusion coefficient (ADC) histogram based on whole lesion volume in distinguishing stage IA endometrial carcinoma from the endometrial polyp. METHODS MRI of 108 patients with endometrial lesions confirmed by pathology were retrospectively analysed, including 65 cases of stage IA endometrial carcinoma and 43 cases of endometrial polyp. The volumetric ADC histogram metrics and general imaging features were evaluated and measured simultaneously. All the features were compared between the 2 groups. The receiver operating characteristic curve was utilized to evaluate the diagnostic performance. RESULTS The mean, max, min, and percentiles (10th, 25th, 50th, 75th, 95th) ADC values of endometrial carcinoma were significantly lower than that of polyp (all P < .05). The skewness and kurtosis of ADC values in the endometrial carcinoma group were significantly higher than those in the endometrial polyp group, and the variance of ADC values in the endometrial carcinoma group was lower than those in the endometrial polyp group (all P < .05). Endometrial carcinoma demonstrated more obvious myometrial invasion combined with intralesion haemorrhage than polyp (all P < .05). The 25th percentile of ADC values achieved the largest areas under the curve (0.861) among all the ADC histogram metrics and general imaging features, and the sensitivity and specificity were 83.08% and 76.74%, with the cut-off value of 1.01 × 10-3 mm2/s. CONCLUSION The volumetric ADC histogram analysis was an effective method in differentiating endometrial carcinoma from an endometrial polyp. The 25th percentile of ADC values has satisfactory performance for detecting malignancy in the endometrium. ADVANCES IN KNOWLEDGE The ADC histogram metric based on whole lesion is a promising imaging-maker in differentiating endometrial benign and malignant lesions.
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Affiliation(s)
- Yujiao Zhao
- Department of Radiology, Tianjin First Central Hospital, School of Medicine, Nankai University, Tianjin, 300192, China
| | - Cong You
- Department of Radiology, The First Central Clinical College of Tianjin Medical University, Tianjin, 300192, China
| | - Xin Zhou
- Department of Radiology, Tianjin Central Hospital of Gynecology Obstetrics, Tianjin, 300052, China
| | - Xiaotian Li
- The School of Medicine, Nankai University, Tianjin, 300071, China
| | - Cheng Zhang
- Department of Radiology, The First Central Clinical College of Tianjin Medical University, Tianjin, 300192, China
| | - Yanhong Wu
- Department of Obstetrics, Tianjin First Central Hospital, School of Medicine, Nankai University, Tianjin, 300192, China
| | - Wen Shen
- Department of Radiology, Tianjin First Central Hospital, School of Medicine, Nankai University, Tianjin, 300192, China
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Vercellini P, Bandini V, Viganò P, Ambruoso D, Cetera GE, Somigliana E. Proposal for targeted, neo-evolutionary-oriented secondary prevention of early-onset endometriosis and adenomyosis. Part II: medical interventions. Hum Reprod 2024; 39:18-34. [PMID: 37951241 DOI: 10.1093/humrep/dead206] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 09/07/2024] [Indexed: 11/13/2023] Open
Abstract
According to consistent epidemiological data, the slope of the incidence curve of endometriosis rises rapidly and sharply around the age of 25 years. The delay in diagnosis is generally reported to be between 5 and 8 years in adult women, but it appears to be over 10 years in adolescents. If this is true, the actual onset of endometriosis in many young women would be chronologically placed in the early postmenarchal years. Ovulation and menstruation are inflammatory events that, when occurring repeatedly for years, may theoretically favour the early development of endometriosis and adenomyosis. Moreover, repeated acute dysmenorrhoea episodes after menarche may not only be an indicator of ensuing endometriosis or adenomyosis, but may also promote the transition from acute to chronic pelvic pain through central sensitization mechanisms, as well as the onset of chronic overlapping pain conditions. Therefore, secondary prevention aimed at reducing suffering, limiting lesion progression, and preserving future reproductive potential should be focused on the age group that could benefit most from the intervention, i.e. severely symptomatic adolescents. Early-onset endometriosis and adenomyosis should be promptly suspected even when physical and ultrasound findings are negative, and long-term ovulatory suppression may be established until conception seeking. As nowadays this could mean using hormonal therapies for several years, drug safety evaluation is crucial. In adolescents without recognized major contraindications to oestrogens, the use of very low-dose combined oral contraceptives is associated with a marginal increase in the individual absolute risk of thromboembolic events. Oral contraceptives containing oestradiol instead of ethinyl oestradiol may further limit such risk. Oral, subcutaneous, and intramuscular progestogens do not increase the thromboembolic risk, but may interfere with attainment of peak bone mass in young women. Levonorgestrel-releasing intra-uterine devices may be a safe alternative for adolescents, as amenorrhoea is frequently induced without suppression of the ovarian activity. With regard to oncological risk, the net effect of long-term oestrogen-progestogen combinations use is a small reduction in overall cancer risk. Whether surgery should be considered the first-line approach in young women with chronic pelvic pain symptoms seems questionable. Especially when large endometriomas or infiltrating lesions are not detected at pelvic imaging, laparoscopy should be reserved to adolescents who refuse hormonal treatments or in whom first-line medications are not effective, not tolerated, or contraindicated. Diagnostic and therapeutic algorithms, including self-reported outcome measures, for young individuals with a clinical suspicion of early-onset endometriosis or adenomyosis are proposed.
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Affiliation(s)
- Paolo Vercellini
- Department of Clinical Sciences and Community Health, Academic Centre for Research on Adenomyosis and Endometriosis, Università degli Studi, Milano, Italy
- Gynecology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Veronica Bandini
- Department of Clinical Sciences and Community Health, Academic Centre for Research on Adenomyosis and Endometriosis, Università degli Studi, Milano, Italy
| | - Paola Viganò
- Department of Clinical Sciences and Community Health, Academic Centre for Research on Adenomyosis and Endometriosis, Università degli Studi, Milano, Italy
- Gynecology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Deborah Ambruoso
- Department of Clinical Sciences and Community Health, Academic Centre for Research on Adenomyosis and Endometriosis, Università degli Studi, Milano, Italy
| | - Giulia Emily Cetera
- Department of Clinical Sciences and Community Health, Academic Centre for Research on Adenomyosis and Endometriosis, Università degli Studi, Milano, Italy
- Gynecology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Edgardo Somigliana
- Department of Clinical Sciences and Community Health, Academic Centre for Research on Adenomyosis and Endometriosis, Università degli Studi, Milano, Italy
- Gynecology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
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Gao M, Bhosale P, Devine C, Palmquist S, Javadi S. US, MRI, CT Performance and Interpretation of Uterine Masses. Semin Ultrasound CT MR 2023; 44:541-559. [PMID: 37821051 DOI: 10.1053/j.sult.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Abstract
Uterine masses are commonly encountered as incidental findings during cross-sectional imaging or when individuals present with symptoms such as pain and bleeding. The World Health Organization categorizes tumors of the uterine corpus into 5 distinct groups: endometrial epithelial tumors and their precursors, tumor-like growths, mesenchymal uterine tumors, tumors with a combination of epithelial and mesenchymal elements, and various other types of tumors. The primary imaging method for assessing uterine abnormalities is transvaginal ultrasound. However, magnetic resonance imaging (MRI) can be employed to enhance the visualization of soft tissues, enabling a more detailed characterization of uterine masses. This article aims to outline the imaging features of both benign and malignant uterine masses using ultrasound, MRI, and computed tomography.
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Affiliation(s)
- Mamie Gao
- University of Texas MD Anderson Cancer Center, Houston, TX.
| | - Priya Bhosale
- University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | - Sanaz Javadi
- University of Texas MD Anderson Cancer Center, Houston, TX
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Satei J, Afrakhteh AN, Aldecoa KAT. Endometrial Adenocarcinoma in Young Women: A Case Report and Review of Literature. Cureus 2023; 15:e45287. [PMID: 37846282 PMCID: PMC10576867 DOI: 10.7759/cureus.45287] [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] [Accepted: 09/14/2023] [Indexed: 10/18/2023] Open
Abstract
Endometrial cancer in young women presents a unique challenge to care teams. With over 90% of cases diagnosed in women over the age of 50, its diagnosis can be delayed in younger patients if the medical team does not maintain a high enough index of suspicion. Once diagnosed, treatment options depend on a desire to maintain fertility. We present a case of a 36-year-old female who, following cross-sectional imaging and pathological analysis, was diagnosed with endometrioid endometrial adenocarcinoma. This case explores the epidemiology of endometrial cancer in young women and the importance of a multi-disciplinary approach to the diagnosis and treatment of this rare malignancy.
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Affiliation(s)
- Jessica Satei
- Medicine, Newcastle University Medical School, Newcastle, GBR
| | | | - Kim Abbegail T Aldecoa
- Internal Medicine, Trinity Health Oakland Hospital/Wayne State University Program, Pontiac, USA
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Omer AAH, Nabag WOM. Antimüllerian hormone and endometrial thickness in predicting xfollicular maturation in patients with polycystic ovary syndrome. AJOG GLOBAL REPORTS 2023; 3:100173. [PMID: 37649780 PMCID: PMC10462663 DOI: 10.1016/j.xagr.2023.100173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND Polycystic ovary syndrome is an anovulatory infertility problem that requires the treatment of ovulation induction. Clomiphene citrate is a first-line regimen for ovulation induction. The antimüllerian hormone is produced by granulosa cells of small, growing follicles in the ovary. Folliculogenesis is an essential process for ovarian function. Endometrial thickness is important throughout a female's life, especially concerning medications for ovulation induction. OBJECTIVE This study aimed to determine the role of basal antimüllerian hormone and midcycle endometrial thickness in predicting follicular maturation and pregnancy in patients with polycystic ovary syndrome treated with clomiphene citrate. STUDY DESIGN This was a prospective cohort study that was conducted at El-sir Abualhassan's Fertility Center (September 2020 to August 2021). The study included 197 patients with polycystic ovary syndrome diagnosed using the Rotterdam criteria. The patients were treated with a dosage of 100 mg of clomiphene citrate. Data were collected using a questionnaire that was filled out after informed consent was provided by the patients. The basal antimüllerian hormone level was measured using enzyme immunoassay, and endometrial thickness and follicular size were measured before and after clomiphene citrate treatment using transvaginal ultrasound. The data were analyzed using SPSS (version 23; IBM Corporation, Armonk, NY). Moreover, the correlation was performed using the chi-square test. RESULTS Almost two-thirds of the participants have normal antimüllerian hormone levels. Before clomiphene citrate was used as the treatment regimen, 95.40% of the patients had an endometrial thickness of ≤5 mm and a follicular size of 1 to 6 mm. After clomiphene citrate treatment, 74.60% of the patients had an endometrial thickness of 6 to 10 mm, and 46.20% of the patients had a follicular size of 7 to 12 mm. A significant correlation was found between basal antimüllerian hormone, follicular maturation, and pregnancy (P=.001). There was a significant association between endometrial thickness after clomiphene citrate treatment and achieving pregnancy (P=.001). CONCLUSION Clomiphene citrate is a first-line regimen for patients with polycystic ovary syndrome with normal antimüllerian hormone levels. After clomiphene citrate treatment, there was a correlation between antimüllerian hormone and follicular maturation and pregnancy. Moreover, there was a correlation between midcycle endometrial thickness and pregnancy.
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Affiliation(s)
- Alaa Abdelaal Hassan Omer
- Department of Obstetrics and Gynecology, Sudan Medical Specialization Board, Khartoum, Sudan (Dr Omer)
| | - Wisal Omer Mohamed Nabag
- Department of Obstetrics and Gynecology, Alzaiem Alazhari University, Khartoum North, Sudan (Dr Nabag)
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Development of MRI-based radiomics predictive model for classifying endometrial lesions. Sci Rep 2023; 13:1590. [PMID: 36709399 PMCID: PMC9884294 DOI: 10.1038/s41598-023-28819-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 01/25/2023] [Indexed: 01/30/2023] Open
Abstract
An unbiased and accurate diagnosis of benign and malignant endometrial lesions is essential for the gynecologist, as each type might require distinct treatment. Radiomics is a quantitative method that could facilitate deep mining of information and quantification of the heterogeneity in images, thereby aiding clinicians in proper lesion diagnosis. The aim of this study is to develop an appropriate predictive model for the classification of benign and malignant endometrial lesions, and evaluate potential clinical applicability of the model. 139 patients with pathologically-confirmed endometrial lesions from January 2018 to July 2020 in two independent centers (center A and B) were finally analyzed. Center A was used for training set, while center B was used for test set. The lesions were manually drawn on the largest slice based on the lesion area by two radiologists. After feature extraction and feature selection, the possible associations between radiomics features and clinical parameters were assessed by Uni- and multi- variable logistic regression. The receiver operator characteristic (ROC) curve and DeLong validation were employed to evaluate the possible predictive performance of the models. Decision curve analysis (DCA) was used to evaluate the net benefit of the radiomics nomogram. A radiomics prediction model was established from the 15 selected features, and were found to be relatively high discriminative on the basis of the area under the ROC curve (AUC) for both the training and the test cohorts (AUC = 0.90 and 0.85, respectively). The radiomics nomogram also showed good performance of discrimination for both the training and test cohorts (AUC = 0.91 and 0.86, respectively), and the DeLong test shows that AUCs were significantly different between clinical parameters and nomogram. The result of DCA demonstrated the clinical usefulness of this novel nomogram method. The predictive model constructed based on MRI radiomics and clinical parameters indicated a highly diagnostic efficiency, thereby implying its potential clinical usefulness for the precise identification and prediction of endometrial lesions.
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Lee NY, Lee EJ, Hong SS, Hwang J, Chang YW, Oh E, Nam B, Jeong J. [Radiologic Evaluation of Uterine Lesions Using a Pattern Recognition Approach]. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2023; 84:127-149. [PMID: 36818713 PMCID: PMC9935953 DOI: 10.3348/jksr.2022.0009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 06/28/2022] [Accepted: 08/06/2022] [Indexed: 01/21/2023]
Abstract
It is important to distinguish uterine lesions from other lesions occurring in the pelvic cavity for the proper management. The primary radiological evaluation of uterine lesions is performed using transvaginal ultrasonography, and if the lesion is too large or shows atypical benign imaging findings, magnetic resonance imaging should be performed. Analyzing radiological findings of uterine lesions through a pattern recognition approach can help establish the accurate diagnosis and treatment plan. In this pictorial assay, we describe imaging characteristics of various lesions arising from the uterus and evaluate them based on the pattern recognition approach.
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Affiliation(s)
- Na Young Lee
- Department of Radiology, Soonchunghyang University Hospital, Seoul, Korea
| | - Eun Ji Lee
- Department of Radiology, Soonchunghyang University Hospital, Seoul, Korea
| | - Seong Sook Hong
- Department of Radiology, Soonchunghyang University Hospital, Seoul, Korea
| | - Jiyoung Hwang
- Department of Radiology, Soonchunghyang University Hospital, Seoul, Korea
| | - Yun-Woo Chang
- Department of Radiology, Soonchunghyang University Hospital, Seoul, Korea
| | - Eunsun Oh
- Department of Radiology, Soonchunghyang University Hospital, Seoul, Korea
| | - Boda Nam
- Department of Radiology, Soonchunghyang University Hospital, Seoul, Korea
| | - Jewon Jeong
- Department of Radiology, Soonchunghyang University Hospital, Seoul, Korea
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Bi Q, Wang Y, Deng Y, Liu Y, Pan Y, Song Y, Wu Y, Wu K. Different multiparametric MRI-based radiomics models for differentiating stage IA endometrial cancer from benign endometrial lesions: A multicenter study. Front Oncol 2022; 12:939930. [PMID: 35992858 PMCID: PMC9389365 DOI: 10.3389/fonc.2022.939930] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 07/12/2022] [Indexed: 11/13/2022] Open
Abstract
PurposeThe aim of this study was to evaluate the value of different multiparametric MRI-based radiomics models in differentiating stage IA endometrial cancer (EC) from benign endometrial lesions.MethodsThe data of patients with endometrial lesions from two centers were collected. The radiomics features were extracted from T2-weighted imaging (T2WI), diffusion-weighted imaging (DWI), apparent diffusion coefficient (ADC) map, and late contrast-enhanced T1-weighted imaging (LCE-T1WI). After data dimension reduction and feature selection, nine machine learning algorithms were conducted to determine which was the optimal radiomics model for differential diagnosis. The univariate analyses and logistic regression (LR) were performed to reduce valueless clinical parameters and to develop the clinical model. A nomogram using the radscores combined with clinical parameters was developed. Two integrated models were obtained respectively by the ensemble strategy and stacking algorithm based on the clinical model and optimal radiomics model. The area under the curve (AUC), clinical decisive curve (CDC), net reclassification index (NRI), and integrated discrimination index (IDI) were used to evaluate the performance and clinical benefits of the models.ResultsA total of 371 patients were incorporated. The LR model was the optimal radiomics model with the highest average AUC (0.854) and accuracy (0.802) in the internal and external validation groups (AUC = 0.910 and 0.798, respectively), and outperformed the clinical model (AUC = 0.739 and 0.592, respectively) or the radiologist (AUC = 0.768 and 0.628, respectively). The nomogram (AUC = 0.917 and 0.802, respectively) achieved better discrimination performance than the optimal radiomics model in two validation groups. The stacking model (AUC = 0.915) and ensemble model (AUC = 0.918) had a similar performance compared with the nomogram in the internal validation group, whereas the AUCs of the stacking model (AUC = 0.792) and ensemble model (AUC = 0.794) were lower than those of the nomogram and radiomics model in the external validation group. According to the CDC, NRI, and IDI, the optimal radiomics model, nomogram, stacking model, and ensemble model achieved good net benefits.ConclusionsMultiparametric MRI-based radiomics models can non-invasively differentiate stage IA EC from benign endometrial lesions, and LR is the best machine learning algorithm. The nomogram presents excellent and stable diagnostic efficiency.
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Affiliation(s)
- Qiu Bi
- Department of MRI, The First People’s Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
| | - Yaoxin Wang
- Department of MRI, The First People’s Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
| | - Yuchen Deng
- Department of MRI, The First People’s Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
| | - Yang Liu
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yuanrui Pan
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China
| | - Yang Song
- MR Scientific Marketing, Siemens Healthineers, Shanghai, China
| | - Yunzhu Wu
- MR Scientific Marketing, Siemens Healthineers, Shanghai, China
| | - Kunhua Wu
- Department of MRI, The First People’s Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
- *Correspondence: Kunhua Wu,
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Kettunen P, Koistinen E, Hintikka J, Perheentupa A. Oestrogen therapy for postpartum depression: efficacy and adverse effects. A double-blind, randomized, placebo-controlled pilot study. Nord J Psychiatry 2022; 76:348-357. [PMID: 34533410 DOI: 10.1080/08039488.2021.1974556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Postpartum depression (PPD) is detrimental to the mother and the family as a whole. Early initiation of appropriate treatment is important. The aim of this pilot study was to evaluate the efficacy and adverse effects of oestradiol treatment. METHODS We performed a pilot double-blind, randomized, placebo-controlled study. Major depression was diagnosed using the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I), and the severity of depression was evaluated using the Edinburgh Postnatal Depression Scale (EPDS). The duration of treatment with sublingual oestradiol hemihydrate (1-3 mg/day) was 12 weeks. RESULTS The treatment group consisted of 16 mothers and the placebo group of 14 mothers. Thirteen mothers in the treatment group and ten in the placebo group recovered from depression during the treatment period as measured with the EPDS (<10). There was no evidence to suggest that oestradiol was more effective than placebo. More mothers in the treatment group than in the placebo group (eight vs. one) received gestagen treatment for irregular bleeding. Oestradiol did not disturb breastfeeding. The mean number of other adverse effects per mother was lower in the treatment group, and these were mostly somatic symptoms. CONCLUSION Our findings warrant further studies on oestrogen therapy for PPD with and without antidepressant and gestagen therapy, and on adverse effects (including effects on vaginal bleeding and breastfeeding).
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Affiliation(s)
- Pirjo Kettunen
- Department of General Hospital Psychiatry, North Karelia Central Hospital, Joensuu, Finland
| | - Eeva Koistinen
- Department of Obstetrics and Gynaecology, North Karelia Central Hospital, Joensuu, Finland
| | - Jukka Hintikka
- Faculty of Medicine and Biotechnology, Tampere University, Tampere, Finland.,Department of Psychiatry, Päijät-Häme Central Hospital, Lahti, Finland
| | - Antti Perheentupa
- Department of Obstetrics and Gynaecology, Turku University Hospital, Turku, Finland.,Institute of Biomedicine, Research Center for Integrative Physiology and Pharmacology, University of Turku, Turku, Finland
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12
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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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Xu J, Rao X, Lu W, Xie X, Wang X, Li X. Noninvasive Predictor for Premalignant and Cancerous Lesions in Endometrial Polyps Diagnosed by Ultrasound. Front Oncol 2022; 11:812033. [PMID: 35155203 PMCID: PMC8828905 DOI: 10.3389/fonc.2021.812033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 12/30/2021] [Indexed: 11/22/2022] Open
Abstract
Background There was no consensus for management of asymptomatic endometrial polyps (EPs) up to date. Objective The aim of present study was to determine the risk factors of malignant lesions in EPs diagnosed by ultrasound and establish a noninvasive predictor to decrease unnecessary hysteroscopy for EPs. Study Design We reviewed the records of all consecutive patients who underwent hysteroscopy for EPs in the Women’s Hospital School of Medicine Zhejiang University between January 1, 2001 and December 31, 2018. The patients with histological diagnoses of atypical hyperplasia or cancer were defined as malignancy, while the patients with histological diagnoses of benign lesions were randomly selected as benign group according to the ratio of 1:4 (malignancy:benign), matching by age and year of hospitalization. Logistic regression analysis was used to analyze the clinical parameters for predicting malignancy of EPs. A Chi-squared automatic interaction detection (CHAID) decision tree analysis was performed to find a noninvasive predictor. The sensitivity, specificity, and the receiver operating characteristic curve (ROC) were used for assess the efficacy of the noninvasive predictor. New diagnosed EPs patients received in 2019 were used for verifying the accuracy of the noninvasive predictor. Results The age in 15,790 cases of benign lesions was significantly younger than that in 230 malignancy cases (41.97 ± 11.53 year vs 53.31 ± 11.61 years, p <0.001). AUB (OR 7.306, 95%CI 4.927–10.835), large EPs (OR 2.595, 95%CI 1.662–4.052), and blood flow signal in EPs (OR 2.690, 95%CI 1.872–3.866) were independent predictive factors of malignancy in all enrolled patients. A noninvasive predictor for malignancy of EPs was established, through combining with AUB, large polyps and blood flow signal. This predictor presented excellent sensitivity and NPV (91.3 and 95.8%), with acceptable specificity and AUC (0.801). Further validation in new diagnosed EPs also suggested excellent sensitivity and reasonable specificity (100 and 58.5%) of the predictor. Factors such as thickened endometrial thickness, menopause shorter than 10 years, hypertension, obesity and nulliparous were also validated as independent predictors of malignancy in different subgroup analysis. Conclusions The noninvasive predictor combined with other risk factors from subgroup analysis would be reliable to distinguish the benign lesions from malignancy for EPs diagnosed by ultrasound.
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Affiliation(s)
- Jianying Xu
- Department of Gynecologic Oncology, Women's Hospital, School of Medicine Zhejiang University, Hangzhou, China
| | - Xuan Rao
- Department of Gynecologic Oncology, Women's Hospital, School of Medicine Zhejiang University, Hangzhou, China
| | - Weiguo Lu
- Department of Gynecologic Oncology, Women's Hospital, School of Medicine Zhejiang University, Hangzhou, China.,Cancer Center, Zhejiang University, Hangzhou, China.,Center for Uterine Cancer Diagnosis & Therapy Research of Zhejiang Province, Hangzhou, China
| | - Xing Xie
- Department of Gynecologic Oncology, Women's Hospital, School of Medicine Zhejiang University, Hangzhou, China
| | - Xinyu Wang
- Department of Gynecologic Oncology, Women's Hospital, School of Medicine Zhejiang University, Hangzhou, China.,Cancer Center, Zhejiang University, Hangzhou, China
| | - Xiao Li
- Department of Gynecologic Oncology, Women's Hospital, School of Medicine Zhejiang University, Hangzhou, China.,Cancer Center, Zhejiang University, Hangzhou, China.,Zhejiang Provincial Key Laboratory of Precision Diagnosis and Therapy for Major Gynecological Diseases, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
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14
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Zheng X, Guo W, Zeng L, Zheng D, Yang S, Xu Y, Wang L, Wang R, Mol BW, Li R, Qiao J. In vitro maturation without gonadotropins versus in vitro fertilization with hyperstimulation in women with polycystic ovary syndrome: a non-inferiority randomized controlled trial. Hum Reprod 2022; 37:242-253. [PMID: 34849920 PMCID: PMC9115328 DOI: 10.1093/humrep/deab243] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 09/30/2021] [Indexed: 01/04/2023] Open
Abstract
STUDY QUESTION Does in vitro maturation (IVM) result in non-inferior cumulative live birth rates compared to those after standard in vitro fertilization (IVF) in infertile women with polycystic ovary syndrome (PCOS)? SUMMARY ANSWER One cycle of IVM, without any stimulation, was inferior to one cycle of standard IVF in women with PCOS in terms of 6-month cumulative live birth rates, when choosing single vitrified-warmed blastocyst transfer. WHAT IS KNOWN ALREADY IVM is an emerging alternative treatment for women with PCOS who need assisted reproductive technology. Since a minimal or even zero dose of gonadotropins are required in the IVM procedure, the occurrence of ovarian hyperstimulation syndrome (OHSS) is eliminated. Only one clinical trial comparing the pregnancy outcome between IVM with FSH priming and IVF has been reported. However, it is still unknown whether IVM treatment without any stimulation can offer a similar live birth outcome in women with PCOS as compared to that in women receiving the standard IVF procedure with ovarian stimulation. STUDY DESIGN, SIZE, DURATION This single-centre, open-label randomized controlled non-inferiority trial in an academic infertility centre in China was performed between March 2018 and July 2019. PARTICIPANTS/MATERIALS, SETTING, METHODS Women aged 20-38 years with PCOS and infertility scheduled for their first IVF attempt were eligible. In total, 351 women were randomly allocated to receive one cycle of unstimulated IVM (n = 175) or one cycle of standard IVF with a flexible GnRH antagonist protocol and hCG as ovulatory trigger (n = 176). A freeze-all and single blastocyst transfer strategy was used in both groups. The primary outcome was ongoing pregnancy (leading to live birth) within 6 months after randomization. A non-inferiority margin of 15% was considered. MAIN RESULTS AND THE ROLE OF CHANCE The IVM procedure without additional gonadotropin resulted in a lower ongoing pregnancy (leading to live birth) within 6 months after randomization compared to standard IVF treatment (22.3% vs. 50.6%; rate difference -28.3%; 95% confidence interval [CI]: -37.9% to -18.7%). Moderate-severe OHSS did not occur in the IVM group, while in the IVF group, ten women (5.7%) had moderate OHSS and one woman (0.6%) had severe OHSS. There was no statistically significant difference in the occurrence of obstetric and perinatal complications. LIMITATIONS, REASONS FOR CAUTION The trial was conducted using an IVM protocol without additional stimulation in a single centre, which may limit its generalizability. In addition, a GnRH agonist trigger rather than hCG for IVF stimulation in women with PCOS would be more consistent with current clinical practice. WIDER IMPLICATIONS OF THE FINDINGS Although IVM is considered to be a convenient, inexpensive and safe alternative to IVF for women with PCOS, our results indicated that one cycle of IVM without any stimulation was inferior to one cycle of standard IVF in terms of the cumulative live birth rate. The inferiority of IVM without ovarian stimulation could be mainly due to the limitations in the developmental potential of embryos. Further IVM development should be tested and validated in a freeze-only and blastocyst transfer setting. Further RCTs are needed to evaluate the effectiveness and safety of other IVM protocols or multiple cycles of IVM compared to IVF. STUDY FUNDING/COMPETING INTEREST(S) This study was supported by the National Key Research and Development Program of China (2016YFC1000201 and 2018YFC1002104) and the National Science Foundation of China (81730038). B.W.M. is supported by a NHMRC Investigator grant (GNT1176437). All other authors declare no competing interests. TRIAL REGISTRATION NUMBER Clinicaltrials.gov NCT03463772. TRIAL REGISTRATION DATE 29 January 2018. DATE OF FIRST PATIENT’S ENROLMENT 16 March 2018.
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Affiliation(s)
- Xiaoying Zheng
- Department of Obstetrics and Gynecology, Centre for Reproductive Medicine, Peking University Third Hospital, Beijing, China
- National Clinical Research Centre for Obstetrics and Gynecology, Beijing, China
- Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, Beijing, China
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing, China
- Research Units of Comprehensive Diagnosis and Treatment of Oocyte Maturation Arrest, Chinese Academy of Medical Sciences, Beijing, China
| | - Wei Guo
- Department of Obstetrics and Gynecology, Centre for Reproductive Medicine, Peking University Third Hospital, Beijing, China
- National Clinical Research Centre for Obstetrics and Gynecology, Beijing, China
- Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, Beijing, China
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing, China
| | - Lin Zeng
- Research Centre of Clinical Epidemiology, Peking University Third Hospital, Beijing, China
| | - Danni Zheng
- Department of Obstetrics and Gynecology, Centre for Reproductive Medicine, Peking University Third Hospital, Beijing, China
- National Clinical Research Centre for Obstetrics and Gynecology, Beijing, China
- Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, Beijing, China
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing, China
| | - Shuo Yang
- Department of Obstetrics and Gynecology, Centre for Reproductive Medicine, Peking University Third Hospital, Beijing, China
- National Clinical Research Centre for Obstetrics and Gynecology, Beijing, China
- Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, Beijing, China
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing, China
| | - Yalan Xu
- Department of Obstetrics and Gynecology, Centre for Reproductive Medicine, Peking University Third Hospital, Beijing, China
- National Clinical Research Centre for Obstetrics and Gynecology, Beijing, China
- Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, Beijing, China
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing, China
| | - Lina Wang
- Department of Obstetrics and Gynecology, Centre for Reproductive Medicine, Peking University Third Hospital, Beijing, China
- National Clinical Research Centre for Obstetrics and Gynecology, Beijing, China
- Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, Beijing, China
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing, China
| | - Rui Wang
- Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC, Australia
| | - Ben Willem Mol
- Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC, Australia
- Aberdeen Centre for Women's Health Research, School of Medicine, University of Aberdeen, Aberdeen, UK
| | - Rong Li
- Department of Obstetrics and Gynecology, Centre for Reproductive Medicine, Peking University Third Hospital, Beijing, China
- National Clinical Research Centre for Obstetrics and Gynecology, Beijing, China
- Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, Beijing, China
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing, China
| | - Jie Qiao
- Department of Obstetrics and Gynecology, Centre for Reproductive Medicine, Peking University Third Hospital, Beijing, China
- National Clinical Research Centre for Obstetrics and Gynecology, Beijing, China
- Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, Beijing, China
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing, China
- Research Units of Comprehensive Diagnosis and Treatment of Oocyte Maturation Arrest, Chinese Academy of Medical Sciences, Beijing, China
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15
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Aires LPN, Gasser B, Silva P, Del Aguila Da Silva P, Silveira MV, Carneiro RK, IwaoYamada D, Padilha-Nakaghi LC, Uscategui RAR, Spada S, Russo M, Feliciano MAR. High-definition ultrasonography in the evaluation of the reproductive tract of bitches during the follicular phase of the estrous cycle. Anim Reprod Sci 2021; 234:106870. [PMID: 34673364 DOI: 10.1016/j.anireprosci.2021.106870] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 10/08/2021] [Accepted: 10/09/2021] [Indexed: 01/19/2023]
Abstract
The aim was to sonographically evaluate the reproductive tract of bitches during the follicular phase of the estrous cycle using High Density (HD) ultrasonic techniques. Females (n = 8) were evaluated at five different times throughout the follicular phase, as determined by vaginal cytology and blood progesterone concentrations. Ultrasonic exams were performed using the ACUSON S2000/SIEMENS device utilizing a multifrequency HD transducer (5.5-18 MHz). Videos of the ovaries were obtained and recordings were evaluated using a DICOM viewer software for counting and measuring the ovarian structures, which were assigned to groups based on diameter in mm: G1: ≤ 1; G2: from 1.01 to 3.5; G3 from 3.51 to 5.5; G4: from 5.51 to 10. There was a greater uterine thickness with the progression of the follicular phase (P < 0.05). Six distinct regions were identified in the uterine wall. The ovarian dimensions increased (P < 0.05) as stage of the follicular phase advanced. There was fluid detected around the ovaries after ovulation. There was a characteristic fat tissue hyperechogenicity around the ovaries at all timepoints. There was a difference in the number of ovarian structures of each dimension group at each time there were assessments (P < 0.05). There was a difference in diameter of the largest ovarian structure and in average value of wall thickness at all timepoints when there were evaluations (P < 0.05). The HD ultrasonography technique provides for excellent image resolution, allowing for a more precise characterization of the bitch's reproductive structures and changes occurring during the follicular phase of the estrous cycle.
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Affiliation(s)
- Luiz Paulo Nogueira Aires
- Department of Pathology, Reproduction and One Health, School of Agricultural and Veterinarian Sciences, São Paulo State University "Júlio de Mesquita Filho" (FCAV/UNESP), Via de Acesso Prof. Paulo Donato Castellane s/n, 14884-900 Jaboticabal, São Paulo, Brazil.
| | - Beatriz Gasser
- Department of Veterinary Clinic and Surgery, School of Agricultural and Veterinarian Sciences, São Paulo State University "Júlio de Mesquita Filho" (FCAV/UNESP), Jaboticabal, São Paulo, Brazil
| | - Priscila Silva
- Department of Veterinary Clinic and Surgery, School of Agricultural and Veterinarian Sciences, São Paulo State University "Júlio de Mesquita Filho" (FCAV/UNESP), Jaboticabal, São Paulo, Brazil
| | - Priscila Del Aguila Da Silva
- Department of Pathology, Reproduction and One Health, School of Agricultural and Veterinarian Sciences, São Paulo State University "Júlio de Mesquita Filho" (FCAV/UNESP), Via de Acesso Prof. Paulo Donato Castellane s/n, 14884-900 Jaboticabal, São Paulo, Brazil
| | - Marcus Vinícius Silveira
- Department of Veterinary Clinic and Surgery, School of Agricultural and Veterinarian Sciences, São Paulo State University "Júlio de Mesquita Filho" (FCAV/UNESP), Jaboticabal, São Paulo, Brazil
| | - Rafael Kretzer Carneiro
- Department of Veterinary Clinic and Surgery, School of Agricultural and Veterinarian Sciences, São Paulo State University "Júlio de Mesquita Filho" (FCAV/UNESP), Jaboticabal, São Paulo, Brazil
| | - Diego IwaoYamada
- Hospital Carlos Fernando Rossato, College Dr. Francisco Maeda - FAFRAM, Ituverava, São Paulo, Brazil
| | - Luciana Cristina Padilha-Nakaghi
- Department of Pathology, Reproduction and One Health, School of Agricultural and Veterinarian Sciences, São Paulo State University "Júlio de Mesquita Filho" (FCAV/UNESP), Via de Acesso Prof. Paulo Donato Castellane s/n, 14884-900 Jaboticabal, São Paulo, Brazil
| | - Ricardo Andrés Ramirez Uscategui
- Department of Veterinary Clinic and Surgery, School of Agricultural and Veterinarian Sciences, São Paulo State University "Júlio de Mesquita Filho" (FCAV/UNESP), Jaboticabal, São Paulo, Brazil; Institute of Agrarian Sciences, Federal University of the Jequitinhonha and Mucuri Valleys (UFVJM), Unaí, Minas Gerais, Brazil
| | - Stefano Spada
- Department of Veterinary Medicine and Animal Productions, University of Naples "Federico II", Napoli, Italy
| | - Marco Russo
- Department of Veterinary Medicine and Animal Productions, University of Naples "Federico II", Napoli, Italy
| | - Marcus Antônio Rossi Feliciano
- Department of Pathology, Reproduction and One Health, School of Agricultural and Veterinarian Sciences, São Paulo State University "Júlio de Mesquita Filho" (FCAV/UNESP), Via de Acesso Prof. Paulo Donato Castellane s/n, 14884-900 Jaboticabal, São Paulo, Brazil; Department of Veterinary Clinic and Surgery, School of Agricultural and Veterinarian Sciences, São Paulo State University "Júlio de Mesquita Filho" (FCAV/UNESP), Jaboticabal, São Paulo, Brazil; Diagnostic Imaging Sector, Department of Large Animals Clinic, Federal University of Santa Maria (UFSM), Santa Maria, Rio Grande do Sul, Brazil
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16
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Patel SK, Valicherla GR, Micklo AC, Rohan LC. Drug delivery strategies for management of women's health issues in the upper genital tract. Adv Drug Deliv Rev 2021; 177:113955. [PMID: 34481034 DOI: 10.1016/j.addr.2021.113955] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 08/23/2021] [Accepted: 08/28/2021] [Indexed: 02/08/2023]
Abstract
The female upper genital tract (UGT) hosts important reproductive organs including the cervix, uterus, fallopian tubes, and ovaries. Several pathologies affect these organ systems such as infections, reproductive issues, structural abnormalities, cancer, and inflammatory diseases that could have significant impact on women's overall health. Effective disease management is constrained by the multifaceted nature of the UGT, complex anatomy and a dynamic physiological environment. Development of drug delivery strategies that can overcome mucosal and safety barriers are needed for effective disease management. This review introduces the anatomy, physiology, and mucosal properties of the UGT and describes drug delivery barriers, advances in drug delivery technologies, and opportunities available for new technologies that target the UGT.
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17
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Nori M. Understanding the Endometrium at Menopause: Magnetic Resonance Imaging: A Radiologist's View. J Midlife Health 2021; 12:168-175. [PMID: 34526753 PMCID: PMC8409710 DOI: 10.4103/jmh.jmh_94_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 07/05/2021] [Accepted: 07/05/2021] [Indexed: 11/12/2022] Open
Affiliation(s)
- Madhavi Nori
- Vista Imaging Centre, Hyderabad, Telangana, India.,Madhavi Scan Centre, Hyderabad, Telangana, India
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18
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Shah N, Sackey N, Gopee S, Sideris M, Broadbent M. Cystic endometrium on ultrasound scan: Sonographic-hysteroscopic-pathologic correlation. Int J Gynaecol Obstet 2021; 157:544-548. [PMID: 34449875 DOI: 10.1002/ijgo.13900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 07/25/2021] [Accepted: 08/26/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To assess the correlation between ultrasound findings of cystic endometrium and hysteroscopic and histopathologic findings. METHODS A retrospective study was performed across two London hospital sites between January and December 2020. RESULTS The percentage chance of having either endometrial hyperplasia or cancer was lower in our cohort of women with postmenopausal bleeding and ultrasound findings of cystic endometrium, compared with population estimates for women with postmenopausal bleeding alone (4.1% vs 10%-15% for endometrial cancer and 1.4% vs 5%-10% for endometrial hyperplasia). Conversely, a higher proportion of women in our cohort were diagnosed with endometrial polyps compared with population estimates for postmenopausal bleeding (68% vs 2%-12%). The rate of endometrial hyperplasia was significantly higher in our cohort of premenopausal women with abnormal uterine bleeding and cystic endometrium compared with population estimates for premenopausal patients with abnormal uterine bleeding (15.4% vs 1.4%). CONCLUSION Cystic endometrium appears to be a powerful predictor of endometrial pathology. The high rate of endometrial hyperplasia in premenopausal women with cystic endometrium would advocate the need to obtain histologic diagnoses. Further studies are required to confirm whether cystic endometrium in women with postmenopausal bleeding confers a lower risk of endometrial hyperplasia and cancer.
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Affiliation(s)
- Neha Shah
- Barnet and Chase Farm Hospital, Barnet, UK
| | | | | | - Michail Sideris
- Women's Health Research Unit, Queen Mary University of London, London, UK
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19
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Pintican R, Bura V, Zerunian M, Smith J, Addley H, Freeman S, Caruso D, Laghi A, Sala E, Jimenez-Linan M. MRI of the endometrium - from normal appearances to rare pathology. Br J Radiol 2021; 94:20201347. [PMID: 34233457 DOI: 10.1259/bjr.20201347] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
MRI was recently included as a standard pre-operative diagnostic tool for patients with endometrial cancer. MR findings allow a better risk assessment and ultimately guides the surgical planning. Therefore, it is vital that the radiological interpretation is as accurate as possible. This requires essential knowledge regarding the appropriate MRI protocol, as well as different appearances of the endometrium, ranging from normal peri- and post-menopausal changes, benign findings (e.g. endometrial hyperplasia, polyp, changes due to exogenous hormones) to common and rare endometrium-related malignancies. Furthermore, this review will emphasize the role of MRI in staging endometrial cancer patients and highlight pitfalls that could result in the underestimation or overestimation of the disease extent.
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Affiliation(s)
- Roxana Pintican
- "Iuliu Hatieganu" University of Medicine and Pharmacy Cluj-Napoca,Romania; County Clinical Emergency Hospital Cluj-Napoca, Cluj-Napoca, Romania
| | - Vlad Bura
- County Clinical Emergency Hospital Cluj-Napoca, Cluj-Napoca, Romania
| | - Marta Zerunian
- Medical-Surgical Sciences and Translational Medicine, Sapienza University of Rome, Sant'Andrea Hospital, Rome, Italy
| | - Janette Smith
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Helen Addley
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Susan Freeman
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Damiano Caruso
- Medical-Surgical Sciences and Translational Medicine, Sapienza University of Rome, Sant'Andrea Hospital, Rome, Italy
| | - Andrea Laghi
- Medical-Surgical Sciences and Translational Medicine, Sapienza University of Rome, Sant'Andrea Hospital, Rome, Italy
| | - Evis Sala
- Department of Radiology and CRUK Cambridge Center, Cambridge Biomedical Campus, Cambridge, UK
| | - Mercedes Jimenez-Linan
- Department of Histopathology, Cambridge University Hospital NHS foundation Trust, Cambridge, UK
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20
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Revzin MV, Sailer A, Moshiri M. Incidental Ovarian and Uterine Findings on Cross-sectional Imaging. Radiol Clin North Am 2021; 59:661-692. [PMID: 34053612 DOI: 10.1016/j.rcl.2021.03.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Incidental adnexal masses and uterine findings occur with a high frequency on cross-sectional imaging examinations, particularly in postmenopausal women in whom imaging is performed for a different reason. These incidentalomas encompass a gamut of potential pelvic gynecologic disorders. Most are benign ovarian cysts; however, other less commonly encountered disorders and improperly positioned gynecologic devices may be seen. A knowledge of the management recommendations for such pelvic incidental findings is critical to avoid unnecessary imaging and surgical interventions, as well as to avoid failure in diagnosis and management of some of these conditions.
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Affiliation(s)
- Margarita V Revzin
- Department of Radiology and Biomedical Imaging, Abdominal Imaging and Emergency Radiology, Yale School of Medicine, 333 Cedar Street, PO Box 208042, Room TE-2, New Haven, CT 06520, USA.
| | - Anne Sailer
- Department of Radiology and Biomedical Imaging, Abdominal Imaging and Emergency Radiology, Yale School of Medicine, 333 Cedar Street, PO Box 208042, Room TE-2, New Haven, CT 06520, USA
| | - Mariam Moshiri
- Department of Radiology, University of Washington Medical Center, 1959 NE Pacific Street, Box 357115, Seattle, WA 98195, USA
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21
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Messina M, Mejia SB, Cassidy A, Duncan A, Kurzer M, Nagato C, Ronis M, Rowland I, Sievenpiper J, Barnes S. Neither soyfoods nor isoflavones warrant classification as endocrine disruptors: a technical review of the observational and clinical data. Crit Rev Food Sci Nutr 2021; 62:5824-5885. [PMID: 33775173 DOI: 10.1080/10408398.2021.1895054] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Soybeans are a rich source of isoflavones, which are classified as phytoestrogens. Despite numerous proposed benefits, isoflavones are often classified as endocrine disruptors, based primarily on animal studies. However, there are ample human data regarding the health effects of isoflavones. We conducted a technical review, systematically searching Medline, EMBASE, and the Cochrane Library (from inception through January 2021). We included clinical studies, observational studies, and systematic reviews and meta-analyses (SRMA) that examined the relationship between soy and/or isoflavone intake and endocrine-related endpoints. 417 reports (229 observational studies, 157 clinical studies and 32 SRMAs) met our eligibility criteria. The available evidence indicates that isoflavone intake does not adversely affect thyroid function. Adverse effects are also not seen on breast or endometrial tissue or estrogen levels in women, or testosterone or estrogen levels, or sperm or semen parameters in men. Although menstrual cycle length may be slightly increased, ovulation is not prevented. Limited insight could be gained about possible impacts of in utero isoflavone exposure, but the existing data are reassuring. Adverse effects of isoflavone intake were not identified in children, but limited research has been conducted. After extensive review, the evidence does not support classifying isoflavones as endocrine disruptors.
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Affiliation(s)
- Mark Messina
- Department of Nutrition, Loma Linda University, Loma Linda, California, USA
| | - Sonia Blanco Mejia
- Department of Nutritional Sciences, University of Toronto, Toronto, Canada
| | - Aedin Cassidy
- Nutrition and Preventive Medicine, Queen's University, Belfast, Northern Ireland, UK
| | - Alison Duncan
- College of Biological Sciences, University of Guelph, Guelph, Canada
| | - Mindy Kurzer
- Department of Food Science and Nutrition, University of Minnesota, Minneapolis, Minnesota, USA
| | - Chisato Nagato
- Graduate School of Medicine, Gifu University, Gifu, Japan
| | - Martin Ronis
- Health Sciences Center, Louisiana State University Health Sciences Center, Baton Rouge, New Orleans, USA
| | - Ian Rowland
- Human Nutrition, University of Reading, Reading, England, UK
| | | | - Stephen Barnes
- Department of Pharmacology and Toxicology, University of Alabama, Alabama, USA
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22
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Moharamzad Y, Davarpanah AH, Yaghobi Joybari A, Shahbazi F, Esmaeilian Toosi L, Kooshkiforooshani M, Ansari A, Sanei Taheri M. Diagnostic performance of apparent diffusion coefficient (ADC) for differentiating endometrial carcinoma from benign lesions: a systematic review and meta-analysis. Abdom Radiol (NY) 2021; 46:1115-1128. [PMID: 32935258 DOI: 10.1007/s00261-020-02734-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 08/20/2020] [Accepted: 08/30/2020] [Indexed: 01/07/2023]
Abstract
To determine the diagnostic performance of mean ADC values in the characterization of endometrial carcinoma (EC) from benign lesions by systematic review of the literature and performing meta-analysis. A systematic search of major electronic bibliographic databases was performed to find studies that used ADC values for differentiating EC from benign lesions. Two reviewers independently screened the titles and abstracts of the search results and then by reading the full texts selected the pertinent studies for final analyses. A bivariate random-effects model with pooled sensitivity and specificity values with 95% CI (confidence interval) was used. Summary receiver operating characteristic (SROC) curve and area under curve (AUC) were created. Between-study heterogeneity was measured using I squared (I2) index. Eleven studies including 269 ECs and 208 benign lesions were analyzed. Pooled average (95% CI) ADC in EC and benign lesions groups were, respectively, 0.82 (0.77-0.87) × 10-3 mm2/s and 1.41 (1.29-1.52) × 10-3 mm2/s. The combined (95% CI) sensitivity and specificity of mean ADC values for differentiating EC from benign lesions were 93% (87-96%; I2 = 41.19%) and 94% (88-97%; I2 = 46.91%), respectively. The AUC (95% CI) of the SROC curve was 98% (96-99%). ADC values had good diagnostic accuracy for differentiating EC from benign lesions. In order to recommend ADC measurement for detecting endometrial lesions in routine clinical practice, more primary studies, especially trials and comparative studies including hysteroscopically-guided biopsy method, with larger sample sizes are still required.
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Affiliation(s)
- Yashar Moharamzad
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amir H Davarpanah
- Department of Radiology and Imaging Sciences, Emory University Hospital, Emory University School of Medicine, Atlanta, GA, 30322, USA
| | - Ali Yaghobi Joybari
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fatemeh Shahbazi
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | | | - Ali Ansari
- Department of Mathematics, K. N. Toosi University of Technology, Tehran, Iran
| | - Morteza Sanei Taheri
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
- Department of Radiology, Shohada Hospital, Tajrish Sq., 1445613131, Tehran, Iran.
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Chen Q, Zhang D, Wang S, Lang JH, Chao XP, Fan QB. A prospective, open-label, single-arm study to evaluate the efficacy of dydrogesterone in the treatment of endometrial polyps. Gynecol Endocrinol 2021; 37:152-156. [PMID: 33274680 DOI: 10.1080/09513590.2020.1840546] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
OBJECT To evaluate the efficacy of dydrogesterone for the treatment of premenopausal patients with endometrial polyps (EPs). METHODS A single-center, open-label, prospective, single-arm clinical treatment trial was conducted in patients of reproductive age with EP(s). Patients were prescribed dydrogesterone from day 15 to day 24 of the menstrual cycle over a period of 3 months. At the 3-month follow-up, the efficacy of dydrogesterone was evaluated based on changes in self-report symptoms and ultrasonographic characteristics. The predictive factors of efficacy as well as the predictive value of the significant factors were also assessed. RESULTS A total of 60 patients were included. Improvements in both symptoms and ultrasound findings occurred in 31 patients, achieving an efficacy rate of 51.67%. Of 41 patients with clinical presentations, 39 (95.1%) reported improvements in symptoms. In terms of ultrasound findings, 33 (55%) of patients demonstrated improvements. Significant decreases were observed in the mean endometrial thickness (1.17 ± 0.33 cm vs 0.90 ± 0.35 cm, p < .001) and polyp size (1.10 ± 0.34 cm vs 0.74 ± 0.65 cm, p = .001) after the application of dydrogesterone. Age (p = .006), polyp size (p = .006), and blood flow within polyps (p = .035) were significant predictors of dydrogesterone efficacy. These factors, when combined, demonstrated a good predictive value ([area under the curve (AUC)=0.81]). CONCLUSION Dydrogesterone is effective in the management of EPs in premenopausal patients. Age, polyp size and blood flow should be taken into consideration when prescribing dydrogesterone for this population of women.
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Affiliation(s)
- Qian Chen
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, P.R. China
| | - Da Zhang
- Department of Obstetrics and Gynecology, the Third People's Hospital of Linyi City, Shandong, P.R. China
| | - Shu Wang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, P.R. China
| | - Jing-He Lang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, P.R. China
| | - Xiao-Pei Chao
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, P.R. China
| | - Qing-Bo Fan
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, P.R. China
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Kim J, Heo SH, Shin SS, Jeong YY. MRI Findings and Differential Diagnosis of Benign and Malignant Tumors of the Uterine Corpus. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2021; 82:1103-1123. [PMID: 36238403 PMCID: PMC9432370 DOI: 10.3348/jksr.2021.0116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 08/12/2021] [Accepted: 08/24/2021] [Indexed: 11/15/2022]
Abstract
자궁은 크게 자궁체부와 자궁경부로 나뉜다. 이 중 자궁내막과 자궁근층으로 이루어진 자궁체부에는 양성에서 악성 종양까지 다양한 질환이 발생한다. 비침습적인 일차적 평가로 초음파와 컴퓨터단층촬영이 있으나 비특이적인 영상 소견으로 감별이 어려운 경우가 있다. 반면높은 해상도와 병리학적 특성 파악이 가능한 자기공명영상은 병변의 위치 확인뿐만 아니라 조직학적 특징, 그 리고 악성 종양의 병기 설정에도 도움을 준다. 이 종설에서는 영상의학과의사들이 알아야 할 자궁체부에서 볼 수 있는 다양한 양성과 악성 종양들의 특징적인 자기공명영상 소견들과 이들의 감별점에 대해 정리했다.
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Affiliation(s)
- Jihyun Kim
- Department of Radiology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Suk Hee Heo
- Department of Radiology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
| | - Sang Soo Shin
- Department of Radiology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Yong Yeon Jeong
- Department of Radiology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
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Lee Y, Kim KA, Song MJ, Park YS, Lee J, Choi JW, Lee CH. Multiparametric magnetic resonance imaging of endometrial polypoid lesions. Abdom Radiol (NY) 2020; 45:3869-3881. [PMID: 32399703 DOI: 10.1007/s00261-020-02567-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Endometrial polypoid lesions encompass various conditions from physiologic changes to benign or malignant disease. Differentiating between the various causes of endometrial polypoid lesions remains difficult by transvaginal sonography. Magnetic resonance imaging (MRI) can provide valuable information regarding endometrial polypoid lesions in situations where it is difficult to obtain histologic samples. Multiparametric MRI including T2-weighted images, T1-weighted fat-saturation contrast-enhanced images, and diffusion-weighted images may be helpful for differentiating the various endometrial polypoid lesions and establishing specific diagnoses and appropriate treatment.
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Affiliation(s)
- Youkyoung Lee
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, 148, Gurodong-ro, Guro-gu, Seoul, 08308, South Korea
| | - Kyeong Ah Kim
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, 148, Gurodong-ro, Guro-gu, Seoul, 08308, South Korea.
| | - Mi Jin Song
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, 148, Gurodong-ro, Guro-gu, Seoul, 08308, South Korea
| | - Yang Shin Park
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, 148, Gurodong-ro, Guro-gu, Seoul, 08308, South Korea
| | - Jongmee Lee
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, 148, Gurodong-ro, Guro-gu, Seoul, 08308, South Korea
| | - Jae Woong Choi
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, 148, Gurodong-ro, Guro-gu, Seoul, 08308, South Korea
| | - Chang Hee Lee
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, 148, Gurodong-ro, Guro-gu, Seoul, 08308, South Korea
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Uyeda JW, George E, Reinhold C, Akin EA, Ascher SM, Brook OR, Henrichsen TL, Henwood PC, Learman LA, Maturen KE, Patlas MN, Robbins JB, Sadowski EA, Saphier C, Wall DJ, Glanc P. ACR Appropriateness Criteria® Postpartum Hemorrhage. J Am Coll Radiol 2020; 17:S459-S471. [PMID: 33153557 DOI: 10.1016/j.jacr.2020.09.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 09/01/2020] [Indexed: 11/16/2022]
Abstract
Postpartum hemorrhage (PPH) can be categorized as primary or early if occurring in the first 24 hours after delivery, whereas late or delayed PPH occurs between 24 hours and 6 weeks. Most of the causes of PPH can be diagnosed clinically, but imaging plays an important role in the diagnosis of many causes of PPH. Pelvic ultrasound (transabdominal and transvaginal with Doppler) is the imaging modality of choice for the initial evaluation of PPH. Contrast-enhanced CT of the abdomen and pelvis and CT angiogram of the abdomen and pelvis may be appropriate to determine if active ongoing hemorrhage is present, to localize the bleeding, and to identify the source of bleeding. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | - Elizabeth George
- Research Author, University of California San Francisco, San Francisco, California
| | | | - Esma A Akin
- George Washington University Hospital, Washington, District of Columbia
| | - Susan M Ascher
- Georgetown University Hospital, Washington, District of Columbia
| | - Olga R Brook
- Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | | | - Patricia C Henwood
- Brigham & Women's Hospital & Harvard Medical School, Boston, Massachusetts; American College of Emergency Physicians
| | - Lee A Learman
- Virginia Tech Carilion School of Medicine, Roanoke, Virginia; American College of Obstetricians and Gynecologists
| | | | | | | | | | - Carl Saphier
- Women's Ultrasound, LLC, Englewood, New Jersey; American College of Obstetricians and Gynecologists
| | | | - Phyllis Glanc
- Specialty Chair, University of Toronto and Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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27
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Gonzalo-Carballes M, Ríos-Vives MÁ, Fierro EC, Azogue XG, Herrero SG, Rodríguez AE, Rus MN, Planes-Conangla M, Escudero-Fernandez JM, Coscojuela P. A Pictorial Review of Postpartum Complications. Radiographics 2020; 40:2117-2141. [PMID: 33095681 DOI: 10.1148/rg.2020200031] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The postpartum period, also known as the puerperium, begins immediately after delivery of the neonate and placenta and ends 6-8 weeks after delivery. The appearance of physiologic uterine changes during puerperium can overlap with that of postpartum complications, which makes imaging interpretation and diagnosis difficult. Obstetric and nonobstetric postpartum complications are a considerable source of morbidity and mortality in women of reproductive age, and the radiologist plays an important role in the assessment of these entities, which often require a multimodality imaging approach. US and contrast material-enhanced CT are the techniques of choice in the emergency department, and they can show characteristic radiologic findings that enable differentiation between normal and abnormal features to help radiologists and emergency department practitioners to reach a correct diagnosis and provide timely treatment. The spectrum of postpartum complications ranges from relatively self-limiting to life-threatening conditions that can be divided into six categories: infectious conditions (endometritis), thrombotic complications (eg, deep vein thrombosis, ovarian vein thrombophlebitis, HELLP [hemolysis, elevated liver enzymes, and low platelet count] syndrome, or cerebral sinus thrombosis), hemorrhagic conditions (eg, uterine atony, trauma of the lower portion of the genital tract, retained products of conception, uterine artery arteriovenous malformations, or uterine artery pseudoaneurysm), cesarean delivery-related complications (eg, bladder flap hematoma, subfascial hematoma, rectus sheath hematoma, abscess formation, uterine dehiscence, uterine rupture, vesicovaginal fistula, or abdominal wall endometriosis), iatrogenic conditions (eg, uterine perforation), and nonobstetric complications (eg, acute cholecystitis, acute appendicitis, uterine fibroid degeneration, renal cortical necrosis, pyelonephritis, posterior reversible encephalopathy syndrome, or pituitary gland apoplexy). The online slide presentation from the RSNA Annual Meeting is available for this article. ©RSNA, 2020.
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Affiliation(s)
- Marta Gonzalo-Carballes
- From the Department of Radiology, Hospital Universitari Vall d'Hebron, Passeig de la Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Miguel Ángel Ríos-Vives
- From the Department of Radiology, Hospital Universitari Vall d'Hebron, Passeig de la Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Eva Castellà Fierro
- From the Department of Radiology, Hospital Universitari Vall d'Hebron, Passeig de la Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Xavier Gurí Azogue
- From the Department of Radiology, Hospital Universitari Vall d'Hebron, Passeig de la Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Susana Gispert Herrero
- From the Department of Radiology, Hospital Universitari Vall d'Hebron, Passeig de la Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Alberto Escudero Rodríguez
- From the Department of Radiology, Hospital Universitari Vall d'Hebron, Passeig de la Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - María Neus Rus
- From the Department of Radiology, Hospital Universitari Vall d'Hebron, Passeig de la Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Marina Planes-Conangla
- From the Department of Radiology, Hospital Universitari Vall d'Hebron, Passeig de la Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Jose Miguel Escudero-Fernandez
- From the Department of Radiology, Hospital Universitari Vall d'Hebron, Passeig de la Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Pilar Coscojuela
- From the Department of Radiology, Hospital Universitari Vall d'Hebron, Passeig de la Vall d'Hebron 119-129, 08035 Barcelona, Spain
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Harfouch N, Stern J, Chowdhary V, Arias Y, Demissie S, Scheiner J, Khodorkovsky B, Hayim M. Utility of ultrasound after a negative CT abdomen and pelvis in the emergency department. Clin Imaging 2020; 68:29-35. [PMID: 32563722 DOI: 10.1016/j.clinimag.2020.06.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 05/21/2020] [Accepted: 06/01/2020] [Indexed: 12/13/2022]
Abstract
PURPOSE The purpose of this study is to assess the utility of an abdominal and/or pelvic ultrasound (US) performed within 24 h after a negative CT of the abdomen and pelvis (CTAP) in the emergency department (ED). The secondary endpoint is to assess whether there is a significant increase in length of stay (LOS) in the ED due to immediate US reimaging. METHOD We reviewed the imaging reports of 335 patients over the course of 3 years in our ED who had an US within 24 h after a negative CTAP. We then assessed type of US and whether the US showed any acute findings. We also evaluated LOS in the ED. RESULTS Out of 335 patients, there were only three US cases suspicious for acute surgical pathology (3/335 or 0.9%). On 30-day clinical follow-up, only one of the three cases was confirmed as cholecystitis on pathology. The most common non-surgical findings on US not initially reported on CTAP were ovarian cysts (29/83) and gallstones (9/83). Additionally, the LOS for patients who received both a CTAP and US was 119 min longer than patients who only received a CTAP. CONCLUSION US abdomen and/or pelvis reimaging within 24 h following a negative CTAP is unlikely to change surgical management in the acute setting. US reimaging can still be useful in diagnosing non-surgical pathology, which could serve to explain the patient's pain. US reimaging after negative CTAP is associated with an average increase in the ED LOS.
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Affiliation(s)
- Nassier Harfouch
- Staten Island University Hospital, Northwell Health, 475 Seaview Ave, Staten Island, NY 10305, USA.
| | - Jonathan Stern
- Staten Island University Hospital, Northwell Health, 475 Seaview Ave, Staten Island, NY 10305, USA
| | - Varun Chowdhary
- Staten Island University Hospital, Northwell Health, 475 Seaview Ave, Staten Island, NY 10305, USA
| | - Yuly Arias
- Staten Island University Hospital, Northwell Health, 475 Seaview Ave, Staten Island, NY 10305, USA
| | - Seleshi Demissie
- Staten Island University Hospital, Northwell Health, 475 Seaview Ave, Staten Island, NY 10305, USA
| | - Jonathan Scheiner
- Staten Island University Hospital, Northwell Health, 475 Seaview Ave, Staten Island, NY 10305, USA
| | - Boris Khodorkovsky
- Staten Island University Hospital, Northwell Health, 475 Seaview Ave, Staten Island, NY 10305, USA
| | - Morris Hayim
- Staten Island University Hospital, Northwell Health, 475 Seaview Ave, Staten Island, NY 10305, USA
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AIUM Practice Parameter for the Performance of an Ultrasound Examination of the Female Pelvis. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2020; 39:E17-E23. [PMID: 32150295 DOI: 10.1002/jum.15205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
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30
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Bi Q, Wu K, Lv F, Xiao Z, Xiong Y, Shen Y. The value of clinical parameters combined with magnetic resonance imaging (MRI) features for preoperatively distinguishing different subtypes of uterine sarcomas: An observational study (STROBE compliant). Medicine (Baltimore) 2020; 99:e19787. [PMID: 32311989 PMCID: PMC7220556 DOI: 10.1097/md.0000000000019787] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
To investigate clinical parameters combined with magnetic resonance imaging (MRI) features including apparent diffusion coefficient (ADC) values in preoperative identification of different subtypes of uterine sarcomas including uterine leiomyosarcoma (LMS), endometrial stromal sarcoma (ESS), and carcinosarcoma (CS).Data from 71 patients with uterine sarcoma confirmed by surgery and pathology were collected. The clinical characteristics, conventional MRI features, mean ADC values, minimum ADC values, and lesion-muscle ADC ratio (rADC) values were compared with different subtypes of uterine sarcomas.Age, clinical manifestation, tumor location, shape, and T1-weighted image (T1WI) signals were significantly different between CS and LMS or ESS (all P < .01). The presence of band sign was significantly higher in ESS than in LMS or CS (both P < .001). The cystic change or necrosis and enhancement could help to differentiate LMS from ESS or CS (both P < .02). Significant differences were observed in T2-weighted image (T2WI) signals of the solid components of LMS compared with CS (P < .001). There was a significant difference between ESS and CS in the rADC values (P = .004).Clinical parameters combined with MRI features could help narrowing preoperative diagnostic possibilities in distinguishing subtypes of uterine sarcomas. These findings may be beneficial in helping guide operative decisions.
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Affiliation(s)
- Qiu Bi
- Department of MRI, The First People's Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, Yunnan
| | - Kunhua Wu
- Department of MRI, The First People's Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, Yunnan
| | - Fajin Lv
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zhibo Xiao
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yulin Xiong
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yiqing Shen
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Hu SY, Xu H, Li Q, Telfer BA, Brattain LJ, Samir AE. Deep Learning-Based Automatic Endometrium Segmentation and Thickness Measurement for 2D Transvaginal Ultrasound. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2019:993-997. [PMID: 31946060 DOI: 10.1109/embc.2019.8856367] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Endometrial thickness is closely related to gyneco-logical function and is an important biomarker in transvaginal ultrasound (TVUS) examinations for assessing female reproductive health. Manual measurement is time-consuming and subject to high inter- and intra- observer variability. In this paper, we present a fully automated endometrial thickness measurement method using deep learning. Our pipeline consists of: 1) endometrium segmentation using a VGG-based U-Net, and 2) endometrial thickness estimation using medial axis transformation. We conducted experimental studies on 137 2D TVUS cases (74/63 secretory phase/proliferative phase). On a test set of 27 cases/277 images, the segmentation Dice score is 0.83. For thickness measurement, we achieved mean absolute error of 1.23/1.38 mm and root mean squared error of 1.79/1.85 mm on two different test sets. The results are considered well within the clinically acceptable range of ±2 mm. Furthermore, our phase-stratified analysis shows that the measurement variance from the secretory phase is higher than that from the proliferative phase, largely due to the high variability of the endometrium appearance in the secretory phase. Future work will extend our current algorithm toward different clinical outcomes for a broader spectrum of clinical applications.
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Martinez-Salazar EL, Tran J, Patiño A, Sureshkumar A, Catanzano T. Infections of the Male and Female Reproductive System: Spectrum of Imaging Findings. Semin Ultrasound CT MR 2020; 41:2-9. [DOI: 10.1053/j.sult.2019.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Foti PV, Tonolini M, Costanzo V, Mammino L, Palmucci S, Cianci A, Ettorre GC, Basile A. Cross-sectional imaging of acute gynaecologic disorders: CT and MRI findings with differential diagnosis-part II: uterine emergencies and pelvic inflammatory disease. Insights Imaging 2019; 10:118. [PMID: 31858287 PMCID: PMC6923316 DOI: 10.1186/s13244-019-0807-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 10/18/2019] [Indexed: 12/11/2022] Open
Abstract
Due to the growing use of cross-sectional imaging in emergency departments, acute gynaecologic disorders are increasingly diagnosed on urgent multidetector computed tomography (CT) studies, often requested under alternative presumptive diagnoses in reproductive-age women. If clinical conditions and state-of-the-art scanner availability permit, magnetic resonance imaging (MRI) is superior to CT due to its more in-depth characterisationof abnormal or inconclusive gynaecological findings, owing to excellent soft-tissue contrast, intrinsic multiplanar capabilities and lack of ionising radiation. This pictorial review aims to provide radiologists with a thorough familiarity with gynaecologic emergencies by illustrating their CT and MRI appearances, in order to provide a timely and correct imaging diagnosis. Specifically, this second instalment reviews with examples and emphasis on differential diagnosis the main non-pregnancy-related uterine emergencies (including endometrial polyps, degenerated leiomyomas and uterine inversion) and the spectrum of pelvic inflammatory disease.
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Affiliation(s)
- Pietro Valerio Foti
- Department of Medical Surgical Sciences and Advanced Technologies, Radiology I Unit, University Hospital "Policlinico-Vittorio Emanuele", Via Santa Sofia 78, 95123, Catania, Italy
| | - Massimo Tonolini
- Department of Radiology, "Luigi Sacco" University Hospital, Via G.B. Grassi 74, 20157, Milan, Italy.
| | - Valeria Costanzo
- Department of Medical Surgical Sciences and Advanced Technologies, Radiology I Unit, University Hospital "Policlinico-Vittorio Emanuele", Via Santa Sofia 78, 95123, Catania, Italy
| | - Luca Mammino
- Department of Medical Surgical Sciences and Advanced Technologies, Radiology I Unit, University Hospital "Policlinico-Vittorio Emanuele", Via Santa Sofia 78, 95123, Catania, Italy
| | - Stefano Palmucci
- Department of Medical Surgical Sciences and Advanced Technologies, Radiology I Unit, University Hospital "Policlinico-Vittorio Emanuele", Via Santa Sofia 78, 95123, Catania, Italy
| | - Antonio Cianci
- Department of General Surgery and Medical-Surgical Specialties, Institute of Obstetrics and Gynecology, University of Catania, Catania, Italy
| | - Giovanni Carlo Ettorre
- Department of Medical Surgical Sciences and Advanced Technologies, Radiology I Unit, University Hospital "Policlinico-Vittorio Emanuele", Via Santa Sofia 78, 95123, Catania, Italy
| | - Antonio Basile
- Department of Medical Surgical Sciences and Advanced Technologies, Radiology I Unit, University Hospital "Policlinico-Vittorio Emanuele", Via Santa Sofia 78, 95123, Catania, Italy
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Caprio MG, Di Serafino M, De Feo A, Guerriero E, Perillo T, Barbuto L, Vezzali N, Rossi E, Ferro F, Vallone G, Orazi C. Ultrasonographic and multimodal imaging of pediatric genital female diseases. J Ultrasound 2019; 22:273-289. [PMID: 30778893 PMCID: PMC6704207 DOI: 10.1007/s40477-019-00358-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 01/10/2019] [Indexed: 12/28/2022] Open
Abstract
Ultrasonography is the first-line imaging modality in the evaluation of the female pelvis in childhood and adolescence, because it is easy to perform, non-invasive and it does not require sedation. The transabdominal approach is preferred in children and adolescents, after filling the bladder to move away the bowel loops from the pelvis. The probe frequency must be adapted to age, thickness of tissues and depth of the structures under examination. High-frequency (4-12 MHz) linear or convex probes are used in newborns; high-frequency linear probes (4-12 MHz) in toddler, convex 5-7.5 MHz probes in girls and convex 3.5-5 MHz probes in teenagers. In this article, the main pathological conditions of the genital female tract in pediatric age are examined, such as congenital anomalies, disorders of sex development, ovarian cysts, ovarian tumors, adnexal torsion, primary amenorrhea, precocious puberty and pelvic inflammatory disease.
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Affiliation(s)
- Maria Grazia Caprio
- Institute of Biostructure and Bioimaging National Research Council, Via Tommaso De Amicis, 95, 80145 Naples, Italy
| | | | - Alessia De Feo
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Elvira Guerriero
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Teresa Perillo
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Luigi Barbuto
- Radiology Department, Umberto I Hospital, Nocera Inferiore, Salerno Italy
| | - Norberto Vezzali
- Radiology Department, Regional Hospital of Bolzano, Bolzano, Italy
| | - Eugenio Rossi
- Radiology Department, “Santobono-Pausilipon” Children Hospital, Naples, Italy
| | - Federica Ferro
- Radiology Department, Regional Hospital of Bolzano, Bolzano, Italy
| | - Gianfranco Vallone
- Paediatric Radiology Department, “Federico II” University Hospital, Naples, Italy
| | - Cinzia Orazi
- Department of Imaging, Bambino Gesù Children’s Hospital Research Institute, P.za S.Onofrio 4, Via Torre di Palidoro, Palidoro, Rome, Italy
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Tran-Harding K, Lee JT, Owen J. Recognizing the CT Manifestations of Gynecologic Conditions Encountered in the Emergency Department. Curr Probl Diagn Radiol 2019; 48:473-481. [DOI: 10.1067/j.cpradiol.2018.07.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 07/02/2018] [Accepted: 07/17/2018] [Indexed: 11/22/2022]
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36
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Faria S, Devine C, Rao B, Sagebiel T, Bhosale P. Imaging and Staging of Endometrial Cancer. Semin Ultrasound CT MR 2019; 40:287-294. [DOI: 10.1053/j.sult.2019.04.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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37
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Revels JW, Dey CB, Aggarwal A, London SS, Katz D, Menias C, Moshiri M. More Than Just 2 Layers: A Comprehensive Multimodality Imaging Review of Endometrial Abnormalities. Curr Probl Diagn Radiol 2019; 49:431-446. [PMID: 31307863 DOI: 10.1067/j.cpradiol.2019.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 06/06/2019] [Accepted: 06/25/2019] [Indexed: 11/22/2022]
Abstract
Endometrial abnormalities develop in female patients of all ages. Symptoms related to endometrial pathologies are among the most common causes of gynecologist office visits, with the radiologists playing an important role in endometrial evaluation. In some instances, the radiologist may be the first physician to note endometrial pathology. In this article, we will provide a comprehensive review of radiologic modalities utilized in the evaluation of the endometrium, as well as the imaging appearance of various endometrial disease processes.
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Affiliation(s)
| | - Courtney B Dey
- Department of Radiology, Eastern Virginia Medical School, Sentara Norfolk General Hospital, Norfolk, VA
| | - Abhi Aggarwal
- Department of Radiology, Eastern Virginia Medical School, Sentara Norfolk General Hospital, Norfolk, VA
| | - Sean S London
- Department of Radiology, University of Washington, Seattle, WA
| | - Douglas Katz
- Department of Radiology, NYU Winthrop Hospital, Mineola, NY
| | | | - Mariam Moshiri
- Department of Radiology, University of Washington, Seattle, WA
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Gilligan LA, Trout AT, Schuster JG, Schwartz BI, Breech LL, Zhang B, Towbin AJ. Normative values for ultrasound measurements of the female pelvic organs throughout childhood and adolescence. Pediatr Radiol 2019; 49:1042-1050. [PMID: 31093723 DOI: 10.1007/s00247-019-04419-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 04/02/2019] [Accepted: 04/22/2019] [Indexed: 12/01/2022]
Abstract
BACKGROUND Normative data from pelvic ultrasonography (US) of the pediatric female reproductive organs are outdated and limited by sample size. OBJECTIVE The purpose of this study was to report normal uterine and ovarian volumes and endometrial stripe thickness in children and young adults and throughout the menstrual cycle in post-menarchal adolescents. MATERIALS AND METHODS Females ages 0 through 20 years who underwent pelvic US between January 2010 and May 2014 were identified. After excluding patients with pelvic and/or endocrine pathology, nomograms of uterine and ovarian volumes and endometrial thickness by age year were created. Data for patients ages 12 years and older with a recorded day of last menstrual period were used to create additional nomograms of volumes/thickness throughout the menstrual cycle. Student's t-tests and linear regression were performed to assess differences in measurements between groups and association of volumes/thickness with age. RESULTS During our study period, 5,647 patients underwent 6,953 pelvic US examinations. After further review, 907 examinations from 889 patients were included (mean age: 11.3±6.0 years). Mean pelvic US volumes (cm3) per organ were 25.5±27.0 (uterus), 4.5±4.7 (right ovary) and 4.0±4.1 (left ovary). Mean endometrial thickness was 4.5±3.7 mm. Right ovarian volume was significantly larger than the left (P=0.0126). Uterine volume, ovarian volume and endometrial thickness were significantly associated with age (P-values<0.0001). Plots of mean organ measurements with respect to week of menses are provided. CONCLUSION We report normal volumes of the uterus and ovaries and endometrial stripe thickness measured by pelvic US throughout childhood and adolescence with reference to the menstrual cycle. These values are significantly associated with age and vary visually by menstrual cycle week.
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Affiliation(s)
- Leah A Gilligan
- Department of Radiology and Medical Imaging, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., MLC 5031, Cincinnati, OH, 45229, USA.
| | - Andrew T Trout
- Department of Radiology and Medical Imaging, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., MLC 5031, Cincinnati, OH, 45229, USA.,Department of Radiology, University of Cincinna College of Medicine, Cincinnati, OH, USA
| | - James G Schuster
- Department of Radiology and Medical Imaging, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., MLC 5031, Cincinnati, OH, 45229, USA
| | - Beth I Schwartz
- Division of Pediatric and Adolescent Gynecology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Lesley L Breech
- Division of Pediatric and Adolescent Gynecology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Bin Zhang
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Division of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Alexander J Towbin
- Department of Radiology and Medical Imaging, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., MLC 5031, Cincinnati, OH, 45229, USA.,Department of Radiology, University of Cincinna College of Medicine, Cincinnati, OH, USA
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Déclaration commune CAR/SOGC en matière d’échographie du pelvis féminin. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 41 Suppl 1:S24-S28. [DOI: 10.1016/j.jogc.2019.02.125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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40
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McGregor J, Thompson G. Role of MRI in uterine didelphys with co-existing endometrial carcinosarcoma. BJR Case Rep 2019; 4:20180010. [PMID: 30931136 PMCID: PMC6438403 DOI: 10.1259/bjrcr.20180010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Revised: 03/28/2018] [Accepted: 03/29/2018] [Indexed: 12/02/2022] Open
Abstract
A case report reviewing MRI in a patient diagnosed with carcinosarcoma and uterine didelphys following presentation with post-menopausal bleeding. Staging MRI images demonstrate the anatomical anomaly and pathological features in these co-existing conditions. This report presents an interesting case of carcinosarcoma in a uterine didelphys. This anatomical abnormality is an uncommon finding and is very rarely complicated by carcinosarcoma. There are very few cases reported to date of this unusual condition. Our case is of a 77-year-old female, para 9, who presented with post-menopausal bleeding for 1 month. She followed the pathway for endometrial cancer using Northern Ireland Cancer Network clinical guidelines. This female’s co-existing uterine anomaly and malignant pathology are outlined, staged and beautifully illustrated with dedicated pelvic MRI. The images captured by MRI are used in all aspects of the patients care and treatment planning, and show the benefit of this modality in multidisciplinary meetings guiding gynaecological-oncology surgeons, who must aware of the anatomical variants before embarking on definitive surgery.
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Affiliation(s)
- Jill McGregor
- Emergency Medicine Department, Ulster Hospital Dundonald, Belfast, UK
| | - Gillian Thompson
- Imaging Department, Western Health and Social Care Trust, Londonderry, UK
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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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Diagnostic performance of sonohysterography and MRI diffusion in benign endometrial lesion characterization. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2018. [DOI: 10.1016/j.ejrnm.2018.02.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Wu S, Liang X, Cui X, Zuo D, Hong L, Chen K. Evaluating the Endometrial Hyperechoic Zone in Early Postpartum Women May Be Deceptive When Utilizing Transcutaneous Sonography. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2018. [DOI: 10.1177/8756479318769029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The objective of this study was to investigate the concordance of measurements for early postpartum endometrial thickness between magnetic resonance imaging (MRI) and transcutaneous diagnostic medical sonography (DMS) as well as its implications. The measurements of early postpartum endometrial thickness were reviewed across 51 postpartum women who underwent MRI and transcutaneous DMS. Additionally, 30 women with a normal menstrual cycle formed a control group, and their data were compared. The results indicated that the endometrial thickness at early postpartum was 4.63 ± 0.62 mm on MRI and 8.18 ± 4.70 mm on DMS, with a comparative significant difference ( P < .001). The endometrial thickness of the control group was 10.02 ± 1.71 mm on MRI and 10.17 ± 1.81 mm on DMS with no comparative significant difference ( P = .124). This cohort study questions whether the hyperechoic zone in the early postpartum uterine cavity represents the actual endometrial thickness. Care should be taken by sonographers in labeling the hyperechoic zone in the early postpartum stage as endometrium.
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Affiliation(s)
- Size Wu
- Department of Ultrasound, the First Affiliated Hospital of Hainan Medical University, Haikou, Hainan, China
| | - Xian Liang
- Department of Ultrasound, the First Affiliated Hospital of Hainan Medical University, Haikou, Hainan, China
| | - Xiaojing Cui
- Department of Ultrasound, the First Affiliated Hospital of Hainan Medical University, Haikou, Hainan, China
| | - Dongsheng Zuo
- Department of Ultrasound, the First Affiliated Hospital of Hainan Medical University, Haikou, Hainan, China
| | - Lian Hong
- Department of Ultrasound, the First Affiliated Hospital of Hainan Medical University, Haikou, Hainan, China
| | - Kailiang Chen
- Department of Ultrasound, the First Affiliated Hospital of Hainan Medical University, Haikou, Hainan, China
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44
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Winter TC. Endometrial Thickness in Symptomatic Postmenopausal Patients Receiving Hormone Replacement Therapy or Tamoxifen. Radiographics 2018. [DOI: 10.1148/rg.2018170211] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Thomas C. Winter
- Department of Radiology, University of Utah, 30 N 1900 E RM 1A071 Radiology, Salt Lake City, Utah 84132–2140
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45
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Abstract
Pelvic ultrasound examination is the primary imaging modality for evaluating a wide range of female pelvic symptomatology, and is often the first imaging test to detect a gynecologic malignancy. Ultrasound imaging is particularly useful for evaluating the thickness and appearance of the endometrium in patients with abnormal bleeding, and in detecting and characterizing ovarian lesions. This article reviews the ultrasound appearance of gynecologic neoplasms grouped by anatomic site of origin, the ultrasound appearance of select benign pelvic pathology not to be misinterpreted as malignancy, as well as available ultrasound imaging-based guidelines for managing potential gynecologic neoplasms.
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Nalgirkar SP, Vinchurkar SA, Saoji AA, Mohanty S. Yoga as a Therapeutic Intervention in the Management of Dysfunctional Uterine Bleeding: A Controlled Pilot Study. J Midlife Health 2018; 9:8-13. [PMID: 29628722 PMCID: PMC5879852 DOI: 10.4103/jmh.jmh_76_17] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Dysfunctional uterine bleeding (DUB) is one of the most common gynecological disorders encountered in women during the reproductive age. Yoga therapy has shown promising benefits in several gynecological disorders. METHODS Thirty women between the ages of 20 and 40 years with primary DUB were randomly assigned to a yoga (n = 15) and a waitlist control group (n = 15). Participants in the yoga group received a 3-month yoga module and were assessed for hemoglobin values, endometrial thickness (ET), pictorial blood loss assessment chart (PBAC), State-Trait Anxiety Inventory, perceived stress scale, and Pittsburgh Sleep Quality Index (PSQI) before and after a 3-month follow-up period. RESULTS At the end of 3 months of intervention, the yoga group, unlike the control group, reported a significant reduction in the anxiety scores (P < 0.05) and perceived stress (P < 0.05). The PSQI scores indicated a reduction in sleep disturbances (P < 0.001) and the need for sleep medications (P < 0.01) and higher global scores (P < 0.001). However, there were no changes in PBAC and ET in both the groups. CONCLUSION The results indicate that yoga therapy positively impacts the outcome of DUB by reducing the perceived stress and state anxiety and improving the quality of sleep. This warrants larger clinical trials to validate the findings of this pilot study.
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Affiliation(s)
| | | | - Apar Avinash Saoji
- Division of Yoga and Life Sciences, S-VYASA, Bengaluru, Karnataka, India
| | - Sriloy Mohanty
- Center for Integrative Medicine and Research, AIIMS, New Delhi, India
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Gupta A, Desai A, Bhatt S. Imaging of the Endometrium: Physiologic Changes and Diseases: Women’s Imaging. Radiographics 2017; 37:2206-2207. [DOI: 10.1148/rg.2017170008] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Akshya Gupta
- From the Department of Imaging Sciences, University of Rochester, 601 Elmwood Ave, PO Box 648, Rochester NY 14642
| | - Amit Desai
- From the Department of Imaging Sciences, University of Rochester, 601 Elmwood Ave, PO Box 648, Rochester NY 14642
| | - Shweta Bhatt
- From the Department of Imaging Sciences, University of Rochester, 601 Elmwood Ave, PO Box 648, Rochester NY 14642
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48
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Elsammak A, Shehata S, Abulezz M, Gouhar G. Efficiency of diffusion weighted magnetic resonance in differentiation between benign and malignant endometrial lesions. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2017. [DOI: 10.1016/j.ejrnm.2017.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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49
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Emergent ultrasound evaluation of the pediatric female pelvis. Pediatr Radiol 2017; 47:1134-1143. [PMID: 28779190 DOI: 10.1007/s00247-017-3843-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 02/13/2017] [Accepted: 03/21/2017] [Indexed: 10/19/2022]
Abstract
Ultrasound is the primary imaging modality of the pediatric female pelvis and is often requested to evaluate girls with pelvic or abdominal pain or abnormal bleeding. The US interpretation can help guide the clinician toward medical or surgical management. Here we discuss the normal US anatomy of the female pelvis and illustrate, through case examples, conditions encountered when performing emergent pelvic US for common and uncommon clinical scenarios.
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50
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Gillies R, Ashley L, Bergin C. Sonographic findings in acute puerperal endometritis: The hypoechoic rim sign and endomyometrial junction indistinctness. Australas J Ultrasound Med 2017; 20:123-128. [PMID: 34760483 PMCID: PMC8409814 DOI: 10.1002/ajum.12057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
PURPOSE To evaluate the accuracy of the sonographic subserosal hypoechoic rim sign and endomyometrial junctional indistinctness in identifying patients with acute endometritis during the puerperal period. METHODS Radiologic coding identified the ultrasound scans of all patients presenting to Auckland City Hospital between January 2014 and February 2016 who were diagnosed clinically as having acute endometritis during the post-partum or post-abortion period. After exclusion criteria were applied, the ultrasound scans of 31 patients with acute endometritis and 32 healthy controls were randomised and anonymised. Images were reviewed retrospectively by two independent reviewers to identify the presence of these signs. RESULTS The average sensitivity and specificity for readers identifying the subserosal hypoechoic rim sign in patients with acute endometritis were 71% and 92%, respectively. Interobserver reliability was good with an average kappa score of 0.63. Average sensitivity and specificity for endomyometrial junctional indistinctness were 79% and 72%, respectively, with good interobserver correlation (average kappa score 0.65). When both signs were either present or absent together, average sensitivity improved to 80.5% and average specificity was 91.7%. CONCLUSION We describe two new sonographic signs for puerperal endomyometritis that could improve the utility of ultrasound in the accurate and timely diagnosis of this condition.
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Affiliation(s)
- Rohana Gillies
- Radiology DepartmentAuckland City Hospital2 Park RdGraftonAuckland1023New Zealand
| | - Linda Ashley
- Radiology DepartmentAuckland City Hospital2 Park RdGraftonAuckland1023New Zealand
| | - Colleen Bergin
- Faculty of Medicine and Health SciencesUniversity of Auckland85 Park RdGraftonAuckland1142New Zealand
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