1
|
Dewilde K, Groszmann Y, Van Schoubroeck D, Grewal K, Huirne J, de Leeuw R, Bourne T, Timmerman D, Van den Bosch T. Enhanced myometrial vascularity secondary to retained pregnancy tissue: time to stop misusing the term arteriovenous malformation. Ultrasound Obstet Gynecol 2024; 63:5-8. [PMID: 37676250 DOI: 10.1002/uog.27476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 08/21/2023] [Accepted: 08/24/2023] [Indexed: 09/08/2023]
Affiliation(s)
- K Dewilde
- Department of Obstetrics & Gynecology, University Hospital Leuven, Leuven, Belgium
| | - Y Groszmann
- Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - D Van Schoubroeck
- Department of Obstetrics & Gynecology, University Hospital Leuven, Leuven, Belgium
| | - K Grewal
- Early Pregnancy and Acute Gynaecology Unit, Department of Obstetrics and Gynaecology, Queen Charlotte's and Chelsea Hospital, Imperial College London, London, UK
| | - J Huirne
- Department of Obstetrics and Gynecology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - R de Leeuw
- Department of Obstetrics and Gynecology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - T Bourne
- Early Pregnancy and Acute Gynaecology Unit, Department of Obstetrics and Gynaecology, Queen Charlotte's and Chelsea Hospital, Imperial College London, London, UK
- Department of Development & Regeneration, KU Leuven, Leuven, Belgium
| | - D Timmerman
- Department of Obstetrics & Gynecology, University Hospital Leuven, Leuven, Belgium
- Department of Development & Regeneration, KU Leuven, Leuven, Belgium
| | - T Van den Bosch
- Department of Obstetrics & Gynecology, University Hospital Leuven, Leuven, Belgium
- Department of Development & Regeneration, KU Leuven, Leuven, Belgium
| |
Collapse
|
2
|
Stefano G, Condous G, Rolla M, Hudelist G, Ferrero S, Alcazar JL, Ajossa S, Bafort C, Van Schoubroeck D, Bourne T, Van den Bosch T, Singh SS, Abrao MS, Szabó G, Testa AC, Di Giovanni A, Fischerova D, Tomassetti C, Timmerman D. Addendum to the consensus opinion from the International Deep Endometriosis Analysis (IDEA) group: sonographic evaluation of the parametrium. Ultrasound Obstet Gynecol 2023. [PMID: 38057967 DOI: 10.1002/uog.27558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 11/24/2023] [Accepted: 11/30/2023] [Indexed: 12/08/2023]
Abstract
Preoperative sonographic staging in patients with suspected parametrial endometriosis is essential to plan the surgical intervention and to anticipate the need for a multidisciplinary approach, and hence optimize surgical outcome. The results of a recent metanalysis suggest that defining more accurately the ultrasonographic criteria of parametrial involvement in endometriosis is needed. The aim of this addendum to the IDEA-consensus is to highlight the sonographic characteristics of the parametrium and identify ultrasound techniques to diagnose deep endometriosis in this area. This article is protected by copyright. All rights reserved.
Collapse
Affiliation(s)
- G Stefano
- Centro Integrato di Procreazione Medicalmente Assistita (PMA) e Diagnostica Ostetrico-Ginecologica, Azienda Ospedaliero Universitaria Cagliari-Policlinico Duilio Casula, Monserrato, Italy
- University of Cagliari, Cagliari, Italy
| | - G Condous
- Acute Gynaecology, Early Pregnancy and Advanced Endoscopy Surgery Unit, Sydney Medical School Nepean, Nepean Hospital, University of Sydney, Penrith, New South Wales, Australia
| | - M Rolla
- Department of Gynecology and Obstetrics of Parma, University of Parma, Parma, Italy
| | - G Hudelist
- Department of Gynecology, Center for Endometriosis, Hospital St John of God, Vienna, Austria
- Rudolfinerhaus Private Clinic and Campus, Vienna, Austria
| | - S Ferrero
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genoa, Italy
- Academic Unit of Obstetrics and Gynecology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - J L Alcazar
- Department of Obstetrics and Gynecology, School of Medicine, Universidad de Navarra, Pamplona, Spain
| | - S Ajossa
- Centro Integrato di Procreazione Medicalmente Assistita (PMA) e Diagnostica Ostetrico-Ginecologica, Azienda Ospedaliero Universitaria-Policlinico Duilio Casula, Monserrato, Italy
| | - C Bafort
- Department of Obstetrics and Gynaecology, Leuven University Fertility Centre, University Hospitals Leuven, Leuven, Belgium
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - D Van Schoubroeck
- Department of Obstetrics and Gynaecology, Leuven University Fertility Centre, University Hospitals Leuven, Leuven, Belgium
| | - T Bourne
- Queen Charlotte's and Chelsea Hospital, Imperial College, London, UK
| | - T Van den Bosch
- Department of Obstetrics and Gynecology, KU Leuven University Hospital, Leuven, Belgium
| | - S S Singh
- Department of Obstetrics and Gynecology, The Ottawa Hospital, Ottawa, Canada
| | - M S Abrao
- Gynecologic Division, BP-A Beneficencia Portuguesa de São Paulo, São Paulo, Brazil
- Disciplina de Ginecologia, Departamento de Obstetricia e Ginecologia, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - G Szabó
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - A C Testa
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
- Dipartimento Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - A Di Giovanni
- Endoscopica Malzoni, Center for Advanced Pelvic Surgery (Drs Giovanni), Avellino, Italy
| | - D Fischerova
- Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - C Tomassetti
- Department of Obstetrics and Gynaecology, Leuven University Fertility Centre, University Hospitals Leuven, Leuven, Belgium
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - D Timmerman
- Department of Obstetrics and Gynaecology, Leuven University Fertility Centre, University Hospitals Leuven, Leuven, Belgium
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| |
Collapse
|
3
|
Tomassetti C, Bafort C, Vanhie A, Meuleman C, Fieuws S, Welkenhuysen M, Timmerman D, Van Schoubroeck D, D'Hooghe T. Estimation of the Endometriosis Fertility Index prior to operative laparoscopy. Hum Reprod 2021; 36:636-646. [PMID: 33367865 DOI: 10.1093/humrep/deaa346] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 11/12/2020] [Indexed: 11/13/2022] Open
Abstract
STUDY QUESTION Can the Endometriosis Fertility Index (EFI) be estimated accurately before surgery? SUMMARY ANSWER The EFI can be estimated accurately based on mere clinical/ultrasound information, with some improvement after adding data from diagnostic laparoscopy. WHAT IS KNOWN ALREADY The EFI is a validated clinical instrument predicting the probability of pregnancy after endometriosis surgery without the use of ART. Being an end-of-surgery-score, it implies the decision for operative laparoscopy to be made in advance-hence, its role in the pre-surgical decision-making process remains to be established. STUDY DESIGN, SIZE, DURATION Single-cohort prospective observational study in 82 patients undergoing complete endometriosis excision (between June and December 2016). Two methods were used to estimate the final EFI: type A based on non-surgical clinical/ultrasound findings only, and type B based on the combination of non-surgical clinical/ultrasound findings and diagnostic laparoscopy data. To calculate EFI type A, an algorithm was created to translate non-surgical clinical/imaging information into rASRM (revised American Society of Reproductive Medicine)-and EFI points. EFI type A and type B estimates were assessed for their clinical and numerical agreement with the final EFI score. Agreement was defined as clinical if EFI scores were within the same range (0-4, 5-6, 7-10), and numerical if their difference was ≤1. PARTICIPANTS/MATERIALS, SETTING, METHODS All 82 patients underwent complete laparoscopic CO2-laser excision of any rASRM stage of endometriosis in the Leuven University Fertility Centre (LUFC) of University Hospitals Leuven, a tertiary referral centre for both endometriosis and infertility. An anonymized clinical research file was created. For each patient, three different data sets were created, in order to allow the estimation of the (surgical part) EFI and of the rASRM scores, defined as follows: 'Estimated type A' contained only non-surgical clinical/imaging data, 'Estimated type B' included type A information plus the information of the diagnostic laparoscopy and 'Final EFI' included information of type A, type B and all intra-operative information required to calculate the final EFI. To calculate EFI type A without surgical information, a set of rules was used to translate pre-surgical clinical/imaging information into (rASRM and EFI points). Scoring was done by one person (C.T.), with a time interval of 4 weeks between sessions for each EFI type. Next to the EFI, also rASRM score and stage were calculated. MAIN RESULTS AND THE ROLE OF CHANCE Agreement rate between estimated EFI type A and final EFI was high for both the clinical (0.915; 95% CI 0.832-0.965) and numerical definition (0.878; 95% CI 0.787-0.940). Agreement rates between estimated EFI type B and final EFI were even higher (clinical (0.988; 95% CI 0.934-1.000), numerical (0.963; 95% CI 0.897-0.992)). LIMITATIONS, REASONS FOR CAUTION Type A estimation is dependent on high-level gynaecological ultrasound expertise, which may not be available in all clinics. A small number of patients had no prior clinical, ultrasound (hard markers) or surgical confirmation of the diagnosis of endometriosis. When applying the estimated EFI type A in clinical practice, a priori assumptions of the presence or absence of endometriosis will need to be made in adjunct to the estimation of the estimated type A EFI when counselling patients on the potential benefit of an (at least diagnostic) laparoscopy. The level of agreement for type A or B should also be taken into account when counselling patients on the type of efforts undertaken to attempt to diagnose or rule out endometriosis. WIDER IMPLICATIONS OF THE FINDINGS As this study reports, the EFI can be estimated accurately based on clinical/ultrasound data only without the need for any surgical data. This means that the EFI could be used as an instrument to guide joint physician-patient decision-making between surgery, ART or other fertility management options for the individualized treatment of women with endometriosis-related infertility. STUDY FUNDING/COMPETING INTEREST(S) During this study period, C.T. was supported by FWO (Research Fund Flanders, Grant number 1700816N) and UZ Leuven KOF (University Hospitals Leuven, Klinisch Onderzoeksfonds).The LUFC received unrestricted research grants from Ferring Pharmaceuticals and Merck SA. Gedeon Richter and MSD sponsored travel to and attendance at scientific meetings. C.M. received consultancy fees from Lumenis (paid to KU Leuven, no private revenue). T.D. has been vice-president and head of global medical affairs infertility for the multinational pharmaceutical company Merck (Darmstadt, Germany) since 1 October 2015. He continues his academic appointment on a part-time basis as Professor of Reproductive Medicine at the University of Leuven (KU Leuven). T.D. has been vice-president and head of global medical affairs infertility for the multinational pharmaceutical company Merck (Darmstadt, Germany) since October 2015. He is also a Guest Professor in Reproductive Medicine and Biology at the Department of Development and Regeneration, Group Biomedical Sciences, KU Leuven (University of Leuven), Belgium, and an Adjunct Professor at the Department of Obstetrics and Gynecology in the University of Yale, New Haven, USA. This work was initiated before he joined Merck KGaA in October 2015, and completed during the subsequent years. TRIAL REGISTRATION NUMBER study registration number at UZ Leuven Clinical Trial Centre: S59221.
Collapse
Affiliation(s)
- C Tomassetti
- Department of Obstetrics and Gynaecology, Leuven University Fertility Centre, University Hospitals Leuven, Leuven 3000, Belgium.,Department of Development and Regeneration, KU Leuven, Leuven 3000, Belgium
| | - C Bafort
- Department of Obstetrics and Gynaecology, Leuven University Fertility Centre, University Hospitals Leuven, Leuven 3000, Belgium.,Department of Development and Regeneration, KU Leuven, Leuven 3000, Belgium
| | - A Vanhie
- Department of Obstetrics and Gynaecology, Leuven University Fertility Centre, University Hospitals Leuven, Leuven 3000, Belgium.,Department of Development and Regeneration, KU Leuven, Leuven 3000, Belgium
| | - C Meuleman
- Department of Obstetrics and Gynaecology, Leuven University Fertility Centre, University Hospitals Leuven, Leuven 3000, Belgium.,Department of Development and Regeneration, KU Leuven, Leuven 3000, Belgium
| | - S Fieuws
- Department of Public Health, Interuniversity Centre for Biostatistics and Statistical Bioinformatics, KU Leuven, Leuven 3000, Belgium
| | - M Welkenhuysen
- Department of Obstetrics and Gynaecology, Leuven University Fertility Centre, University Hospitals Leuven, Leuven 3000, Belgium
| | - D Timmerman
- Department of Obstetrics and Gynaecology, Leuven University Fertility Centre, University Hospitals Leuven, Leuven 3000, Belgium.,Department of Development and Regeneration, KU Leuven, Leuven 3000, Belgium
| | - D Van Schoubroeck
- Department of Obstetrics and Gynaecology, Leuven University Fertility Centre, University Hospitals Leuven, Leuven 3000, Belgium
| | - T D'Hooghe
- Department of Development and Regeneration, KU Leuven, Leuven 3000, Belgium
| |
Collapse
|
4
|
Van den Bosch T, Van Schoubroeck D, Alcazar JL, Guerriero S, Martins WP. Importance of transient myometrial contractions in diagnosis of adenomyosis and congenital uterine anomalies. Ultrasound Obstet Gynecol 2021; 57:651-653. [PMID: 32250499 DOI: 10.1002/uog.22036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 03/18/2020] [Accepted: 03/27/2020] [Indexed: 06/11/2023]
Affiliation(s)
- T Van den Bosch
- Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium
| | - D Van Schoubroeck
- Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium
| | - J L Alcazar
- Department of Obstetrics and Gynecology, Clinica Universidad de Navarra, Pamplona, Spain
| | - S Guerriero
- Department of Obstetrics and Gynecology, University of Cagliari, Policlinico Universitario Duilio Casula, Cagliari, Italy
| | - W P Martins
- SEMEAR Fertilidade, Reproductive Medicine, Ribeirão Preto, Brazil
- Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| |
Collapse
|
5
|
Bielen D, Tomassetti C, Van Schoubroeck D, Vanbeckevoort D, De Wever L, Van den Bosch T, D'Hooghe T, Bourne T, D'Hoore A, Wolthuis A, Van Cleynenbreughel B, Meuleman C, Timmerman D. IDEAL study: magnetic resonance imaging for suspected deep endometriosis assessment prior to laparoscopy is as reliable as radiological imaging as a complement to transvaginal ultrasonography. Ultrasound Obstet Gynecol 2020; 56:255-266. [PMID: 31503381 DOI: 10.1002/uog.21868] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 07/18/2019] [Accepted: 08/27/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To compare the value of using one-stop magnetic resonance imaging (MRI) vs standard radiological imaging as a supplement to transvaginal ultrasonography (TVS) for the preoperative assessment of patients with endometriosis referred for surgery in a tertiary care academic center. METHODS This prospective observational study compared the diagnostic value of the standard preoperative imaging practice of our center, which involves expert TVS complemented by intravenous urography (IVU) for the evaluation of the ureters and double-contrast barium enema (DCBE) for the evaluation of the rectum, sigmoid and cecum, with that of expert TVS complemented by a 'one-stop' MRI examination evaluating the upper abdomen, pelvis, kidneys and ureters as well as rectum and sigmoid on the same day, for the preoperative triaging of 74 women with clinically suspected deep endometriosis. The findings at laparoscopy were considered the reference standard. Patients were stratified according to their need for monodisciplinary surgical approach, carried out by gynecologists only, or multidisciplinary surgical approach, involving abdominal surgeons and/or urologists, based on the extent to which endometriosis affected the reproductive organs, bowel, ureters, bladder or other abdominal organs. RESULTS Our standard preoperative imaging approach and the combined findings of TVS and MRI had similar diagnostic performance, resulting in correct stratification for a monodisciplinary or a multidisciplinary surgical approach of 67/74 (90.5%) patients. However, there were differences between the estimation of the severity of disease by DCBE and MRI. The severity of rectal involvement was underestimated in 2.7% of the patients by both TVS and DCBE, whereas it was overestimated in 6.8% of the patients by TVS and/or DCBE. CONCLUSIONS Complementary to expert TVS, 'one-stop' MRI can predict intraoperative findings equally well as standard radiological imaging (IVU and DCBE) in patients referred for endometriosis surgery in a tertiary care academic center. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
Collapse
Affiliation(s)
- D Bielen
- Department of Radiology, KU Leuven University Hospitals, Leuven, Belgium
- Department of Imaging and Pathology, KU Leuven University Hospitals, Leuven, Belgium
| | - C Tomassetti
- Leuven University Fertility Center, KU Leuven University Hospitals, Leuven, Belgium
- Department of Obstetrics and Gynecology, KU Leuven University Hospitals, Leuven, Belgium
- Department of Development and Regeneration, KU Leuven University Hospitals, Leuven, Belgium
| | - D Van Schoubroeck
- Department of Obstetrics and Gynecology, KU Leuven University Hospitals, Leuven, Belgium
| | - D Vanbeckevoort
- Department of Radiology, KU Leuven University Hospitals, Leuven, Belgium
| | - L De Wever
- Department of Radiology, KU Leuven University Hospitals, Leuven, Belgium
| | - T Van den Bosch
- Department of Obstetrics and Gynecology, KU Leuven University Hospitals, Leuven, Belgium
| | - T D'Hooghe
- Leuven University Fertility Center, KU Leuven University Hospitals, Leuven, Belgium
- Global Medical Affairs Fertility, Merck Healthcare KGaA, Darmstadt, Germany
| | - T Bourne
- Department of Obstetrics and Gynecology, KU Leuven University Hospitals, Leuven, Belgium
- Department of Gynecology and Obstetrics, Imperial College Healthcare NHS Trust, London, UK
| | - A D'Hoore
- Department of Abdominal Surgery, KU Leuven University Hospitals, Leuven, Belgium
- Department of Oncology, KU Leuven University Hospitals, Leuven, Belgium
| | - A Wolthuis
- Department of Abdominal Surgery, KU Leuven University Hospitals, Leuven, Belgium
- Department of Oncology, KU Leuven University Hospitals, Leuven, Belgium
| | | | - C Meuleman
- Department of Obstetrics and Gynecology, KU Leuven University Hospitals, Leuven, Belgium
- Department of Development and Regeneration, KU Leuven University Hospitals, Leuven, Belgium
- Leuven University Endometriosis Center, KU Leuven University Hospitals, Leuven, Belgium
| | - D Timmerman
- Department of Obstetrics and Gynecology, KU Leuven University Hospitals, Leuven, Belgium
- Department of Development and Regeneration, KU Leuven University Hospitals, Leuven, Belgium
| |
Collapse
|
6
|
Froyman W, Van Schoubroeck D, Timmerman D. Automated follicle count using three-dimensional ultrasound in polycystic ovarian morphology. Ultrasound Obstet Gynecol 2018; 51:147-149. [PMID: 28876497 DOI: 10.1002/uog.18896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 08/17/2017] [Accepted: 08/24/2017] [Indexed: 06/07/2023]
Affiliation(s)
- W Froyman
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium
| | - D Van Schoubroeck
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium
| | - D Timmerman
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium
| |
Collapse
|
7
|
Guerriero S, Condous G, van den Bosch T, Valentin L, Leone FPG, Van Schoubroeck D, Exacoustos C, Installé AJF, Martins WP, Abrao MS, Hudelist G, Bazot M, Alcazar JL, Gonçalves MO, Pascual MA, Ajossa S, Savelli L, Dunham R, Reid S, Menakaya U, Bourne T, Ferrero S, Leon M, Bignardi T, Holland T, Jurkovic D, Benacerraf B, Osuga Y, Somigliana E, Timmerman D. Systematic approach to sonographic evaluation of the pelvis in women with suspected endometriosis, including terms, definitions and measurements: a consensus opinion from the International Deep Endometriosis Analysis (IDEA) group. Ultrasound Obstet Gynecol 2016; 48:318-332. [PMID: 27349699 DOI: 10.1002/uog.15955] [Citation(s) in RCA: 405] [Impact Index Per Article: 50.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Revised: 04/11/2016] [Accepted: 04/25/2016] [Indexed: 06/06/2023]
Abstract
The IDEA (International Deep Endometriosis Analysis group) statement is a consensus opinion on terms, definitions and measurements that may be used to describe the sonographic features of the different phenotypes of endometriosis. Currently, it is difficult to compare results between published studies because authors use different terms when describing the same structures and anatomical locations. We hope that the terms and definitions suggested herein will be adopted in centers around the world. This would result in consistent use of nomenclature when describing the ultrasound location and extent of endometriosis. We believe that the standardization of terminology will allow meaningful comparisons between future studies in women with an ultrasound diagnosis of endometriosis and should facilitate multicenter research. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
Collapse
Affiliation(s)
- S Guerriero
- Department of Obstetrics and Gynecology, University of Cagliari, Policlinico Universitario Duilio Casula, Monserrato, Cagliari, Italy
| | - G Condous
- Acute Gynaecology, Early Pregnancy & Advanced Endosurgery Unit, Sydney Medical School Nepean, University of Sydney, Nepean Hospital, Penrith, NSW, Australia
| | - T van den Bosch
- Department Obstetrics and Gynecology, University Hospitals, KU Leuven, Leuven, Belgium and Department of Obstetrics and Gynecology, Tienen Regional Hospital, Tienen, Belgium
| | - L Valentin
- Lund University, Department of Obstetrics and Gynecology, Skåne University Hospital, Malmö, Sweden
| | - F P G Leone
- Department of Obstetrics and Gynecology, Clinical Sciences Institute L. Sacco, Milan, Italy
| | - D Van Schoubroeck
- Department Obstetrics and Gynecology, University Hospitals, KU Leuven, Leuven, Belgium and Department of Obstetrics and Gynecology, Tienen Regional Hospital, Tienen, Belgium
| | - C Exacoustos
- Department of Biomedicine and Prevention, Obstetrics and Gynecological Clinic, Faculty of Medicine, University of Rome 'Tor Vergata', Rome, Italy and Ospedale Generale S. Giovanni Calibita Fatebene Fratelli, Rome, Italy
| | - A J F Installé
- KU Leuven, Department of Electrical Engineering (ESAT), STADIUS, Center for Dynamical Systems, Signal Processing and Data Analytics, Leuven, Belgium and iMinds Medical IT, Leuven, Belgium
| | - W P Martins
- Department of Obstetrics and Gynecology, Ribeirao Preto Medical School, University of Sao Paulo, Sao Paulo, Brazil
| | - M S Abrao
- Endometriosis Division, Obstetrics and Gynecological Department, Sao Paulo University, Sao Paulo, Brazil
| | - G Hudelist
- Hospital St John of God Johannes, Vienna, Austria
| | - M Bazot
- Department of Radiology, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris and Université Pierre et Marie Curie, Paris, France
| | - J L Alcazar
- Department of Obstetrics and Gynecology, Clínica Universidad de Navarra School of Medicine, University of Navarra, Pamplona, Spain
| | - M O Gonçalves
- Clinica Medicina da Mulher and RDO Medicina Diagnóstica, Sao Paulo, Brazil
| | - M A Pascual
- Department of Obstetrics, Gynaecology and Reproduction, Institut Universitari Dexeus, Barcelona, Spain
| | - S Ajossa
- Department of Obstetrics and Gynecology, University of Cagliari, Policlinico Universitario Duilio Casula, Monserrato, Cagliari, Italy
| | - L Savelli
- Gynecology and Early Pregnancy Ultrasound Unit, S. Orsola - Malpighi Hospital, University of Bologna, Bologna, Italy
| | - R Dunham
- Department of Radiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - S Reid
- Department of Obstetrics and Gynaecology, Wollongong Hospital, Wollongong, NSW, Australia
| | - U Menakaya
- Department of Obstetrics and Gynaecology Calvary Public Hospital & JUNIC Specialist Imaging & Women's Center, Canberra, Australia
| | - T Bourne
- Queen Charlotte's & Chelsea Hospital, Imperial College, London, UK
| | - S Ferrero
- Unit of Obstetrics and Gynaecology, IRCCS AOU San Martino - IST, Genova, Italy and Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genova, Genova, Italy
| | - M Leon
- Ultrasound Unit, Department of Gynaecology and Obstetrics, Clinica Indisa, Santiago, Chile
| | - T Bignardi
- Department of Obstetrics and Gynecology, Azienda, Ospedaliera Niguarda Ca' Granda, Milan, Italy
| | - T Holland
- Institute for Women's Health, University College Hospital, London, UK
| | - D Jurkovic
- Institute for Women's Health, University College Hospital, London, UK
| | - B Benacerraf
- Department of Obstetrics, Gynecology and Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Y Osuga
- Department of Obstetrics and Gynecology, The University of Tokyo, Tokyo, Japan
| | - E Somigliana
- Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - D Timmerman
- Department Obstetrics and Gynecology, University Hospitals, KU Leuven, Leuven, Belgium and Department of Obstetrics and Gynecology, Tienen Regional Hospital, Tienen, Belgium
| |
Collapse
|
8
|
Van Schoubroeck D, Raine-Fenning N, Installé AJF, De Neubourg D, De Moor B, Bourne T, Van den Bosch T, Timmerman D. Interobserver agreement in assessment of polycystic ovarian morphology using pattern recognition. Ultrasound Obstet Gynecol 2016; 47:652-653. [PMID: 26415824 DOI: 10.1002/uog.15768] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Revised: 08/29/2015] [Accepted: 09/25/2015] [Indexed: 06/05/2023]
Affiliation(s)
- D Van Schoubroeck
- Department of Obstetrics and Gynecology, University Hospitals KU Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - N Raine-Fenning
- Division of Child Health, Obstetrics & Gynaecology, University of Nottingham, Nottingham, UK
| | - A J F Installé
- KU Leuven, Department of Electrical Engineering ESAT, STADIUS Center for Dynamical Systems, Signal Processing and Data Analytics, Leuven, Belgium
- iMinds Medical IT, Leuven, Belgium
| | - D De Neubourg
- Department of Obstetrics and Gynecology, University Hospitals KU Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - B De Moor
- KU Leuven, Department of Electrical Engineering ESAT, STADIUS Center for Dynamical Systems, Signal Processing and Data Analytics, Leuven, Belgium
- iMinds Medical IT, Leuven, Belgium
| | - T Bourne
- Department of Obstetrics and Gynecology, University Hospitals KU Leuven, Herestraat 49, 3000 Leuven, Belgium
- Queen Charlotte's and Chelsea Hospital, Imperial College London, London, UK
| | - T Van den Bosch
- Department of Obstetrics and Gynecology, University Hospitals KU Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - D Timmerman
- Department of Obstetrics and Gynecology, University Hospitals KU Leuven, Herestraat 49, 3000 Leuven, Belgium
| |
Collapse
|
9
|
Van den Bosch T, Dueholm M, Leone FPG, Valentin L, Rasmussen CK, Votino A, Van Schoubroeck D, Landolfo C, Installé AJF, Guerriero S, Exacoustos C, Gordts S, Benacerraf B, D'Hooghe T, De Moor B, Brölmann H, Goldstein S, Epstein E, Bourne T, Timmerman D. Terms, definitions and measurements to describe sonographic features of myometrium and uterine masses: a consensus opinion from the Morphological Uterus Sonographic Assessment (MUSA) group. Ultrasound Obstet Gynecol 2015; 46:284-98. [PMID: 25652685 DOI: 10.1002/uog.14806] [Citation(s) in RCA: 351] [Impact Index Per Article: 39.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2014] [Revised: 01/18/2015] [Accepted: 01/27/2015] [Indexed: 05/14/2023]
Abstract
The MUSA (Morphological Uterus Sonographic Assessment) statement is a consensus statement on terms, definitions and measurements that may be used to describe and report the sonographic features of the myometrium using gray-scale sonography, color/power Doppler and three-dimensional ultrasound imaging. The terms and definitions described may form the basis for prospective studies to predict the risk of different myometrial pathologies, based on their ultrasound appearance, and thus should be relevant for the clinician in daily practice and for clinical research. The sonographic features and use of terminology for describing the two most common myometrial lesions (fibroids and adenomyosis) and uterine smooth muscle tumors are presented.
Collapse
Affiliation(s)
- T Van den Bosch
- Department of Obstetrics and Gynecology, University Hospitals KU Leuven, Leuven, Belgium
| | - M Dueholm
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | - F P G Leone
- Department of Obstetrics and Gynecology, Clinical Sciences Institute L Sacco, University of Milan, Milan, Italy
| | - L Valentin
- Department of Obstetrics and Gynecology, Skåne University Hospital, Lund University, Malmö, Sweden
| | - C K Rasmussen
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | - A Votino
- Department of Obstetrics and Gynecology, Brugmann University Hospital, Brussels, Belgium
| | - D Van Schoubroeck
- Department of Obstetrics and Gynecology, University Hospitals KU Leuven, Leuven, Belgium
| | - C Landolfo
- Department of Obstetrics and Gynecology, Sant' Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - A J F Installé
- KU Leuven, Department of Electrical Engineering (ESAT), STADIUS, Center for Dynamical Systems, Signal Processing and Data Analytics, Leuven, Belgium
- iMinds Medical IT, Leuven, Belgium
| | - S Guerriero
- Department of Obstetrics and Gynaecology, Azienda Ospedaliera Universitaria of Cagliari and University of Cagliari, Cagliari, Italy
| | - C Exacoustos
- Department of Biomedicine and Prevention, Obstetrics and Gynecological Clinic, University of Rome 'Tor Vergata', Rome, Italy
| | - S Gordts
- L.I.F.E. (Leuven Institute for Fertility & Embryology), Leuven, Belgium
| | - B Benacerraf
- Departments of Radiology and Obstetrics & Gynecology, Harvard Medical School, Boston, MA, USA
| | - T D'Hooghe
- Leuven University Fertility Centre, University Hospitals KU Leuven, Leuven, Belgium
| | - B De Moor
- KU Leuven, Department of Electrical Engineering (ESAT), STADIUS, Center for Dynamical Systems, Signal Processing and Data Analytics, Leuven, Belgium
- iMinds Medical IT, Leuven, Belgium
| | - H Brölmann
- Department of Obstetrics and Gynecology, VU University Medical Center, Amsterdam, The Netherlands
| | - S Goldstein
- Department of Obstetrics and Gynecology, New York University School of Medicine, New York, NY, USA
| | - E Epstein
- Department of Obstetrics and Gynecology, Karolinska University Hospital, Stockholm, Sweden
| | - T Bourne
- Department of Obstetrics and Gynecology, University Hospitals KU Leuven, Leuven, Belgium
- Queen Charlotte's and Chelsea Hospital, Imperial College, London, UK
| | - D Timmerman
- Department of Obstetrics and Gynecology, University Hospitals KU Leuven, Leuven, Belgium
| |
Collapse
|
10
|
Van Schoubroeck D, Van den Bosch T, Ameye L, Boes AS, D'Hooghe T, Timmerman D. Pain during Fallopian-tube patency testing by hysterosalpingo-foam sonography. Ultrasound Obstet Gynecol 2015; 45:346-350. [PMID: 25092501 DOI: 10.1002/uog.14646] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Revised: 07/20/2014] [Accepted: 07/22/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVES To evaluate perception of pain during Fallopian-tube patency testing by hysterosalpingo-foam sonography (HyFoSy). METHODS In this cross-sectional study, 216 consecutive women presenting at a university fertility clinic for HyFoSy examination were included. Patients were instructed to take ibuprofen 1 hour before the procedure. Immediately after the procedure, patients filled in a questionnaire concerning discomfort or pain experienced during the process, including a visual analog scale (VAS) score for perception of pain. RESULTS The median VAS score for perception of pain during transvaginal ultrasound examination and during HyFoSy examination was 1.5 (95% CI, 1.2-1.7) and 3.6 (95% CI, 3.0-4.0), respectively. One-third of women reported that the level of discomfort or pain during HyFoSy examination was similar to that during the preceding transvaginal ultrasound examination and 48% of women considered HyFoSy examination to be neutral/unpleasant, but not painful. There was an inverse association between both patients' age and parity and the pain experienced. CONCLUSIONS HyFoSy examination is tolerated well and allows for reliable tubal patency testing without exposing the patient to ionizing radiation in an outpatient setting with a low technical failure rate.
Collapse
Affiliation(s)
- D Van Schoubroeck
- Department of Development and Regeneration, University Hospitals Leuven, Katholieke Universiteit Leuven, Leuven, Belgium
| | | | | | | | | | | |
Collapse
|
11
|
Votino A, Van den Bosch T, Installé A, Van Schoubroeck D, Kaijser J, Kacem Y, De Moor B, Van Pachterbeke C, Timmerman D. Optimizing the ultrasound visualization of the endometrial-myometrial junction (EMJ). Facts Views Vis Obgyn 2015; 7:60-3. [PMID: 25897372 PMCID: PMC4402444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVES The aim of this study was to find the best 3D reconstruction technique to visualize the endometrial-myometrial junction (EMJ). METHODS Retrospective observational study on 240 stored 3D volumes of 80 patients. The first author reconstructed the 2D midcoronal image without volume contrast imaging (VCI), with VCI set at 4 mm and with VCI set at 2 mm. Three images per patient (240 images) were saved and integrated in the web-based electronic data capture software Clinical Data Miner (CDM) (http://cdm.esat.kuleuven.be). Five experienced gynaecologists analysed the images shown in random order. They scored the image quality (good, moderate, poor, insufficient) and described the EMJ of these images using IETA terminology (regular, irregular, interrupted, not defined). One of the examiners (CVP) also re-evaluated the same set of images after 12 days to assess intra-observer variability. RESULTS The use of VCI significantly improved the recorded subjective image quality. The Fleiss' kappa coefficient for evaluating the inter-observer variability of the EMJ description using coronal view without VCI, with VCI at 4 mm and VCI at 2 mm were 0.36 ± 0.05, 0.34 ± 0.05 and 0.42 ± 0.05, respectively. The corresponding figures for the intra-observer variability were 0.58 ± 0.08, 0.36 ± 0.08 and 0.68 ± 0.07, respectively. DISCUSSION In this study on 3D reconstructed coronal images of the uterine cavity, the 2 mm VCI slices gave the best quality images of the EMJ.
Collapse
Affiliation(s)
- A. Votino
- Department of Obstetrics and Gynaecology, University Hospitals KULeuven, Leuven, Belgium.
,Brugmann Departments of Obstetrics and Gynaecology, University Hospital Brugmann, Brussels, Belgium.
| | - T. Van den Bosch
- Department of Obstetrics and Gynaecology, University Hospitals KULeuven, Leuven, Belgium.
| | - A.J.F. Installé
- KU Leuven, Department of Electrical Engineering ESAT, STADIUS Centre for Dynamical Systems, Signal Processing and Data Analytics, Leuven, Belgium.
,iMinds Medical IT, Leuven, Belgium.
| | - D. Van Schoubroeck
- Department of Obstetrics and Gynaecology, University Hospitals KULeuven, Leuven, Belgium.
| | - J. Kaijser
- Department of Obstetrics and Gynaecology, University Hospitals KULeuven, Leuven, Belgium.
| | - Y. Kacem
- Brugmann Departments of Obstetrics and Gynaecology, University Hospital Brugmann, Brussels, Belgium.
| | - B. De Moor
- KU Leuven, Department of Electrical Engineering ESAT, STADIUS Centre for Dynamical Systems, Signal Processing and Data Analytics, Leuven, Belgium.
,iMinds Medical IT, Leuven, Belgium.
| | - C. Van Pachterbeke
- Brugmann Departments of Obstetrics and Gynaecology, University Hospital Brugmann, Brussels, Belgium.
| | - D. Timmerman
- Department of Obstetrics and Gynaecology, University Hospitals KULeuven, Leuven, Belgium.
| |
Collapse
|
12
|
Van den Bosch T, Ameye L, Van Schoubroeck D, Bourne T, Timmerman D. Intra-cavitary uterine pathology in women with abnormal uterine bleeding: a prospective study of 1220 women. Facts Views Vis Obgyn 2015; 7:17-24. [PMID: 25897368 PMCID: PMC4402439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVES Our primary aim was to assess how patients' characteristics, bleeding pattern, sonographic endometrial thickness (ET) and additional features at unenhanced ultrasound examination (UTVS) and at fluid instillation sonography (FIS) contribute to the diagnosis of intracavitary uterine pathology in women presenting with abnormal uterine bleeding (AUB). We further aimed to report the prevalence of pathology in women presenting with AUB. METHODS 1220 consecutive women presenting with AUB underwent UTVS, colour Doppler imaging (CDI) and FIS. Most women (n = 1042) had histological diagnosis. RESULTS Mean age was 50 years and 37% were postmenopausal. Of 1220 women 54% were normal, polyps were diagnosed in 26%, intracavitary fibroids in 11%, hyperplasia without atypia in 4% and cancer in 3%. All cancers were diagnosed in postmenopausal (7%) or perimenopausal (1%) women. ET had a low predictive value in premenopausal women (LR+ and LR- of 1.34 and 0.74, respectively), while FIS had a LR+ and LR- of 6.20 and 0.24, respectively. After menopause, ET outperformed all patient characteristics for the prediction of endometrial pathology (LR+ and LR- of 3.13 and 0.24). The corresponding LR+ and LR- were 10.85 and 0.71 for CDI and 8.23 and 0.26 for FIS. CONCLUSION About half of the women presenting to a bleeding clinic will have pathology. In premenopausal women, benign lesions are often the cause of AUB. For the prediction of intracavitary pathology ET is of little value in premenopausal women. CDI and FIS substantially improve the diagnostic accuracy.
Collapse
Affiliation(s)
- T. Van den Bosch
- Department of Obstetrics and Gynaecology, University Hospitals KULeuven, Leuven, Belgium.
| | - L. Ameye
- KU Leuven Department of Development and Regeneration, Leuven, Belgium.
| | - D. Van Schoubroeck
- Department of Obstetrics and Gynaecology, University Hospitals KULeuven, Leuven, Belgium.
| | - T. Bourne
- KU Leuven Department of Development and Regeneration, Leuven, Belgium.
,Department of Obstetrics and Gynecology, Imperial College London, Hammersmith Campus, London, United Kingdom.
| | - D. Timmerman
- Department of Obstetrics and Gynaecology, University Hospitals KULeuven, Leuven, Belgium.
,KU Leuven Department of Development and Regeneration, Leuven, Belgium.
| |
Collapse
|
13
|
Pasman S, Claes L, Lewi L, Van Schoubroeck D, Debeer A, Emonds M, Geuten E, De Catte L, Devlieger R. Intrauterine transfusion for fetal anemia due to red blood cell alloimmunization: 14 years experience in Leuven. Facts Views Vis Obgyn 2015; 7:129-36. [PMID: 26175890 PMCID: PMC4498170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE The purpose of this study is to report on the pregnancy and neonatal outcome of intrauterine transfusion (IUT) for red blood cell (RBC-)alloimmunization. MATERIAL AND METHODS Retrospective cohort study of all IUT for RBC-alloimmunization in the University Hospital of Leuven, between January 2000 and January 2014. The influence of hydrops, gestational age and technique of transfusion on procedure related adverse events were examined. RESULTS 135 IUTs were performed in 56 fetuses. In none of the cases fetal or neonatal death occurred. Mild adverse events were noted in 10% of IUTs, whereas severe adverse events occurred in 1.5%. Hydrops and transfusion in a free loop were associated with an increased risk of adverse events whereas gestational age (GA) at transfusion after 34 weeks was not. Median GA at birth was 35.6 weeks and 9% was born before 34 weeks. Besides phototherapy 65.4% required additional neonatal treatment for alloimmune anemia. Non-hematologic complications occurred in 23.6% and were mainly related to preterm birth. CONCLUSION In experienced hands, IUT for RBC-alloimmunization is a safe procedure in this era. Patients should be referred to specialist centers prior to the development of hydrops. IUT in a free loop of cord and unnecessary preterm birth are best avoided.
Collapse
Affiliation(s)
- S.A. Pasman
- Department of Obstetrics and Gynecology, University Hospitals Leuven, Belgium.
| | - L. Claes
- Department of Obstetrics and Gynecology, University Hospitals Leuven, Belgium.
| | - L. Lewi
- Department of Obstetrics and Gynecology, University Hospitals Leuven, Belgium.
| | - D. Van Schoubroeck
- Department of Obstetrics and Gynecology, University Hospitals Leuven, Belgium.
| | - A. Debeer
- Department of Neonatology, University Hospitals Leuven, Belgium.
| | - M. Emonds
- Department of Hematology, University Hospitals Leuven, Belgium and Blood transfusion center, Red Cross Flanders, Leuven, Belgium.
| | - E. Geuten
- Department of Obstetrics and Gynecology, University Hospitals Leuven, Belgium.
| | - L. De Catte
- Department of Obstetrics and Gynecology, University Hospitals Leuven, Belgium.
| | - R. Devlieger
- Department of Obstetrics and Gynecology, University Hospitals Leuven, Belgium.
| |
Collapse
|
14
|
DeKoninck P, Richter J, Van Mieghem T, Van Schoubroeck D, Allegaert K, De Catte L, Deprest JA. Cardiac assessment in fetuses with right-sided congenital diaphragmatic hernia: case-control study. Ultrasound Obstet Gynecol 2014; 43:432-436. [PMID: 23857637 DOI: 10.1002/uog.12561] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Revised: 06/07/2013] [Accepted: 07/04/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To evaluate cardiac anatomy and function in fetuses with right-sided congenital diaphragmatic hernia (RCDH), and to compare these values with those of normal controls. METHODS Fetal echocardiography was performed in 17 consecutive cases with isolated RCDH and 17 gestational age-matched controls. Two-dimensional measurements included ventricular and outflow tract diameters. Doppler ultrasound was used to measure the flow pattern in the ductus venosus and over the pulmonary and aortic valves, right and left ventricular myocardial performance index and the E/A wave ratio over the atrioventricular valves. Stroke volume, cardiac output and shortening fraction were calculated. RESULTS Median gestational age at evaluation was 27.4 (interquartile range, 24.4-28.9) weeks. RCDH cases had a significantly smaller right ventricle and pulmonary valve diameter. Furthermore, stroke volume and cardiac output from the right ventricle were lower than in controls. Myocardial contractility, however, appeared normal. CONCLUSIONS Despite significantly reduced right ventricular dimensions and cardiac output, cardiac contractility was normal in a cohort of fetuses with RCDH.
Collapse
Affiliation(s)
- P DeKoninck
- Fetal Medicine Unit, Department of Obstetrics and Gynecology, University Hospitals Leuven & Research Unit Fetus, Placenta and Neonate, Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | | | | | | | | | | | | |
Collapse
|
15
|
Van den Bosch T, Valentin L, Van Schoubroeck D, Luts J, Bignardi T, Condous G, Epstein E, Leone FP, Testa AC, Van Huffel S, Bourne T, Timmerman D. Detection of intracavitary uterine pathology using offline analysis of three-dimensional ultrasound volumes: interobserver agreement and diagnostic accuracy. Ultrasound Obstet Gynecol 2012; 40:459-463. [PMID: 22461338 DOI: 10.1002/uog.11163] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/13/2012] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To estimate the diagnostic accuracy and interobserver agreement in predicting intracavitary uterine pathology at offline analysis of three-dimensional (3D) ultrasound volumes of the uterus. METHODS 3D volumes (unenhanced ultrasound and gel infusion sonography with and without power Doppler, i.e. four volumes per patient) of 75 women presenting with abnormal uterine bleeding at a 'bleeding clinic' were assessed offline by six examiners. The sonologists were asked to provide a tentative diagnosis. A histological diagnosis was obtained by hysteroscopy with biopsy or operative hysteroscopy. Proliferative, secretory or atrophic endometrium was classified as 'normal' histology; endometrial polyps, intracavitary myomas, endometrial hyperplasia and endometrial cancer were classified as 'abnormal' histology. The diagnostic accuracy of the six sonologists with regard to normal/abnormal histology and interobserver agreement were estimated. RESULTS Intracavitary pathology was diagnosed at histology in 39% of patients. Agreement between the ultrasound diagnosis and the histological diagnosis (normal vs abnormal) ranged from 67 to 83% for the six sonologists. In 45% of cases all six examiners agreed with regard to the presence/absence of intracavitary pathology. The percentage agreement between any two examiners ranged from 65 to 91% (Cohen's κ, 0.31-0.81). The Schouten κ for all six examiners was 0.51 (95% CI, 0.40-0.62), while the highest Schouten κ for any three examiners was 0.69. CONCLUSION When analyzing stored 3D ultrasound volumes, agreement between sonologists with regard to classifying the endometrium/uterine cavity as normal or abnormal as well as the diagnostic accuracy varied substantially. Possible actions to improve interobserver agreement and diagnostic accuracy include optimization of image quality and the use of a consistent technique for analyzing the 3D volumes.
Collapse
Affiliation(s)
- T Van den Bosch
- Department of Obstetrics & Gynecology, University Hospitals K.U. Leuven, Leuven, Belgium.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
16
|
Servaes K, Van Schoubroeck D, Welkenhuysen M, D'Hooghe T, De Neubourg D. How reproducible are 2D follicular measurements? Fertil Steril 2012. [DOI: 10.1016/j.fertnstert.2012.07.811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
17
|
Van den Bosch T, Van Schoubroeck D, Van Calster B, Cornelis A, Timmerman D. Pre-sampling ultrasound evaluation and assessment of the tissue yield during sampling improves the diagnostic reliability of office endometrial biopsy. J OBSTET GYNAECOL 2012; 32:173-6. [PMID: 22296431 DOI: 10.3109/01443615.2011.635223] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
We evaluated the implementation of a strict procedure for endometrium biopsy, including pre-sampling ultrasound examination and assessment of the tissue yield during sampling, in 257 consecutive women with abnormal bleeding. The tissue yield was assessed during sampling and scored from 1 to 4. The median endometrial thickness as measured by ultrasound was 5.0 mm, 5.1 mm, 10.0 mm and 18.7 mm for a tissue yield score of 1, 2, 3 and 4, respectively. The median endometrial thickness at ultrasound and the median tissue yield score was 18.3 mm and score 4 in the endometrial cancer cases, compared with 3.9 mm and score 1, and 14.8 mm and score 3 in the case of endometrial atrophy and hyperplasia, respectively; and 11.5 mm and score 2 in endometrial polyp cases. Overall, 12 cancers were diagnosed. No endometrial cancer was diagnosed during follow-up (median 447 days). A strict office endometrial biopsy procedure contributes to the diagnostic reliability for intracavitary pathology.
Collapse
Affiliation(s)
- T Van den Bosch
- Department of Obstetrics and Gynaecology, University Hospitals Leuven, K. U. Leuven, Belgium.
| | | | | | | | | |
Collapse
|
18
|
Pexsters A, Luts J, Van Schoubroeck D, Bottomley C, Van Calster B, Van Huffel S, Abdallah Y, D'Hooghe T, Lees C, Timmerman D, Bourne T. Clinical implications of intra- and interobserver reproducibility of transvaginal sonographic measurement of gestational sac and crown-rump length at 6-9 weeks' gestation. Ultrasound Obstet Gynecol 2011; 38:510-515. [PMID: 21077156 DOI: 10.1002/uog.8884] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/27/2010] [Indexed: 05/30/2023]
Abstract
OBJECTIVES To assess intra- and interobserver agreement of routinely performed measurements-crown-rump length (CRL) and mean gestational sac diameter (MSD)-for assessing the likelihood of miscarriage in the first trimester of pregnancy using transvaginal sonography. METHODS A cross-sectional study of CRL and gestational sac measurements in first-trimester pregnancies was conducted in a fetal medicine referral center with a predominantly Caucasian population. Gestational age ranged from 6 to 9 weeks. All patients underwent a transvaginal ultrasound examination using a high-resolution ultrasound machine. Two measurements of CRL and measurements of three diameters of the gestational sac were obtained by two observers. Agreement within and between observers for CRL and between observers for MSD was analyzed using 95% prediction intervals, Bland-Altman plots with 95% limits of agreement and the intraclass correlation coefficient (ICC). RESULTS In total 54 patients were included in the study, with measurements obtained by both observers in 44 of these. Intra- and interobserver ICCs were high for CRL measurements, with values of 0.992 and 0.993 for intraobserver agreement and 0.993 for interobserver agreement. For the MSD, the interobserver ICC was 0.952. Limits of agreement were ± 8.91 and ± 11.37% for intraobserver agreement of CRL and ± 14.64% for interobserver agreement of CRL. For MSD, the interobserver limits of agreement were ± 18.78%. For an MSD measurement of 20 mm by the first observer, the prediction interval for the second observer was 16.8-24.5 mm. For a CRL measurement of 6 mm, the prediction interval for the second observer was 5.4-6.7 mm. CONCLUSION For dating purposes, there is reasonable reproducibility of CRL measurements using transvaginal ultrasonography at 6-9 weeks' gestation. When diagnosing miscarriage based on measurements of CRL care must be taken for values close to any decision boundary. The higher interobserver variability that we observed for MSD has implications for the diagnosis of miscarriage based on this measurement in the absence of a visible embryo or yolk sac.
Collapse
Affiliation(s)
- A Pexsters
- Department of Obstetrics and Gynaecology, University Hospitals, Katholieke Universiteit Leuven, Leuven, Belgium.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
19
|
Van Den Bosch T, Van Schoubroeck D, Luts J, Bignardi T, Condous G, Epstein E, Leone FP, Testa AC, Valentin L, Van Huffel S, Bourne T, Timmerman D. Effect of gel-instillation sonography on Doppler ultrasound findings in endometrial polyps. Ultrasound Obstet Gynecol 2011; 38:355-359. [PMID: 21557371 DOI: 10.1002/uog.9043] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/26/2011] [Indexed: 05/30/2023]
Abstract
OBJECTIVE Saline infusion sonohysterography has been reported to suppress the color signal within the endometrium at color or power Doppler evaluation. The aim of this study was to evaluate if gel-instillation sonography (GIS) affects the power Doppler signal in patients with endometrial polyps. METHODS Ultrasound volumes of the uterus, obtained by three-dimensional ultrasound imaging of 25 women with histologically confirmed endometrial polyps, were assessed offline by six gynecologists with a special interest in gynecological ultrasound. Each woman contributed four volumes: one gray-scale volume and one power Doppler volume before GIS, and one gray-scale volume and one power Doppler volume at GIS. Power Doppler features before and after gel infusion were compared. RESULTS At unenhanced ultrasound a pedicle artery was seen in 27-46% of cases, whereas, after gel infusion the examiners reported a pedicle artery in 30-46% of cases (Exact McNemar's test P-values ranged from 0.50 to 1.00). The level of agreement between unenhanced ultrasound and GIS ranged from 59 to 91% (Cohen's kappa values ranged from 0.17 to 0.79). There was no tendency for a pedicle artery to be identified less often at GIS than before gel instillation. CONCLUSION Gel infusion does not affect the power Doppler signal in patients with endometrial polyps.
Collapse
Affiliation(s)
- T Van Den Bosch
- Department of Obstetrics & Gynecology, University Hospitals KU Leuven, Leuven, Belgium.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
20
|
Done E, Allegaert K, Lewi P, Jani J, Gucciardo L, Van Mieghem T, Gratacos E, Devlieger R, Van Schoubroeck D, Deprest J. Maternal hyperoxygenation test in fetuses undergoing FETO for severe isolated congenital diaphragmatic hernia. Ultrasound Obstet Gynecol 2011; 37:264-271. [PMID: 20652932 DOI: 10.1002/uog.7753] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
OBJECTIVES To predict neonatal survival and pulmonary hypertension by measurement of fetal pulmonary artery reactivity to maternal hyperoxygenation in fetuses with severe congenital diaphragmatic hernia treated by fetoscopic endoluminal tracheal occlusion (FETO). METHODS Thirty-eight fetuses underwent FETO at around 28 weeks' gestation and the balloon was removed at 34 weeks in most cases. We performed a hyperoxygenation test and measured the lung-to-head ratio of each fetus before and after each procedure. Outcome measures were neonatal survival, occurrence of pulmonary hypertension and its response to inhaled nitric oxide (iNO). RESULTS Fetuses that survived had a larger increase in lung size and decrease of resistance in the first branch of the main pulmonary artery than did those that died. Both measures were also predictive of pulmonary hypertension unresponsive to iNO. The hyperoxygenation test and lung-to-head ratio were both best predictive for neonatal survival when measured following removal of the balloon (P < 0.002). Discriminant analysis confirmed that these two parameters are independent predictors of outcome. CONCLUSIONS In fetuses undergoing FETO, pulmonary vascular reactivity in relation to oxygen and lung size are independent predictors of neonatal survival and pulmonary hypertension. The hyperoxygenation test merits further study in expectantly managed cases.
Collapse
Affiliation(s)
- E Done
- Department of Obstetrics and Gynaecology, Division of Woman and Child, University Hospitals Leuven, Leuven, Belgium
| | | | | | | | | | | | | | | | | | | |
Collapse
|
21
|
Van Mieghem T, Eixarch E, Gucciardo L, Done E, Gonzales I, Van Schoubroeck D, Lewi L, Gratacos E, Deprest J. Outcome prediction in monochorionic diamniotic twin pregnancies with moderately discordant amniotic fluid. Ultrasound Obstet Gynecol 2011; 37:15-21. [PMID: 20737453 DOI: 10.1002/uog.8802] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
OBJECTIVE The aim of this study was to identify predictors of twin-to-twin transfusion syndrome (TTTS) and selective intrauterine growth restriction (sIUGR) in monochorionic diamniotic (MCDA) twin pregnancies with moderate amniotic fluid discordance (mAFD). METHODS Monochorionic twins with mAFD (n = 45; gestational age, 15-29 weeks) were assessed for extent of fluid discordance, fetal growth discordance and fetal cardiac dysfunction, and were followed longitudinally. A prediction algorithm was constructed for TTTS and sIUGR and validated in an unrelated cohort (n = 52). RESULTS Cardiac dysfunction could not predict TTTS or sIUGR. Twins below 20 weeks of gestation with a fluid discordance of ≥ 3.1 cm had a risk of TTTS of 85.7%. Sensitivity for TTTS was nevertheless only 55%. An intertwin weight discordance of ≥ 25% had 63% sensitivity and 76% specificity for sIUGR without TTTS. CONCLUSION The outcome of MCDA twins with mAFD remains unpredictable, yet high-risk and low-risk subgroups for TTTS can be identified based on severity of fluid discordance and gestational age.
Collapse
Affiliation(s)
- T Van Mieghem
- University Hospitals Leuven, Division of Woman and Child, Department of Obstetrics and Gynecology, Fetal Diagnosis and Therapy Unit, Leuven, Belgium
| | | | | | | | | | | | | | | | | |
Collapse
|
22
|
Van den Bosch T, Van Schoubroeck D, Daemen A, Domali E, Vandenbroucke V, De Moor B, Deprest J, Timmerman D. Lidocaine Does Not Reduce Pain Perception during Gel Instillation Sonography or Subsequent Office Hysteroscopy: Results of a Randomized Trial. Gynecol Obstet Invest 2011; 71:236-9. [DOI: 10.1159/000319240] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2010] [Accepted: 07/12/2010] [Indexed: 11/19/2022]
|
23
|
Pexsters A, Daemen A, Bottomley C, Van Schoubroeck D, De Catte L, De Moor B, D'Hooghe T, Lees C, Timmerman D, Bourne T. New crown-rump length curve based on over 3500 pregnancies. Ultrasound Obstet Gynecol 2010; 35:650-655. [PMID: 20512816 DOI: 10.1002/uog.7654] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
OBJECTIVES The Robinson and Hadlock crown-rump length (CRL) curves are commonly used to estimate gestational age (GA) based on the CRL of an embryo or fetus. However, the Robinson curve was derived from a small population using transabdominal sonography and the Hadlock curve was generated using early transvaginal ultrasound equipment. The aim of this study was to use transvaginal and transabdominal ultrasound to study a large population of early pregnancies to assess embryonic or fetal size, and so create a new normal CRL curve from 5.5 weeks' gestation. We compared this with the Robinson and Hadlock CRL curves. METHODS A retrospective database study of CRL in first-trimester embryos was conducted in a fetal medicine referral center with a predominantly Caucasian population. Linear mixed-effects analysis was performed to determine the relationship between CRL and GA. After internal validation of this curve, the CRL was compared with the expected CRL at a given GA according to both the Robinson and Hadlock models based on the paired t-test. Bland-Altman plots were constructed to compare the CRL measurements obtained in our study population with those predicted according to GA by both the Robinson and Hadlock curves. RESULTS In total 3710 normal singleton pregnancies with a known last menstrual period were included in the study, corresponding to 4387 scans. Our data differed significantly from both the Robinson and the Hadlock curves (paired t-test, P < 0.0001). A mixed-effects model for CRL as a function of GA was developed on 70% of the data and internally validated with z-scores on the remaining 30%. The new curve extended from 5.5 to 14 weeks' gestation. Compared to our CRL curve, the Robinson curve gave a 4-day underestimation of GA at 6 weeks with a difference in CRL of 3.7 mm and a 1-day overestimation from 11 to 14 weeks with a difference in CRL of 0.9-1 mm. A comparison between our curve and the Hadlock curve showed a difference in CRL of 2.7 mm at 6 weeks, equivalent to an underestimation of 3 days, and a difference in CRL of 4.8 mm at 14 weeks, equivalent to an overestimation of 2 days. At 9 weeks all three curves were similar. CONCLUSION The new CRL curve suggests differences in the range of CRL measurements compared with the Robinson and Hadlock curves. These differences are most significant at the beginning and the end of the first trimester, and may lead to more accurate estimations of GA.
Collapse
Affiliation(s)
- A Pexsters
- Department of Obstetrics and Gynecology, University Hospitals, Katholieke Universiteit Leuven, Leuven, Belgium.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
24
|
Van den Bosch T, Betsas G, Van Schoubroeck D, Daemen A, Vandenbroucke V, Cornelis A, De Moor B, Deprest J, Timmerman D. Gel infusion sonography in the evaluation of the uterine cavity. Ultrasound Obstet Gynecol 2009; 34:711-714. [PMID: 19902475 DOI: 10.1002/uog.7463] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVES To compare gel infusion sonohysterography (GIS) with saline contrast sonohysterography (SCSH) with regard to technical feasibility and procedure-related pain experienced by patients. METHODS This prospective observational cohort study included 551 consecutive patients with abnormal bleeding: SCSH was attempted in the first 402 women and GIS was attempted in the following 149. All procedures were performed by the same examiner, in the same clinical setting, using a 2-mm diameter catheter. After contrast sonohysterography, most patients underwent office hysteroscopy (n = 502) and endometrial sampling (n = 323). The women were asked to rate the pain experienced during each procedure using a 100-mm visual analog scale (VAS). Patients' characteristics, ultrasound findings, histological diagnosis, technical failures and procedure-related pain were compared between the two procedures. RESULTS The mean +/- SD VAS score for contrast sonography, subsequent hysteroscopy and endometrial biopsy were 22.9 +/- 21.7, 38.8 +/- 26.6 and 50.0 +/- 26.3, respectively, in the SCSH subgroup vs. 16.5 +/- 21.5, 27.6 +/- 28 and 33.6 +/- 30.3, respectively, in the GIS subgroup (P = 0.0051, P = 0.0005 and P = 0.0003, respectively). The technical failure rate was 5% in the SCSH subgroup vs. 2% in the GIS subgroup (P = 0.1522). CONCLUSIONS GIS and SCSH showed similar technical feasibility. The procedure-related pain reported by patients during contrast sonohysterography, as well as during subsequent hysteroscopy and endometrial sampling, was less in the GIS group.
Collapse
Affiliation(s)
- T Van den Bosch
- Department of Obstetrics and Gynecology, University Hospitals, KU Leuven, Leuven, Belgium.
| | | | | | | | | | | | | | | | | |
Collapse
|
25
|
Van Mieghem T, Gucciardo L, Doné E, Van Schoubroeck D, Graatsma EM, Visser GHA, Verhaeghe J, Deprest J. Left ventricular cardiac function in fetuses with congenital diaphragmatic hernia and the effect of fetal endoscopic tracheal occlusion. Ultrasound Obstet Gynecol 2009; 34:424-429. [PMID: 19753655 DOI: 10.1002/uog.7340] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVES The pre-existing compression of the left ventricle in congenital diaphragmatic hernia (CDH) could be aggravated by the amplified lung growth after fetoscopic endoluminal tracheal occlusion (FETO). Our aim was to document left ventricular (LV) size and function in fetuses with isolated left-sided CDH and to document the effect of FETO on the fetal heart. METHODS We determined cardiac axis, LV diameters, ejection fraction, shortening fraction, mitral E/A index and myocardial performance index (MPI) in 27 fetuses with isolated left-sided CDH, and compared these with values in a reference population (n = 117). In fetuses with severe CDH that subsequently underwent FETO and/or reversal of occlusion, additional measurements were obtained 24 h before and after each fetal intervention. We recorded fetal electrocardiograms non-invasively in six CDH fetuses and compared the duration of the QRS complex with data obtained from 12 controls. RESULTS LV end-diastolic diameter was 32% smaller in CDH fetuses than in controls (P < 0.0001) but LV function was comparable. QRS duration was no different between CDH and control fetuses. FETO did not affect cardiac size but reduced the MPI (P = 0.004). Reversal of FETO had no significant effect on cardiac size and function. CONCLUSIONS CDH fetuses have a smaller left ventricle than do healthy fetuses. There is no overall adverse impact of CDH and FETO on LV cardiac function.
Collapse
Affiliation(s)
- T Van Mieghem
- Division of Woman and Child, Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium
| | | | | | | | | | | | | | | |
Collapse
|
26
|
Done E, Gucciardo L, Van Mieghem T, Debeer A, Sgro A, Van Schoubroeck D, El handouni N, Naulaers G, Deprest J. Abstracts of 19th World Congress on Ultrasound in Obstetrics and Gynecology. September 13-17, 2009. Hamburg, Germany. Ultrasound Obstet Gynecol 2009; 34 Suppl 1:1-286. [PMID: 19742777 DOI: 10.1002/uog.6457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
|
27
|
Van den Bosch T, Vandenbroucke V, Daemen A, Domali E, Van Schoubroeck D, De Moor B, Deprest J, Timmerman D. Removal of focal intracavitary lesions results in cessation of abnormal uterine bleeding in the vast majority of women. Ultrasound Obstet Gynecol 2009; 33:612-613. [PMID: 19360754 DOI: 10.1002/uog.6358] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
|
28
|
Gewillig M, Brown SC, De Catte L, Debeer A, Eyskens B, Cossey V, Van Schoubroeck D, Van Hole C, Devlieger R. Premature foetal closure of the arterial duct: clinical presentations and outcome. Eur Heart J 2009; 30:1530-6. [DOI: 10.1093/eurheartj/ehp128] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
29
|
Van Mieghem T, Gucciardo L, Lewi P, Lewi L, Van Schoubroeck D, Devlieger R, De Catte L, Verhaeghe J, Deprest J. Validation of the fetal myocardial performance index in the second and third trimesters of gestation. Ultrasound Obstet Gynecol 2009; 33:58-63. [PMID: 18973212 DOI: 10.1002/uog.6238] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVES To test the validity of the myocardial performance index (MPI) and its components against the more conventional methods of fetal cardiac function assessment: the ejection fraction (EF) for systolic function and the E/A index (ratio of transmitral flow during early (E) ventricular filling to flow during atrial (A) contraction) for diastolic function, both in a normal population and in a population at risk for cardiac failure because of volume overload (recipient fetuses in cases of twin-twin transfusion syndrome (TTTS)). METHODS The MPI was measured prospectively in addition to more commonly used indices of systolic (EF) and diastolic (E/A index) cardiac function in 117 healthy fetuses (gestational age range, 20-36 weeks) and in 14 fetuses suspected of cardiac failure because of the presence of TTTS. Nomograms were constructed for all variables, and correlations between the MPI, EF and E/A index were assessed. The time taken to obtain the measurements as well as the interobserver and intraobserver variability were determined for the MPI and EF. RESULTS In healthy fetuses, the MPI and EF were independent of gestational age, whereas the E/A index and isovolumetric relaxation time (IRT) increased with gestational age. The MPI correlated inversely with the EF (P<0.001). The IRT showed a trend towards an inverse correlation with the E/A index (P=0.10). The mean+/-SD time needed to measure the MPI and EF was 140+/-65 s and 185+/-187 s, respectively (P=0.43). Interobserver and intraobserver intraclass correlation coefficients for the MPI were 0.98 (95% CI, 0.85-0.99) and 0.82 (95% CI, 0.14-0.95), respectively; those for the EF were 0.58 (95% CI, -0.16 to 0.85) and 0.51 (95% CI, -0.46 to 0.83), respectively; and those for the E/A index were 0.97 (95% CI, 0.88-0.99) and 0.91 (95% CI, 0.66-0.98), respectively. All variables, except ejection time, were significantly different between normal fetuses and those with TTTS. CONCLUSIONS The MPI is an indicator of the systolic component of fetal left ventricular function that can be easily acquired and reproduced. The MPI is strongly correlated with the EF but shows less interobserver and intraobserver variability.
Collapse
Affiliation(s)
- T Van Mieghem
- Division of Woman and Child, Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium
| | | | | | | | | | | | | | | | | |
Collapse
|
30
|
Van Schoubroeck D, Van Den Bosch T, Mortelman P, Timmerman D. Sonographic determination of the position of a levonorgestrel intrauterine device. Ultrasound Obstet Gynecol 2009; 33:121-124. [PMID: 19111011 DOI: 10.1002/uog.6288] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Affiliation(s)
- D Van Schoubroeck
- Department of Obstetrics and Gynecology, University Hospitals KU Leuven, Leuven, Belgium.
| | | | | | | |
Collapse
|
31
|
Jani J, Cannie M, Done E, Van Mieghem T, Van Schoubroeck D, Gucciardo L, Dymarkowski S, Deprest JA. Relationship between lung area at ultrasound examination and lung volume assessment with magnetic resonance imaging in isolated congenital diaphragmatic hernia. Ultrasound Obstet Gynecol 2007; 30:855-860. [PMID: 17932997 DOI: 10.1002/uog.5168] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
OBJECTIVES To prospectively examine the relationship between contralateral lung area measured by two-dimensional (2D) ultrasound examination and contralateral and total fetal lung volume (FLV) estimated by magnetic resonance imaging (MRI) in the assessment of fetuses with congenital diaphragmatic hernia (CDH). METHODS Sixty-six fetuses with isolated CDH were entered in this prospective study. Contralateral fetal lung area was measured by 2D ultrasonography using the longest axis method. Ipsilateral, contralateral and total FLV were measured using multiplanar axial T2-weighted MRI. Regression analysis was used to determine the significance of associations between contralateral lung area and contralateral and total FLV, and the predicted total FLV was subsequently calculated using the regression equation. Univariate regression analysis was used to investigate the effect on the proportionate difference between the predicted and the observed total FLV of gestational age, proportionate volume of ipsilateral vs. total FLV, side of CDH, intrathoracic herniation of the liver and intratracheal presence of a balloon. RESULTS The 66 fetuses underwent a total of 191 paired 2D ultrasound and MRI examinations at a median gestational age of 30 (range, 18-38) weeks. It was possible to visualize and measure the contralateral lung area by 2D ultrasound, as well as both the ipsilateral and contralateral lung volumes by MRI, in all instances. There was a significant association between contralateral lung area and contralateral lung volume (r = 0.86; P < 0.001) and with total FLV (r = 0.84; P < 0.001). Univariate regression analysis showed that the proportionate difference between the predicted and the observed total FLV was significantly associated with the proportionate volume of ipsilateral vs. total FLV but not with gestational age, side of CDH, intrathoracic herniation of the liver or intratracheal presence of the balloon. CONCLUSIONS In CDH, contralateral lung area measurement by 2D ultrasound correlates well with the total FLV estimated by MRI, irrespective of gestational age, liver herniation or side of herniation. Inconsistencies between the two measurements are attributable to the contribution of the ipsilateral lung to the total lung volume.
Collapse
Affiliation(s)
- J Jani
- Unit of Prenatal and Gynecological Ultrasound and Fetal Therapy, Department of Obstetrics and Gynecology, University Hospital Gasthuisberg, Leuven, Belgium
| | | | | | | | | | | | | | | |
Collapse
|
32
|
Van den Bosch T, Van Schoubroeck D, Domali E, Vergote I, Moerman P, Amant F, Timmerman D. A thin and regular endometrium on ultrasound is very unlikely in patients with endometrial malignancy. Ultrasound Obstet Gynecol 2007; 29:674-9. [PMID: 17523157 DOI: 10.1002/uog.4031] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
OBJECTIVE To evaluate the clinical and sonographic features in patients with endometrial malignancy in whom endometrial thickness on ultrasound examination had been recorded in our database to be < 5 mm. METHODS This was a retrospective observational study on 187 consecutive patients diagnosed with endometrial malignancy in whom an ultrasound evaluation of the endometrium had been performed in our institution. The characteristics of those patients presenting with an endometrial thickness < 5 mm were analyzed. RESULTS The median endometrial thickness was 15 mm: 12 mm for the women who underwent endometrial sampling before ultrasound examination vs. 17 mm in those who did not (P = 0.0086). In 13 women (6.9%), the endometrial thickness recorded in our database was < 5 mm. In 12 of these the measurement was compromised in some way: nine of these patients had undergone endometrial sampling (Pipelle biopsy in one and dilatation and curettage in eight patients) before the ultrasound examination, in two cases, focal malignant lesions were not included in the recorded endometrial thickness and in one, the endometrial thickness was visualized poorly due to myometrial distortion. In only one case was was the endometrium correctly measured to be < 5 mm; this woman had diffuse uterine and endometrial metastases of a breast cancer. CONCLUSIONS A thin and regular endometrial line is very reliable for the exclusion of endometrial carcinoma. The suspicion of focal lesions as well as incomplete visualization of the endometrium on sonography should be considered abnormal. Recently performed endometrial sampling makes measurement of the endometrial thickness unreliable.
Collapse
Affiliation(s)
- T Van den Bosch
- Department of Obstetrics and Gynecology, University Hospitals Leuven, K.U. Leuven, Belgium.
| | | | | | | | | | | | | |
Collapse
|
33
|
Van Keirsbilck J, Naulaers G, Cannie M, Lewi L, Demaerel P, Van den Bosch T, Van Schoubroeck D. Prenatal diagnosis of a dural sinus thrombosis with favorable outcome. Prenat Diagn 2007; 27:1056-8. [PMID: 17636853 DOI: 10.1002/pd.1816] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
|
34
|
Abstract
A fetus presented with a large pericardial effusion caused by a right atrial transmural tumor. Correct prenatal diagnosis by use of targeted fetal echocardiography indicated that treatment was not required until the gestational age of 36 weeks. At that time, cesarean section was performed because early signs of imminent cardiac tamponade developed ("swinging heart"). At birth, the pericardial effusion was drained with a percutaneous drain. Elective surgical resection was performed on day 6 of life. Histologically, the tumor was a benign capillary hemangioma.
Collapse
Affiliation(s)
- S Laga
- Department of Cardiac Surgery, Gasthuisberg University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium.
| | | | | | | |
Collapse
|
35
|
Jani J, Peralta CFA, Van Schoubroeck D, Deprest J, Nicolaides KH. Relationship between lung-to-head ratio and lung volume in normal fetuses and fetuses with diaphragmatic hernia. Ultrasound Obstet Gynecol 2006; 27:545-50. [PMID: 16586473 DOI: 10.1002/uog.2735] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
OBJECTIVE To examine the relationship between the fetal lung area and lung area to head circumference ratio (LHR) and lung volume by three-dimensional (3D) ultrasonography in normal fetuses and in fetuses with unilateral congenital diaphragmatic hernia (CDH). METHODS In 64 fetuses with CDH at median 26 (range, 20-32) weeks of gestation the contralateral lung volume, lung area and LHR were measured and the values were compared to those of 650 normal fetuses at 12-32 weeks. In the normal fetuses both lungs were assessed but in the 64 fetuses with CDH only the contralateral lung was measured because the ipsilateral lung could be visualized adequately in only 40 (62.5%) of the cases. Regression analysis was used to assess the significance of the association between lung volume and lung area or LHR. In the fetuses with CDH, the observed to expected ratios for lung area and LHR were calculated. The expected lung area and LHR were the normal median for a given lung volume. The significance of the differences between the observed to expected lung area and LHR in fetuses with CDH and normal fetuses was determined. In the 64 fetuses with CDH and in 64 normal fetuses, matched for gestational age, the lung length between the apex and the superior aspect of the diaphragm dome was also recorded. RESULTS In normal fetuses the median lung area and LHR in both the left and right lungs increased significantly with lung volume. In the fetuses with CDH, the lung area and lung volume for gestation were substantially lower than in normal fetuses and the ratios of observed to expected lung area and LHR for a given lung volume were significantly lower than the respective values in normal fetuses. Additionally, the mean lung length was 13% greater and the mean lung area was 44% smaller than the respective values in the normal controls matched for gestational age. CONCLUSIONS The finding of a significant association between LHR and lung volume has validated the use of LHR in the assessment of lung growth. However, the study has also demonstrated that in fetuses with CDH, LHR underestimates the actual lung volume, because the herniated viscera cause a greater lateral, rather than vertical, compression of the contralateral lung.
Collapse
Affiliation(s)
- J Jani
- University Hospital Gasthuisberg, Leuven, Belgium
| | | | | | | | | |
Collapse
|
36
|
Van Keirsbilck J, Cannie M, Robrechts C, de Ravel T, Dymarkowski S, Van den Bosch T, Van Schoubroeck D. First trimester diagnosis of sirenomelia. Prenat Diagn 2006; 26:684-8. [PMID: 16752437 DOI: 10.1002/pd.1479] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
We present a case of sirenomelia diagnosed on a first trimester ultrasound at 10 weeks' gestation and confirmed on 3D-ultrasound and MRI. The pregnancy was terminated at 15 gestational weeks and the post-mortem examination, including RX and microscopy, is presented. The sirenomelia sequence is a rare and lethal anomaly characterized by fusion, rotation, hypotrophy or atrophy of the lower limbs and severe urogenital abnormalities leading to oligohydramnios in the second half of pregnancy. Our case illustrates that the diagnosis of sirenomelia can be reliably made in the first trimester.
Collapse
Affiliation(s)
- J Van Keirsbilck
- Department of Obstetrics and Gynaecology, A.Z. Heilig Hart, Tienen, Belgium.
| | | | | | | | | | | | | |
Collapse
|
37
|
Van den Bosch T, Van Schoubroeck D, Ameye L, Van Huffel S, Timmerman D. Ultrasound examination of the endometrium before and after Pipelle endometrial sampling. Ultrasound Obstet Gynecol 2005; 26:283-6. [PMID: 16082721 DOI: 10.1002/uog.1967] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
OBJECTIVE To evaluate if, and to what extent, Pipelle de Cornier endometrial sampling influences the ultrasonographic features of the endometrium. METHODS This was a prospective descriptive study on 99 consecutive women in whom a Pipelle endometrial biopsy was performed. All patients first underwent a transvaginal ultrasound evaluation of the uterus. The endometrial thickness (ET) was measured and endometrial sonographic features were recorded. Thereafter, a Pipelle endometrial biopsy was taken. Finally, the ultrasound examination was repeated. The patients' characteristics, the sampling procedure, the endometrial histology and the sonographic findings before and after Pipelle biopsy were compared. RESULTS Ninety-nine women, of whom 45% were postmenopausal, entered the study. The mean age was 59.0 years (SD, 9.9) for the postmenopausal women, and 41.6 years (SD, 8.7) for the rest. On histological examination, endometrial cancer was diagnosed in four patients and endometrial hyperplasia in eight patients. The average ET before Pipelle sampling was 9.0 mm (SD, 6.6) vs. 8.6 mm (SD, 7.0) after biopsy (P < 0.0001). After Pipelle sampling, the endometrium was less clearly delineated (P = 0.03) and more echogenic endometrial spots were seen (P < 0.0001). If an endometrial three-layer pattern was noted before sampling, it was not observed in most women after Pipelle biopsy (P = 0.0003). CONCLUSIONS ET measurements are affected by Pipelle sampling and the quality of the ultrasound features tends to be altered by biopsy. Performing the ultrasound examination before proceeding with endometrial sampling may therefore improve diagnostic accuracy of ultrasound.
Collapse
Affiliation(s)
- T Van den Bosch
- Department of Obstetrics and Gynecology, A. Z. Heilig Hart, Tienen, Belgium.
| | | | | | | | | |
Collapse
|
38
|
Deprest J, Jani J, Cannie M, Van Schoubroeck D, Verbeken E, Devlieger H, Dymarkowski S. Progress in intrauterine assessment of the fetal lung and prediction of neonatal function. Ultrasound Obstet Gynecol 2005; 25:108-111. [PMID: 15685667 DOI: 10.1002/uog.1845] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Affiliation(s)
- J Deprest
- Lung Development Study Group, Department of Obstetrics & Gynaecology, University Hospitals Leuven, Leuven, Belgium.
| | | | | | | | | | | | | |
Collapse
|
39
|
Lewi L, Van Schoubroeck D, Van Ranst M, Bries G, Emonds MP, Arabin B, Welch R, Deprest J. Successful patching of iatrogenic rupture of the fetal membranes. Placenta 2004; 25:352-6. [PMID: 15028428 DOI: 10.1016/j.placenta.2003.09.003] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2002] [Revised: 08/19/2003] [Accepted: 09/10/2003] [Indexed: 11/23/2022]
Abstract
Rupture of the fetal membranes is a common, but potentially serious complication of invasive fetal procedures. Quintero described a technique to seal the fetal membrane defect by means of a bloodpatch, usually called 'amniopatch' in this application. The successful use in two consecutive patients with ruptured membranes after a fetoscopic intervention at respectively 17 and 22 weeks' gestational age is described, together with a literature review of published experience.
Collapse
Affiliation(s)
- L Lewi
- Department of Obstetrics and Gynecology, Fetal Medicine Unit, University Hospital Gasthuisberg, Leuven, Belgium
| | | | | | | | | | | | | | | |
Collapse
|
40
|
Van Schoubroeck D, Van den Bosch T, Scharpe K, Lu C, Van Huffel S, Timmerman D. Prospective evaluation of blood flow in the myometrium and uterine arteries in the puerperium. Ultrasound Obstet Gynecol 2004; 23:378-381. [PMID: 15065189 DOI: 10.1002/uog.963] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
OBJECTIVE Heavy bleeding in the late postpartum has, in some cases, been attributed to subinvolution of the placental bed and enhanced myometrial vascularity (EMV) as seen on color Doppler imaging. The aim of this study was to investigate the incidence and spontaneous evolution of areas of enhanced vascularization over the whole thickness of the myometrium in asymptomatic women after uncomplicated term pregnancy. METHODS This was a prospective descriptive study involving 93 consecutive women who were examined on day 3 (mean 2.6 +/- 1.5) and at 6 weeks (mean 6.5 +/- 1.3) after delivery following an uncomplicated term pregnancy. EMV was defined as the presence of marked flow over the full thickness of the myometrium reaching the uterine cavity. Doppler flow examination within the area of EMV and of both uterine arteries was performed. RESULTS The mean patient age was 29.1 years and average parity was 1.7. The mean gestational age at delivery was 39.1 weeks. Areas of EMV were visualized in 50.5% of patients on day 3 vs. 3.9% at 6 weeks. None of the patients required therapy for bleeding problems. The mean pulsatility index and peak systolic velocity in the area of EMV on day 3 were 0.45 +/- 0.30 and 0.37 +/- 0.20 m/s, respectively. A consistent increase in vascular resistance and decrease in blood flow velocity was observed in both uterine arteries between day 3 and week 6. CONCLUSIONS Most areas of EMV reflect intermediate stages in the involution of the placental bed and do not cause abnormal postpartum bleeding. EVM is common in the puerperium, disappears spontaneously in the vast majority of cases, and does not warrant treatment if asymptomatic. Further research is needed to predict the rare cases in which subinvolution of the placental bed leads to heavy bleeding in the late postpartum.
Collapse
Affiliation(s)
- D Van Schoubroeck
- Department of Obstetrics and Gynecology, University Hospital Gasthuisberg, Belgium.
| | | | | | | | | | | |
Collapse
|
41
|
Missant C, Van Schoubroeck D, Deprest J, Devlieger R, Teunkens A, Van de Velde M. Remifentanil for foetal immobilisation and maternal sedation during endoscopic treatment of twin-to-twin transfusion syndrome : a preliminary dose-finding study. Acta Anaesthesiol Belg 2004; 55:239-44. [PMID: 15515301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
Twin to twin transfusion syndrome (TTTS) affects 10 to 15% of monochorionic twin pregnancies. Untreated, perinatal loss exceeds 80%, of which survivors have a great risk for long-term neurological disorders as psychomotor retardation or cerebral palsy. TTTS can be treated using foetoscopy and selective ablation of the twin-to-twin blood vessels under local or regional anaesthesia. However, local or regional anaesthesia does not always result in excellent maternal comfort, nor does it provide foetal immobilisation, necessary for optimal surgical conditions. Using a continuous infusion rate of remifentanil 0.1 microg/kg/min, perfect foetal immobilisation and excellent maternal sedation was achieved. Only mild respiratory acidosis was observed as a result of mild respiratory depression. In no mother apnoe occurred. All haemodynamic parameters, both foetal and maternal, remained stable during the procedure. Maternal sedation, respiratory depression and foetal immobilisation were quickly reversible following cessation of the remifentanil infusion.
Collapse
Affiliation(s)
- C Missant
- Department of Anaesthesiology, University Hospital Gasthuisberg, Katholieke Universiteit Leuven, Herestraat 49, B-3000 Leuven, Belgium
| | | | | | | | | | | |
Collapse
|
42
|
Van den Bosch T, Van Schoubroeck D, Timmerman D, Deprest J. Uterine intramural bone after mid-trimester termination of pregnancy may not affect fertility: a case report. Ultrasound Obstet Gynecol 2003; 22:407-408. [PMID: 14528479 DOI: 10.1002/uog.220] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
We present a case of a 27-year-old asymptomatic woman, gravida 2 para 0 abortus 2, diagnosed with uterine intramural fetal bone 30 days after a mid-trimester termination of pregnancy (TOP) by dilatation and evacuation (D&E). On ultrasound part of a fetal spine was seen within the right lateral isthmocervical area, adjacent to the descending branch of the uterine artery. Within 4 months after TOP the patient conceived again. This case illustrates the risk of myometrial penetration during mid-trimester TOP by D&E. Removal of intramural bony fragments may not be needed in an asymptomatic patient, as their presence does not seem to compromise fertility.
Collapse
Affiliation(s)
- T Van den Bosch
- Department of Obstetrics and Gynaecology, A.Z. Heilig Hart, Tienen, Belgium.
| | | | | | | |
Collapse
|
43
|
Timmerman D, Verguts J, Konstantinovic ML, Moerman P, Van Schoubroeck D, Deprest J, van Huffel S. The pedicle artery sign based on sonography with color Doppler imaging can replace second-stage tests in women with abnormal vaginal bleeding. Ultrasound Obstet Gynecol 2003; 22:166-171. [PMID: 12905512 DOI: 10.1002/uog.203] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
OBJECTIVE Unenhanced transvaginal sonography is not accurate in the detection of endometrial polyps. Currently, second-stage tests such as saline contrast sonohysterography and office hysteroscopy are used to diagnose endometrial lesions, but both have limitations and side effects. We proposed visualization of the pedicle artery on color Doppler imaging as a sign of polyps. METHODS This was a prospective observational study involving 3099 consecutive patients referred for assessment of the endometrium and myometrium. The uterus was assessed in sagittal and coronal planes using color Doppler sonography. Patients with suspected endometrial pathology on sonography were noted and the volume of the focal lesion was calculated. Patients with a clearly visible pedicle artery reaching the central part of the endometrium were regarded as test-positive. The gold standard was defined as the presence or absence of an endometrial polyp at hysterectomy, hysteroscopy and/or endometrial histology on dilatation and curettage within 1 year of sonography. RESULTS Of the 3099 women, no gold standard was available in 2230. Only 28 of the 199 patients who were test-positive did not have a gold standard. In the 869 patients in whom a gold standard was available, 182 had one or more endometrial polyps. The pedicle artery test had an apparent sensitivity for detection of endometrial polyps of 76.4%, specificity of 95.3%, positive predictive value (PPV) of 81.3%, and negative predictive value of 93.8%. When extending the test to the prediction of any focal intracavitary pathology the PPV was 94.2%. CONCLUSIONS The pedicle artery test has a very high PPV for intracavitary pathology. We expect that in the majority of patients with an endometrial polyp this test may replace more invasive established second-stage tests, such as saline contrast sonohysterography and office hysteroscopy.
Collapse
Affiliation(s)
- D Timmerman
- Department of Obstetrics and Gynecology, University Hospitals, Katholieke Universiteit Leuven, Belgium.
| | | | | | | | | | | | | |
Collapse
|
44
|
Breysem L, Bosmans H, Dymarkowski S, Schoubroeck DV, Witters I, Deprest J, Demaerel P, Vanbeckevoort D, Vanhole C, Casaer P, Smet M. The value of fast MR imaging as an adjunct to ultrasound in prenatal diagnosis. Eur Radiol 2003; 13:1538-48. [PMID: 12695920 DOI: 10.1007/s00330-002-1811-6] [Citation(s) in RCA: 122] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2002] [Revised: 10/14/2002] [Accepted: 12/06/2002] [Indexed: 11/29/2022]
Abstract
The aim of this study was to evaluate the role of MR imaging of the fetus to improve sonographic prenatal diagnosis of congenital anomalies. In 40 fetuses (not consecutive cases) with an abnormality diagnosed with ultrasound, additional MR imaging was performed. The basic sequence was a T2-weighted single-shot half Fourier (HASTE) technique. Head, neck, spinal, thoracic, urogenital, and abdominal fetal pathologies were found. This retrospective, observational study compared MR imaging findings with ultrasonographic findings regarding detection, topography, and etiology of the pathology. The MR findings were evaluated as superior, equal to, or inferior compared with US, in consent with the referring gynecologists. The role of these findings in relation to pregnancy management was studied and compared with postnatal follow-up in 30 of 40 babies. Fetal MRI technique was successful in 36 of 39 examinations and provided additional information in 21 of 40 fetuses (one twin pregnancy with two members to evaluate). More precise anatomy and location of fetal pathology (20 of 40 cases) and additional etiologic information (8 of 40 cases) were substantial advantages in cerebrospinal abnormalities [ventriculomegaly, encephalocele, vein of Galen malformation, callosal malformations, meningo(myelo)cele], in retroperitoneal abnormalities (lymphangioma, renal agenesis, multicystic renal dysplasia), and in neck/thoracic pathology [cervical cystic teratoma, congenital hernia diaphragmatica, congenital cystic adenomatoid lung malformation (CCAM)]. This improved parental counseling and pregnancy management in 15 pregnancies. In 3 cases, prenatal MRI findings did not correlate with prenatal ultrasonographic findings or neonatal diagnosis. The MRI provided a more detailed description and insight into fetal anatomy, pathology, and etiology in the vast majority of these selected cases. This improved prenatal parental counseling and postnatal therapeutic planning.
Collapse
Affiliation(s)
- L Breysem
- Department of Radiology, University Hospitals, Herestraat 49, 3000, Leuven, Belgium,
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
45
|
Timmerman D, Wauters J, Van Calenbergh S, Van Schoubroeck D, Maleux G, Van Den Bosch T, Spitz B. Color Doppler imaging is a valuable tool for the diagnosis and management of uterine vascular malformations. Ultrasound Obstet Gynecol 2003; 21:570-577. [PMID: 12808674 DOI: 10.1002/uog.159] [Citation(s) in RCA: 147] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
OBJECTIVE The aim of this study was to assess the spontaneous outcome of uterine vascular malformations detected with ultrasonography and color Doppler, and to investigate the predictive value of color Doppler imaging as to which patients require invasive treatment. METHODS This was a prospective observational study conducted between January 1999 and February 2001 comprising all consecutive patients diagnosed with a uterine vascular malformation by ultrasonography and color Doppler imaging. Spectral analysis included measurement of flow velocities, pulsatility index (PI) and resistance index (RI). Close follow-up was arranged in all cases and the outcomes were recorded. RESULTS A total of 30 consecutive patients with uterine vascular malformations were included in the study. Spectral analysis of the vessels in the vascular malformations within the myometrium and endometrium revealed the presence of a low-impedance and high-velocity flow. The average values for PI, RI, peak systolic velocity (PSV) and time-averaged maximum velocity (TAMXV) were 0.50, 0.38, 0.63 m/s and 0.46 m/s, respectively. Eight patients (27%) eventually required embolization of the uterine arteries and three of them had true arteriovenous malformations confirmed at angiography. PSV values of >/= 0.83 m/s were associated with higher probabilities of further treatment, such as an embolization, whereas no vascular malformation with a PSV value < 0.39 m/s required embolization. CONCLUSION Conservative management is possible in more than two-thirds of patients presenting with uterine vascular malformations diagnosed by color Doppler sonography. Despite considerable overlap, PSV values appear to be useful in distinguishing between low- and high-risk patients.
Collapse
Affiliation(s)
- D Timmerman
- Department of Obstetrics and Gynecology, University Hospital Gasthuisberg, Katholieke Universiteit Leuven, Leuven, Belgium.
| | | | | | | | | | | | | |
Collapse
|
46
|
Witters I, Delattin P, Van Schoubroeck D, Fryns JP. Increased nuchal translucency with de novo acrocentric/18p translocation. Genet Couns 2003; 13:203-5. [PMID: 12150225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
|
47
|
Van den Bosch T, Van Schoubroeck D, Lu C, De Brabanter J, Van Huffel S, Timmerman D. Color Doppler and gray-scale ultrasound evaluation of the postpartum uterus. Ultrasound Obstet Gynecol 2002; 20:586-591. [PMID: 12493048 DOI: 10.1046/j.1469-0705.2002.00851.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
OBJECTIVES To evaluate the color Doppler and gray-scale sonographic appearance of the uterus after pregnancy, with special attention to the occurrence of areas of enhanced vascularity and placental remnants. PATIENTS AND METHODS Cross-sectional observational study involving 385 consecutive women presenting at their first visit after pregnancy. The uterus was evaluated using ultrasound with color Doppler. In the presence of placental remnants, blood was sampled for measurement of beta human chorionic gonadotropin (beta hCG), hemoglobin (Hb) and infectious parameters. If indicated, a dilatation and curettage was performed. RESULTS In 8.3% of women, areas of enhanced vascularity were detected with color Doppler examination. Most cases (68.9%) were focal areas of one or more vessels. In 2.6% of patients abnormal vascularity extended over a large area of the whole myometrium. In 6.75% of cases, placental remnants were detected. In 46% of these, blood sampling revealed beta hCG levels below 30 mIU/mL; serological infection parameters and Hb concentration were within the normal range. CONCLUSIONS Areas of enhanced vascularity of the uterus, ranging from a focal vascular pedicle to a larger area of the myometrium, are relatively common after pregnancy. They are predominantly seen in the presence of placental remnants, in the early postpartum period and after instrumental or manual delivery of the placenta. There are no clear risk factors for retained placental tissue, besides the history of blood transfusion in the early postpartum, and perhaps multigravidity. Serology is of little help in the diagnosis of retained gestational products. The knowledge of the ultrasound and color Doppler features of the uterus after pregnancy may prove of practical value for the management of abnormal uterine bleeding in the postpartum period.
Collapse
Affiliation(s)
- T Van den Bosch
- Department of Obstetrics and Gynecology, A. Z. Heilig Hart, Tienen, Belgium.
| | | | | | | | | | | |
Collapse
|
48
|
Van den Bosch T, Van Schoubroeck D, Ameye L, De Brabanter J, Van Huffel S, Timmerman D. The influence of hormone replacement therapy on the ultrasound features of the endometrium: a prospective study. Eur J Cancer 2002; 38 Suppl 6:S78-9. [PMID: 12409087 DOI: 10.1016/s0959-8049(02)00298-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- T Van den Bosch
- Departments of Obstetrics and Gynecology, A.Z. Heilig Hart, Tienen, Belgium.
| | | | | | | | | | | |
Collapse
|
49
|
Van den Bosch T, Donders GGG, Riphagen I, Debois P, Ameye L, De Brabanter J, Van Huffel S, Van Schoubroeck D, Timmerman D. Ultrasonographic features of the endometrium and the ovaries in women on etonogestrel implant. Ultrasound Obstet Gynecol 2002; 20:377-380. [PMID: 12383321 DOI: 10.1046/j.1469-0705.2002.00816.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
OBJECTIVE To evaluate the ultrasound features of the endometrium and ovaries in women on etonogestrel implant, and to correlate these features with the bleeding pattern. METHODS Observational study including 188 consecutive women presenting for follow-up transvaginal ultrasound examination after insertion of an etonogestrel implant contraceptive device. Thirty women had more than one follow-up examination. The bleeding pattern was considered abnormal if, in the last 3 months, there were more than five episodes of vaginal bleeding, or there was prolonged bleeding exceeding 14 consecutive days. RESULTS At first follow-up examination, the mean age was 29.7 years and 47% of women had an abnormal bleeding pattern. Most bleeding episodes were of less intensity than menses. The mean endometrial thickness (ET) on ultrasound was 2.9 mm (standard deviation, 2.0). Ovarian follicle growth exceeding 5 mm was observed in 60% of the cases. Ovulation was demonstrated in one woman. Univariate analysis showed a positive association (P < 0.01) between ET, bleeding pattern, and bleeding intensity. Follicle growth was positively associated (P < 0.01) with ET, bleeding pattern, and interval between insertion and examination. Multivariate analysis showed that the ET was on average 1.25 mm greater in women with abnormal bleeding (P = 0.0001). The odds of finding follicle growth were 2.8 times higher (95% confidence interval, 1.2-6.2) in women presenting with a three-layer type of endometrial morphology. There was no association between the other patients' characteristics and the bleeding pattern. CONCLUSIONS Abnormal uterine bleeding in women on etonogestrel implant was associated with follicle growth and a thicker, three-layer type of endometrium, suggesting incomplete ovarian inhibition and estrogen stimulation of the endometrium.
Collapse
Affiliation(s)
- T Van den Bosch
- Department of Obstetrics and Gynecology of AZ Heilig Hart, Tienen, Belgium.
| | | | | | | | | | | | | | | | | |
Collapse
|
50
|
Gratacós E, Van Schoubroeck D, Carreras E, Devlieger R, Roma E, Cabero L, Deprest J. Impact of laser coagulation in severe twin-twin transfusion syndrome on fetal Doppler indices and venous blood flow volume. Ultrasound Obstet Gynecol 2002; 20:125-130. [PMID: 12153662 DOI: 10.1046/j.1469-0705.2002.00749.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
OBJECTIVE To evaluate the impact of fetoscopic laser coagulation of placental anastomoses in severe twin-twin transfusion syndrome on fetal Doppler indices and umbilical vein blood flow volume as calculated with Doppler and two-dimensional ultrasound. METHODS Thirty-two cases of second-trimester severe twin-twin transfusion undergoing laser therapy were examined with serial ultrasound before and 1, 3 and 5 days after therapy. Pulsatility indices in the umbilical artery and ductus venosus were measured. Blood volume flow at the level of the intra-abdominal umbilical vein was calculated by means of Doppler and two-dimensional ultrasound. The development of hydropic signs in donors was recorded. Perinatal outcome in terms of neonatal survival was recorded for all cases. RESULTS In recipients, ductus venosus pulsatility index decreased progressively after therapy and, by day 5, median pulsatility index was significantly lower than that before therapy (0.97 vs. 0.82, P < 0.0001). Umbilical vein blood flow volume in recipient twins showed no significant variations before and after laser. In donors, umbilical artery pulsatility index decreased significantly by the first day following therapy (2.1 vs. 1.6, P < 0.0001). Previously absent or reverse umbilical end-diastolic flow reappeared after therapy in 46% (7/15) of donors. Ductus venosus pulsatility index in donors increased significantly by day 1 after therapy (0.99 vs. 1.35, P < 0.0001) but, over days 3 and 5, it returned towards preoperative values. Umbilical vein flow volume measurements (mL/min/kg) in the donor increased by approximately 50% the day after treatment (151 vs. 232, P < 0.0001) and remained elevated. Umbilical vein flow volume before laser therapy was significantly lower in donors compared to recipients (151 vs. 260, P < 0.0001), but the difference was non-significant after treatment (240 vs. 267). One or more hydropic signs developed in eight (25%) donors during the 5 days' observation after therapy. CONCLUSIONS Laser therapy induced important changes in fetal hemodynamic parameters, resulting in a reversion of the disturbances associated with severe twin-twin transfusion syndrome. The recipient twin showed a progressive improvement of previous signs of right cardiac overload. The donor experienced a substantial increase in umbilical vein blood volume flow accompanied by a transitory state of relative right overload, which may explain the development of transient hydropic signs in a proportion of donors.
Collapse
Affiliation(s)
- E Gratacós
- Fetal Medicine Unit, Department of Obstetrics and Gynaecology, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Spain.
| | | | | | | | | | | | | |
Collapse
|