Evaluation of the Relationship Between Quantitative Ultrasound Findings and Morbidly Adherent Placenta

Aim

The accuracy of ultrasound findings in predicting the incidence of morbidly adherent placenta has been evaluated previously. In this study, we assessed the sensitivity and specificity of different quantitative findings of color Doppler and grayscale ultrasonography in predicting morbidly adherent placenta.

Material and methods

In this prospective cohort study, all pregnant women over 20 weeks of gestational age with anterior placenta and a history of previous cesarean section were evaluated for inclusion. Various ultrasound findings were measured. The non-parametric receiver operating characteristic curves, the area under the curve, and the cut-off values were assessed.

Results

A total of 120 patients were ultimately included for analysis, of whom 15 had morbidly adherent placenta. The two groups were significantly different regarding the number of vessels. Based on color Doppler ultrasonography, in predicting the morbidly adherent placenta, more than two intraplecental echolucent zones with color flow had 93% and 98% sensitivity and specificity, respectively. According to grayscale ultrasonography, more than thirteen intraplacental echolucent zones had the sensitivity and specificity of 86% and 80% in predicting morbidly adherent placenta, respectively. Echolucent zone >11 mm at non-fetal surface had a sensitivity of 93% and a specificity of 66% in detecting morbidly adherent placenta.

Conclusions

According to the results, the quantitative findings of color Doppler ultrasound have considerable sensitivity and specificity in detecting morbidly adherent placenta. More than two echolucent zones with color flow are recommended as the main diagnostic parameter indicating the presence of morbidly adherent placenta with a sensitivity of 93% and a specificity of 98%.

Performance Evaluation of Multiple Ultrasonographical Methods for the Detection of Primary Sjögren's Syndrome

Major salivary gland ultrasonography (SGUS) is increasingly being recognized as having critical roles in differentiating primary Sjögren’s syndrome (pSS) from other connective tissue disorders. Contrast-enhanced ultrasonography (CEUS) has been reported to evaluate microvascularity of lesions in different tissues with objective angiographic index, eliminating the observer-dependent defect of ultrasonography. However, there are few relevant studies concentrating on the application of CEUS in the diagnosis and assessment for pSS, and their clinical utility prospect remains uncertain. In this study, a total of 227 eligible patients were enrolled, including 161 pSS and 66 non-pSS patients with comprehensive ultrasonographic evaluation of the parotid and submandibular glands, including grayscale ultrasonography, color Doppler sonography (CDS), and CEUS. Compared with non-pSS, pSS patients had significantly higher grayscale ultrasound (US) scores and CDS blood grades in the parotid gland and significantly higher grayscale US and CEUS scores in the submandibular glands. Diagnostic model combining ultrasonographic signatures, anti-SSA/Ro60, and keratoconjunctivitis sicca (KCS) tests showed a remarkable discrimination [mean area under the curve (AUC)0.963 in submandibular glands and 0.934 in parotid glands] for pSS, and the nomogram provided excellent prediction accuracy and good calibration in individualized prediction of pSS. A combination of multiple ultrasonographical examinations of the major salivary glands (SGs) is a promising technique that may be used as a practical alternative to minor SG biopsy in the detection of pSS.