place of transvaginal color and pulsed Doppler sonography in the diagnosis of benign and malignant endometrial pathology in patients with post menopausal bleeding

Transvaginal color Doppler ultrasound [TVCDUS] may play significant role in diagnosis of endometrial pathology particulary endometrial carcinoma in women with postmenopausal bleeding [PMB]. Increasing experience in this field may help many women to overcome long waiting lists for surgery. In [65] women with postmenopausal bleeding we measured endometrial thickness [ET] [double layer] considering [8] mm as cut-off point to differentiate between benign and malignant endometrial lesions. We also looked for homogenicity, regularity of endometrium and integrity of sub endometrialhalo. [TVCDUS] was used to asses the vascularity, and vascular density of endometrium, myometrium and endometrial tumor. Resistance index [RI] and peak systolic velocity [PS] were also measured for endometrial, myometrial and uterine arteries. Correlation between [TVCDUS] and results of histopathology of endometrial specimens [24 hysterectomy and 41 D and C] was done. [ET] of [8] mm was found to be predictive for endometrial carcinoma with sensitivity of 100% and visualization rate of endometrial flow was significantly higher in case of carcinoma versus benign conditions of endometrium. Vascular density was significantly higher in case of carcinoma. [RI] of [0.42] was considered as cut-off point to differentiate between benign and malignant lesions with sensitivity of [80%]. [PI/ ] for myometrial and uterine arteries were not significantly different between cancer and benign conditions. TVCDUS has an important role in diagnosis of endometrial carcinoma especially in high risk group of women. Intra-tumoral blood flow is more sensitive marker of carcinoma than uterine blood flow. Adopting this method with increasing experience may result with considerable saving of both potential and economic costs

value of color doppler ultrasonography in prediction of ovulation during the normal menstrual cycle

To evaluate transvaginal color Doppler ultrasonography [U/S] as a tool to predict ovulation during the normal menstrual cycle through the measurement of blood flow changes in ovarian and uterine blood vessels. A prospective study was conducted on 30 women attending an infertility clinic at Baghdad Teaching Hospital. All the woman had infertility not attributed to ovulation and had regular menstrual cycles. Transvaginal color Doppler U/S scan was performed on each women daily form day 10 of the menstrual cycle until ovulation. Each woman underwent 4-5 vaginal U/S examinations. To confirm reported ovulation, serum progesterone level was estimated 6-7 days after the expected date of ovulation. Signs of ovulation were demonstrated by U/S in 23 of 30 the women. The mean diameter of the dominant follicle [DF] one day before ovulation was [20.26 mm +/- 2.09] with an average growth rate of 2.2mm/day. The mean serum progesterone level 6-7 days after ovulation was 19.12 +/- 5.24ng/mL. Ovarian and uterine blood flow, assessed by pulsed color Doppler U/S indices, showed a marked increase particularly around the time of ovulation, whereby mean resistive index [RI] of the ovary having the DF was 0.56 +/- 0.03 four days before ovulation, and it reached its nadir one day before ovulation [0.47 +/- 0.02] [P<0.0001]. A similar change was observed in the ipsilateral uterine artery, as a consequence of the follicular growth and subsequent corpus luteum formation. The mean RI was 0.86 +/- 0.05 four days before ovulation and 0.85 +/- 0.04 on the day of ovulation [P<0.05], while its mean pulsatility index [PI] was 2.97 +/- 0.063 four days before ovulation and became 2.59 +/- 0.59 on the day of ovulation [P<0.05]. Assessment of ovarian and uterine vascularity by pulsed color Doppler U/S has a potential value in prediction of ovulation and may be used as a parameter in infertility practice