Doppler study of myometrium in invasive gestational trophoblastic disease.

OBJECTIVE: In this prospective study, we aimed to assess the prognostic and diagnostic role of color Doppler flow of myometrium in patients with invasive gestational trophoblastic disease (GTD). METHODS: Thirty-seven patients, who were enrolled in the study with invasive mole, were assessed with the help of transvaginal color Doppler ultrasound before and after chemotherapy. The place and the size of the myometrial invasions were assessed. RESULTS: Thirty patients of 37 were treated with the help of single-agent chemotherapy--methotrexate (mtx). In this group, the resistance index (RI) ratios ranged between 0.26 and 0.45 and the size of the myometrial invasion varied between 10 and 50 mm. On the other hand, six patients were treated with mtx and actinomycin D combination and one patient was treated with the help of total abdominal hysterectomy. In this group, the RI ratios ranged between 0.16 and 0.25 and the size of the myometrial invasion varied between 60 and 90 mm. Remission was achieved in all patients. CONCLUSION: Transvaginal color Doppler study can easily detect invasive GTD. When the depth and the width of the myometrial invasion increase and when there is a low diastolic/systolic ratio, the number of courses and the need for combination of chemotherapy increase.

Three-dimensional magnetic resonance imaging of fetal brains.

We assessed ten prenatal magnetic resonance imaging(MRI) scans for fetal brain anomalies, and identified eight that were suitable for post-processing. Anatomical abnormalities were assessed on three-dimensional (3D) models and compared with two-dimensional (2D) imaging. We calculated the volumes of the intracranial ventricles and of a periventricular haemorrhage. In three cases, additional clinical information was obtained. 3D modelling of the brain in-utero is possible and can be used to plan treatment.

Volume assessment of the normal female cervix with MR imaging: comparison of the segmentation technique and two geometric formula.

RATIONALE AND OBJECTIVES: The purpose of this study was to determine the volume of the normal female cervix and to determine the geometric formula that yields the best estimate. MATERIALS AND METHODS: Magnetic resonance images of the pelvis in 30 young women were reviewed retrospectively. The volume of the cervix was estimated by using the formulas for an ellipse and a cylinder. Manual labeling and segmentation of the cervix were also performed, and the volume was calculated on the basis of the number and size of the voxels. Comparison of these methods was then performed by using a two-tailed Student t test. RESULTS: No statistically significant difference was found (P = .7) between the volume calculated with the segmentation technique (25.3 mL) and that estimated with the formula for a cylinder (24.8 mL). A statistically significant difference (P < .05) was found between the volume calculated with the segmentation technique and that estimated with the formula for an ellipse (16.4 mL). CONCLUSION: The normal volume of the cervix in this population of young women was approximately 25 mL. The volume of the cervix should be estimated with the formula for a cylinder.

Virtual CT cystoscopy: color mapping of bladder wall thickness.

RATIONALE AND OBJECTIVES: To improve the conspicuity of bladder tumors in a virtual environment, we developed an algorithm for color mapping the thickness of the bladder wall. The purpose of this study was to demonstrate the feasibility of this algorithm as a component of virtual CT cystoscopy. METHODS: Five subjects with a history of superficial transitional-cell carcinoma of the bladder underwent helical CT scanning after insufflation of the bladder with air. Source images were transformed into three-dimensional models, and the thickness of the bladder wall was demarcated by using a new computer algorithm and a fixed color scale. Results were compared with those obtained by conventional cystoscopy. RESULTS: Three tumors, one site of benign wall thickening, and normal wall thickness were correctly identified by using axial source images and virtual cystoscopy with color mapping. CONCLUSIONS: Color mapping of bladder wall thickness is feasible and demonstrates both normal and thickened urothelium. Its value in identification of small or sessile tumors will require further trials.

MR-based three-dimensional modeling of the normal pelvic floor in women: quantification of muscle mass.

OBJECTIVE: Our objective was to use a combination of axial MR source images and three-dimensional (3D) models to describe the anatomy of the normal pelvic floor in young nulliparous women and to measure the volume of the levator ani. SUBJECTS AND METHODS: Ten healthy nulliparous female volunteers (average age, 27 years) underwent T2-weighted MR imaging of the pelvis. Three-dimensional color-coded models of the pelvic bones and organs and the three major components of the levator ani--puborectalis, iliococcygeus, and coccygeus--were created. Source images were used to measure muscle width and signal intensity and to identify ligamentous structures. Using 3D models, we measured the volume of the levator ani, the angle of the levator plate, the posterior urethrovesical angle, and the distance of the bladder neck from the symphysis pubis and the pubococcygeal line. RESULTS: In all volunteers, the signal intensity of the puborectalis exceeded that of the obturator externus. The average volume of the levator ani was 46.6 ml, the average width of the levator hiatus was 41.7 mm, and the average posterior urethrovesical angle was 143.5 degrees. Vaginal shape in the volunteers followed no recognizable pattern. CONCLUSION: Muscle morphology, signal intensity, and volume is relatively uniform among healthy young women.

Color Doppler ultrasonography in the earlier differentiation of benign molehydatidiforms from malignant gestational trophoblastic disease.

BACKGROUND: To find out the effectiveness of color Doppler ultrasonography of the uterine arteries in the differentiation of benign molehydatidiforms from malignant gestational trophoblastic disease. METHODS: Prospective study was performed in 32 women who were referred to the Oncology Department with the diagnosis of gestational trophoblastic disease. Uterine artery Doppler studies were made and resistance index for both uterine arteries were calculated. In the follow-up, twelve of these patients required chemotherapy (first group) and 20 of them were treated with only suction curettage (second group). Non parametric Mann Whitney U test was used for the statistical analysis. RESULTS: Median of the lowest uterine artery resistance index were 0.29 for the first group and 0.46 for the second group. Resistance index were significantly lower in the first group (alpha<0.001). Color Doppler study of the uterine arteries is helpful in the differentiation of benign molehydatiforms from malignant gestational trophoblastic disease.

Portal vein thrombosis concomitant with thrombophilia during pregnancy.

The experience with portal vein thrombosis, an uncommon cause of portal hypertension complicating pregnancy is currently too brief to form definite conclusions regarding the management. The coexistence of the manifestations of portal hypertension as hypersplenism and esophageal varices together with Protein C and S deficiencies during pregnancy presents a real dilemma for diagnosis and management. We report the clinical follow-up of a 24-year-old woman in whom Protein C was detected in her two subsequent pregnancies besides portal vein thrombosis and discuss the changing levels of these proteins during pregnancy.