Sonohysterography combined with sonosalpingography: correlation with endoscopic findings in infertility patients.

The diagnostic accuracy of sonohysterography combined with sonosalpingography or sonohysterosalpingography was evaluated in 100 infertility patients who also underwent endoscopic (hysteroscopy with or without laparoscopy) procedures. In patients with normal endometrial biopsy results, single endometrial layer thickness ranged from 3 to 5 mm and varied up to 2 mm in some areas. Diagnostic accuracy was 98% for submucosal fibroids, 96% for polyps, and 81% for synechiae. Missed lesions, were less than 2 mm in diameter. Tubal patency was successfully assessed in 79% of women with saline solution and in 92% of those who received contrast agent. This study demonstrates the efficacy of the combined use of SHG and SSG in infertility patients with uterine or tubal factor disorders.

The plain chest radiograph and clinical management of pulmonary edema in pregnancy.

OBJECTIVE: To evaluate the reproducibility of radiographic quantification of pulmonary edema on the supine plain chest radiograph and to correlate the radiographic appearance of edema with the clinical assessment and treatment of pulmonary edema. STUDY DESIGN: Retrospective, blind, descriptive study of 24 women with singleton pregnancies in the last trimester selected because of a clinical question of pulmonary edema. RESULTS: Interobserver variability between radiologists resulted in an average weighted kappa of .71 in grading edema on a 0-3 scale where 0 = no edema and 3 = alveolar flooding. The vascular pedicle (a measure of central circulating volume) was larger among patients who received furosemide (63.4 mm) than those who did not (57.0 mm) (P = .01). The vascular pedicle was also larger among patients receiving tocolytics or steroids (62.8 mm) than those who did not (56.0 mm) (P = .01). The radiographic edema score tended to be lower in patients who received tocolytics and steroids (P = .05). The other correlations were not significant. CONCLUSION: Radiographic assessment of pulmonary edema shows fair to good reproducibility, but the clinical correlations are modest. A wider understanding of the wealth of physiologic information available on the plain chest radiograph may prove invaluable in understanding the clinical course and treatment of these patients.

Color Doppler sonography of tubal torsion.

These case reports illustrate the clinical and color Doppler sonographic findings in two cases of isolated tubal torsion. This condition may be associated with prior tubal ligation. The presence of high impedance or absent flow in a tubular structure in a patient with a history of tubal ligation should make one suspect this condition.

Correlation of histomorphology of ovarian masses with color Doppler sonography.

This study correlates the color Doppler sonography (CDS) findings in ovarian masses according to histomorphologic groups. Sixty-two surgically excised ovarian masses (31 benign and 31 malignant) in patients who underwent CDS were retrospectively reviewed. Lowest pulsatility index (PI) was used in benign and malignant unilocular cysts, septated cysts, predominantly cystic masses with solid components, predominantly solid masses with cystic areas and solid masses. The mean of the lowest PIs of benign lesions (1.7 +/- 0.7) were statistically significantly different (p < 0.05) from malignancies (0.7 +/- 0.3). The group of septated cysts (1.8 +/- 0.5 vs. 0.61 +/- 0.3) and predominantly cystic masses with solid areas (1.1 +/- 0.1 vs. 0.6 +/- 0.2) achieved statistical significance for benign vs. malignant masses. Predominantly solid masses with cystic areas (1.8 +/- 0.5 vs. 0.8 +/- 0.2) and solid masses (1.4 +/- 1.0 vs. 0.7 +/- 0.3) were not statistically significantly different. Because of a limited number of cases, statistically significant differences in the mean of the lowest PIs of benign vs. malignant unilocular cysts (2.1 +/- 0.5 vs. 1.9) could not be determined. When analyzed according to histomorphology, CDS findings were of predictive value in certain morphologies and not as much in others. This fact should be taken into account when evaluating an ovarian mass for malignancy with CDS.

Early detection of ovarian carcinoma with transvaginal color Doppler ultrasonography.

OBJECTIVE: Our purpose was to assess the potentials and limitations of the early detection of ovarian cancer in protocols that involve transvaginal color Doppler ultrasonography. STUDY DESIGN: Retrospective analysis was performed on the data from 206 referred patients who either had surgical or clinical follow-up of ovarian masses evaluated by transvaginal color Doppler ultrasonography. Most of the patients were referrals or had risk factors. RESULTS: In this series of 206 patients, 26 ovarian cancers were detected, > 70% of which were stage I or II. CONCLUSION: Transvaginal color Doppler ultrasonography is capable of early detection of ovarian carcinoma. An improved detection rate may be realized with better identification of high-risk patients who should be studied with transvaginal color Doppler ultrasonography.

Color Doppler sonography of adnexal torsion.

The purpose of this study was to describe the color Doppler sonographic findings in adnexal torsion that distinguish viable from nonviable ovaries. We present the color Doppler sonographic features in 13 patients with surgically proved adnexal torsion that help determine whether or not the ovaries were viable or nonviable at the time of surgery. Eleven combined ovarian and tubal torsions and two isolated tubal torsions were studied. In 10 cases the ovaries were considered nonviable at the time of surgery and in three cases they were considered viable. Of the nonviable group, six showed absent arterial and venous flow centrally, but two had low velocity (< 5 cm/s) arterial flow peripherally in the region of the adnexal branch of the uterine artery or in the main ovarian artery, and two demonstrated absent or reversed diastolic arterial flow. None of the nonviable ovaries showed venous flow centrally. In contrast, all of the viable ovaries demonstrated venous flow centrally, and two had peripheral and central arterial flow. Although the CDS findings in adnexal torsion are variable, ovarian viability may be predicted if central venous flow is present.

Sonohysterography: a technique for endometrial evaluation.

Sonohysterography involves the instillation of sterile saline under continuous sonographic visualization to assess the endometrial cavity. The technique is most useful for evaluating women with fertility problems, postmenopausal bleeding, or an abnormal endometrial interface as seen at baseline sonography. The procedure is performed with saline instilled into the endometrial cavity through a 5-F pediatric feeding tube or a hysterosalpingography or insemination catheter. In the normal uterus, the endometrium appears symmetric, surrounding the anechoic, saline-distended endometrial cavity. Adhesions appear as bridging bands of tissue that distort the uterine cavity or as very thin, undulating membranes, best seen at real-time examination. An intracavitary polyp is seen surrounded by anechoic fluid, with the point of attachment and thickness of the stalk clearly demonstrated. The location of leiomyomas can be determined: Intramural lesions do not distort the endometrial cavity, whereas submucosal lesions often do, with the overlying normal layer of endometrium clearly seen. In women with abnormal bleeding, focal areas of asymmetric endometrial thickening can be identified. Sonohysterography allows differentiation of intracavitary, endometrial, and submucosal abnormalities without the use of ionizing radiation or contrast agents.

Transrectal and transperineal sonography during guided intrauterine procedures.

Transrectal sonography was used to provide intraoperative guidance for dilatation and curettage and placement of intrauterine tandem apparatus in 20 patients in whom the external cervical os could not be visualized adequately. Transrectal sonography was found to be useful in providing guidance for these procedures and at the same time helped avoid uterine perforation. This method also was used during cerclage placement in two patients who had undergone several conizations. Transperineal sonography was used in three patients whose area of abnormality was best approached transperineally. These cases included transvaginal biopsy of a metastatic trophoblastic tumor and one guided aspiration of a perirectal abscess after pelvic exenteration. The potential advantages and pitfalls in the intraoperative use of transrectal and transperineal sonography for guided intrauterine procedures are discussed and illustrated.

Serial assessment of adnexal masses with transvaginal color Doppler sonography.

Transvaginal color Doppler sonography (TV-CDS) was performed on 64 women with adnexal masses at 3, 6 and 12 weeks after initial presentation. In 47 (72% of patients studied), the pelvic mass demonstrated a decrease in size and increase in pulsatility index (PI) after 12 weeks. Of the patients undergoing surgery in this group, one had a tubo-ovarian abscess, one diverticular abscess and one hydrosalpinx. In seven patients (10%), there was no change in size or PI. Three in this group had an endometrioma, whereas two had a peritoneal cyst. In five (7%), there was no change in size and an increase in PI. One of these patients had a mucinous cystadenoma. In three (5%), there was a decrease in size and PI. Two of these patients had a tubo-ovarian abscess. In two (3%) patients studied, the mass showed an increase in size and decrease in PI; both had corpora luteum cysts with acute hemorrhage. Seventy-two percent of masses with high impedance underwent regression, whereas only 21% of lesions with low impedance did. Only 20% of masses demonstrating low impedance or morphologically complex structure regressed. Sixty-five percent of lesions that regressed had a significant drop in PI, whereas all the lesions that showed no change in size or enlargement had either no change or decrease in PI. Probability of regression was the greatest in young women (less than 40 years of age) and in masses < 5 cm. Ninety-three percent of women with persistent masses that underwent progestational suppression demonstrated regression with decrease of PI and peak systolic velocity.(ABSTRACT TRUNCATED AT 250 WORDS)

Conventional and color Doppler transvaginal sonography of pelvic masses: a comparison of relative histologic specificities.

The relative specificity of CDS versus conventional TVS was assessed in 96 women with surgically excised and pathologically examined pelvic masses. In general, CDS was more specific than TVS in 43% of cases, both were equally specific in 41%, neither was more specific in 10%, and TVS was more specific than CDS in 6%. In particular, CDS seemed to be most specific in detecting ovarian malignancies, ovarian torsion, and ectopic pregnancy. The positive and negative predictive values of CDS were higher in postmenopausal women than in premenopausal women. The use of CDS as an adjunct to TVS is supported by the data from this study.