The effect of hysteroscopic metroplasty on fertility in T-shaped and Y-shaped dysmorphic uterus

OBJECTIVE

T/Y-shaped dysmorphic uterus is frequently associated with subfertility, abortion, preterm delivery, and recurrent implantation failure. In this study, the impact of hysteroscopic metroplasty for a T/Y-shaped uterus on obstetric outcomes was investigated in patients with infertility and recurrent pregnancy loss (RPL) and compared the uterine anomaly subgroups.

METHOD

Cases with infertility and/or RPL diagnosed with T/Y-shaped uterus by hysterosalpingography (HSG) and 3D transvaginal ultrasonography (3D TVUSG) with no other male or female pathology have recruited the study. Medical history and the obstetric outcome after two years of follow-up were recorded.

RESULTS

Out of the 92 cases recruited, T-shaped uteri (Group-1) were observed in 30, while 62 (67.3%) patients had Y-shaped uteri. Pregnancy was achieved in 50 (54.3%) of the cases, 28 (56%) of the pregnancies occurred spontaneously, and in 22 (44%) pregnancy was achieved through assisted reproductive techniques (ART). Term delivery occurred in 29 (76.3%) of the pregnancies while 9 (23.6%) had preterm deliveries and a total of 38 (76%) resulted in a live birth. Out of the 31 patients with previous RPL history, 13 (41.9%) achieved pregnancy and 11 out of 13 (84.6%) had a term pregnancy followed by live birth.

CONCLUSION

Spontaneous pregnancy, and term pregnancy rates after surgery were found to be promising in these uterine anomalies. The pregnancy outcome of the primary infertile patients was found the same in two groups (50%-46.1%), but the results of the RPL patients were found to be better in the T-shaped group than in the Y-shaped group (70%-28.5%).

A New Model for Birth Weight Prediction Using 2- and 3-Dimensional Ultrasonography by Principal Component Analysis: A Chinese Population Study

OBJECTIVES

To establish a new model for birth weight prediction using 2- and 3-dimensional ultrasonography (US) by principal component analysis (PCA).

METHODS

Two- and 3-dimensional US was prospectively performed in women with normal singleton pregnancies within 7 days before delivery (37-41 weeks' gestation). The participants were divided into a development group (n = 600) and a validation group (n = 597). Principal component analysis and stepwise linear regression analysis were used to develop a new prediction model. The new model's accuracy in predicting fetal birth weight was confirmed by the validation group through comparisons with previously published formulas.

RESULTS

A total of 1197 cases were recruited in this study. All interclass and intraclass correlation coefficients of US measurements were greater than 0.75. Two principal components (PCs) were considered primary in determining estimated fetal birth weight, which were derived from 9 US measurements. Stepwise linear regression analysis showed a positive association between birth weight and PC1 and PC2. In the development group, our model had a small mean percentage error (mean ± SD, 3.661% ± 3.161%). At least a 47.558% decrease in the mean percentage error and a 57.421% decrease in the standard deviation of the new model compared with previously published formulas were noted. The results were similar to those in the validation group, and the new model covered 100% of birth weights within 10% of actual birth weights.

CONCLUSIONS

The birth weight prediction model based on 2- and 3-dimensional US by PCA could help improve the precision of estimated fetal birth weight.

Applications of 3-Dimensional Ultrasonography in the Neck, Excluding the Thyroid

Ultrasonography (US) of the neck is an accepted, useful imaging modality for many applications beyond its usefulness in thyroid disease. Two-dimensional US has been effectively used for evaluation of many types of neck conditions, and now, 3-dimensional US can be added to the imaging armamentaria. Three-dimensional US is useful in the evaluation of cervical lymph nodes, recurrent/residual thyroid neoplasia, parathyroid glands, parotid and submandibular glands, as well as thyroglossal duct cysts and other assorted palpable and visible abnormalities because of its unique capabilities, including multiplanar reconstruction, accessibility of the coronal view, volume calculation, and regularly spaced incremental slice evaluation.

The importance of prenatal 3-dimensional sonography in a case of a segmental overgrowth syndrome with unclear chromosomal microarray results

PIK3CA-related overgrowth spectrum, caused by mosaic mutations in the PIK3CA gene, is associated with regional or generalized asymmetric overgrowth of the body or a body part in addition to other clinical findings. Three-dimensional ultrasonography (3-D US) has the capability to display structural abnormalities in soft tissues or other organs, thereby facilitating identification of segmental overgrowth lesions. We present a case suspected of having a segmental overgrowth disorder based on 3-D US, whose chromosomal microarray result was abnormal, but apparently was not the cause of the majority of the fetus's clinical features.

Prediction of Tubal Ectopic Pregnancy Using Offline Analysis of 3-Dimensional Transvaginal Ultrasonographic Data Sets: An Interobserver and Diagnostic Accuracy Study

OBJECTIVES

To assess interobserver reproducibility in detecting tubal ectopic pregnancies by reading data sets from 3-dimensional (3D) transvaginal ultrasonography (TVUS) and comparing it with real-time 2-dimensional (2D) TVUS.

METHODS

Images were initially classified as showing pregnancies of unknown location or tubal ectopic pregnancies on real time 2D TVUS by an experienced sonologist, who acquired 5 3D volumes. Data sets were analyzed offline by 5 observers who had to classify each case as ectopic pregnancy or pregnancy of unknown location. The interobserver reproducibility was evaluated by the Fleiss κ statistic. The performance of each observer in predicting ectopic pregnancies was compared to that of the experienced sonologist. Women were followed until they were reclassified as follows: (1) failed pregnancy of unknown location; (2) intrauterine pregnancy; (3) ectopic pregnancy; or (4) persistent pregnancy of unknown location.

RESULTS

Sixty-one women were included. The agreement between reading offline 3D data sets and the first real-time 2D TVUS was very good (80%-82%; κ = 0.89). The overall interobserver agreement among observers reading offline 3D data sets was moderate (κ = 0.52). The diagnostic performance of experienced observers reading offline 3D data sets had accuracy of 78.3% to 85.0%, sensitivity of 66.7% to 81.3%, specificity of 79.5% to 88.4%, positive predictive value of 57.1% to 72.2%, and negative predictive value of 87.5% to 91.3%, compared to the experienced sonologist's real-time 2D TVUS: accuracy of 94.5%, sensitivity of 94.4%, specificity of 94.5%, positive predictive value of 85.0%, and negative predictive value of 98.1%.

CONCLUSIONS

The diagnostic accuracy of 3D TVUS by reading offline data sets for predicting ectopic pregnancies is dependent on experience. Reading only static 3D data sets without clinical information does not match the diagnostic performance of real time 2D TVUS combined with clinical information obtained during the scan.

Contribution of 3-Dimensional Contrast-Enhanced Ultrasonography (CEUS) Compared With 2-Dimensional CEUS in the Analysis of Liver Tumors

OBJECTIVES

In this study, we investigated the vascular characteristics of liver tumors on 3-dimensional (3D) and 2-dimensional (2D) contrast-enhanced ultrasonography (CEUS). The clinical value of these CEUS methods in the diagnosis of benign and malignant liver tumors was evaluated and compared.

METHODS

A total of 126 liver tumors were examined by conventional ultrasonography (US), 2D CEUS, and dynamic 3D CEUS (frequency range, 1-6 MHz; focusing ability, 2-25 cm in depth; mechanical index, 0.09). Dynamic 3D CEUS images were postprocessed with high-resolution intelligent tomographic technology. The sensitivity and specificity of the CEUS methods in differentiating benign and malignant liver tumors were compared, as were the vascular characteristics (including the number and spatial relationships of the tumor vessels, such as origin and continuity) of the tumors in the arterial phase.

RESULTS

The imaging methods did not significantly differ in their sensitivity and specificity for differentiating benign and malignant liver tumors (P > .05). Dynamic 3D CEUS was significantly better than 2D CEUS in revealing the vascular characteristics of the tumors (P < .05). The vascular morphologic characteristics of benign and malignant hepatic tumors in the arterial phase of dynamic 3D CEUS using intelligent tomographic technology differed significantly (P < .05).

CONCLUSIONS

Dynamic 3D CEUS of liver tumors provides a more intuitive and comprehensive view of the spatial relationships of their blood vessels, including their peripheral and internal distribution. The volume information obtained with dynamic 3D CEUS combined with intelligent tomographic technology can improve the US-based diagnosis of liver tumors and thus guide their treatment.

Use of 3D Ultrasonography in Diagnosing Ovarian Adenocarcinoma in a Common Mynah ( Acridotheres tristis )

A 12-year-old female common mynah ( Acridotheres tristis ) was examined because of dyspnea and coelomic enlargement. Abdominal radiographs revealed hepatomegaly and a coelomic mass of unknown origin. Both brightness mode (2-dimensional; 2D) and 3-dimensional (3D) ultrasonography were performed to identify the origin of the mass. Ultrasonographic findings distinguished the mass from the liver and revealed high vascularization of the mass and a moderate increase in echogenicity of the liver. Three-dimensional ultrasonographic histogram analysis of the mass was performed. The mynah was treated with supportive care but died after 3 days. Histopathologic examination showed ovarian adenocarcinoma, with concurrent mild to moderate hepatopathy. In diagnostic imaging using ultrasound in birds, 3D ultrasonography allows perspective images of the internal organs to be obtained and is potentially superior to 2D ultrasonography in evaluating irregularly shaped objects.

Utility of 3-dimensional ultrasound imaging to evaluate carotid artery stenosis: comparison with magnetic resonance angiography

BACKGROUND

We evaluated the utility of 3-dimensional (3-D) ultrasound imaging for assessment of carotid artery stenosis, as compared with similar assessment via magnetic resonance angiography (MRA).

METHODS

Subjects comprised 58 patients with carotid stenosis who underwent both 3-D ultrasound imaging and MRA. We studied whether abnormal findings detected by ultrasound imaging could be diagnosed using MRA. Ultrasound images were generated using Voluson 730 Expert and Voluson E8.

RESULTS

The degree of stenosis was mild in 17, moderate in 16, and severe in 25 patients, according to ultrasound imaging. Stenosis could not be recognized using MRA in 4 of 17 patients diagnosed with mild stenosis using ultrasound imaging. Ultrasound imaging showed ulceration in 13 patients and mobile plaque in 6 patients. When assessing these patients, MRA showed ulceration in only 2 of 13 patients and did not detect mobile plaque in any of these 6 patients. Static 3-D B mode images demonstrated distributions of plaque, ulceration, and mobile plaque, and static 3-D flow images showed flow configuration as a total structure. Real-time 3-D B mode images demonstrated plaque and vessel movement. Carotid artery stenting was not selected for patients diagnosed with ulceration or mobile plaque.

CONCLUSIONS

Ultrasound imaging was necessary to detect mild stenosis, ulcerated plaque, or mobile plaque in comparison with MRA, and 3-D ultrasound imaging was useful to recognize carotid stenosis and flow pattern as a total structure by static and real-time 3-D demonstration. This information may contribute to surgical planning.

Objective evaluation of sylvian fissure development by multiplanar 3-dimensional ultrasonography

OBJECTIVE

Evaluation of fetal cerebral cortex sulcation is important for the pre-natal diagnosis of neuronal migration disorders. Although abnormal sylvian fissure morphologic features are frequently observed in these conditions, the diagnosis of an abnormal sylvian fissure relies on subjective interpretation of ultrasonographic images. This study was performed to develop an objective ultrasonographic parameter for sylvian fissure evaluation.

METHODS

This cross-sectional study included 202 normal singleton pregnancies without fetal anomalies. Using multiplanar, 3-dimensional ultrasonography, the sylvian fissure midpoint was identified. The sylvian fissure-to-parietal bone distance (SPB) was measured from the midpoint to the inner surface of the parietal bone, perpendicular to the falx cerebri. Bland-Altman plots were used to determine intraobserver and interobserver agreement. Regression analysis was used to evaluate the correlation between SPB measurements and gestational age.

RESULTS

Two hundred (99%) of 202 pregnancies had a visible sylvian fissure, identifiable as early as 12 weeks of gestation. The mean SPB values at 12 and 41 weeks were 2.1 and 14.3 mm, respectively. Intraobserver and interobserver mean differences between paired measurements were 0.01 mm (95% limits of agreement, -0.41 to 0.43 mm) and 0.05 mm (95% limits of agreement, -1.79 to 1.90 mm), respectively. A linear correlation was observed between the SPB and gestational age (multiple R=0.91; R2=0.82 [SPB = -2.85 + 0.42 x gestational age]).

CONCLUSIONS

(1) The SPB can be reproducibly measured from 12 weeks of gestation to term; and (2) a strong positive correlation was observed between the SPB and gestational age.