P–679 Magnetic resonance imaging (MRI), an alternative method to evaluate the ovarian reserve

Study question

Is magnetic resonance imaging (MRI) a valid method to access antral follicles count (AFC) compared to two-dimensional (2D) transvaginal ultrasonography (USG) and Anti-Mullerian Hormone (AMH) to evaluate the ovarian reserve?

Summary answer

AFC has a high agreement between MRI and USG methods, as well as with AMH. MRI can be an alternative method to evaluate ovarian reserve.

What is known already

In fact, two methods are the most used today to assess ovarian reserve: USG and AMH. The USG is considered the gold standard method for AFC, and contributes to predict and tailor treatment strategies, such as in-vitro fertilization. The major limitations of USG are its user dependency and equipment. Also, there are limitations in displaying a global view of the pelvis and large ovarian lesions. Magnetic resonance imaging (MRI), with its excellent soft-tissue contrast resolution and characteristics, is a useful non-invasive alternative modality to USG. Just one study evaluated MRI and revealed more small size antral follicles compared to 3D-USG.

Study design, size, duration

A prospective cross-sectional observational study was performed in an assisted reproduction techniques (ART) post-graduation program setting from an assisted reproductive center in Sao Paulo, Brazil, which ran throughout 2019–2020, with a total number of 59 patients that were in fertility treatment and needed to undergo to a MRI procedure to evaluate uterine or pelvic diseases as, Myoma, Adenomyosis, endometriosis, and adnexal cysts.

Participants/materials, setting, methods

Patients were evaluated to access the AFC by the MRI method and 2D transvaginal USG, and Anti-Mullerian Hormone (AMH) concentration to evaluate the ovarian reserve. Comparison between methods was done through Wilcoxon signed ranks test and Bland-Altman analysis. Ovarian reserve was classified as follows: very low (<4 follicles/AMH<0.5); low (5–7 follicles/AMH=0.5–1.1); normal (8–15 follicles/AMH=1.1–3.5); normal-high (>15 follicles/AMH>3.5). Weighted Cohen’s kappa was used to verify agreement between MRI, USG and AMH classifications of ovarian reserve.

Main results and the role of chance

Average AFC for USG were 5,55±4.01 for left ovary and 5.55±3.8 for right ovary. Average follicle count for both ovaries was 10±7.07. Regarding MRI, mean counts were 6.44±4.81 for left ovary, 5.65±3.85 for right ovary, and a 11.89±7.89 follicle sum mean count. Average concentration of AMH was 1.79±1.44. The Wilcoxon test and Bland-Altman analyses found differences and systematic biases for comparison between USG and MRI for both ovaries (–2.58; limits of agreement=–14.56 to 9.40, Wilcoxon p = 0,008) and for the right ovary (–1.48; limits of agreement=–8.32 to 5.35, Wilcoxon p = 0,031). There was no difference between methods for the left ovary. Weighted Cohen Kappa coefficients showed substantial agreement between ovarian reserve classifications based on AMH levels, USG, and MRI. The conducted paired comparisons were USG with MRI (k = 0.676), AMH with MRI (k = 0.760) and USG (k = 0.609).

Limitations, reasons for caution

The systematic biases found when comparing USG to MRI methods may suggest a consistent detection of more follicles with MRI procedures in comparison to the USG method. This bias found warrants caution as it must be confirmed, in future studies.

Wider implications of the findings: The MRI method reveals similar ovarian reserve to USG when used the same classification, and a higher agreement to AMH. This suggests that MRI is a reliable method of quantifying antral follicles and can also be adopted when the patient will need to evaluate pelvic pathologies.

Trial registration number

Not applicable

Penetrance of the TP53 R337H Mutation and Pediatric Adrenocortical Carcinoma Incidence Associated with Environmental Influences in a 12-Year Observational Cohort in Southern Brazil

The TP53 R337H mutation is associated with increased incidence of pediatric adrenocortical tumor (ACT). The different environmental conditions where R337H carriers live have not been systematically analyzed. Here, the R337H frequencies, ACT incidences, and R337H penetrance for ACT were calculated using the 2006 cohort with 4165 R337H carriers living in Paraná state (PR) subregions. The effectiveness of a second surveillance for R337H probands selected from 42,438 tested newborns in PR (2016 cohort) was tested to detect early stage I tumor among educated families without periodical exams. Estimation of R337H frequencies and ACT incidence in Santa Catarina state (SC) used data from 50,115 tested newborns without surveillance, ACT cases from a SC hospital, and a public cancer registry. R337H carrier frequencies in the population were 0.245% (SC) and 0.306% (PR), and 87% and 95% in ACTs, respectively. The ACT incidence was calculated as ~6.4/million children younger than 10 years per year in PR (95% CI: 5.28; 7.65) and 4.15/million in SC (CI 95%: 2.95; 5.67). The ACT penetrance in PR for probands followed from birth to 12 years was 3.9%. R337H carriers living in an agricultural subregion (C1) had a lower risk of developing pediatric ACT than those living in industrial and large urban subregion (relative risk = 2.4). One small ACT (21g) without recurrence (1/112) was detected by the parents in the 2016 cohort. ACT incidence follows R337H frequency in each population, but remarkably environmental factors modify these rates.

Use of nutrition literacy scale in elderly minority population

OBJECTIVES

The major objective of our paper was to test and validate the nutritional literacy scale (NLS) in a pre-dominantly African-American geriatric population.

DESIGN

Completion of the 2 literacy scales Short Test of Functional Health Literacy in Adults (STOHFLA) and nutritional literacy scale (NLS) during a 5-month period from September 2008 to January 2009.

SETTING

The Rosa Parks Geriatric Center at Detroit Medical Center/Wayne State University.

PARTICIPANTS

The study cohort consisted of elderly (>65 years old) 150 patients that had presented to the geriatric clinic.

MEASUREMENTS

NLS and STOHFLA were simultaneously given to the patients. The NLS consists of 28 questions regarding organic foods; calorie intake etc. and questions in each section were arranged from easier to more difficult ones. The baseline characteristics were stratified according to the NLS (< 25 and ≥ 25) and STOHFLA (< 35 and ≥ 35) scores. Additionally we also collected data on demographic information, educational experience, blood pressure recordings from 3 consecutive clinic visits.

RESULTS

The patients with a higher NLS score were younger (72 ± 9) as compared to those with lower NLS score (76 ± 9) (p = 0.005), and also had more years of education (16 ± 3 years v/s 13 ± 3 years; p <0.001). A higher proportion of patients with lower score on NLS had hypertension (95.10 % for NLS < 25 v/s 77.08 % for NLS > 25; p =0.001).

CONCLUSION

We validated a potentially useful nutritional literacy tool that might prove to be useful intervention aimed at identifying individuals with lower levels of education and insight regarding their nutritional behaviors.

A time-motion study of the activities of attending physicians in an internal medicine and internal medicine-pediatrics resident continuity clinic

PURPOSE

To describe the activities of attending physicians in a residency-based continuity clinic and to examine factors that affect their teaching of, supervision of, and interaction with residents.

METHOD

Six full-time board-certified faculty members (three internal medicine, three internal medicine-pediatrics) in an urban residency program participated in a descriptive observational time-motion study. The attending faculty were directly observed by "shadow" technique for 30 half-day sessions from April 1994 through September 1994. Each activity was measured by a trained research assistant using a digital stopwatch. The observed activities were assigned to one of 16 subcategories.

RESULTS

6,389 minutes of activities were observed. Activities were distributed among four general categories: direct contact with residents (43.1%), clinic operations (33.7%), personal and/or professional activities (18.0%), and miscellaneous time (5.2%). Attending physicians spent the most time in direct contact with residents when the patient-to-attending ratio was 10-14:1.

DISCUSSION

The activities of the clinic's attending physicians were quite varied. Less than half of their time in the clinic was spent in contact with residents. This contact time may be significantly increased by changes to clinic policies, such as optimizing the patient-to-faculty ratio and increasing administrative support for the clinic. These findings can be used as a reference point for studies of attending physicians' activities since the federally mandated rules changes regarding their responsibilities for supervising residents.

Congenital rudimentary medial meniscus--report of a case of development arrest of medial meniscus

We present an unusual case, where the medial meniscus does not coincide with the embryological development of the formation of a discoid cartilage. A fairly, careful perusal of English literature since 1945 to date makes us feel that the following case merits recording. The meniscus had a normal anterior horn attached to the intercondylar area, in front of the anterior cruciate ligament. Medially, it was attached to the capsule and the condylar surface of the medial tibial plateau. The posterior horn was rounded, smooth, and floating free of any attachments. It was approximately 2 cms in length, semilunar in shape, and extended posteriorly up to the anterior margin of the medial collateral ligament. The rest of the medial tibial plateau had no other protective covering.