3D Ultrasound Examination Research Articles

Possibilities of elastography in the diagnosis of stress urinary incontinence in women

BACKGROUND:Stress urinary incontinence in women is a widespread disease. It can occur in women of reproductive age, while progressing and disrupting the quality of life. Ultrasound elastography allows for evaluating the stiffness of the urethral supporting structures and can help in studying the pathophysiology of stress urinary incontinence and in diagnosing its mild forms for timely initiation of therapy and preventing the development of severe forms of the disease.
 AIM:The aim of this study was to improve the diagnosis of mild stress urinary incontinence in women using ultrasound compression elastography of the ureterovesical junction.
 MATERIALS AND METHODS:We examined 25 women with mild stress urinary incontinence (main group) and 15 patients without urinary incontinence (control group) of reproductive and perimenopausal age. The diagnosis of stress urinary incontinence was confirmed during a comprehensive urodynamic study. To assess the urethral mobility and determine the stiffness of the supporting structures, a 2D ultrasound examination was performed with compression elastography of the ureterovesical junction using Voluson E6 and E10 ultrasound systems equipped with a transvaginal probe (GE Healthcare, USA). Four areas of interest in the paraurethral region of the proximal and middle urethra were examined. The obtained elastograms were used to evaluate the color characteristics and strain ratio of the areas of interest in three dimensions, the average values being calculated.
 RESULTS:The strain ratios in all studied areas of the paraurethral region had no significant relationship with age and were lower in patients with stress urinary incontinence compared to control values (p 0.01). Urethral hypermobility (mobility: mean urethral α angle rotation of 40 degrees) was identified in 84% of women with stress urinary incontinence. According to the results of correlation analysis, the strain ratios in the three areas of interest had a significant negative relationship with changes in the urethral α angle rotation. The ROC analysis showed that the stiffness values of the paraurethral region of the proximal posterior wall of the urethra are the most significant parameters for the diagnosis of stress urinary incontinence. The threshold value of the strain ratio for diagnosing stress urinary incontinence was determined to be less than or equal to 0.85 (sensitivity 96.0%; specificity 86.7%;p 0.001).
 CONCLUSIONS:Ultrasound compression elastography of the ureterovesical junction is a new non-invasive technique that can improve the accuracy of diagnosing stress urinary incontinence in women. It is advisable to use the technique in women with mild stress urinary incontinence who are planned for conservative treatment to confirm the diagnosis and monitor therapy.

Predictive value of 3D ultrasound assessment of endometrial receptivity for PGD/PGS for transfer pregnancy outcome

ObjectiveTo investigate the predictive value of three-dimensional ultrasound assessment of endometrial receptivity in PGD/PGS transplantation patients on pregnancy outcome.Methods280 patients undergoing PGD/PGS transplantation were enrolled and divided into group A and group B according to the patients’ pregnancy outcomes. The general conditions, endometrial receptivity indexes of the two groups were compared. Multifactorial logistic regression analysis was used to determine the factors influencing pregnancy outcome in PGD/PGS transplant patients. ROC curves were plotted to analyze the predictive value of 3D ultrasound parameters on pregnancy outcome. The results of the study were validated with patients who underwent FET transplantation, and the patients in the validation group were treated with the same 3D ultrasound examination method and treatment plan as the observation group.ResultsThe differences in basic situations between two groups were not statistically significant (P > 0.05). The percentage of endometrial thickness, endometrial blood flow, and endometrial blood flow classification type II + II were higher in group A than in group B (P < 0.05). Multifactorial logistic regression analysis showed that endometrial thickness, endometrial blood flow and endometrial blood flow classification were influencing factors of pregnancy outcome in PGD/PGS patients. The sensitivity of predicting pregnancy outcome based on the results of transcatheter 3D ultrasound was 91.18%, the specificity was 82.35%, and the accuracy was 90.00%, which has a high predictive value.Conclusion3D ultrasound can predict pregnancy outcome by assessing the endometrial receptivity of PGD/PGS transplantation, in which endometrial thickness and endometrial blood flow have a good predictive value.

Ultrasound Tomography (3D) Triage for Oculofacial emergencies- new paradigms

Background: The incidence of ocular trauma has been on the rise for the past few years. This impels the medical community to be more adroit at diagnosing and treating these injuries. An effective way to diagnose different manifestations of ocular trauma involve the use of ultrasound to visualize the anatomical details of the eye and orbit, which is vital for deciding the best management plan. Aim: To assess the suitability of 3D Ultrasound as a first-line investigation for oculofacial emergencies resulting from projectile and blast injuries. Methods: In this review article, the focus of discussion will be the accuracy of 3D ultrasound in diagnosing oculofacial injuries and the utility of ultrasound in triage of vision threatening emergencies in austere environments. Results: Understanding the utility of ultrasound data for diagnosis will assist ophthalmologists in managing ocular trauma more effectively. Conclusion: We recommend that patients with suspected eye injuries should undergo careful 3D ultrasound examination by appropriately trained ophthalmologists as a part of triage for oculofacial emergencies in austere environments.

Трехмерная эхография в оценке морфофункционального состояния эндометрия у пациенток после односторонней аднексэктомии

Objective. To study the morphological and functional characteristics of the endometrium in patients of reproductive age before and after unilateral adnexectomy using a three-dimensional (3D) ultrasound imaging. Patients and methods. A total of 113 patients after unilateral adnexectomy were examined. The mean age of patients was 32.85 ± 4.01 years. Two patient groups were identified: group 1 (n = 51) consisted of patients with mature teratomas; group 2 (n = 62) included patients who underwent surgery for epithelial ovarian tumors (endometrioid (30; 48.4%), serous (21; 33.9%), and mucinous (11; 17.7%) cystadenomas). The 3D ultrasound examination of pelvic organs was performed in the middle luteal phase of the menstrual cycle before surgery and at 6, 12 months after it. The endometrial thickness, volume, and ultrasound pattern were studied, as well as volumetric vascularity indices: vascularization index (VI), flow index (FI), and the vascularizationflow index (VFI). Based on the ESHRE consensus (2022), the ovarian reserve was assessed. Results. The improvement of endometrial perfusion was noted at 12 months after surgery. In patients with ovarian teratomas, compensatory restoration of morphological and functional properties of the ovary and endometrium was recorded. The opposite pattern was observed in the group of patients with epithelial tumors. Thus, patients operated on for ovarian endometriomas had an extremely thin endometrium (3.5 ± 0.1 mm), whose values were 1.5 times lower compared to those of patients with serous and mucinous cystadenomas; the glandular layer volume was expectedly low (1.1 ± 0.9 cm3). Conclusion. The minimum effective restoration period for the collateral ovary after unilateral adnexectomy is at least 6 months. The qualitative and quantitative parameters of 3D Doppler velocimetry can be used as predictors of the endometrial morphological and functional state in patients of reproductive age. Key words: 3D ultrasound, mature teratomas, cystadenomas, endometrium, endometrioid cysts, VOCAL

Normal variation of infant hip development : patterns revealed by 3D ultrasound.

Studies of infant hip development to date have been limited by considering only the changes in appearance of a single ultrasound slice (Graf's standard plane). We used 3D ultrasound (3DUS) to establish maturation curves of normal infant hip development, quantifying variation by age, sex, side, and anteroposterior location in the hip. We analyzed 3DUS scans of 519 infants (mean age 64 days (6 to 111 days)) presenting at a tertiary children's hospital for suspicion of developmental dysplasia of the hip (DDH). Hips that did not require ultrasound follow-up or treatment were classified as 'typically developing'. We calculated traditional DDH indices like α angle (αSP), femoral head coverage (FHCSP), and several novel indices from 3DUS like the acetabular contact angle (ACA) and osculating circle radius (OCR) using custom software. α angle, FHC, and ACA indices increased and OCR decreased significantly by age in the first four months, mean αSP rose from 62.2° (SD 5.7°) to 67.3° (SD 5.2°) (p < 0.001) in one- to eight- and nine- to 16-week-old infants, respectively. Mean αSP and mean FHCSP were significantly, but only slightly, lower in females than in males. There was no statistically significant difference in DDH indices observed between left and right hip. All 3DUS indices varied significantly between anterior and posterior section of the hip. Mean 3D indices of α angle and FHC were significantly lower anteriorly than posteriorly: αAnt = 58.2° (SD 6.1°), αPost = 63.8° (SD 6.3°) (p < 0.001), FHCAnt = 43.0 (SD 7.4), and FHCPost = 55.4° (SD 11.2°) (p < 0.001). Acetabular rounding measured byOCR indices was significantly greater in the anterior section of the hip (p < 0.001). We used 3DUS to show that hip shape and normal growth pattern vary significantly between anterior and posterior regions, by magnitudes similar to age-related changes. This highlights the need for careful selection of the Graf plane during 2D ultrasound examination. Whole-joint evaluation by obtaining either 3DUS or manual 'sweep' video images provides more comprehensive DDH assessment.Cite this article: Bone Jt Open2022;3(11):913-923.

Study of fetal central nervous system anomalies by the means of antenatal 2D ultrasound examination in varying trimesters

Aims and Objectives: 1) Objective is to study the range of Congenital neurological anomalies occurring in utero; 2) To evaluate the incidence of congenital anomalies in varying trimesters; 3) To confirm the diagnosis by post natal examination or autopsy as and when possible. Material and Methods: This is a prospective study which was conducted in the Radio-diagnosis department in Dhiraj General hospital, from January 2021 till February 2022. Ultrasound screening of pregnant women was performed. Pregnancy with ultrasound findings of central nervous system anomalies were followed up. Prenatal ultrasound findings were confirmed by post MTP examination in cases of therapeutic abortions and fetal losses. In case of live birth postnatal findings were noted. Results: After conducting a ultrasound screening in all three trimesters, a total of 30 congenital neurological anomalies were diagnosed. It was seen that majority of anomalies were detected in 2nd trimester. Among the neurological anomalies, most common anomalies were found to be hydrocephalus (4), Anencephaly (3) and lumbar myelo-meningocoele (3). Ultrasound findings were matching in 87 % of cases with post natal examination findings. In this study rare congenital neurological syndromes like Meckel Gruber syndrome and iniencephaly like disorders were also detected via ultrasound.

Three-Dimensional Ultrasound Images in the Assessment of Bladder Tumor Health Monitoring under Deep Learning Algorithms.

This study was aimed at exploring the application value of three-dimensional (3D) ultrasound based on deep learning and continued nursing health monitoring (CNHM) mode in promoting the recovery of bladder cancer patients after surgery. 60 patients who underwent muscular noninvasive superficial bladder cancer and bladder perfusion treatment were selected as the research objects. The patients were randomly divided into two groups: an experimental group (30 cases) and a control group (30 cases). Patients in the experimental group adopted a CNHM model during the bladder perfusion treatment. The patients in control group adopted ordinary health monitoring mode. All patients underwent 3D ultrasound examination, and all images were processed using the convolutional neural network (CNN) algorithm. All patients were followed up regularly within 12 after the treatment. The imaging data, quality of life, satisfaction, and complications of the two groups of patients were compared in each time period. The ultrasound image processed by the CNN algorithm was clearer than that processed by the original method, showing higher image quality and more prominent lesion features. After 12 months of health monitoring intervention, the overall health status, scores of various functional areas, and score of functional subscales of the experimental group were greatly higher than those of the control group, and the differences were statistically significant (P < 0.05). The incidence of adverse reactions in the experimental group was much lower than that in the control group, and the difference was statistically obvious (P < 0.05). The comparison of the recurrence rate between the two groups of patients in each time period was statistically significant. The satisfaction score of the experimental group was much higher than the score of the control group, showing statistically significant difference (P < 0.05). CNN algorithm showed high application value in 3D ultrasound image processing, and the CNHM model was very beneficial to the postoperative recovery of bladder cancer patients.

Echolucent Carotid Plaques Becomes More Echogenic over Time – A 3D Ultrasound Study

Despite the presence of only a few established risk factors, some patients will experience atherosclerotic events. Therefore, methods for improved risk stratification for atherosclerotic events are wanted. We aimed to detect changes in carotid artery atherosclerotic plaque volume and echogenicity over time in patients with an acute thromboembolic event and in patients with chronic atherosclerotic disease, both treated with statin, using a novel 3D ultrasound system. We included two cohorts of patients; 70 patients, naïve to statin treatment, admitted with acute, first-time myocardial infarction (aMI), and 69 patients who had been on statin treatment for a minimum of 6 months with chronic peripheral arterial disease (cPAD). 3D ultrasound examination was performed at baseline and after 3 and 12 months. Plaque volume was quantified in 3D ultrasound plaque acquisitions, and echogenicity was assessed using grayscale median (GSM) and normalized with adventitia as reference. The aMI group had darker plaques than the cPAD group at baseline (mean GSM: 60.98, standard deviation (SD): 24.09 vs. 71.75, SD: 21.55; P=0.006), 3 months (63.64, SD: 20.47 vs. 73.44, SD: 20.46; P=0.006) and at 12 months follow-up (59.25, SD: 18.07 vs. 71.02, SD: 22.31; P=0.004). The differences were not significant after adjusting for traditional risk factors. Dividing both groups by the median GSM, the darkest half of the aMI group's had an increase in GSM mainly within the first 3 months (10.49, CI 95%: 2.45 to 18.53; P=0.012) and hereafter remained unchanged at 12 months follow-up (-0.53, CI 95%: -7.28 to 6.22, P=0.875). In the darkest cPAD group GSM also increased within 3 months (8.14, CI 95%: 1.85-14.32, P=0.012) and hereafter stabilized till 12 months (-2.54, CI 95%: -9.62 to 4.53, P=0.475). Plaque volume did not change in the aMI group from baseline (median: 55.41mm3, interquartile range (IQR): 24.24-84.31) to 12 months (58.67mm3, IQR: 31.81-93.51) (P=0.220) whereas there was a small decrease in the cPAD group from baseline (71.63mm3, IQR: 40.12-135.61) to 12 months (67.73mm3, IQR: 31.00-122.38) (P=0.026). Echolucent carotid plaque, assessed with the novel 3D matrix ultrasound system, had increasing GSM within 3 months period, indicating stabilization of the more vulnerable plaques in aMI and cPAD patients. Plaque volume decreased over 12 months follow-up in a long-term statin-treated patient with cPAD, but not during the first 12months statin therapy in patients with aMI.

Application of virtual touch tissue imaging quantification in diagnosis of supraspinatus tendon injury.

To explore the value of virtual touch imaging and quantification (VTIQ) shear wave elastography (SWE) in diagnosis of supraspinatus tendon tear. Eighty patients with unilateral supraspinatus tendon tear underwent shoulder arthroscopy were prospective studied. Tendinopathy, partial-thickness tear or full-thickness tear of supraspinatus tendon were diagnosed according 2D ultrasound examination. Sensitivity, specificity and accuracy of ultrasonic diagnosis of supraspinatus tendon tear were calculated by arthroscopy as the gold standard. VTIQ was applied to measure the shear-wave velocity (SWV) of both normal and affected supraspinatus tendon. The differences of SWV in three types of supraspinatus tendon tear and receiver operating characteristic (ROC) curves were analyzed. Among 80 patients, there were 20 tendinopathy, 31 partial tears and 29 full-thickness tears diagnosed by shoulder arthroscopy. Sensitivity, specificity and accuracy of 2D ultrasound in diagnosis of tendinopathy, partial tear and full-thickness tear groups were 78%, 90%and 83%; 71%, 86%and 73%; 86%, 88%and 88%, respectively. SWV of 80 supraspinatus tendon tears was 4.59±1.00 m/s, which was lower than that of normal supraspinatus tendon (4.59±1.00 m/s vs. 6.68±1.05 m/s, P < 0.01). SWV of supraspinatus tendon in tendinopathy, partial tear and full-thickness tear groups respectively were 5.66±0.97, 4.66±1.00, and 3.78±0.55 m/s, all lower than that of the contralateral normal supraspinatus tendon (all P < 0.05). In addition, the analysis of variance and pairwise comparison showed that SWV of supraspinatus tendon among three different degree of injury was statistically significant (all P < 0.001). The cutoff thresholds of SWV was 4.83 m/s to identify tendinopathy tear from partial tear and was 4.08 m/s to identify full-thickness tear from partial-thickness tear. VTIQ SWE with SWV might identify degree of supraspinatus tendon tear and improve the value of ultrasonography, which should be further evaluated in large multicenter studies.

The added value of three-dimensional ultrasonography in uterine pathology.

The rapid development achieved over the last decades in volume rendering of ultrasound data, known as three-dimensional (3D) ultrasound technique, leads to new opportunities for refining the diagnosis in many gynaecologic conditions. The aim of the present study was to evaluate the advantages of 3D ultrasound over two-dimensional (2D) ultrasound in uterine pathology and to establish the optimal time point during the menstrual cycle to perform 3D ultrasound examination in order to achieve the maximum of useful information. A cross-sectional study on 200 patients who underwent gynaecologic 2D and 3D ultrasound examinations was performed. The addition of 3D examination to 2D ultrasound in uterine pathology provided the most useful information concerning: Congenital uterine anomalies, intrauterine devices (IUDs), adenomyosis, and submucous myomas. The findings showed that the 3D ultrasound scan is a useful tool in gynaecology, especially in cases with congenital uterine anomalies, myoma, and IUD. Although initially it was used for research purposes only, recent findings suggest its usefulness in routine ultrasound scan and the possibility of witnessing its introduction as a recommended examination procedure in the foreseeable future. Further research should be conducted in order to establish the sensitivity of 3D ultrasound in the detection of minor endometrial conditions, by correlating the imaging findings with the hysteroscopic results.

Neural Network Algorithm-Based Three-Dimensional Ultrasound Evaluation in the Diagnosis of Fetal Spina Bifida

In order to realize the automatic recognition and diagnosis in ultrasound images of fetal spina bifida, the U-Net algorithm was improved in this study to obtain a new convolutional neural network algorithm—Oct-U-Net. 3,300 pregnant women were selected as the research objects, who underwent three-dimensional (3D) ultrasound examinations. Then, Oct-U-Net was applied to evaluate the diagnostic effect of fetal spina bifida by recall rate, precise rate, mean standard error, pixel accuracy (PA), mean intersection over union (MIoU), and running time. Besides, the fully convolutional network (FCN) algorithm and the U-Net algorithm were introduced for comparison. Results showed that recall rate, precise rate, PA, and MioU of Oct-U-Net were 0.93, 0.96, 0.949, and 0.917, respectively, which were markedly higher than those of FCN and U-Net P &lt; 0.05 . The mean standard error of Oct-U-Net was 4.1243, and its average running time was 12.15 seconds. The values of the above two indicators were sharply lower than those of FCN and U-Net P &lt; 0.05 . In conclusion, Oct-U-Net had a better diagnostic effect on 3D ultrasound images of fetal spina bifida, with higher segmentation accuracy and shorter running time, so it was worthy of clinical application.

Ultrasound markers informative of efficient non-pharmacological correction of hypofibrinolysis at preconception period in patients with recurrent pregnancy loss

Aim. To find reliable ultrasound markers of efficient non-pharmacological correction of hypofibrinolysis at preconception period in patients with recurrent pregnancy loss.Materials and Methods. We conducted a single-center, prospective, non-randomized study in patients with recurrent pregnancy loss and hypofibrinolysis (n = 120), who received intermittent pneumatic compression during preconception care. During the pregnancy, we performed a comprehensive 3D ultrasound examination of the endometrium and corpus luteum in the VOCAL mode. Then, we compared patients with (n = 97) and without (n = 23) favorable outcome. Predictive power of the ultrasound parameters was evaluated by a calculation of the area under the receiver operating characteristic (ROC) curve (AUC) and ROC curve comparison.Results. Vascularization flow index of endometrial perfusion (AUC = 0.566) and corpus luteum (AUC = 0.639) was identified as a potential marker of efficient intermittent pneumatic compression at preconception period.Conclusions. Adequate perfusion of endometrium and corpus luteum, reflected by vascularization flow index, may indirectly indicate successful trophoblast invasion and minimize the risk of recurrent pregnancy loss.

Exploring the clinical diagnostic value of pelvic floor ultrasound images for pelvic organ prolapses through deep learning

The 3D ultrasound features of patients with pelvic organ prolapses (POP) were analyzed using deep learning algorithms to explore the diagnostic efficacy of deep learning in identifying the types of POP and evaluate the feasibility of pelvic floor 3D ultrasound in diagnosing POP. Forty-four POP patients were included as the research objects, including 17 cases of anterior cavity prolapse, 23 cases of middle cavity prolapse, and four cases of posterior cavity prolapse. Twenty healthy women without POP were the control group. The 3D perineum ultrasound images of the patients were collected. A feature classification model for pelvic floor ultrasound images was built using deep learning algorithms. The proposed model was then compared with three convolutional neural network (CNN) models: support vector machine (SVM), radial basis function (RBF), and K-nearest neighbor (KNN), to evaluate its diagnostic efficiency in identifying the types of POP. Furthermore, the POP-Q score was performed based on ultrasound features. The results showed that the area under the curve (AUC) of the deep learning model was 0.79, and the 95% confidence interval was 0.76–0.80, higher than those of the CNN models. The accuracy (0.86), sensitivity (0.89), and specificity (0.84) of the deep learning model were higher than those of the three CNN models. The pelvic mouths of the study group and the control group were significantly more extensive than that of the nonproductive group (p < 0.05). The levator ani muscle of the POP group was significantly more extensive than that of the control group, and the difference was statistically significant (p < 0.05). The model based on deep learning has high efficiency in identifying the types of POP. The 3D ultrasound examination has important clinical significance for POP diagnosis.

Vessel morphology depicted by three‐dimensional power Doppler ultrasound as second‐stage test in adnexal tumors that are difficult to classify: prospective diagnostic accuracy study

ABSTRACTObjectivesTo assess whether vessel morphology depicted by three‐dimensional (3D) power Doppler ultrasound improves discrimination between benignity and malignancy if used as a second‐stage test in adnexal masses that are difficult to classify.MethodsThis was a prospective observational international multicenter diagnostic accuracy study. Consecutive patients with an adnexal mass underwent standardized transvaginal two‐dimensional (2D) grayscale and color or power Doppler and 3D power Doppler ultrasound examination by an experienced examiner, and those with a ‘difficult’ tumor were included in the current analysis. A difficult tumor was defined as one in which the International Ovarian Tumor Analysis (IOTA) logistic regression model‐1 (LR‐1) yielded an ambiguous result (risk of malignancy, 8.3% to 25.5%), or as one in which the ultrasound examiner was uncertain regarding classification as benign or malignant when using subjective assessment. Even when the ultrasound examiner was uncertain, he/she was obliged to classify the tumor as most probably benign or most probably malignant. For each difficult tumor, one researcher created a 360° rotating 3D power Doppler image of the vessel tree in the whole tumor and another of the vessel tree in a 5‐cm3 spherical volume selected from the most vascularized part of the tumor. Two other researchers, blinded to the patient's history, 2D ultrasound findings and histological diagnosis, independently described the vessel tree using predetermined vessel features. Their agreed classification was used. The reference standard was the histological diagnosis of the mass. The sensitivity of each test for discriminating between benign and malignant difficult tumors was plotted against 1 – specificity on a receiver‐operating‐characteristics diagram, and the test with the point furthest from the reference line was considered to have the best diagnostic ability.ResultsOf 2403 women with an adnexal mass, 376 (16%) had a difficult mass. Ultrasound volumes were available for 138 of these cases. In 79/138 masses, the ultrasound examiner was uncertain about the diagnosis based on subjective assessment, in 87/138, IOTA LR‐1 yielded an ambiguous result and, in 28/138, both methods gave an uncertain result. Of the masses, 38/138 (28%) were malignant. Among tumors that were difficult to classify as benign or malignant by subjective assessment, the vessel feature ‘densely packed vessels’ had the best discriminative ability (sensitivity 67% (18/27), specificity 83% (43/52)) and was slightly superior to subjective assessment (sensitivity 74% (20/27), specificity 60% (31/52)). In tumors in which IOTA LR‐1 yielded an ambiguous result, subjective assessment (sensitivity 82% (14/17), specificity 79% (55/70)) was superior to the best vascular feature, i.e. changes in the diameter of vessels in the whole tumor volume (sensitivity 71% (12/17), specificity 69% (48/70)).ConclusionVessel morphology depicted by 3D power Doppler ultrasound may slightly improve discrimination between benign and malignant adnexal tumors that are difficult to classify by subjective ultrasound assessment. For tumors in which the IOTA LR‐1 model yields an ambiguous result, subjective assessment is superior to vessel morphology as a second‐stage test. © 2020 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Three Dimensional Ultrasound of Pelvic Floor to Evaluate the Anatomical and Functional Changes of Primipara After Delivery

Objective: During pregnancy and childbirth, a series of remodeling processes may lead to the occurrence of pelvic floor dysfunction. Our aim was to explore the influence of different delivery methods on pelvic floor in primipara after delivery through three-dimensional (3D) ultrasound examination. Method: A total of 48 primiparas were selected as the study object. Among which, 21 primiparas underwent cesarean section were selected as observation group, 27 primiparas in vaginal delivery were selected as the control group. The 3D ultrasound examination of pelvic floor was carried out 6–8 weeks postnatally to observe and compare the prolapse of anterior, middle and posterior pelvic organs of parturient women in Valsalva movement. The posterior ureterovesical angel (PUA), urethral tilt angel (UTA), cervical mouth position (CMP), and bladder neck position (BNP) were measured. The changes of hiatus of levator ani muscle in patients with anal constriction, rest and Valsalva were observed and measured. Result: Compared with the data in control group, the number of cases of anterior, middle and posterior pelvic organ exfoliation in observation group was lesser, the UTA and BNP were higher, the CMP was lower, and the area of hiatus of levator ani muscle was smaller both at the time of calm, contraction and Valsalva movements. Conclusion: The damage of pelvic floor in primipara during transvaginal delivery is great. The 3D ultrasound is an objective and simple imaging method to screen the diseases of pelvic floor dysfunction.

Gender determination in equine fetuses in early pregnancy using two- and three-dimensional ultrasound

The aim of this study was to compare transrectal two-dimensional (2D) and three-dimensional (3D) ultrasound examination with regards to required time and accuracy of fetal sex determination in early pregnant mares. For this purpose 47 mares were examined transrectally once between days 58 and 115 of gestation. Initially, the fetal sex was determined by identifying the location of the genital tubercle (GT) or external genitalia using 2D-ultrasound. Subsequently, the ultrasound machine was switched to 3D-mode to obtain images for later computer-based evaluation. The gestational period between days 58 and 79 of pregnancy was the most appropriate time for sex determination with 77 % (2D and first 3D evaluation) correct diagnoses. The accuracy of the sex determination could be increased by about 16 % by a second evaluation of the 3D-images in a minimum time interval of 2 weeks. For each mare the additional time needed to perform the 3D-examination and to assess the 3D-images was approximately 6-7 minutes. This study demonstrates that the accuracy of transrectal fetal gender determination is higher by using 3D-mode compared to the 2D-ultrasound. For experienced examiners however, 3D ultrasound technology does not offer any decisive advantages and is also more time-consuming.

Study on 3D ultrasound imaging technology for measuring bladder tumour health care and information sensing

Abstract This paper explores the value of three-dimensional ultrasound combined with surface three-dimensional imaging for measuring bladder tumours and their preoperative staging. Through the information sensing effect of three-dimensional ultrasound, it can help bladder cancer to perform preoperative and postoperative care. In the paper, 75 patients who were admitted to our hospital for bladder tumour treatment from January 2017 to December 2018 were selected for 3D ultrasound examination and compared with surgical pathological results and pre-CT staging results. The study found that in this study, 74 patients with correct three-dimensional ultrasound diagnosis had 132 tumours. The diagnostic accuracy of 3D ultrasound was 98.7%, and the diagnostic accuracy of CT for bladder tumours was 90.7%, which was statistically different (P

Diagnosis of Parathyroid Adenomas with New Ultrasound Imaging Modalities

Ultrasound technology is becoming an integral part of diagnosing parathyroid adenomas. Careful ultrasound evaluation with b-mode, shear wave elastography, and three-dimensional (3D) of parathyroid adenomas may improve localization and outcome.Introduction: A 60-year-old woman was referred for the evaluation of hyperparathyroidism. This patient gave her informed consent. She had a history of hypothyroidism and thyroid nodules. She was being treated with levothyroxine 50 mcg daily. Routine testing revealed hypercalcemia. The serum calcium was 11.2 (nL range 8.7–10.2 mg/dL), creatinine was 0.69 (nL range 0.57–1.00 mg/dL), intact parathyroid hormone (PTH) was 70 (nL range 15–65 pg/mL), phosphorus was 2.7 (nL range 2.5–4.5 mg/dL), vitamin D was 38.7 (30–100 ng/mL), and 24 hours urine calcium was 362.9 (100–300 mg/24 hour). The neck ultrasound showed two lesions one superior/posterior and the other in the inferior/posterior aspect of the right thyroid lobe measuring 11.6 × 4.4 × 9.7 mm and 14.6 × 5.0 × 10.0 mm, respectively. Both lesions resembled parathyroid adenomas. Shear wave velocity (SWV) measurements for the superior and inferior lesions were 1.67 and 1.77 m/second, respectively. For the adjacent thyroid tissue SWV was 2.3 m/second, significantly higher. 3D ultrasound examination demonstrated a polar artery in both lesions.A sestamibi scan showed a probable right parathyroid adenoma and she was referred for surgery. She was found to have two right parathyroid adenomas in the superior and inferior poles corresponding with the ultrasound finding. Intraoperative PTH level decreased from 139.9 to 17 pg/mL postresection. Six weeks after surgery, her calcium and PTH were normal.Materials and Methods: This patient was evaluated in our clinic with ultrasound imaging, including b-mode, shear wave elastography (SWE), and 3D ultrasound.Discussion: Most patients with primary hyperparathyroidism have a single parathyroid adenoma. Other causes include glandular hyperplasia, multiple adenomas, and parathyroid carcinoma.1,2 This case shows two parathyroid adenomas in the neck posterior to the right thyroid lobe. The role of ultrasound in diagnosing parathyroid adenomas is becoming more prominent because of improved technology, low cost, and noninvasive nature.With this case we illustrate that SWE can be an added value to b-mode ultrasound in diagnosing parathyroid adenomas. Our previous publication in the Journal of European Radiology reported that SWV measurement of parathyroid adenomas may enhance other sonographic parameters to predict the diagnosis. In our view, parathyroid adenomas appear to have a more homogenous texture and lower tissue stiffness when compared with the thyroid gland.3 This case confirms our prior findings.It can be challenging to differentiate parathyroid adenomas from lymph nodes (LNs) and ectopic thyroid tissue at level 6, with b-mode ultrasound. A combination of 3D ultrasound images with 3D color Doppler (CD) might improve our ability to identify the polar artery and enhance differentiation from LN. 3D technology might improve the view by adding coronal view to current b-mode that comprises of transverse and longitudinal views. This is a preliminary report, and more studies need to be done.Conclusion: Combining multiple image modalities, including b-mode, shear wave elastography, and 3D technology, may improve our ability to identify parathyroid adenomas. Parathyroid adenomas have a lower SWV compared with thyroid tissue. 3D ultrasound technology may enhance view of polar artery when adding 3D CD. This challenging case illustrates the utility of these additional modalities.No competing financial interests exist.Runtime of video: 1 min, 52 secs

EP31.24: Clinical application of 3D ultrasound examination in diagnosis of Caesarean scar (CS) endometriosis

EP31.24: Clinical application of 3D ultrasound examination in diagnosis of Caesarean scar (CS) endometriosis

The effect of the first vaginal birth on pelvic floor anatomy and dysfunction

Introduction and hypothesisFirst vaginal delivery severely interferes with pelvic floor anatomy and function. This study determines maternal and pregnancy-related risk factors for pelvic floor dysfunction (PFD), including urinary incontinence (UI), urgency, anal incontinence (AI), pelvic organ prolapse (POP) and levator ani muscle (LAM) avulsion.MethodsThis is a single-centre prospective observational cohort study on healthy women in their first singleton pregnancy. All underwent clinical and 3D transperineal ultrasound examination at 6 weeks and 12 months postpartum. Objective outcomes were POP-Q and presence or absence of LAM trauma. Functional outcomes were measured by the ICIQ-SF and PISQ 12. Multivariate regression was performed to determine birth and maternal habitus-related risk factors for UI, urgency, AI, dyspareunia, LAM avulsion and ballooning.ResultsNine hundred eighty-seven women were included. Risk factors for UI were maternal age per year of age (OR: 1.09; 95% CI: 1.04–1.13; p = 0.0001) and BMI before pregnancy (OR: 1.08; 95% CI: 1.04–1.13; p = 0.001); for POP stage II+ maternal age (OR: 1.08; 95% CI: 1.08–1.14; p = 0.005). Avulsion was more likely after forceps (OR: 3.22; 95% CI:1.54–8.22; p = 0.015) but less likely after epidural analgesia (OR: 0.58; 95% CI: 0.37–0.90; p = 0.015) and grade I perineal rupture (OR: 0.50; 95% CI: 0.29–0.85; p = 0.012). Ballooning was more likely at increased maternal age (OR: 1.08; 95% CI: 1.02–1.13; p = 0.005), epidural (OR: 1.64; 95% CI: 1.06–2.55; p = 0.027) and grade I perineal rupture (OR: 1.79; 95% CI: 1.10–2.90; p = 0.018).ConclusionThough maternal characteristics at birth such as age or BMI increase the risk of PFD, labour and birth factors play a similarly important role. The most critical risk factor for MLA avulsion was forceps delivery, while an epidural had a protective effect.