Echogenic Line Research Articles

P-277 Focal rather than diffuse nature of adenomyosis might be more detrimental to IVF outcomes after single euploid embryo transfer

Abstract Study question Is the nature of adenomyosis a factor to consider after a single euploid embryo transfer? Summary answer Focal adenomyosis was associated with lower live birth rate per transfer when compared to diffuse adenomyosis. What is known already Adenomyosis is widely described to hamper reproductive potential of women who suffer it. This uterine pathology has a detrimental impact on in vitro fertilization (IVF) clinical outcomes, as described by a series of recent metanalysis. Nevertheless, there is scarce evidence regarding clinical studies that address the impact of adenomyosis depending either on its diffuse or focal nature. Study design, size, duration A multicenter retrospective cohort study in which 229 patients undergoing IVF treatment were included. Patients with single embryo transfer (SET) in blastocyst stage after pregestational testing for aneuploidy (PGT-A) between years 2015 and May 2023 were divided into two groups: diffuse adenomyosis (n = 167) and focal adenomyosis (n = 62). Participants/materials, setting, methods Inclusion criteria consisted of patients in a PGT-A program who had a cryotransfer of a single euploid blastocyst-stage embryo. Patients were diagnosed within our facilities using transvaginal ultrasonography (TVUS) prior to their IVF cycle. Diffuse adenomyosis was diagnosed when irregular endometrial-myometrial junction, increased uterine volume, ill-defined myometrial heterogeneity, presence of anechoic round myometrial cysts, hyperechoic islands, fan-shaped shadows and/or echogenic subendometrial lines were detected. Focal adenomyosis was diagnosed when foci with adenomyotic characteristics were observed. Main results and the role of chance Clinical pregnancy rate per embryo transfer was 81/167 (48.5%) in those women diagnosed with diffuse adenomyosis versus 23/62 (37.1%) in the focal adenomyosis group (OR = 0.63 95% CI [0.33-1.18], NS). Differences found in clinical miscarriage rate were not statistically significant, being 33/81 (40.7%) for diffuse adenomyosis and 14/23 (60.1%) for the focal adenomyosis group (OR = 2.24 95% CI [0.79-6.63], NS). A lower live birth rate per euploid embryo transfer was observed in women diagnosed with focal adenomyosis, being 9/62 (14.5%) and 48/167 (28.7%) for women who presented diffuse adenomyosis (OR = 0.42 95% CI [0.17-0.95], p=0.027). There were no statistically significant differences between childbirth delivery method (vaginal versus caesarean section). Furthermore, means of gestational age at the time of delivery, newborn size and weight and incidences of low birth weight did not differ between the two groups. Limitations, reasons for caution The retrospective nature of this observational study implies that possible confounders cannot be completely excluded. Also, the accurate diagnostic of adenomyosis is not without complexity and although gynecologists were equally trained to identify direct and indirect markers, different criteria may have been used Wider implications of the findings To our knowledge this is the first study to use an euploid model to assess the impact of the focal versus diffuse nature of adenomyosis in IVF patients. This model permits to correct for numerous covariables attributed to patient’s age and embryo genetic constitution. Trial registration number Not applicable

Knot-and-ear sign: a pathognomonic ultrasonographic feature of suture granuloma after thyroid surgery.

This study investigated the clinical and ultrasonographic (US) findings of suture granulomas and recurrent tumors, and aimed to identify specific characteristics of suture granulomas through an experimental study. This retrospective study included 20 pathologically confirmed suture granulomas and 40 recurrent tumors between January 2010 and December 2020. The clinical findings included suture material, surgery, and initial TNM stage. The US findings included shape, size, margin, echogenicity, heterogeneity, vascularity, and internal echogenic foci. The distribution, paired appearance, and "knot-and-ear" appearance of internal echogenic foci were assessed. An experiment using pork meat investigated the US configuration of suture knots. Eighteen patients with 20 suture granulomas (15 women; mean age, 52±13 years) and 37 patients with 40 recurrent tumors (24 women; 54±18 years) were included. Patients with suture granulomas exhibited earlier initial T and N stages than those with recurrent tumors. The knot-and-ear appearance, defined as an echogenic dot accompanied by two adjacent echogenic dots or lines based on experimental findings, was observed in 50% of suture granulomas, but not in recurrent tumors (P<0.001). Central internal echogenic foci (68.8%, P=0.023) and paired appearance (75.0%, P<0.001) were more frequent in suture granulomas. During follow-up, 94.1% of suture granulomas shrunk. The knot-and-ear appearance is a potential pathognomonic finding of suture granuloma, and central internal echogenic foci with paired appearance were typical US features. Clinically, suture granulomas showed early T and N stages and size reduction during follow-up. Understanding these features can prevent unnecessary biopsy or diagnostic surgery.

Subcutaneous dirofilariasis in a 25-year-old male patient in Belgium on ultrasonography: a case report

BackgroundSubcutaneous dirofilariasis is a parasitic zoonosis commonly described in Canidae but rarely seen in humans. Most physicians are unfamiliar with this disease, especially in nonendemic areas, which can lead to medication error and diagnostic and treatment delay. To the best of our knowledge, no previous case of subcutaneous dirofilariasis preoperatively diagnosed on ultrasound has been described in Western Europe.Case presentationA 25-year-old Belgian male patient presented with a subcutaneous nodule in the epigastric region. Ultrasound investigation showed a typical cystic lesion with an internal serpiginous structure with echogenic lines, and there was active twirling movement of this serpentine structure during investigation, pathognomonic for subcutaneous dirofilariasis. Surgical extirpation was performed, and the diagnosis was histopathologically confirmed.ConclusionSubcutaneous dirofilariasis has a characteristic appearance on ultrasound but is not well known in nonendemic areas, often leading to diagnostic delay and initial incorrect treatment. More knowledge of this disease and of its characteristic ultrasound appearance will hopefully lead to better patient care.

Prediction of adenomyosis according to revised definitions of morphological uterus sonographic assessment features.

This study aimed to predict the diagnosis of adenomyosis by revised definitions of morphological uterus sonographic assessment (MUSA) features in individuals who had hysterectomy. This was retrospective cohort research conducted at a tertiary facility. Between January 2022 and January 2023, 196 individuals who had hysterectomy were analyzed in the research. The revised definitions of MUSA features of the adenomyosis approach were used to record the direct and indirect results of the sonography. The cases were classified as Group 1 (adenomyosis; n = 40, 20.4%) and Group 2 (control; n = 156, 79.6%) according to histopathology reports. Hyperechogenic islands and echogenic subendometrial buds and lines were the most predictive direct features (p = 0.02). Globular uterus and irregular junctional zone were the most predictive indirect features (p = 0.04; p = 0.03, respectively). Among all indirect features, the globular uterus was the most predictive (p = 0.02). Total feature >4 was determined as the significant cutoff value to predict adenomyosis (p < 0.001). This study shows that combinations with a total number of features >4 can be practically used in the evaluation of adenomyosis using the revised definitions of MUSA features.

Endometrial pattern predicts pregnancy outcome in single-blastocyst frozen-embryo transfer: An analysis of 1383 cycles.

Several studies investigated endometrial patterns, with respect to pregnancy rates following the transfer of embryos but did not distinguish between single- and multiple-blastocyst procedures. We clarified how the endometrial pattern imaged to transfer a frozen embryo is associated with pregnancy outcomes in single-blastocyst frozen-embryo transfer (sbFET). Patients ≤35 years who underwent sbFET on the hormone replacement protocol. We analyzed endometrial patterns' associations with pregnancy outcomes in relation to blastocyst grade and pregnancy-related factors. Of the 1383 cycles, 483 were Lf, 840 were partial-Lf, and 60 were non-Lf. Leaf pattern (Lf): central echogenic line present and continuous. Overall, decreasing distinctness of the central echogenic line was associated with significantly lower rates of clinical pregnancy (Lf: 70.4%; partial-Lf: 58.1%; non-Lf: 28.3%) and live birth (56.3%, 45.5%, and 15.0%) and a higher miscarriage rate (20.0%, 21.7%, and 47.1%). Logistic regressions showed pregnancy and live birth to be significantly more likely and miscarriage less likely in Lf than non-Lf: OR (95% CI): 6.07 (3.24-11.37), 7.43 (3.47-15.39), and 0.20 (0.07-0.57). Non-Lf presentation was associated with lower rates of pregnancy and live birth, suggesting it signals unsuitable conditions for embryo transfer. We provide information on the pregnancy outcomes of sbFET for endometrial patterns.

Ultrasonography of the Explanted Uterus in Placenta Accreta Spectrum: Correlation With Intraoperative Findings and Gross Pathology.

To better understand placenta accreta spectrum (PAS) by correlating postoperative ultrasonographic findings of the explanted uteroplacental interface with intraoperative findings and gross pathology. We enrolled consecutive pregnant patients aged 18 years and older with a prior cesarean delivery and antenatal diagnosis of lower uterine segment PAS who planned to undergo hysterectomy into this prospective, descriptive study. All underwent cesarean hysterectomy with standardized intraoperative photography. Ultrasonography of explanted postsurgical uteruses was performed by expert radiologists to obtain standard detailed images of the myometrial-placental interface and other areas of interest. Sagittal views of the gross pathologic specimen were photographed. We correlated the intraoperative, ultrasonographic, and gross pathologic findings as a study team and report four consistent patterns that emerged from this systematic evaluation. Thirty-four consecutive eligible patients were enrolled. The following consistent observations emerged: 1) The uteroplacental interface in the explanted specimen was smooth and distinct. At the point of maximal placental protrusion, the myometrium was imperceptible, but the placenta was confined by a smooth thin echogenic line of uterine serosa (the scar shell) unless surgically disrupted. 2) Every specimen of PAS grade 2-3 showed placenta bulging through the lower uterine segment in the region of prior hysterotomy. 3) Placentas extended to, but not through, the uterovesical interface or scar shell. Dense adhesive disease was found between the placenta and bladder. There were no cases of true bladder invasion. 4) Placental extension beyond the serosa (invasion) has a distinct appearance on postoperative ultrasonography with irregular frond-like protrusion of placental tissue. This appearance was always the result of surgical manipulation and was not present before delivery of the neonate. These findings suggest that PAS severity is likely mediated by progressive scar dehiscence and uterine remodeling, not placental invasion. This challenges the existence of in situ invasive percreta as it is currently described.

Cat-Ear-Line: A Sonographic Sign of Cortical Development?

Diagonal echogenic lines outside the lateral ventricle have often been observed in the anterior coronal planes of the normal fetal brain by neurosonography. We have observed abnormal shapes of these echogenic lines in cases of malformation of cortical development (MCD). We named the ultrasound finding "cat-ear-line" (CEL). This study aimed to examine how and when CEL develops in normal cases compared with MCD cases. We retrospectively examined the fetal brain volume dataset acquired through transvaginal 3D neurosonography of 575 control cases and 39 MCD cases from 2014 to 2020. We defined CEL as the hyperechogenic continuous lines through subplate (SP) and intermediate zone (IZ), pre-CEL as the lines that existed only within the SP, and abnormal CEL as a mass-like or mosaic shadow-like structure that existed across the SP and IZ. All fetuses in the MCD group had some neurosonographic abnormalities and were ultimately diagnosed with MCD. The CEL was detected in 97.9% (369/377) of the control group from 19 to 30 weeks. The CEL visualization rate of the MCD group in the same period was 40.0% (14/35) which was significantly lower than that of the control group (P < .001). From this study, it appears that the CEL is an ultrasound finding observed at and beyond 19 weeks in a normally developing fetus. In some MCD cases, pre-CEL at and beyond 19 weeks or abnormal CEL was observed. Maldeveloped CEL at mid-trimester may help identify cases at-risk of subsequent MCD.

Consensus on revised definitions of Morphological Uterus Sonographic Assessment (MUSA) features of adenomyosis: results of modified Delphi procedure.

ABSTRACTObjectivesTo evaluate whether the Morphological Uterus Sonographic Assessment (MUSA) features of adenomyosis need to be better defined and, if deemed necessary, to reach consensus on the updated definitions.MethodsA modified Delphi procedure was performed among European gynecologists with expertise in ultrasound diagnosis of adenomyosis. To identify MUSA features that might need revision, 15 two‐dimensional (2D) video recordings (four recordings also included three‐dimensional (3D) still images) of transvaginal ultrasound (TVS) examinations of the uterus were presented in the first Delphi round (online questionnaire). Experts were asked to confirm or refute the presence of each of the nine MUSA features of adenomyosis (described in the original MUSA consensus statement) in each of the 15 videoclips and to provide comments. In the second Delphi round (online questionnaire), the results of the first round and suggestions for revision of MUSA features were shared with the experts before they were asked to assess a new set of 2D and 3D still images of TVS examinations and to provide feedback on the proposed revisions. A third Delphi round (virtual group meeting) was conducted to discuss and reach final consensus on revised definitions of MUSA features. Consensus was predefined as at least 66.7% agreement between experts.ResultsOf 18 invited experts, 16 agreed to participate in the Delphi procedure. Eleven experts completed and four experts partly finished the first round. The experts identified a need for more detailed definitions of some MUSA features. They recommended use of 3D ultrasound to optimize visualization of the junctional zone. Fifteen experts participated in the second round and reached consensus on the presence or absence of ultrasound features of adenomyosis in most of the still images. Consensus was reached for all revised definitions except those for subendometrial lines and buds and interrupted junctional zone. Thirteen experts joined the online meeting, in which they discussed and agreed on final revisions of the MUSA definitions. There was consensus on the need to distinguish between direct features of adenomyosis, i.e. features indicating presence of ectopic endometrial tissue in the myometrium, and indirect features, i.e. features reflecting changes in the myometrium secondary to presence of endometrial tissue in the myometrium. Myometrial cysts, hyperechogenic islands and echogenic subendometrial lines and buds were classified unanimously as direct features of adenomyosis. Globular uterus, asymmetrical myometrial thickening, fan‐shaped shadowing, translesional vascularity, irregular junctional zone and interrupted junctional zone were classified as indirect features of adenomyosis.ConclusionConsensus between gynecologists with expertise in ultrasound diagnosis of adenomyosis was achieved regarding revised definitions of the MUSA features of adenomyosis and on the classification of MUSA features as direct or indirect signs of adenomyosis. © 2021 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Morphological Uterus Sonographic Assessment Criteria for Adenomyosis Diagnostic: A Case Report

BACKGROUND : The MUSA (Morphological Uterus Sonographic Assessment) statement is a consensus statement on terms, definitions and measurements that may be used to describe and report the sonographic features of the myometrium using gray-scale sonography, color/power Doppler and three-dimensional ultrasound imaging. MUSA Adenomyosis ultrasound features : Asymmetrical thickening, fan shape shadowing, cyst, hyperechoic island, Echogenic sub endometrial lines and buds, trans lesion vascularity, Irregular junctional zone, Interrupted junctional zone. Classification and descriptions of the MUSA criteria for adenomyosis are presented : location, classification (diffuse/focal), cystic, layer involvement (type), extent, size of the lesion.

Role of Ultrasonography in the Evaluation of Normal Developmental Pattern of Fetal Cerebral Sulci Between 18 and 32 Weeks of Gestational Age.

BackgroundBrain development is a crucial process of intrauterine life and can be readily visualized on ultrasonography. This study aims to visualize developmental patterns of various fetal cerebral sulci using ultrasonography between 18 and 32 weeks of gestation. Sulci are best visualized on images that are taken perpendicular to their expected course of development. Initially, they appear as small dot/dimple on the brain surface and later develop into a V-shaped indentation and finally deepen to form notch and echogenic line into the brain forming a Y-shaped configuration.Material and methodsThis was a cross-sectional observational study conducted on 241 antenatal mothers with a singleton pregnancy between 18 and 32 weeks of gestational age. Demographic and clinical data were obtained. Ultrasonography was performed using PHILIPS EPIQ 5, a curvilinear probe of frequency 2-5MHz. Sulci/fissures that are reported to appear early on anatomical studies were evaluated, specifically the parieto-occipital fissure, calcarine fissure, cingulate sulci, insula/Sylvian fissure, and convexity sulci. Comparison of the categorical outcomes was performed between study groups using the chi-square test. A p-value of <0.05 was considered statistically significant.ResultsThe study included 241 participants. The mean age of antenatal mothers was 24.09 ± 4.13 years, and the mean fetal gestational age was 24.99 ± 4.13 weeks. Parieto-occipital fissure was the first fissure to develop and was present as a V-shaped indentation at 18 weeks and as a Y-shaped configuration by 21-22 weeks. Calcarine fissure was the next fissure to appear; it appeared as a dot by 18 weeks and developed into a V-shaped indentation by 20 weeks and as a Y-shaped configuration by 23 weeks. All fissures except cingulate sulci had appeared by 20 weeks, and calcarine sulci appeared later in the gestation by 21 weeks. Sylvian fissure initially appeared as a smooth surface and later underwent operculization to form obtuse and acute angulations with the adjacent temporal lobe by 20 and 24 weeks, respectively. Convexity sulci appeared later in gestation, beyond 25-26 weeks.ConclusionsUltrasonography, which is the commonest modality used in antenatal assessment of the fetus, can also be used to identify, familiarize, and provide a standard reference to assess normality of fetal sulcations. Neuronal migration disorders result in a wide spectrum of malformations of cortical development whose clinical manifestations include severe psychomotor retardation, developmental delays, motor deficits, seizures, and failure to thrive. Knowledge of normal development patterns of fetal cerebral sulci helps in early suspicion and detection of these cortical malformations, when present.

Morphology and Morphometry of Foetal Corpus Callosum Using MRI – A Retrospective Study

Introduction: Corpus callosum (CC) is the largest commissural white fibres interconnecting cerebral hemispheres. The corpus callosum is responsible for interhemispheric transfer of information which is essential for cognitive function. The foetal corpus callosum serves as sensitive indicator for normal brain development and maturation. As the corpus callosum is a part of the highest order latest maturing mental network of the brain, its measurements are important to assess normal brain development and to locate structural changes. A comprehensive evaluation of normal human foetal corpus callosal development is essential to detect and understand the congenital anomalies of the brain. Thus, the prenatal diagnosis of partial or complete agenesis of the corpus callosum is important for predicting the normal development of the foetus. Foetal neural anomalies that are suspected on prenatal ultrasonography (USG) can be detected in early stage using foetal MRI. This imaging technique is highly useful for detailed visualization of normal neural development. Certain conditions like colpocephaly and widening of interhemispheric fissure can be clearly visualized using foetal MRI when compared to prenatal ultrasonography. Aim and objective: Was to establish the normal reference values for the measurement of foetal corpus callosum. The length and thickness of the foetal CC was measured corresponding to gestational age (GA) between 18-36weeks. Materials and methods: A retrospective MRI study was carried out in Radiology department of Sri Ramachandra Hospital. The study was conducted on 50 pregnant women with GA of 18-32 weeks and morphology of foetal corpus callosum was measured using MRI. The corpus callosum was visualized in a mid-sagittal plane as an anechoic structure, delimited by two echogenic lines superiorly by sulcus of the corpus callosum and inferiorly by the septum pellucidum. The length of corpus callosum was measured from the anterior most aspect of genu to the posterior most aspect of the splenium and the width of individual parts were measured and correlated with gestational age. The values obtained from the study were statistically calculated using regression coefficient method. Results: In the present study following parameters were observed such as length and width of diverse parts of Corpus callosum. The length of foetal CC ranged from 25.96 to 47.2 mm in 18 to 32 weeks of gestational age. The range of width of rostrum, genu, body and splenium were 1.2 to 2.2 mm, 1.2-2.8mm, 1.3-3.1mm and 1.36-3.2mm respectively. Conclusion: The periodic development of nervous system can be calculated more effectively with the morphometric measurement of foetal CC and its correlation with BPD. It is considered to be accurate than using BPD measurement of head circumference in USG. Hence, with the normative data of foetal CC measurements correlated with gestational age would give us accurate details of neuronal growth rather than measuring biparietal diameter (BPD) alone using USG. This knowledge will be highly helpful for the gynaecologists to predict the abnormal development of the foetus and it is advised to include foetal CC parameters as a one of the tools for early detection of CNS anomalies.

Subgaleal Lipoma: Imaging Findings

Subgaleal lipoma is a benign tumor of adipose tissue. It should be suspected when a semi-spherical avascular mass with well-defined margins, iso- or hyperechoic in most cases, with thin internal echogenic lines parallel to the long axis of the tumor, is observed between the galea aponeurosis and periosteum of the cranial bone. We report a series of cases of three patients who underwent surgical lesion excision and whose histopathological examination findings confirmed the diagnosis of lipoma.Main Teaching Point:The presence of long continuous echogenic lines within a lens-shaped soft tissue mass located beneath the galea aponeurosis may suggest the diagnosis of subgaleal lipoma.

Diagnostic Accuracy of Transvaginal Ultrasound and Magnetic Resonance Imaging for Adenomyosis: Systematic Review and Meta-Analysis and Review of Sonographic Diagnostic Criteria.

We aim to first systematically review and perform a meta-analysis of the diagnostic accuracy of transvaginal ultrasound (TVUS) and magnetic resonance imaging (MRI) and, second, to evaluate the accuracy of various sonographic diagnostic criteria for adenomyosis. A search of PubMed and Embase yielded 32 eligible studies. In diagnosing adenomyosis, the diagnostic performance of TVUS was found to be high and comparable to the performance of MRI. Of the eight sonographic criteria, only five were assessable. The best individual criterion was echogenic subendometrial lines and buds. Limited data exist for the various sonographic criteria, and further studies are required to compare their performance.

Ultrasonography of left displaced abomasum in local cattle breed

The aims of the current study were a definitive diagnosis of left displaced abomasum by using ultrasonography furthermore determination of abomasal position and measurements. Study includes sixteen local cattle breed, six have anorexia, weakness and drop milk production, on clinical examination there was decrease rumen contractions 3.6 5 minutes, furthermore a pinging sound heard on auscultation of left intercostal spaces there were diagnosed as left displaced abomasum, other ten clinically healthy cows considered as normal control group. Ultrasonographic imaging was performed for stand nonsedated cows by use 3.5-5 MHz transducer at the ventral midline and in the intercostal spaces 9, 10, 11, and 12 from the left side. Ultrasonography revealed a left side displaced abomasum to an area between the abdominal wall and the rumen, which appeared as hypoechoic fluid content ventrally and hyperechoic parallel echogenic lines of gas gap dorsally, abomasal folds appear as filiform echogenic lines. While in healthy cows an abomasum located in the ventral midline and directed mainly to the right side. In conclusion, ultrasonography as a non-invasive technique could be used as a confirmative diagnosis of left displaced abomasal and help for differential diagnosis of left abomasum displacement a well as can be useful for measurement of abomasum in healthy local breed cattle.

Ultrasonographic characterization of the organs in the middle third and caudal coelomic cavity of snakes in the Boidae Family

ABSTRACT: The aim of this study was the ultrasonographic evaluation of the organs in the middle third and caudal coelomic cavity of healthy snakes in the Boidae family. For such, 15 adult snakes from five species were evaluated: Boa constrictor amarali, Boa constrictor constrictor, Eunectes murinus, Epicrates assisi and Epicrates crassus. The animals were physically restrained for examination. After the application of acoustic gel over the scales the transducer was positioned in the frontal plane of the coelomic cavity. Microconvex and linear transducers at 10MHz were used. The ultrasound examination was conducted in the craniocaudal direction, with longitudinal and transversal sections to assess syntropy, echogenicity and echotexture of the organs. The liver was bilobulated, hyperechoic, homogeneous echotexture, hyperechoic capsule, with a hepatic lobe measuring 1.15±0.64cm wide, and the presence of a central hepatic vein, measuring 0.44±0.21cm in diameter. The gallbladder was characterized as an anechoic structure with echogenic walls and dimensions of 2.91±1.18cm x 1.38±0.84cm (length x width). The stomach showed a pleated and linear texture, echogenic, with hypoechoic walls measuring 0.3±0.07cm wide. The splenopancreas was a circular and echogenic structure, homogeneous echotexture and measuring 1.18±0.62cm in width and 1.56±0.88cm in length. The kidneys were characterized by elongated, lobulated, hypoechoic structures, an echogenic capsule and an echogenic central line, measuring 1.05±0.7cm in width. The testis were characterized by fusiform, hypoechoic structures, homogeneous echotexture, measuring 2.31±0.79cm in length and 0.6±0.23cm in width. Ovarian follicles were seen in different stages, 0.67±0.39cm wide and 0.73±0.38cm long. No differences were found between species of syntropy, echogenicity and echotexture of the organs of the coelomic cavity. The ultrasound examination proved to be a safe, non-invasive and efficient technique for characterizing the organs of the coelomic cavity of snakes.

Absent Cavum Septi Pellucidi

Absent Cavum Septi Pellucidi

Adenomyosis, a Predictor of Endometriosis Severity? a Pilot Study.

Study Objective Are sonographic features of adenomyosis associated with the three endometriosis phenotypes, superficial peritoneal endometriosis (SPE), ovarian endometrioma (OE) and deep infiltrative endometriosis (DE)? Design This retrospective cohort study analyses the presence of sonographic features of adenomyosis in reproductive age women with suspected endometriosis who underwent laparoscopic surgery at Liverpool Hospital during 2018-20 period. Setting N/A Patients or Participants 73 women of reproductive age with suspected endometriosis (pelvic pain or infertility). Interventions Women underwent a specialized transvaginal ultrasound (TVUS) by a single expert sonologist, to diagnose deep endometriosis and adenomyosis using the IDEA (International Deep Endometriosis Analysis) and MUSA (Morphological Uterus Sonographic Assessment) diagnostic criteria. All women underwent laparoscopic surgery within 6 months of the TVUS by an advanced laparoscopic surgeon, who documented intraoperative and histopathological findings. Measurements and Main Results The mean age was 35 years. 53/73 (73%) women had endometriosis at laparoscopy. 20/73 (27%) women had features of adenomyosis on TVUS with 14/20 of these women having endometriosis. 6/14 (43%) had DE with pouch obliteration, 7/14 (50%) had SPE and 1/14 (0.1%) had OE. Overall, the most common feature of adenomyosis at TVUS for women with endometriosis was heterogenous myometrium. Echogenic subendometrial lines was the most common TVUS feature for women with DE, whereas heterogenous myometrium was the most frequent TVUS features for women with SPE. An irregular interrupted junctional zone was the most common TVUS feature in women without endometriosis. Conclusion Women with adenomyosis at TVUS appear to be at high risk (70%) of concurrent endometriosis. 43% of women with adenomyosis at TVUS had advanced endometriosis (DE w pouch obliteration), with echogenic subendometrial lines the most common sonographic feature of adenomyosis. Further studies are needed to confirm whether specific features of adenomyosis at TVUS are associated with endometriosis phenotype, which in turn may aid in surgical planning for these women.

USE OF ULTRASONOGRAPHY IN REDUCTION OF ISOLATED ZYGOMATIC ARCH FRACTURE

Background: Isolated zygomatic arch fractures, managed by closed methods, can be inadequate leading to facial asymmetry. Assessment of the reduction and ensuring correct alignment of frac­tured fragments in the operation table always avoids next surgery. This study aims to determine intraoperative, adequacy of reduction of by use of ultrasound in isolated zygomatic arch fracture.&#x0D; Methods: During the closed reduction of isolated zygomatic arch linear probe of ultrasound was used to check the continuity of the echogenic line. The intraoperative ultrasound finding was com­pared with the gold standard CT scan.&#x0D; Results: Ultrasound has 100% sensitivity and 80 % specificity. It also has high precision and accu­racy to determine the reduction of the fractured bone.&#x0D; Conclusions: Ultrasound is a handy tool in the reduction of zygomatic arch fracture. It not only shows but also guides to adequate reduction.

Use of ultrasonography in reduction of isolated zygomatic arch fracture

Background: Isolated zygomatic arch fractures, managed by closed methods, can be inadequate leading to facial asymmetry. Assessment of the reduction and ensuring correct alignment of frac­tured fragments in the operation table always avoids next surgery. This study aims to determine intraoperative, adequacy of reduction of by use of ultrasound in isolated zygomatic arch fracture.&#x0D; Methods: During the closed reduction of isolated zygomatic arch linear probe of ultrasound was used to check the continuity of the echogenic line. The intraoperative ultrasound finding was com­pared with the gold standard CT scan.&#x0D; Results: Ultrasound has 100% sensitivity and 80 % specificity. It also has high precision and accu­racy to determine the reduction of the fractured bone.&#x0D; Conclusions: Ultrasound is a handy tool in the reduction of zygomatic arch fracture. It not only shows but also guides to adequate reduction.

Transcranial sonography imaging of brainstem raphe, substantia nigra and cerebral ventricles in patients with geriatric depression.

Geriatric depression is a special condition associated with a chronic course, treatment resistance and vascular processes. However, its neurobiology has not been fully elucidated. There is no study in geriatric depression evaluating deep brain structures with transcranial sonography (TCS) which is a low-cost, non-invasive and practical tool. The present study aimed to evaluate the changes in the echogenicity of brainstem raphe (BR), substantia nigra (SN) and ventricular diameters by TCS in association with cognitive dysfunctions in patients with geriatric depression. Echogenicity of BR and SN were assessed and transverse diameters of the third ventricle and frontal horns of the lateral ventricles were measured by TCS in 34 patients with DSM-5 major depression and 31 healthy volunteers aged 60 and older. Cognitive functions were evaluated by using Mini Mental State Examination, Montreal Cognitive Assessment Tool, Clock Drawing Test and Subjective Memory Complaints Questionnaire. Although depressed patients had more subjective memory complaints than controls, they had similar cognitive performances. Reduced echogenicity (interrupted/invisible echogenic line) of BR was found to be significantly higher and the ventricular diameters were larger in the depressed group. There was no difference between the groups in terms of SN echogenicity. There was no correlation between ventricular diameters and depression severity or cognitive functions. Results of the present study are important in terms of pointing out neurobiological changes related to geriatric depression which are in parallel with the results of the studies in younger patients with depression. However, long-term follow-up studies are required for accurate differentiation of neurocognitive disorders.