Ultrasonography In Women Research Articles

Complementing Mammography Screening with Automated 3D Ultrasound in Women with High-Density Breasts

Background. In early breast screening structure, an important factor is breast density. Women with types C and D breast density according to American College of Radiology (ACR) classification have 4–6-fold increased risk of cancer compared to women with type A breast density. With this type of density, the effectiveness of diagnostic mammography (MG) is significantly decreased. Today, automated breast 3D ultrasound can be considered as an additional screening method in women with breast structure types C and D according to ACR.Objective: to perform a comparative analysis of the diagnostic efficacy of 2D and 3D ultrasound in women aged 40 years and older with high breast tissue density.Material and methods. Retro-prospective, observational, single-center study was conducted. From February 2019 to May 2023, 1283 patients aged 40 years and older were examined. The patients were divided into two groups. In group A, women underwent 2D ultrasound and MG. In group B, additionally to these methods, 3D ultrasound was performed. In both groups, the results were evaluated according to Breast Imaging-Reporting and Data System (BI-RADS). Based on the obtained data, the following indicators were determined: positive (PPV) and negative (NPV) predictive values, sensitivity, specificity and accuracy of all methods. For 2D and 3D ultrasound, the predictive model areas under curve (AUC) of receiver operating characteristic (ROC) were calculated.Results. MG method showed PPV 0.89, NPV 0.93, sensitivity 0.53, specificity 0.99, and balanced accuracy 0.76. Indicators for 2D ultrasound demonstrated PPV 0.8, NPV 0.98, sensitivity 0.9, specificity 0.97, balanced accuracy 0.93, AUC ROC 0.968. The results for 3D ultrasound were as follows: PPV 0.97, NPV 0.97, sensitivity 0.9, specificity 0.99, balanced accuracy 0.94, AUC ROC 0.98.Conclusion. The diagnostic efficiency of breast automated 3D ultrasound in patients aged 40 years and older is comparable to 2D ultrasound in terms of sensitivity, and it’s better in terms of accuracy, specificity. The prognostic model of 3D ultrasound is also better compared to 2D ultrasound.

A Second Trimester Prediction Algorithm for Early-Onset Hypertensive Disorders of Pregnancy Occurrence and Severity Based on Soluble fms-like Tyrosine Kinase 1 (sFlt-1)/Placental Growth Factor (PlGF) Ratio and Uterine Doppler Ultrasound in Women at Risk.

Hypertensive disorders of pregnancy (HDPs) represent a significant source of severe maternal and fetal morbidity. Screening strategies relying on traditional medical history and clinical risk factors have traditionally shown relatively modest performance, mainly in the prediction of preeclampsia, displaying a sensitivity of 37% for the early-onset form and 29% for the late-onset form. The development of more accurate predictive and diagnostic models of preeclampsia in the early stages of pregnancy represents a matter of high priority. The aim of the present paper is to create an effective second trimester prediction algorithm of early-onset HDP occurrence and severity, by combining the following two biochemical markers: a soluble fms-like tyrosine kinase 1 (sFlt-1)/placental growth factor (PlGF) ratio and uterine artery Doppler ultrasound parameters, namely the pulsatility index (PI) and the resistivity index (RI), in a population of high-risk pregnant women, initially assessed through traditional risk factors. A prospective single-center observational longitudinal study was conducted, in which 100 women with singleton pregnancy and traditional clinical and medical history risk factors for preeclampsia were enrolled at 24 weeks of gestation. Shortly after study enrollment, all women had their sFlt-1 and PlGF levels and mean uterine artery PI and RI determined. All pregnancies were followed up until delivery. Receiver operating characteristic (ROC) analysis established algorithms based on cutoffs for the prediction of the later development of preeclampsia: PI 1.25 (96.15% sensitivity, 86.49% specificity), RI 0.62 (84.6% sensitivity, 89.2% specificity) and sFlt-1/PlGF ratio 59.55 (100% sensitivity, 89.2% specificity). The sFlt-1/PlGF ratio was the best predictor for preeclampsia, as it displayed the highest area under the curve (AUC) of 0.973. The prediction algorithm for the severe form of preeclampsia, complicated by fetal growth restriction leading to preterm birth, antepartum fetal demise or acute fetal distress with a cerebro-placental ratio of <one consisted of the following cutoffs: PI 1.44 (93.75% sensitivity, 95.24% specificity), RI 0.69 (87.5% sensitivity, 100% specificity) and sFlt-1/PlGF ratio 102.74 (93.75% sensitivity, 95.2% specificity). These algorithms may significantly enhance the prediction accuracy of preeclampsia compared to traditional risk factors. The combination of the sFlt-1/PlGF ratio with mean uterine PI and RI in particular displayed an improved performance in the prediction of severe preeclampsia with the above-mentioned complications, compared to the biochemical markers or uterine Doppler parameters used alone. Therefore, HDP screening strategies should increasingly focus on implementing such algorithms for women who are initially regarded as high risk based on traditional risk factors, in order to properly diagnose HDP and properly limit or manage the later maternal and fetal complications.

Comparative analysis of the linear dimensions of the ovary, determined using sonography, in an age aspect

Aim of the study was to carry out a comparative analysis of the linear size of the right and left ovaries, determined using sonography in women in adolescence, the elderly, and old age.Material and methods. The study was based on the results of ultrasound examination of 84 women with normal pelvic dimensions who were examined at the gynecology department of the Perm Krai Clinical Hospital during the period 2021–2022 in order to exclude probable pathology of the reproductive system. Measurement of longitudinal (length), transverse (width), and anteroposterior (thickness) dimensions of the ovary was performed using transvaginal access. Women were divided into three groups: the first consisted of 28 adolescents (16 to 20 years old), the second – 29 elderly persons (56 to 74 years old), the third – 27 seniors (75 to 85 years old).Results. When comparing the indicators of ovarian size, their statistically significant decrease by old age was revealed. Right ovary length from adolescence to the old age decreased by 20.56 % (p &lt; 0.01), left – by 28.62 % (p &lt; 0.01). Right ovarian width becomes smaller by 20.87 % (p &lt; 0.01) in elderly age and by 26 % (p &lt; 0.01) in senile age, left – by 20.8 % (p &lt; 0.01) and by 28.32 % (p &lt; 0.01), respectively, the anteroposterior dimension of the right ovary – by 23.2 % (p &lt; 0.01) and by 38.8 % (p &lt; 0.01), of the left ovary – by 31.19 % (p &lt; 0.01) and by 39 % (p &lt; 0.01), respectively.Conclusions. The results obtained allow us to expand our understanding of the features of the age-related structure of the ovaries and further continue their detailed study, since new knowledge is needed to develop modern methods for the prevention of pathology of the female reproductive system and the timely provision of quality medical care.

Correlation between clinical examination and perineal ultrasound in women treated for pelvic organ prolapse

IntroductionLifetime risk of surgery for female pelvic organ prolapse (FPOP) is estimated at 10 to 20%. Prolapse assessment is mostly done by clinical examination. Perineal ultrasound is easily available and performed to evaluate and stage FPOP. This study's aim is to evaluate the agreement between clinical examination by POP-Q and perineal sonography in women presenting pelvic organ prolapse. Materials and methodsWe carried out a prospective study from December 2015 to March 2018 in the gynecologic department of a teaching hospital. Consecutive woman requiring a surgery for pelvic organ prolapse were included. All women underwent clinical examination by POP-Q, perineal ultrasound with measurements of each compartment descent, levator hiatus area and posterior perineal angle. They also answered several functional questionnaires (PFDI 20, PFIQ7, EQ-5D and PISQ12) before and after surgery. Data for clinical and sonographic assessments were compared with Spearman's test and correlation with functional questionnaires was tested. Results82 women were included. We found no significant agreement between POP-Q and sonographic measures of bladder prolapse, surface of the perineal hiatus or perineal posterior angle. There was a significant improvement of most of the functional scores after surgery. DiscussionOur study does not suggest correlation between clinical POP-Q and sonographic assessment of bladder prolapse, hiatus surface or perineal posterior angle. Ultrasound datasets were limited by an important number of missing data resulting in a lack of power.

Clinical Profile of Patients with Polycystic Ovary Syndrome at Tertiary Care Hospital

Polycystic ovary syndrome, with an incidence of up to 10%, is one of the communal causes of anovulation in females of reproductive age. Diagnostic criteria for PCOS include enlarged polycystic ovaries, obesity, hirsutism, and oligomenorrhea. These women are more susceptible to endometrial cancer, type II diabetes, dyslipidemia and premature atherosclerosis. Objective: The aim of this study was to determine the different clinical profiles of PCOS patients and to educate patients about the long-term outcomes related with this condition. Methods: This cross-sectional study was conducted at the obstetrics and gynaecology department of Ayub Teaching Hospital, Abbottabad for the duration from 1st January 2019 to 31st December 2019. The study included 110 people with oligomenorrhea, obesity, acne, infertility and hirsutism. Young women who had their menarche less than two years ago, women over 45 years of age, and patients receiving exogenous estrogen or progesterone therapy were excluded from the study. For the social sciences, data was entered and analyzed with SPSS 25.0. The percentages and mean values were determined for several parameters. Results: Of the 110 patients selected for this study, 46 (41.8%) were married and 64 (58.2%) were unmarried. In contrast to rural areas, there were more patients from urban areas (63.6% vs 36.4%). 6.4% of patients were underweight, 20% and 59.1% were overweight and obese. Most patients (71.8%) had oligomenorrhea or amenorrhea. 70% of patients gained weight, many of whom attributed this to menstrual problems. Infertility affected 30% of married patients. Hirsutism and acne were found in 21.8% and 25.5%, respectively. Acanthosis Nigricans, a manifestation of insulin resistance, was found in 31.8% of patients. Eight patients were taking medication for hyperprolactinemia, ten women (10%) had type 2 diabetes taking oral hypoglycemics for glycemic control, and six had hypertension. All patients underwent USG and 85 (77.3%) of them showed a characteristic necklace pattern of follicular arrangement. Conclusion: Using clinical features and ultrasonography in women, PCOS can be accurately diagnosed using the Rotterdam criteria. The two main findings we observed in our patients were weight gain and amenorrhea or oligomenorrhea. It is very important to inform and educate unmarried patients with PCOS about the relationship of this condition with infertility and chronic health problems. Keywords: Oligomenorrhea, PCOS, Anovulation and obesity

Assessment of Ultrasonography Diagnostic Capacity in Women with Stress Urinary Incontinence with or without Pelvic Prolapse

Aim: The aim of this study was to assess the diagnostic validity of Ultrasonography in women with Stress Urinary Incontinence (SUI) with or without pelvic prolapse.Method: In this cross-sectional study, women with SUI were enrolled. The first group consisted of 25 patients with vaginal anterior wall prolapse, and the other group included 18 patients without vaginal anterior wall prolapse. After Systemic and genital examinations, the patients underwent the coughing test and Valsalva maneuver. The urinary leakage was examined during coughing. All the patients with positive coughing test underwent transprineal ultrasound. The posterior uretherovesical angle (β angel) as well as the bladder neck funneling were evaluated and recorded at both resting and during Valsalva.Results: In the patients with prolapse, the mean values of β angel were 121.0±25.9 and 137.7±24.5 degrees at the rest and during the Valsalva respectively. In the patients without prolapse, the means of β angel were 124.2 and 142.5 degrees at the rest and during the Valsalva respectively. The sensitivity and specificity of β angel were higher in patients with prolapse. During the Valsalva, β angel &gt;120° and Bladder neck funneling showed higher PPV and NPV in the patients with prolapse than patients without prolapse. At the rest; however, β angel &gt;120° delivered higher PPV and NPV in the patients without prolapse group. At the rest, β angel &gt; 114° rendered the sensitivity and specificity of 80% and 55% respectively. During the Valsalva, β angel &gt;129° revealed the sensitivity and specificity of 80% and 45% respectively.Conclusion: It seems that ultrasound is not appropriate enough to be an alternative diagnostic tool for urodynamic test in detecting SUI.

Investigation of Doppler Indices in Copper Intrauterine Device-induced Heavy Menstrual Bleeding

Background: Copper intrauterine devices (IUDs) are one of the most commonly used methods of contraception all over the world. However, nearly 20% of users have their IUD removed due to increased or irregular uterine bleeding. We aimed to investigate if the occurrence of heavy menstrual bleeding (HMB) after application of IUDs could be predicted using transvaginal color Doppler ultrasonography in women without dysmenorrhea. Method: Fifty-five women with regular menstruation without dysmenorrhea who were willing to use an IUD were included in the study. The women were divided into two groups as those whose menstrual characteristics did not change after IUD insertion (group A, n = 31) and those who developed HMB secondary to IUD insertion (group B, n = 24). IUDs were inserted on the 2nd or 3rd day of menstruation in all women and color Doppler assessments of the uterine, arcuate, and utero-ovarian arteries were performed twice; the first measurement was performed just before IUD deployment and the second measurement was performed on the 2nd or 3rd day of menstruation after 2 months. After recording these two measurements, Doppler parameters were compared between the groups. Results: The first and the second pulsatility index (PI) and resistance index (RI) values of the uterine arteries were significantly lower in group B when compared with group A (p &lt; 0.05). Likewise, the first and the second PI values of the arcuate arteries in group B were significantly lower than in group A (p = 0.009 and p = 0.035, respectively). The second RI measurements of the arcuate arteries were significantly lower in group B than in group A (p = 0.037); however, the first RI measurement of the arcuate arteries showed no statistically significant differences between the groups (p = 0.073). The first and the second PI and RI values of the utero-ovarian arteries showed no statistically significant difference between groups A and B. Conclusions: The results propose that low impedance to blood flow in the uterine and arcuate arteries prior to IUD insertion may help predict HMB secondary to IUD insertion in women without dysmenorrhea.

Intrapartum ultrasound measurement of the lower uterine segment thickness in parturients with previous scar in labor: a cross-sectional study

BackgroundThere is a lack of reliable methods to estimate the risk of uterine rupture or dehiscence during a trial of labor in women with previous cesarean sections. This study aimed to assess the lower uterine segment and myometrial thickness by ultrasonography in women with previous cesarean sections during labor and assess their association with the uterine defect.MethodsA cross-sectional study was conducted on 161 women in the active phase of labor having one previous cesarean section. The study was conducted et al.-Azhar University Hospital, Assiut City, Egypt, from March 2018 to March 2019. Ultrasound measurements of lower uterine segment thickness and myometrial thickness were conducted by vaginal and abdominal ultrasound by two observers. The correlation of both thicknesses with the uterine defect was analyzed.ResultsUterine defects were reported in 42 women (25.9%), uterine rupture in four women (2.5%), and dehiscence in 38 women (23.5%). The uterine defects were not associated with maternal factors (maternal age, gestational age at labor, body mass index, birth weight, interpregnancy, and inter-delivery interval). Receiver operating curve analysis demonstrated that lower uterine segment thickness was linked with uterine defect, with an area under the curve of 60% (95% CI, 51–70%, P = 0.044). Myometrial thickness was also linked to the uterine defect, with an area under the curve of 61% (95% CI, 52–71%, P = 0.025). Full lower uterine segment thickness of 2.3 mm and myometrial thickness of 1.9 mm were the cutoff value with the best combination of sensitivity and specificity for the uterine defect. Lower uterine segment thickness (OR = 0.49, 95%CI 0.24–0.96) and myometrial thickness (OR = 0.44, 95%CI 0.20–0.94) were significantly associated with the uterine defect. Lower uterine segment thickness (OR = 0.41, 95%CI 0.22–0.76) and myometrial thickness (OR = 0.33, 95%CI 0.16–0.66) were also significantly associated with cesarean section delivery.ConclusionA lower uterine segment thickness of 2.3 mm and myometrial thickness of 1.9 mm during the first stage of labor are associated with a high risk of uterine defects during a labor trial. These measurements during labor can have a practical application in deciding the mode of delivery in women with previous cesarean sections and might reduce uterine rupture.

The Influence of Oral Drotaverine Administration on Materno-Fetal Circulation during the Second and Third Trimester of Pregnancy.

Background and Objectives: The study aimed to evaluate the effect of the oral administration of drotaverine on maternal and fetal circulation as measured by Doppler sonography in women with a risk of preterm birth. Materials and Methods: The present prospective study was conducted on 34 women with singleton pregnancy at 26–36 weeks of gestation. Doppler flow and pulsatility index (PI) assessments of the umbilical artery, fetal middle cerebral artery, and uterine arteries were performed before and 90–120 min after oral drotaverine administration. Results: There were no statistically significant differences between the Doppler assessment (PI Uma—umbilical artery, MCA—middle cerebral artery, and ltUta—left uterine artery) before drotaverine administration and 90–120 min after oral intake, but there were statistically significant differences between the PI assessment of the rtUta (right uterine artery, 0.55 vs. 0.75, p = 0.05) and the mean of the Uta (0.66 vs. 0.74, p = 0.03). For changes in the CUR (cerebro–umbilical ratio) and % changes in the CUR and mean PI of the Uta, there was no correlation with obstetric history, AFI (amniotic fluid index), gestation week, infertility history, systolic pressure, or diastolic pressure. There was a statistically positive correlation between changes in the CUR and % change in the CUR and body weight and in height. Conclusions: Drotaverine has no statistically significant influence on the MCA and Uma PI. The oral administration of drotaverine has an impact on PI rtUta and the mean PI Uta.

The Evaluation of Posterior Urethrovesical Angle, Urethral Length, Bladder Wall Thickness, and Residual Volume with Transperineal Ultrasonography in Women with Urinary Incontinence

Objective: In the recent decades, transperineal ultrasonography has been used to examine patients in urogynaecology practice. In this study, we aimed to evaluate the function of transperineal ultrasonography in women with urinary incontinence.Methods: Forty-five patients who were admitted to our institution between December 2012 and May 2013 and clinically and urodynamically diagnosed as having urinary incontinence (SUI n=20, DI+UUI n=13, MUI n=12) were included in the study. Additionally, 25 clinically and urodynamically continent women were included as the control group. The patients were evaluated using transperineal ultrasonography (USG) in the supine position during rest and straining. An abdominal probe was placed in the perineum vertically and sagittally; when the symphysis pubis, urethra, bladder, vagina, and rectum could be seen clearly on the monitor, the image was frozen. Posterior urethrovesical angle (PUVA), urethral length, bladder wall thickness, and residual urine volume were measured on the image. All measurements were compared statistically between the SUI, UUI, MUI groups, and control group. The post-void residual volume measured using transperineal ultrasonography was compared with the post-void residual volume measured using a catheter during urodynamics.Results: PUVA was significantly different in the SUI and MUI groups at rest than in the control group (p&amp;lt;0.05). During Valsalva maneuvers, PUVA was statistically significantly different in the SUI and MUI groups than in the UUI and control groups (p&amp;lt;0.01). Conclusion: The measurement of PUVA and bladder wall thickness by transperineal ultrasonography is shown to be useful in diagnosis of patients with suspected detrusor instability and structural defects in pelvic floor. Therefore, transperineal USG may be an easy and reliable method which could be an alternative to urodynamic studies in patients who cannot undergo urethral catheterization.

The diagnostic value of the early extended fetal heart examination at 13 to 14 weeks gestational age in a high-risk population.

BackgroundCongenital heart disease (CHD) is the most common congenital malformation that affects high-risk populations. A more definite heart diagnosis in the first trimester should be provided to guide clinical treatment. The study aim was to evaluate the diagnostic precision of the early extended fetal heart examination (EFHE) that includes abdominal situs view, four-chamber view (4CV), left ventricular outflow tract view (LVOT), right ventricular outflow tract view (RVOT), 3-vessel and tracheal view (3VT), ductal arch view, and the aortic arch view in the detection of CHD at the gestational age (GA) 13 to 14 weeks in a population with high risks.MethodsThis study was a diagnostic test study. EFHE was performed by transabdominal sonography in women at GA 13 to 14 weeks with singleton pregnancies who were at high risk for CHD. The risk of CHD was determined by family history of CHD, rubella infection, metabolic disorders, exposure to teratogens, conception by in-vitro fertilization (IVF), increased nuchal translucency (NT) thickness, abnormal obstetric ultrasound, etc. The operator had more than 5 years of experience in first-trimester scans and fetal echocardiography. Early scans were compared with a fetal echocardiography in the second trimester (16–24 weeks).ResultsEFHE was performed, and the pregnancy outcomes were obtained in 234 single pregnancies with a high risk of CHD. The average crown-rump length (CRL) was (76.17±7.09) mm. CHD was diagnosed in 43 cases by EFHE; 10 of these cases were misdiagnosed, and 2 cases were missed. Four cases were inconsistent in the main diagnosis of CHD. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and kappa coefficient (Ko) value of EFHE in diagnosing CHD by type and severity was 84.6% [95% confidence interval (CI), 69.5–94.1%], 96.9% (95% CI, 93.4–98.9%), 84.6% (95% CI, 69.5–94.1%), 96.9% (95% CI, 93.4–98.9%), and 0.82 (P<0.001), respectively.ConclusionsEFHE can work as a diagnose examination for most major CHD cases at GA 13 to 14 weeks by an experienced operator; Therefore, this diagnostic system for fetal CHD may be applied in the first trimester. The study has been registered in the Chinese Clinical Trial Registry (www.chictr.org.cn). The registration number is ChiCTR2000038451.

Outcomes of Return to Routine Screening for BI-RADS 3 Lesions Detected at Supplemental Automated Whole-Breast Ultrasound in Women With Dense Breasts: A Prospective Study.

BACKGROUND. Supplemental screening breast ultrasound (US) detects additional cancers in women with dense breasts but identifies many BI-RADS 3 lesions that result in short-term follow-up and biopsies. OBJECTIVE. The purpose of this study was to evaluate outcomes in patients recommended for return to routine screening for lesions assessed as BI-RADS 3 on supplemental automated whole-breast US. METHODS. This prospective study invited patients with BI-RADS 1 or 2 on screening mammography and breast density C or D to undergo supplemental automated breast US (ABUS). ABUS was interpreted as BI-RADS 1, 2, 3, or 0. Return to routine screening was recommended for ABUS BI-RADS 1, 2, or 3. ABUS BI-RADS 0 lesions underwent targeted handheld US. Remaining patients were followed for 2 years. Malignancy rates were compared using Fisher exact tests. RESULTS. A total of 2257 women (mean age, 58.0 ± 11.2 [SD] years) were included. Supplemental ABUS was scored as BI-RADS 1 in 1186 (52.5%) women, BI-RADS 2 in 591 (26.2%), BI-RADS 3 in 395 (17.5%), and BI-RADS 0 in 85 (3.8%). A total of 394 patients with ABUS BI-RADS 3 had 2-year follow-up, during which no cancer (0%; 95% CI, 0.0-0.9%) was diagnosed in the quadrant of the lesion. Among patients with 2-year follow-up, breast cancer was diagnosed in 4/1117 (0.4%) with ABUS BI-RADS 1, 2/556 (0.4%) with ABUS BI-RADS 2, and 2/394 (0.5%) with ABUS BI-RADS 3 (cancer in other quadrant than the lesion). Malignancy rates were not different between ABUS BI-RADS 1, 2, and 3 (p = .28). The ABUS recall rate was 3.8% (85/2257; 95% CI, 3.6-4.0%). If short-term follow-up had been recommended for ABUS BI-RADS 3, the ABUS recall rate would have been 21.3% (480/2257, 95% CI 19.6-23.0%). The biopsy rate was 0.5% (12/2257; 95% CI, 0.3-0.9%); the positive biopsy rate was 58.3% (7/12). One of seven cancers diagnosed by initial supplemental ABUS and none of eight cancers diagnosed during subsequent follow-up were node-positive cancer. CONCLUSION. Return to routine screening for ABUS BI-RADS 3 lesions results in a substantial decrease in recall rate and is unlikely to result in an adverse outcome. CLINICAL IMPACT. This prospective study supports a recommendation for routine annual follow-up for BI-RADS 3 lesions at supplemental ABUS. TRIAL REGISTRATION. ClinicalTrials.gov NCT02650778.

MRI versus Mammography plus Ultrasound in Women at Intermediate Breast Cancer Risk: Study Design and Protocol of the MRIB Multicenter, Randomized, Controlled Trial

In women at high/intermediate lifetime risk of breast cancer (BC-LTR), contrast-enhanced magnetic resonance imaging (MRI) added to mammography ± ultrasound (MX ± US) increases sensitivity but decreases specificity. Screening with MRI alone is an alternative and potentially more cost-effective strategy. Here, we describe the study protocol and the characteristics of enrolled patients for MRIB feasibility, multicenter, randomized, controlled trial, which aims to compare MRI alone versus MX+US in women at intermediate breast cancer risk (aged 40–59, with a 15–30% BC-LTR and/or extremely dense breasts). Two screening rounds per woman were planned in ten centers experienced in MRI screening, the primary endpoint being the rate of cancers detected in the 2 arms after 5 years of follow-up. From July 2013 to November 2015, 1254 women (mean age 47 years) were enrolled: 624 were assigned to MX+US and 630 to MRI. Most of them were aged below 50 (72%) and premenopausal (45%), and 52% used oral contraceptives. Among postmenopausal women, 15% had used hormone replacement therapy. Breast and/or ovarian cancer in mothers and/or sisters were reported by 37% of enrolled women, 79% had extremely dense breasts, and 41% had a 15–30% BC-LTR. The distribution of the major determinants of breast cancer risk profiles (breast density and family history of breast and ovarian cancer) of enrolled women varied across centers.

Diagnostic Accuracy of Ultrasonography in Women with Postabortive and Postpartum Hemorrhage

Diagnostic Accuracy of Ultrasonography in Women with Postabortive and Postpartum Hemorrhage

Comparison of Abbreviated MRI with Mammography and Ultrasound in Women with a Personal History of Breast Cancer

To compare abbreviated MRI with mammography and US for screening in women with a personal history of breast cancer. In addition, the first and subsequent rounds of abbreviated MRI were compared. The Institutional Review Board approved this retrospective study. Nine hundred and thirty-nine abbreviated MRI scans of 710 women with a personal history of breast cancer were included (mean age, 54.1±9.4 years). The diagnostic performances of abbreviated MRI, mammography, and US for the detection of the second breast cancer were compared. When more than one round of abbreviated MRI was performed, we compared the scans of the first and subsequent rounds. There were 15 (2.1%) cases of second breast cancer. Thirty-nine of the 939 abbreviated MRI scans were diagnosed as positive; of them, 11 were diagnosed as breast cancer, with a PPV2 of 28.2% (US, 19.0%; mammography, 28.6%). The AUC, sensitivity, and cancer detection rate (per 1000) were the highest for abbreviated MRI (0.829, 68.8% and 11.7) (US: 0.616, 25.0%, and 4.3; mammography: 0.560, 12.5%, and 2.1, respectively). Two hundred women underwent multiple rounds of abbreviated MRI. AUC, PPV2, and the cancer detection rates were higher during the subsequent rounds (0.987, 45.5, and 21.8) than during the first round (0.605, 11.1, and 5). Abbreviated MRI for women with a personal history of breast cancer was more sensitive for the diagnosis of second breast cancer than US or mammography. In addition, subsequent rounds of MRI showed better performance than the first round.

Hourly fetal urine production rate in isolated oligohydramnios at term.

ObjectiveThe aim of this study was to evaluate the hourly fetal urine production rate (HFUPR) via three-dimensional ultrasonography in women with isolated oligohydramnios and compare with normal pregnant women at term.Materials and methodsThis was a prospective observational cohort study of 112 women from 34 to 40 6/7 weeks’ gestation. They were classified into three groups according to the amniotic fluid index (AFI) and ultrasonographic estimated fetal weight (EFW) as isolated oligohydramnios (defined as AFI below 5% and appropriate EFW corresponding to gestational age) (n = 34) and IUGR (defined as EFW below 5% corresponding to gestational age irrespective amniotic fluid) (n = 17), and normal pregnancy (n = 61). HFUPR was measured using three-dimensional virtual organ computer-aided analysis. Adverse perinatal outcomes in all participants were examined.ResultsThere was no significant difference in HFUPR between patients with isolated oligohydramnios and women with normal pregnancies (median, 40.0 mL/h [interquartile range [IQR] 31.0–66.5] vs. 48.6 [31.5–81.2], p = 0.224). HFUPR was significantly decreased in the IUGR group (13.8 mL/h [IQR 10.1–24.8]), compared to the normal pregnancy group (p<0.001) and the isolated oligohydramnios group (p<0.001). HFUPR was significantly decreased in neonates with adverse perinatal outcomes compared to the control (24.7 mL/h [IQR 13.4–47.4] vs. 43.6 [29.8–79.0], p = 0.016).ConclusionHFUPR was not decreased in patients with isolated oligohydramnios but was decreased in patients with IUGR when compared to normal controls at term.

Ovarian Volume Measurement by Transvaginal Ultrasonography in Women with Postmenopausal Bleeding and Thickened Endometrium

Background: Postmenopausal bleeding (PMB) is one of the most common reasons for referral to gynecology services. This is due to the concern of possible underlying malignancy, as approximately 10% of women with PMB will have endometrial carcinoma. Objective: Early diagnosis of endometrial changes in women with postmenopausal bleeding and thickened endometrium. Patients and Methods: A cross sectional study was conducted at Obstetrics and Gynecology Department, from December 2018 to January 2020 at Zagazig University Hospitals. The study included 56 women with post-menopausal bleeding and thickened endometrium (> 4 mm). They underwent vaginal sonography for endometrial thickness and ovarian volume measurement; endometrial sampling was done for definitive histologic diagnosis. Results: There was statistically significant difference between normal, over weight and obese females as regards mean ovarian volume and endometrial thickness (p = 0.001and p = 0.01) respectively. Where, over weight and obese females had large mean ovarian volume (median = 1.80 and 2.350) respectively and larger endometrial thickness (median = 9.0 and 14.0) respectively compared to normal ones. We found that 51% of studied females were having hyperplasic lesions followed by 37.3% of them were having benign lesions then 11.8% of them were having malignant lesions. Conclusions: That enlarged ovaries in women with postmenopausal bleeding and thickened endometrium are associated with endometrial adenocarcinoma risk. Whereas obesity represents a marker of risk for that endometrial change.

Dimethylarginines correlate to common carotid artery wall layer dimensions and cardiovascular risk factors in pregnant women with/without preeclampsia: A group comparative study

ObjectivesAsymmetric- and symmetric dimethylarginines (ADMA, SDMA) are elevated in cardiovascular disease (CVD). Preeclampsia is a pregnancy-specific syndrome and is an independent risk factor for subsequent CVD. Aims were to investigate whether ADMA, SDMA levels and l-arginine/ADMA and l-arginine/SDMA ratios during pregnancy and their changes from pregnancy to postpartum are associated to arterial wall layer dimensions and cardiovascular risk factors in women with and without preeclampsia. Study designDimethylarginines were analyzed by LC–MS, and the common-carotid-artery (CCA) intima and media thicknesses were estimated using 22-MHz non-invasive ultrasonography in women with preeclampsia (cases = 48) and normal pregnancies (controls = 58) in similar gestational age, with reassessment one-year postpartum. A thick intima, thin media and high intima/media ratio (I/M) indicates a less healthy arterial wall. ResultsThe median age of cases and controls was 30 years. During pregnancy, women with preeclampsia had higher plasma ADMA, SDMA and lower l-arginine/ADMA and l-arginine/SDMA (all p < 0.01) than women with normal pregnancies. Further, ADMA, SDMA, l-arginine/ADMA and l-arginine/SDMA correlated to intima thickness (rs = 0.33/0.33/−0.33/−0.35 and p < 0.01), I/M (rs = 0.26/0.28/−0.22/−0.26 and p < 0.05) and mean arterial pressure (MAP) (rs = 0.43/0.42/−0.39/−0.40 and p < 0.0001). Changes in ADMA, SDMA and l-arginine/SDMA from pregnancy to postpartum correlated to changes in intima thickness (rs = 0.22/0.32/-0.21 and p < 0.05/<0.01/<0.05), I/M (rs = 0.22/0.31/0.08 and p < 0.05/<0.01/=0.43) and MAP (rs = 0.31/0.53/-0.25 and p < 0.01/<0.001/<0.05). No correlations were found for conventional CCA intima-media-thickness. ConclusionsDimethylarginines were associated to signs of adverse effects on arterial wall layer dimensions and cardiovascular risk factors in women with and without preeclampsia, during pregnancy and to their changes from pregnancy up to one-year postpartum.

Clinical profile of PCOS patients at a tertiary care center in Gandaki Province of Nepal

Background: Polycystic Ovary Syndrome is one of the most common cause of anovulation in women of reproductive age, with a prevalence of upto 10%. Oligomenorrhea, hirsutism and obesity together with enlarged polycystic ovaries are the diagnostic criteria of PCOS. These women are vulnerable to type II diabetes, dyslipidemia, premature arteriosclerosis, and endometrial carcinoma.&#x0D; Aims and Objectives: The aim and objective of this study was to see the various clinical profile of PCOS patients at a Medical College in Nepal and to make patients aware about the long term sequalae associated with it.&#x0D; Materials and Methods: This was a retrospective study conducted in the outpatient department of Obstetrics and Gynaecology at Manipal Teaching Hospital from January 2018 till June 2019. A total of 90 patients presenting with oligomenorrhoea, obesity, acne, infertility and hirsutism were included in the study. The exclusion criteria were young women who had their menarche less than 2 years back, women older than 45 years, and patients on exogenous estrogen or progesterone therapy.&#x0D; Results: Out of 90 patients studied, 37(41%) were married and 53(59%) were unmarried. There were many patients from urban compared to rural areas (67% vs 33%). Many patients were either overweight (22%) or obese (61%) and 6% of the patients were underweight. Mean age at the time of presentation was 31.66 years with many patients (37%) between 30-35 years age group. Majority of the patients were either oligomenorrhoeic or amenorrhoeic (78 %). Weight gain was present in 83% of the patients. Infertility was present in 81% of the married patients. Fifteen women (17%) had hypothyroidism and were receiving treatment for the same. Ultrasonography was done in all the patients and typical necklace pattern of follicular arrangement was seen in 70 (78%) patients.&#x0D; Conclusion: The diagnosis of PCOS can be reliably predicted with the help of clinical features and sonography in women according to Rotterdam criteria. Oligomenorrhoea or amenorrhea and weight gain were main symptoms in our patients. It is important to educate and make unmarried PCOS patients aware of its association with infertility and long-term medical problems.

Sonographic features of anterior chest wall lesions detected on breast sonography in women: A pictorial essay.

Although anterior chest wall lesions rarely occur and the associated imaging findings are nonspecific, various disease processes can affect the chest wall. It is important for radiologists to understand the anatomic relationship between the chest wall and breast and differentiate the tumor origin. This pictorial essay presents the sonographic features of various anterior chest wall lesions that were detected on breast ultrasonography.