Transabdominal Ultrasound Scan Research Articles

FRI422 The Fates Of Ovarian Dominant Follicles In The First Two Gynecologic Years: An Investigation Of Morphologic And Endocrinologic Features

Abstract Disclosure: M. Calvert: None. S. Molsberry: None. S. Denslow: None. H. Vanden Brink: None. M.E. Lujan: None. N. Shaw: None. Introduction: Irregular menses are common during the early, post-menarchal years owing to the immaturity of the hypothalamic-pituitary-ovarian axis. Few studies have attempted to delineate the factors that contribute to cycle irregularity during this time. In the current study, we aimed to characterize the fate of ovarian dominant follicles in a longitudinal cohort of healthy, early post-menarchal girls. Methods: Participants contributed daily urine samples for reproductive hormone profiling (Cr-corrected LH, estrone conjugates [E1C], and pregnanediol-3-glucuronide [PdG]), and underwent periodic transabdominal ultrasound scans and body composition analysis. The current analysis includes cycles: 1) with an LH surge and ultrasounds performed 1-9 days before and/or <11 days after the surge, or 2) without an LH surge but with ultrasound documentation of a dominant follicle. LH surge requirements were > 40 mIU/mg Cr with concentrations > mean+3sd of the preceding 5 days. Ultrasounds were evaluated offline by two investigators using a standardized rubric for ovarian structures. Results: 26 participants contributed 74 ultrasound scans, spanning 45 cycles. Participants were 12.6 (range 9.8-14.7) years-old, 2.7 (range 0.3-9.6) months post-menarche, predominantly non-Hispanic White (65.4% vs. 26.9% Black, 3.8% Asian, 3.8% Multiracial), and of normal weight (76.9% with BMI <85th percentile). In 41/45 cycles, there was morphological (antral follicle diameter > 10 mm observed ultrasonographically, n=22) and/or endocrinological (LH surge, n=38) evidence for the presence of a dominant follicle. In 4/45 cycles, a dominant follicle was observed but peak LH did not meet LH surge criteria. In 17/41 cycles, dominant follicle fate could not be determined for technical reasons. In the remaining 24/41 cycles, dominant follicles fates post LH-surge were: corpus luteum (CL, 15/24, 71%), CL or luteinized unruptured follicle [LUF] (2/24, 8%), persistent dominant follicle (3/24, 13%), or no structure observed, implying follicular regression/collapse (4/24, 17%). In logistic GEE models, there was no association between peak E1C or LH, follicular phase length, gynecologic age, or free testosterone with odds of having a CL versus any other dominant follicle outcome. There were marginally significant associations between peak PdG (OR: 1.0003, 95% CI: 0.9999, 1.00008) and total body fat percent (OR: 0.86, 95% CI: 0.74, 1.01) with odds of having a CL versus any other dominant follicle outcome. Conclusion: In the first two gynecologic years, dominant follicles develop in most cycles and frequently ovulate. A variety of mechanisms, however, contribute to anovulation, including an absent LH surge, the formation of LUFs, and follicle regression. Whether degree of adiposity is related to ovulatory success of a dominant follicle early in gynecological life will be pursued in future research. Presentation: Friday, June 16, 2023

Sonographic Correlations between Intravesical Prostatic Protrusion and Bladder Outlet Obstruction in Patients with Symptomatic Benign Prostatic Hyperplasia in Ibadan, Nigeria

Background: Evaluating bladder outlet obstruction (BOO) in patients with prostatic enlargement may reflect the severity of the disease and aid in predicting the treatment outcome. Objectives: To determine the sonological correlation between intravesical prostatic protrusion and bladder outlet obstruction in patients with symptomatic benign prostatic enlargement. Methods: This prospective study was conducted over one year at the Department of Radiology, University College Hospital, Ibadan. A transabdominal ultrasound scan of the urinary bladder and prostate gland was carried out on patients with prostatic enlargement and BOO. The intravesical prostatic protrusion, pre-and post-void urine volumes, prostate volume and bladder wall thickness were measured. Results: A total of 132 men aged 43 to 90 years (mean age: 63.8±8.64 years) were studied. The median size of the intravesical prostatic protrusion (IPP) was 7.25 mm (IQR: 0.00 mm; 14.9 mm). The mean prostate volume was 63.3ml±36.0ml. Most subjects (55; 41.7%) had a prostate volume above 60ml, and most patients (101, 77.2%) had bladder wall thickness less than 5mm. The mean bladder wall thickness was 4.26mm±1.54mm. There was a statistically significant correlation between IPP and pre-void urine volume and prostate volume (p = 0.002 and <0.001, respectively). Patients over 70 years had increasing IPP and post-void urine, which lacked statistical significance (p = 0.15). Conclusion: The severity of bladder outlet obstruction was reflected in the pre-void urine volume, which correlated with the size of IPP.

Management of Cervical Stenosis - Mechanical Dilatation Adjunct with Hormonal Therapy

Madam C was a 39-year-old primiparous lady having history of one IVF pregnancy delivered by Caesarean section (CS). She was found cervical intra-epithelial neoplasia (CIN) 2-3 with loop electro-excision procedure (LEEP) performed 6 months after her delivery while she was still breastfeeding. 1.8cm-thick, 2cmwide cervix was resected and diagnosed CIN 1. Two 6-monthly cervical smears were negative for CIN in the presence of transformation zone component. She presented to us 17 months after LEEP for severe lower abdominal pain which required pethidine for relief. She experienced hypomenorrhea with mainly brownish spotting, and intermenstrual spotting and dyspareunia since returning of menses 9 months after LEEP. Physical examination showed cervix was flushed with vault. Transabdominal (TAS) and transvaginal ultrasound scans (TVS) showed enlarged uterine cavity and endocervical canal filled with blood, up to 3.64cm. The clinical diagnosis was haematometra due to cervical stenosis after LEEP.

Ultrasound Measurement of Foetal Kidney Length during Healthy Pregnancy: Relationship with Gestational Age.

Foetal kidney length (FKL) measurements and comparisons to normal charts can be used to assess the development of the foetal kidneys throughout the entire course of pregnancy. This study was designed to assess FKL between 20 - 40 weeks' gestation, establish reference ranges for FKL and determine the relationship between FKL and gestational age (GA) in normal pregnancy. This descriptive, cross-sectional study was conducted between March-August 2022, at the Obstetric Units and Radiology Departments of the two tertiary health facilities, one secondary facility and one radio-diagnostic facility in Bayelsa State, Southern Nigeria. Transabdominal ultrasound scan was used to evaluate the foetal kidneys. The relationship between foetal kidney dimensions and GA was explored using Pearson's correlation analysis. Linear regression analysis was done to define the relationship between GA and mean kidney length (MKL). A nomogram predicting GA from MKL was constructed. Level of significance was set at p<0.05. There was a very strong significant correlation between foetal renal dimensions and GA. The correlation coefficient between GA and mean FKL, width and anteroposterior diameter were 0.89 (p=0.001), 0.87 (p=0.001) and 0.82 (p=0.001), respectively. A unit change in mean FKL corresponded to a 79% change in GA (ɼ2), showing a very strong association between mean FKL and GA. The regression equation: GA = 9.87 + 5.91 x MKL, was derived for estimation of GA for a given MKL. Our study revealed a significant relationship between FKL and GA. The FKL can therefore be reliably used to estimate GA.

Evaluation of socio-demographic and clinical characteristics of PCOS patients attending a tertiary care institute in Colombo

Background and objectivesPolycystic ovary syndrome (PCOS) is a common endocrine disorder with heterogeneous aetiology. It is characterized by irregular menses and or oligo/anovulation, hyper-androgenism, and polycystic ovaries. The prevalence and diagnosis of PCOS changes depending on which clinical criteria are utilized to confirm the diagnosis. The prevalence can be high as 8–13% when the Rotterdam criteria are used. However, there is significant inter-individual variation in presentation. We have studied the socio-demographic and clinical characteristics of PCOS patients attending the Endocrinology clinic in a tertiary care institute in Sri Lanka.MethodsA descriptive cross sectional study was conducted from September 2019 to September 2020 at the Endocrinology Unit of the National Hospital of Sri Lanka. All the patients who met the inclusion and exclusion criteria and who has a diagnosis of PCOS made according to Rotterdam criteria were recruited in to the study. After obtaining informed written consent, the data was collected using an interviewer administered questionnaire. HOMA-IR was calculated using the fasting insulin and blood glucose level.ResultsThe study enrolled sixty females. The mean age was 26.7 years (range 18–44). The mean weight was 64.8 (SD = 11.9) kg and BMI was 27.1 (SD = 4.8) kg/m−2. According to Asian BMI cut-offs, 1 (1.7%) patient was underweight and 13 (21.7%) had normal weight. Forty six (76.7%) had their weight in the overweight or obese category. Fifty four (90.0%) patients had clinical or biochemical evidence of hyperandrogenism while 24 (40%) had polycystic ovaries on trans-abdominal ultrasound scan and 50 (83.3%) had irregular menstrual cycles. According to the body fat percentage assessed by the whole body DEXA scan 4.1% normal body fat, while 50.0% and 45.8% had overweight and obesity respectively. HOMA-IR detected 61.1% to have high insulin resistance. Out of the patients who had USS of the abdomen 27.5% had co-existent non-alcoholic fatty liver. Fifty four percent of the patients had sub/infertility.ConclusionsThe majority of the population were overweight or obese and had higher prevalence of insulin resistance and non-alcoholic fatty liver. Out of the clinical characteristics used to make the diagnosis of PCOS, the presence of clinical or biochemical evidence of hyperandrogenism and irregular menstrual cycles are more common than the detection of polycystic ovaries on trans-vaginal USS. The higher prevalence of overweight, obesity, insulin resistance and NAFLD associated with PCOS makes the diagnosis and management of the disease crucial to prevent long term consequences of the disease.

Eighteen-Year-Old Nulliparous Woman with Massive Mucinous Cystadenoma in Pregnancy: Case Report

Background: Ovarian mucinous cystadenoma is rare in adolescents. We report the diagnosis and management of a massive ovarian mucinous cystadenoma in a pregnant adolescent. Case Presentation: An 18-year-old G1PO was referred by a midwife to the Komfo Anokye Teaching Hospital on account of excessive abdominal distension at 25 weeks’ gestation and an ultrasound scan finding of a large non-septate cystic adnexal mass. She, however,reported to the hospital 6 weeks later with a complaint of worsening abdominal distension and discomfort. A transabdominal ultrasound scan revealed single intrauterine gestation and a large non-septate cystic adnexal lesion measuring more than 19 cm in its widest plane. She had a conservative in-patients management followed by emergency caesarean delivery, exploratory laparotomy and unilateral salpingo-ophorectomy at 33 weeks 1 day. The outcome of the delivery was a 1.8 kg female infant with Apgar score of 4 and 6 at 1 and 5 minutes respectively. A 6.8 kg cystic ovarian mass measuring about 40 cm at its widest diameter was removed.Conclusion: Although pregnancy-associated adnexal masses are not uncommon, significant socio-economic challenges may render the diagnosis and treatment of extremely large pelvic masses in pregnant adolescents difficult. The decision to optimize maternal and fetal outcomes is essential in managing rare conditions in marginalized obstetric populations.

Effectiveness of Ultrasound Screening for a Placenta Accreta Spectrum Using Standard Ultrasound Criteria in a Secondary Care Setting

Objectives: Ultrasound detection of a placenta accreta spectrum (PAS) among women at risk is a key goal to reduce obstetric morbidity, but there is scarce information on its performance in real clinical settings. We report the effectiveness of a standardized ultrasound protocol to detect PAS in women with placenta previa (PP) in a secondary-level hospital. Methods: A retrospective analysis, including a cohort of 126 women with persistent PP among 27,975 pregnancies between 2008 and 2020, was performed. All 126 women underwent standardized transabdominal and transvaginal ultrasound scan that assessed 5 criteria: (1) loss of hypoechoic retroplacental zone and/or myometrial thinning <1 mm; (2) lacunar images with a flow of >15 cm/s; (3) thick and bulging placenta; (4) thinning or interruption of the uterine-bladder serous interface; and (5) placental or uterovesical hypervascularity. The presence of at least one criterion was considered a high risk for PAS. Diagnosis of PAS was confirmed during the caesarean section and by histopathological analysis. Results: Among 126 women with PP, 11 (8.7%) cases of PAS were diagnosed, of which 10 were detected prenatally by ultrasound scan. This resulted in a sensitivity of 90.9%, a specificity of 98.3%, a positive predictive value of 83.3%, and a negative predictive value of 99.1%. Histopathological assessment showed 6 placenta increta (54.5%), 4 percreta (36.4%), and 1 accreta (9.1%). All 10 cases of invasive placenta presented more than 3 ultrasound criteria. Conclusions: Standardized ultrasound screening protocol in women at risk due to PP in the third trimester was highly effective in detecting PAS in a secondary-level hospital setting.

Heterotopic pregnancy in natural conception – A case report

Introduction: Heterotopic pregnancy is the coexistence of living or dead intrauterine pregnancy, single or multiple, and extra-uterine pregnancy located in the oviduct, ovary, uterine cornua, cervix or peritoneal cavity. Heterotopic gestation, although common with assisted reproductive techniques, is very rare in natural conception. A high index of suspicion can help in timely diagnosis and appropriate intervention.Case report: A 37- year-old primigravida lady with spontaneous pregnancy presented with amenorrhoea of 5 weeks, sudden and increasing lower abdominal pains of 5 days, dizziness of 2 days and vaginal bleeding of 4hours. Transabdominal and Transvaginal ultrasound scan was performed and revealed a non-viable intrauterine gestation at 6 weeks and 3 days, associated with a heterogenous complex right adnexal mass. Laparotomy was done, it revealed a ruptured right fallopian tube with remnant products of conception and hemoperitoneum; and right salpingectomy was done. The specimen was sent for histopathology. The patient tolerated the procedure well, though was resuscitated with normal saline and blood transfusion; she was taken to the recovery room in stable condition. The histopathological report confirmed the diagnosis of ectopic pregnancy.Conclusion: Despite the rarity of heterotopic pregnancy it should be suspected in patients with hemoperitoneum and an adnexal mass, even in the absence of risk factors, and should be included in the differential diagnosis of acute abdomen in the first trimester. The patient should be thoroughly investigated using abdominal and transvaginal ultrasound to exclude this rare diagnosis and allow on-time proper management.

Umbilical artery thrombosis diagnosed at different gestational ages and fetal outcomes: a case series

BackgroundUmbilical artery thrombosis is a rare complication of pregnancy strongly associated with poor fetal and perinatal outcomes, such as intrauterine asphyxia, fetal growth restriction, and stillbirth. Its pathogenesis remains unclear, and there is the added challenge of selecting an appropriate delivery time to achieve excellent neonatal outcomes.MethodsOur Hospital is a critical maternal rescue center with approximately 7000 births annually. We present a series of 8 cases of umbilical artery thrombosis diagnosed at the hospital between Apr 1, 2018, and Jan 31, 2020. We identified the cases through a keyword search of the maternity and pathology information management systems.ResultsThree patients were diagnosed with a transabdominal ultrasound scan and hypoxia on fetal heart monitoring. All three patients had emergency cesarean section delivery. Four patients were observed closely for 5 to 13 weeks from initial detection by an ultrasound scan to delivery. Only one patient was diagnosed after vaginal delivery by Hematoxylin-eosin staining of umbilical cord sections. Seven patients had deliveries by cesarean section, and one patient had a vaginal delivery. All infants were born alive.ConclusionsUmbilical artery thrombosis is a challenging and rare condition that can occur at different gestational ages, especially when diagnosed in the third trimester and accompanied by fetal growth restriction. Consequently, these patients require close monitoring of umbilical blood flow and fetal growth and intervention at the appropriate time to achieve an optimal outcome.

Intraoperative ultrasound assessment of ureteral patency during pelvic surgery.

Ureteral injuries probably represent the most feared complication of benign hysterectomies. Lack of proper intraoperative detection causes diagnostic delay, which results in additional hospitalization, prolonged catheterization, and multiple additional procedures. However, the policy of universal cystoscopy is still under debate, owing to costs, increased operative time, lack of proper training, and risk of trauma. Intraoperative ultrasound assessment can offer a valid alternative for evaluating ureteral patency. After intravenous administration of 300ml of saline solution and 10mg of furosemide, the bladder is filled with 300ml of saline solution. Transabdominal ultrasound bladder scans are obtained with a convex 3.5-MHz probe in transverse planes. The power Doppler field size is set to include the entire posterior wall of the bladder, at the level of the ureterovesical junctions. Ureteral patency test is considered normal if jets are present on both sides. It is considered abnormal when either absent or comparatively diminished on one side. It is considered nondiagnostic when neither side is visualized. Cystoscopy should be performed in the case of abnormal or nondiagnostic sonographic findings. Intraoperative transabdominal power Doppler ultrasound represents a feasible, non-invasive, and inexpensive diagnostic tool for assessing ureteral patency during gynecological surgery.

POS0163 INCIDENT FRACTURE RISK PREDICTION USING THE FRAGILITY SCORE CALCULATED BY LUMBAR SPINE RADIOFREQUENCY ECHOGRAPHIC MULTI SPECTROMETRY (REMS) SCANS

Background:The main consequence of osteoporosis is the occurrence of fractures due to bone fragility, with important sequelae in terms of disability and mortality. It has been already demonstrated that the information about bone mass density (BMD) alone is not sufficient to predict the risk of fragility fractures, since several fractures occur in patients with normal BMD [1].The Fragility Score is a parameter that allows to estimate skeletal fragility thanks to a trans-abdominal ultrasound scan performed with Radiofrequency Echographic Multi Spectrometry (REMS) technology. It is calculated by comparing the results of the spectral analysis of the patient’s raw ultrasound signals with reference models representative of fragile and non-fragile bones [2]. It is a dimensionless parameter, which can vary from 0 to 100, in proportion to the degree of fragility, independently from BMD.Objectives:This study aims to evaluate the effectiveness of Fragility Score, measured during a bone densitometry exam performed with REMS technology at lumbar spine, in identifying patients at risk of incident osteoporotic fractures at a follow-up period of 5 years.Methods:Caucasian women with age between 30 and 90 were scanned with spinal REMS and DXA. The incidence of osteoporotic fractures was assessed during a follow-up period of 5 years. The ability of the Fragility Score to discriminate between patients with and without incident fragility fractures was subsequently evaluated and compared with the discriminatory ability of the T-score calculated with DXA and with REMS.Results:Overall, 533 women (median age: 60 years; interquartile range [IQR]: 54-66 years) completed the follow-up (median 42 months; IQR: 35-56 months), during which 73 patients had sustained an incident fracture.Both median REMS and DXA measured T-score values were significantly lower in fractured patients than for non-fractured ones, conversely, REMS Fragility Score was significantly higher (Table 1).Table 1.Analysis of T-score values calculated with REMS and DXA and Fragility Score calculated with REMS. Median values and interquartile ranges (IQR) are reported. The p-value is derived from the Mann-Whitney test.Patients without incident fragility fracturePatients with incident fragility fracturep-valueT-score DXA[median (IQR)]-1.9 (-2.7 to -1.0)-2.6 (-3.3 to -1.7)0.0001T-score REMS[median (IQR)]-2.0 (-2.8 to -1.1)-2.7 (-3.5 to -1.9)&lt;0.0001Fragility Score[median (IQR)]29.9 (25.7 to 36.2)53.0 (34.2 to 62.5)&lt;0.0001By evaluating the capability to discriminate patients with/without fragility fractures, the Fragility Score obtained a value of the ROC area under the curve (AUC) of 0.80, higher than the AUC of the REMS T-score (0.66) and of the T-score DXA (0.64), and the difference was statistically significant (Figure 1).Figure 1.ROC curve comparison of Fragility Score, REMS and DXA T-score values in the classification of patients with incident fragility fractures.Furthermore, the correlation between the Fragility Score and the T-score values was low, with Pearson correlation coefficient r=-0.19 between Fragility Score and DXA T-score and -0.18 between the Fragility Score and the REMS T-score.Conclusion:The Fragility Score was found to be an effective tool for the prediction of fracture risk in a population of Caucasian women, with performances superior to those of the T-score values. Therefore, this tool presents a high potential as an effective diagnostic tool for the early identification and subsequent early treatment of bone fragility.

Incidence of postpartum urinary retention in a tertiary hospital in Ibadan, Nigeria.

To determine the incidence of postpartum urinary retention (PUR) after vaginal delivery and associated risk factors. A total of 250 women were recruited following vaginal delivery at the UCH, Ibadan. Sociodemographic and obstetrical data were collected using a pro forma. Transabdominal ultrasound scan of the urinary bladder was performed 6hours after delivery to estimate the post-void residual bladder volume (PVRBV) of participants. PVRBV was compared with obstetrical characteristics and labor events. Data collected were analyzed using SPSS 17.0. The level of statistical significance was set at P value less than 0.05. The incidence of PUR was 17.6%. Women with PUR, had longer duration of first stage (591 versus 501minutes; P=0.001), and second stage (50 versus 32minute; P<0.001) of labor compared with those without PUR. There was evidence that augmentation of labor (P<0.01), catheterization during labor (P<0.01), perineal injury (P<0.01), and episiotomy (P<0.01) were associated with developing PUR. Also, women with PUR were more likely to experience storage and obstructive urinary symptoms than those without PUR. Resolution of PUR occurred within 24hours. This study showed that postpartum urinary retention is relatively common following vaginal delivery. Awareness of risk factors will increase index of suspicion especially in women with storage and obstructive symptoms.

Long-Term Medical Therapy after Laparoscopic Excision of Ovarian Endometriomas: Can We Reduce and Predict the Risk of Recurrence?

Objectives: Up to 32% of women experience anatomic recurrence after conservative surgery for endometriomas, while pain recurs in 10–40% of cases. Long-term postoperative hormonal therapy is recommended to prevent disease recurrence. We evaluated the efficacy of long-term therapy with estroprogestins (EPs) or progestins (Ps) in preventing endometrioma recurrence, as identifiable cysts and subjective symptoms, after laparoscopic excision. Design: This retrospective cohort study included 375 women submitted to laparoscopic endometrioma excision. Women were followed up at 6 and 12 months and then yearly after surgery. Based on postoperative medical therapy, women were divided into 4 groups: nonusers, cyclic EP users, continuous EP users, and progestogen users. Materials, Setting, Methods: Anamnestic and anthropometric characteristics were collected as well as clinical and surgical data. Gynecological examination, and transvaginal and transabdominal ultrasound scans were performed. Pain (numerical rating score >5) and endometrioma recurrence at ultrasound (ovarian cyst with typical sonographic features ≥10 mm in mean diameter) were recorded at each examination. The reoperation rate in women with recurrence was investigated. Results: The median follow-up was 3.7 years with a maximum of 16.7 years. Most patients used EPs (119 cyclic and 61 continuous users), 95 used P, and 100 were nonusers. In 135 women (36%), endometriotic cyst recurrence was diagnosed, with a mean diameter of 18.7 ± 10.8 mm (range 10–55 mm). The median recurrent cyst-free time was 7.9 years (95% CI 5.8–10.8). Dysmenorrhea was the first symptom to reappear, affecting 162 patients (43.2%). Upon multivariable regression analysis, continuous users had a lower risk of relapse (OR 0.56, 95% CI 0.32–0.99), in terms of both cysts and symptom recurrence, than patients who received no medications. The reoperation rate was 16.2%. Limitations: The main limitation of this study is its retrospective design. Also, women switching therapies throughout the follow-up period were sorted into one of the study groups based on the longest treatment taken, without considering the discontinuation rates. Conclusions: Long-term EPs, administered in a continuous regimen and starting immediately after conservative surgery for endometriomas, seem to reduce the disease recurrence risk.

Vitamin D as a risk factor for the presence of asymptomatic uterine fibroids in premenopausal Han Chinese women

To investigate the relationship between vitamin D deficiency and the risk of asymptomatic uterine fibroids (UFs). Cross-sectional study. University hospital. The present analysis recruited 133 asymptomatic patients with UFs and 80 normal control subjects from October 2017 to June 2020. Age matching created 61 pairs. Medical history, transvaginal or transabdominal genital ultrasound scan, blood sampling, and measurement of vitamin D concentrations. Evaluation of the impact of vitamin D level on the risk of newly diagnosed asymptomatic UFs in premenopausal Han Chinese women. Vitamin D levels of UF-positive patients were lower than those of healthy control subjects in unmatched samples (12.1 ng/mL vs. 16.8 ng/mL) and in matched samples (11.4 vs. 17.5 ng/mL). Younger patients (≤40 years) had a lower vitamin D level than older subjects in healthy control group (15.1 ng/mL vs. 19.0 ng/mL). We did not observe any age-vitamin D interactive effect in unmatched samples. Multivariate logistic regression revealed that asymptomatic patients presented a lower level of vitamin D than did normal groups in both unmatched and matched sample. In addition, the optimal threshold vitamin D level for having asymptomatic UFs was 14.34 ng/mL. Vitamin D deficiency may be associated with increased risk of asymptomatic UFs in premenopausal Han Chinese women.

A Study on Validity of Ultrasonography and Magnetic Resonance Imaging in Assessment of Uterine Adnexal Masses

Introduction: Adnexal mass lesions are common among women which has a prevalence of 0.17%-5.9% in asymptomatic women and 7.1%-12% in symptomatic women of all ages. Making a differential diagnosis among adnexal masses is difficult and complex. Recognising the severity of the problem, appropriate and timely evaluation and treatment with good outcome is the goal. Aim: To find out the validity of Ultrasonography (USG) and Magnetic Resonance Imaging (MRI) in evaluation of uterine adnexal masses. Materials and Methods: A cross-sectional study of 50 subjects with suspected various adnexal masses has been conducted over a period of two years from November 2017 to November 2019 in the Department of Radiodiagnosis and Pathology, for USG were included. All patients later underwent surgery and biopsy specimens were sent for Histopathological Examination (HPE). The data was entered in master chart then mean, Standard Deviation (SD) and other statistical tests was applied and analysed using Statistical Package for the Social Sciences (SPSS) 16 statistical package, Chi-square test has been used to compare the sensitivity of Transabdominal Ultrasound (TAUS) and MRI scan with level of significance of &lt;0.05. The results were expressed in form of tables, charts, graphs, figures and photographs. Results: The subjects age ranged from 9 to 84 years with a mean age of 40.36. Ovary was the most common site of origin of adnexal masses was (right 44% and left 30%), main symptoms was lump followed by pain abdomen. Most common adnexal masses on HPE were papillary followed by serious cystadenocarcinoma in malignant cases. USG showed an overall sensitivity of 88.9%, specificity of 81.3% PPV-72.7% and NPV- 92.9% in comparison to the histopathological findings benign cases had peripheral vascularity (65.62%) and had 59.4% cases with more than 0.8 resistive index. Among malignant cases (88.9%) had central vascularity with 83.3% cases having resistive index less than 0.8. Sensitivity, Specificity, PPV, NPV of MRI was 94.4%, 93.8%, 89.5% and 96.8%, respectively. Conclusion: USG is the initial choice of imaging modality for evaluation of adnexal mass lesions. But imaging with MRI has high accuracy in identifying the origin of a mass, characterising its tissue content and staging and preoperative plan. But still the HPE of specimen obtained from laparotomy of adnexal mass is the gold standard for confirming the diagnosis.

Correlation of International Prostate Symptom Score With Intravesical Protrusion of Prostate in Patients With Benign Enlargement of Prostate

Objective: To determine the correlation of international prostate symptom score with Intravesical protrusion of prostate.&#x0D; Methods: This prospective clinical study was performed on 60 elderly patients presented with LUTS suggestive of Benign Enlargement of Prostate. Their evaluation included DRE, IPSS, Uroflowmetry (Qmax), serum PSA measurements and trans abdominal ultrasound scan. Statistical analysis was performed by SPSS version 13 using Chi square test and scatter plots together with Spearman’s correlation coefficients were used to assess the relationship between IPP and IPSS.&#x0D; Results: Mean age of the patients was 66.7+9.85 years, IPSS 23.6+6.53, mean prostatic volume was 60.23+38.16 mL, Qmax 7.98+3.87, PVR was 163.18+141.73 mL. Fifty percent of patients had severe degree (&gt;10mm) of intravesical protrusion of the prostate, 30% had moderate and 20% had mild IPP. There was significant positive correlation between IPSS and IPP (r=0.698, P &lt; 0.001).&#x0D; Conclusion: From this prospective clinical study it is revealed that IPP had strong correlation with IPSS.&#x0D; Bangladesh Journal of Urology, Vol. 22, No. 2, July 2019 p.151-154

H-scan, Shear Wave and Bioluminescent Assessment of the Progression of Pancreatic Cancer Metastases in the Liver

The non-invasive quantification of tumor burden and the response to therapies remain an important objective for imaging modalities. To characterize the performance of two newly optimized ultrasound-based analyses, we applied shear wave and H-scan scattering analyses to repeated trans-abdominal ultrasound scans of a murine model of metastatic pancreatic cancer. In addition, bioluminescence measurements were obtained as an alternative reference. The tumor metastases grow aggressively and result in death at approximately 4 wk if untreated, but longer for those treated with chemotherapy. We found that our three imaging methods (shear wave speed, H-scan, bioluminescence) trended toward increasing output measures with time during tumor growth, and these measures were delayed for the group receiving chemotherapy. The relative sensitivity of H-scan tracked closely with bioluminescence measurements, particularly in the early to mid-stages of tumor growth. The correlation between H-scan and bioluminescence was found to be strong, with a Spearman's rank correlation coefficient greater than 0.7 across the entire series. These preliminary results suggest that non-invasive ultrasound imaging analyses are capable of tracking the response of tumor models to therapeutic agents.

Sonographic evaluation of the portal vein diameter in patients with chronic liver disease in northeastern Nigeria.

Chronic liver disease is a public health burden worldwide. Portal hypertension is a major portosystemic abnormality in chronic liver disease. This study aimed to determine the main, right, and the left portal vein diameter in patients with chronic liver disease. A cross-sectional study was carried out at the Abubakar Tafawa Balewa University Teaching Hospital, Bauchi, northeastern Nigeria from December 2018 to September 2019. Ethical clearance was obtained from the institutional review board. A total of 200 subjects were recruited comprising 100 patients with chronic liver disease and 100 age-matched controls, aged 18 years and above. A transabdominal ultrasound scan was carried out measuring the main, right, and left portal vein diameter while lying supine and/or in the right anterior oblique position after overnight fasting, or 6 hours before the scan. Data analysis was done using SPSS version 22.0. Descriptive statistics (mean, standard deviation) and Pearson's correlation were used. There were 106(53%) males and 94(47%) females, aged between 18 and 73 years with a mean age of 46.79 ± 15.43. The main, right, and left portal vein diameter in patients with chronic liver disease was 14.51 ± 0.78 mm, 6.83 ± 0.81 mm, and 6.26 ± 0.74 mm, which were higher than those of their control. The portal vein diameter positively correlated (weak) with age and respiratory phases among participants (P < 0.05). This study found the main, right, and left portal vein diameter among patients with chronic liver disease to be larger than those of the controls. Ultrasonography is a reliable diagnostic tool in evaluating portosystemic pathologies.

Associations between First Trimester Maternal Nutritional Score, Early Markers of Placental Function, and Pregnancy Outcome.

This study investigated the associations between maternal adherence to a healthy diet, first trimester placental markers, and pregnancy outcome. Singleton spontaneous pregnancies were enrolled at 11+0–13+6 gestational weeks in a prospective cohort study. A nutritional score (0–10) measuring the adherence to a healthy diet was calculated. A transabdominal ultrasound scan for placental marker assessment was performed (uterine artery (UtA) doppler, placental volume). Biochemical placental markers were recorded (Pregnancy Associated Plasma Protein A (PAPP-A), free β- Human Chorionic Gonadotropin (HCG)). Birth outcomes were obtained from medical records. Associations between the maternal nutritional score, first trimester placental markers, and pregnancy outcome were investigated by using multi-adjusted general linear models. In total, 112 pregnancies were enrolled with a median nutritional score of 7 (range 3–10). Median gestational age at birth was 277 days (range 203–296). The nutritional score was positively associated with PAPP-A concentrations, whereas a negative association was detected with the UtA mean pulsatility index and placental volume. A positive association was detected between nutritional score and gestational age at birth. This study demonstrates that a first trimester nutritional score as a measure of adherence to a healthy diet is significantly associated with early biochemical and ultrasound markers of placental development, with further association with gestational age at birth.

A prospective study of the role of bladder scanning and post-void residual volume measurement in improving diagnostic accuracy of cauda equina syndrome

Diagnosis of cauda equina syndrome (CES) remains difficult; clinical assessment has low accuracy in reliably predicting MRI compression of the cauda equina (CE). This prospective study tests the usefulness of ultrasound bladder scans as an adjunct for diagnosing CES. A total of 260 patients with suspected CES were referred to a tertiary spinal unit over a 16-month period. All were assessed by Board-eligible spinal surgeons and had transabdominal ultrasound bladder scans for pre- and post-voiding residual (PVR) volume measurements before lumbosacral MRI. The study confirms the low predictive value of 'red flag' symptoms and signs. Of note 'bilateral sciatica' had a sensitivity of 32.4%, and a positive predictive value (PPV) of only 17.2%, and negative predictive value (NPV) 88.3%. Use of a PVR volume of ≥ 200 ml was a demonstrably more accurate test for predicting cauda equina compression on subsequent MRI (p < 0.001). The PVR sensitivity was 94.1%, specificity 66.8%, PPV 29.9% and NPV 98.7%. The PVR allowed risk-stratification with 13% patients deemed 'low-risk' of CES. They had non-urgent MRI scans. None of the latter scans showed any cauda equina compression (p < 0.006) or individuals developed subsequent CES in the intervening period. There were considerable cost-savings associated with the above strategy. This is the largest reported prospective evaluation of suspected CES. Use of the PVR volume ≥ 200 ml was considerably more accurate in predicting CES. It is a useful adjunct to conventional clinical assessment and allows risk-stratification in managing suspected CES. If adopted widely it is less likely incomplete CES would be missed. Cite this article: Bone Joint J 2020;102-B(6):677-682.