Transvaginal Ultrasonography In Patients Research Articles

Uterine Anteroposterior Diameter Measured by Transvaginal Sonography is a Predictor for Dysmenorrhea in Patients With and Without Endometriosis: A Pilot Study.

The aim of this study was to determine the correlation between uterine diameters and menstrual abdominal pain intensity in patients with and without endometriosis (EM), and the independent influence of EM on the pain intensity. Uterine diameters and the diagnosis of adenomyosis were ascertained by transvaginal ultrasonography (TVS). Menstrual abdominal pain intensity was estimated by visual analog scale (VAS). Linear regression was used to figure out the impact of uterine diameters and EM on the VAS scores. Logistic regression was used to calculate the correlation between uterine diameters and the diagnosis of adenomyosis. The cutoff values of uterine anteroposterior diameter (AD) to predict dysmenorrhea (VAS ≥ 4) and the diagnosis of adenomyosis were determined by receiver operating characteristic curves. There were 220 patients with and 233 patients without EM included. Uterine AD independently correlated with the VAS scores in patients with (B=.230, P=.000) and without (B=.203, P=.000) EM. A uterine AD of 39.5 mm predicted dysmenorrhea in both groups. The presence of EM increased the VAS scores by 1.151 points when controlling for uterine diameters. Uterine AD also independently correlated with the diagnosis of adenomyosis under TVS in patients with (OR=1.212, 95% CI=1.130-1.301; P=.000) and without (OR=1.192, 95% CI=1.123-1.263; P=.000) EM. A uterine AD of 38.5 and 39.5 mm predicted the diagnosis of adenomyosis under TVS in patients with and without EM, respectively. Increased uterine AD, which is probably ascribed to adenomyosis, plays an important role in augmented menstrual abdominal pain intensity. Meanwhile, the presence of EM reinforces the pain.

Comparison of complication rates after transvaginal ultrasound-guided oocyte pick-up procedures with respect to ovarian response.

ObjectiveThe aim of this study was to compare the complication rates of oocyte pick-up (OPU) procedures via transvaginal ultrasonography in patients with different levels of ovarian reserve. MethodsIn total, 789 patients who underwent OPU procedures for in vitro fertilization (IVF) were included in the study.ResultsIndividuals with normal ovarian reserve had a 2.947-fold higher risk of complications in OPU procedures than individuals with low ovarian reserve, and individuals with high ovarian reserve had a 7.448-fold higher risk of complications than individuals with low ovarian reserve. In addition, a higher number of IVF trials was associated with an increased risk of complications.ConclusionThe results of this study show that OPU has a higher risk of complications, particularly severe pain, in patients with high ovarian reserve. It is thought that complications can be reduced by preferring mild stimulation in patients with high ovarian reserve. Collecting fewer oocytes is also associated with a lower risk of complications from OPU. Even if a patient’s reserve is very good, fewer and higher-quality oocytes should be targeted with the use of the lowest possible dose of drugs.

Evaluation of the Diagnostic Performance of Physical Examination Combined with Transvaginal Ultrasonography in Patients with Endometriosis

Objective: Owing to its high sensitivity and specificity, and because it is widely available, transvaginal ultrasonography is the first-line imaging test of choice used for the diagnosis of endometriosis. Ultrasonographic findings evaluated in conjunction with symptoms and signs may improve the diagnosis of endometriosis. Therefore, we hypothesized that transvaginal ultrasonography combined with physical examinations performed by physicians could predict endometriosis better in patients with symptoms suggestive of endometriosis compared with asymptomatic patients at presentation.Study Design: In this retrospective cohort study, the first subjective impression obtained from the history, physical examination, and transvaginal ultrasonography performed by the physician during the first visit in the outpatient clinic was taken into consideration. Patients who underwent surgery with the indication of ovarian mass were divided into two groups according to their admission types; symptomatic and asymptomatic.Results: The number of patients reported to have endometriosis histopathologically was 138;132 were in the premenopausal period (symptomatic group n=101, asymptomatic group n=31) and 6 were in the postmenopausal period (symptomatic group n=1, asymptomatic group n=5). The positive predictive value and positive likelihood ratio of the combination of pelvic examination and transvaginal ultrasonography in premenopausal symptomatic and asymptomatic patients, and postmenopausal symptomatic and asymptomatic patients were 97.8%, 11.5; 47.3%, 6.9; 25.0%, 4.6; and 11.1%, 2.3, respectively.Conclusion: The diagnostic performance of transvaginal ultrasonography in combination with physical examination in patients with asymptomatic endometriosis cannot reach the diagnostic accuracy of physical examination combined with transvaginal ultrasonography in patients with endometriosis who present with symptoms.

Evaluation of the Diagnostic Performance of Physical Examination Combined with Transvaginal Ultrasonography in Patients with Endometriosis

<p><strong>Objective:</strong> Owing to its high sensitivity and specificity, and because it is widely available, transvaginal ultrasonography is the first-line imaging test of choice used for the diagnosis of endometriosis. Ultrasonographic findings evaluated in conjunction with symptoms and signs may improve the diagnosis of endometriosis. Therefore, we hypothesized that transvaginal ultrasonography combined with physical examinations performed by physicians could predict endometriosis better in patients with symptoms suggestive of endometriosis compared with asymptomatic patients at presentation.</p><p><strong>Study Design:</strong> In this retrospective cohort study, the first subjective impression obtained from the history, physical examination, and transvaginal ultrasonography performed by the physician during the first visit in the outpatient clinic was taken into consideration. Patients who underwent surgery with the indication of ovarian mass were divided into two groups according to their admission types; symptomatic and asymptomatic.</p><p><strong>Results:</strong> The number of patients reported to have endometriosis histopathologically was 138;132 were in the premenopausal period (symptomatic group n=101, asymptomatic group n=31) and 6 were in the postmenopausal period (symptomatic group n=1, asymptomatic group n=5). The positive predictive value and positive likelihood ratio of the combination of pelvic examination and transvaginal ultrasonography in premenopausal symptomatic and asymptomatic patients, and postmenopausal symptomatic and asymptomatic patients were 97.8%, 11.5; 47.3%, 6.9; 25.0%, 4.6; and 11.1%, 2.3, respectively.</p><p><strong>Conclusion:</strong> The diagnostic performance of transvaginal ultrasonography in combination with physical examination in patients with asymptomatic endometriosis cannot reach the diagnostic accuracy of physical examination combined with transvaginal ultrasonography in patients with endometriosis who present with symptoms.</p>

The Diagnostic accuracy of transvaginal ultrasonography, magnetic resonance imaging and diffusion weighted image in female patients with endometrial carcinoma

Aim of workTo evaluate the efficacy of transvaginal ultrasonography (TVUS), magnetic resonance imaging (MRI) and diffusion weighted imaging (DWI) in presurgical staging of endometrial cancer. MethodologyThis work included 35 female patients. Thirty patients were diagnosed to have endometrial carcinoma. ResultsThe sensitivity, specificity, predictive values, accuracy of transvaginal ultrasound in detection of invasion of myometrial cavity were 67.25%, 75.0%, 90.00%, 30.00% and in distant metastasis were 77.78%, 80.95%, 63.64%, 89.47% and %80. These variables for MRI were 88.89%, 100.0%, 100%, 66.67% and 91% in myometrial invasion and in distant metastasis were 100.0%, 100.0%, 100.0%, 100% and 100.0%. There was an inversely proportional relationship between ADC values and the tumor grading. Apparent diffusion coefficient (ADC) magnitude of 0.77 ± 0.21 × 10−3 mm2/s was associated with endometrial cancer while normal endometrial cavity showed ADC value of 1.31 ± 0.11 × 10−3 mm2/s). ConclusionConventional MRI, diffusion weighted imaging and contrast enhanced MR images are superior to TVUS in patients with endometrial cancer and ADC values help to differentiate between normal and endometrial cancer which may replace MR contrast enhanced images.

Retrospective Evaluation of Endometrial Thickness Measurement with Transvaginal Ultrasonography in Patients with Postmenopausal Hemorrhage and the Relationship to the Results of Histopathology

Retrospective Evaluation of Endometrial Thickness Measurement with Transvaginal Ultrasonography in Patients with Postmenopausal Hemorrhage and the Relationship to the Results of Histopathology

Uterine junctional zone at three-dimensional transvaginal ultrasonography in patients with recurrent miscarriage: a new diagnostic tool?

ObjectiveTo evaluate the characteristics of the uterine junctional zone (JZ) by three-dimensional (3D) transvaginal sonography (TVS) in women with recurrent miscarriage (RM) as compared to normal fertile controls. Study designThe thickness and the morphology of the JZ were evaluated in 75 women with a history of RM due to different causes and in 20 fertile women without a history of miscarriages or pelvic disease. All patients included in the study were selected among those who attended the outpatient clinic of “Tor Vergata” University. The JZ characteristics were evaluated in the midluteal phase of the cycle on the uterine coronal section obtained by 3D TVS. ResultsPatients with RM showed a JZ maximum thickness significantly increased when compared to that observed in control group (5.8±0.7 vs. 5.0±1.1mm). When grouped according to the different causes of RM, all groups of patients with RM showed an increased JZ thickness when compared to fertile women, with the exception of those with anti-phospholipid antibody syndrome, probably due to the small number of cases with this pathology. ConclusionsA thickened JZ could be an independent indicator of the risk of miscarriage and may represent an important contributing factor to some causes of RM. These observations may offer new perspectives for the screening and treatment of patients with RM. Although further studies are needed to ascertain if the reduction of the JZ thickness can determine a better pregnancy outcome, 3D TVS evaluation of the JZ could provide the opportunity to identify women in which appropriate therapeutic protocols can improve the possibility of successful pregnancy.

Transvaginal ultrasonography is the diagnostic method for evaluation of abnormal uterine bleeding

Objective: The objective of this study is to assess the utility of transvaginal ultrasonography in patients presenting abnormal uterine bleeding Materials and methods: Between July 2000 to December 2000, 50 patients underwent transvaginal sonography (TVS) for abnormal uterine bleeding. All patients had transvaginal sonography before histopathology. On TVS, the sonographic appearance of the endometrium was classified according to the following parameters: normal or abnormal thickness, homogeneous or heterogeneous echogenicity, bulbous contour, discontinuous, or obscured. A comparison was performed between TVS with histopathology. Results: The most common causes for the abnormal uterine bleeding were leiomyoma in TVS (42.0%). Other causes were dysfunctional uterine bleeding (28.0%). adenomyosis (6.0%), endometrial polyp (4.0%), thin atrophic endometrium (8.0%), endometrial hyperplasia (8.0%), and endometrial carcinoma (4.0%). After histopathologic evaluation 40.0% patients had leiomyoma, 24.0% DUB, 10.0% adenomyosis, 8.0% endometrial polyp, 8.0% thin atrophic endometrium, 6.0% endometrial carcinoma and 4.0% endometrial hyperplasia. Comparing the TVS with histopathologic findings, TVS had a sensitivity of 94.3%, specificity of 80.0%. accuracy of 90.0%, PPV of 91.6% and NPV of 85.7%. Conclusion: TVS is an easy, safe, rapid and tolerable procedure. It has an excellent diagnostic accuracy in the diagnosis of uterine pathology responsible for abnormal uterine bleeding. Abbreviation: TVS transvaginal sonography; AUB abnormal uterine bleeding; DUB dysfunctional uterine bleeding, PPV positive predictive value, NPV Negative predictive value. DOI: http://dx.doi.org/10.3329/jssmc.v1i1.12168 Journal of Shaheed Suhrawardy Medical College Vol.1, No.1, December 2009 p.11-13

Diagnóstico do parto pré-termo pela medida ultrassonográfica do comprimento do colo uterino

OBJETIVO: Medir o comprimento do colo uterino, utilizando a ultrassonografia transvaginal, em pacientes com quadro clínico compatível com ameaça de parto pré-termo, e correlacionar a medida do colo uterino, em cada caso, com a interrupção espontânea da gravidez dentro de sete dias. MATERIAIS E MÉTODOS: Foram realizados exames ultrassonográficos em 72 pacientes com quadro clínico compatível com ameaça de parto pré-termo. RESULTADOS: A sensibilidade do exame foi de 90,5%, a especificidade, de 98%, o valor preditivo positivo, de 95%, e o valor preditivo negativo, de 96%. A análise foi realizada utilizando-se a medida de 15 mm de comprimento do colo uterino como valor preditivo do parto pré-termo. CONCLUSÃO: Parece ser possível prever o parto pré-termo em pacientes com colo uterino menor que 15 mm. Tal observação poderá trazer contribuição para a administração mais oportuna de corticoides, com o intuito de acelerar a maturidade pulmonar fetal.

OC24: The role of magnetic resonance imaging and transvaginal ultrasonography in patients with an adnexal mass and chronic pelvic pain or infertility

Objectives: Previously we showed that sonovaginography is an accurate ultrasonographic tool in the assessment of rectovaginal endometriosis. The aim of this study was to compare the diagnostic accuracy of sonovaginography and NMR in the diagnosis of rectovaginal endometriosis. Methods: This was a longitudinal prospective study in which 28 women with rectovaginal endometriosis suspected from the medical history and/or pelvic examination were enrolled. The study group underwent transvaginal ultrasonography and sonovaginography was performed in the same session as follows: an assistant inserted a Foley catheter into the vagina and an ultrasound probe covered with a specific balloon to swell the vagina. The balloon was filled with water (mean 40 mL) and soon after 60–180 mL saline solution was inserted through the Foley catheter to fill the vagina in order to create an acoustic window through the vagina to detect rectovaginal lesions. Within a mean of 30 days after the examination patients were scheduled for pelvic NMR. Once all the diagnostic tests had been performed, patients underwent laparoscopic surgery to enucleate the endometriotic lesion, which was sent for pathological examination. Results: Twenty-three (82.1%) patients had rectovaginal endometriotic lesions. The sensitivity of sonovaginography was 91.7%, specificity 75%, PPV 95.6% and NPV 60%; the area under the receiver-operating characteristic (ROC) curve was 0.87. In comparison, NMR had a sensitivity of 73.9%, specificity 60%, PPV 89.5% and NPV 33.3%, with an area under the ROC curve of 0.67. The procedure was well tolerated with a median visual analogue scale score of 2 (range, 0–8). Conclusions: Sonovaginography is a well tolerated procedure, with higher accuracy than NMR in the detection of rectovaginal endometriosis.

Abnormalities detected on transvaginal ultrasonography in tamoxifen-treated postmenopausal breast cancer patients may represent endometrial cystic atrophy

OBJECTIVE: This study was conducted to examine the histopathologic changes in tamoxifen-treated postmenopausal patients with endometrial thickness ≥5 mm with transvaginal ultrasonography. STUDY DESIGN: Thirty-five tamoxifen-treated postmenopausal breast cancer patients underwent transvaginal pelvic ultrasonography with endometrial thickness ≥5 mm followed by either curettage-hysteroscopy ( n = 24), or hysterectomy ( n = 11). Endometrial histopathologic findings were examined. RESULTS: Overall, endometrial polyps were the most common histopathologic finding (23 of 35 patients). Endometrial cystic atrophy was uncommonly detected in patients undergoing curettage-hysteroscopy (1 of 24 patients) compared with patients undergoing hysterectomy (9 of 11 patients). No cases of endometrial cancer or hyperplasia were detected. CONCLUSIONS: Endometrial polyps were a frequent finding in tamoxifen-treated postmenopausal women who had endometrial thickness ≥5 mm with the use of transvaginal ultrasonography. Endometrial cystic atrophy may explain “thickened endometrium” on transvaginal ultrasonography in this patient population with no evidence of endometrial polyps, hyperplasia, or adenocarcinoma after surgical evaluation. (Am J Obstet Gynecol 1998;178:1145-50.)

Normal intrauterine pregnancy is unlikely in emergency department patients with either menstrual days > 38 days or beta-hCG > 3,000 mIU/mL, but without a gestational sac on ultrasonography.

To determine whether the absence of a gestational sac on transvaginal ultrasonography in patients with a quantitative beta-human chorionic gonadotropin (beta-hCG) > 3,000 mIU/mL and/or menstrual days > 38 excludes the diagnosis of a normal intrauterine pregnancy (IUP). A retrospective analysis was performed of ED patients evaluated from August 1991 to December 1994 at an urban teaching hospital. Patients presented with abdominal pain and/or vaginal bleeding and had a positive serum beta-hCG test. Patients who had transvaginal ultrasonographies performed during the ED visit that were read as indeterminate were reviewed. Menstrual days were determined by subtracting the date of the last normal menstrual period (LMP) from the ED visit date. ED beta-hCGs were quantified. Patients were excluded if the LMP or quantitative beta-hCG result was not available or if the final diagnosis could not be definitively determined. 248 patients met eligibility criteria; of these, 54 were excluded. Therefore, 194 patients were enrolled. Menstrual days ranged from 5 to 151, with a median of 54 days. Of 143 patients with menstrual days > 38 and no gestational sac by ultrasonography, only 4 (2.8%) had a final diagnosis of normal IUP. The menstrual days for the 4 normal IUPs were 39, 41, 42, and 59 days. beta-hCGs ranged from 19 to 151,926 mIU/mL, with a median of 2,410 mIU/mL. None of the 74 patients with a beta-hCG > 3,000 mIU/mL and no gestational sac by ultrasonography had a final diagnosis of normal IUP. In patients with either a beta-hCG > 3,000 mIU/mL or menstrual days > 38 and no gestational sac by transvaginal ultrasonography, the likelihood of a normal IUP is low.

Transvaginal ultrasonography in patients at risk for ectopic pregnancy

Transvaginal ultrasonography was performed in 139 patients at risk for ectopic pregnancy. Among these patients, 22 ectopic pregnancies and 117 intrauterine pregnancies were eventually confirmed. Transvaginal ultrasonography definitively identified 18 of 22 (82%) ectopic pregnancies at initial evaluation by either direct visualization of an ectopically placed gestational sac ( N = 14) or failure to visualize an intrauterine gestational sac combined with a level of the β-subunit of human chorionic gonadotropin >1300 mlU/ml (First International Reference Preparation) ( N = 4). Transvaginal ultrasonography definitively diagnosed 103 of 117 (88%) intrauterine pregnancies at initial evaluation. Eighteen patients could not be definitively diagnosed by transvaginal ultrasonography at initial evaluation because nonvisualization of a gestational sac and a β-subunit of human chorionic gonadotropin value <1300 mlU/ml. Evaluation of this group with serial measurements of β-subunit of human chorionic gonadotropin, repeat ultrasonography, or both, revealed ectopic gestation ( N = 4), early intrauterine pregnancy ( N = 4), and complete abortion ( N = 10).