Transvaginal Ultrasound Research Articles

Evaluation of Endometrial Thickness by Transvaginal Sonography in Postmenopausal Women with Bleeding: A Cross-sectional Study

Introduction: Abnormal Uterine Bleeding (AUB), occurring atleast one year after menopause, is one of the most concerning complaints among gynaecological patients. Endometrial atrophy is the most common endometrial finding in women with Postmenopausal Bleeding (PMB), approximately 10-15% of whom have endometrial carcinoma. Earlier studies suggested that obesity, Type 2 diabetes mellitus, and hypertension are risk factors for endometrial hyperplasia. Diabetes mellitus, obesity, and hypertension form the triad of endometrial cancer. Aim: To assess endometrial thickness by Transvaginal Sonography (TVS) and compare it with histopathological findings in women with PMB, evaluating whether an endometrial thickness of <4 mm on TVS is more suggestive of malignancy. Materials and Methods: The present cross-sectional study was conducted in the Department of Obstetrics and Gynaecology at King George Hospital, Vishakapatnam, Andhra Pradesh, India, from January 2022 to December 2022, comprising n=100 subjects. After routine necessary investigations for PMB, a transvaginal ultrasound examination was carried out to calculate endometrial thickness and compare it with the results of histopathological diagnosis of the endometrium. The parameters assessed were endometrial thickness and appearance, Type 2 Diabetes Mellitus (T2DM), hypertension, and Body Mass Index (BMI). The data was compiled and compared using the Chi-square test, with a p-value of ≤0.05 considered highly significant. Results: The results showed normal atrophic and thickened endometrium in 36% of subjects each, and abnormal endometrium such as hyperplasia, carcinoma, and polyps were recorded in 14%, 8%, and 6% (n=6) of cases, respectively. The histopathological results showed normal endometrium such as atrophic, secretory, and proliferative endometrium in 49%, 6%, and 19% of subjects, respectively. Abnormal endometrial findings such as endometrial hyperplasia, carcinoma, and polyps were observed in 14%, 7%, and 5% of cases, respectively. The majority of cases (58%) had endometrial thickness ≤4 mm, followed by 36% of cases with 5-10 mm and 6% of cases >11 mm, with mean and Standard Deviation (SD) values of 5.8±3. mm Statistical analysis data on the association between TVS findings and Histopathological Examination (HPE) findings was observed to be statistically significant (p<0.001). A statistically significant association was observed between T2DM, and BMI >25 kg/m2 together, DM+hypertension+BMI (Triad) and endometrial thickness, respectively. Conclusion: The TVS is easy, simple, non invasive, and involves no complications. Therefore, it can be used as the first diagnostic step in the investigations of women with PMB, combined with histopathological assessment.

A new method that facilitates the diagnosis of endometrial cancer: the ratio of endometrial thickness to the full thickness of the uterine wall and subcutaneous adipose tissue measurements.

The aim of the present study was to investigate the association between some risk factors and endometrial pathologies determined by transvaginal sonography (TVS), as well as the diagnostic predictive values of serum oestradiol (E2) levels, subcutaneous adipose tissue (SAT) thickness, endometrium thickness (ET), and the ratio of ET to uterine wall full thickness (UWT) in differential diagnosis of malignant, precancerous, and benign pathologies of endometrium in patients with postmenopausal bleeding (PMB) or with asymptomatic increased endometrial thickness. The study was conducted with 211 women who applied to the hospital with complaints of PMB or ET of 5 mm or more in their routine controls. Venous blood samples were taken for complete blood count and the measurement of E2 levels. Patients also underwent TVS; ET, UWT, and the ratio of ET to UWT were measured. Menopausal age and body mass index averages were significantly higher in atypical hyperplasia and endometrial cancer (EC) groups. Endometrial thickness and endometrial thickness/uterine wall full thickness ratio measured by TVS were significantly higher in all precancerous pathologies and EC. Subcutaneous adipose tissue thickness was significantly higher in all precancerous pathologies and EC. Oestradiol levels were higher in the atypical hyperplasia and EC groups. Postmenopausal bleeding is a common symptom of EC, but in some cases this disease may occur asymptomatically. Measurement of the endometrium thickness, and the ratio of endometrium thickness/uterine wall full thickness and SAT thickness by sonography has a high predictive value for this disease.

Successful Management of Spontaneous Unilateral Twin Ectopic Pregnancy With Two‐Step Dose of Methotrexate

The incidence of unilateral tubal twin pregnancy is 1/20,000–1/250,000 with about 100 reported cases. Four of the six cases that were medically managed were successful. A 24‐year‐old female presented to the emergency department (ED) with vaginal bleeding and abdominal cramping. She was hemodynamically stable without signs of an acute abdomen. Laboratory evaluation revealed she was pregnant with a serum beta‐human chorionic gonadotropin (b‐hCG) of 798 mIU/mL. Transvaginal ultrasound (TVUS) revealed a single left tubal pregnancy with a yolk sac. The patient elected medical management with body surface area (BSA)–based intramuscular (IM) methotrexate (MTX). On Day 4, the patient returned to the ED; her b‐hCG was 727 mIU/mL. TVUS revealed twin left tubal pregnancies with yolk sacs and fetal poles without cardiac activity. The patient elected to continue medical management with a second dose of BSA‐based IM MTX. On Day 6, the patient returned to the ED with abdominal and rectal pain. She was hemodynamically stable without signs of an acute abdomen. Her b‐hCG was 533 mIU/mL. TVUS showed persistent twin left tubal pregnancies—one at 5 weeks gestational age and the other at 6 weeks gestational age—without evidence of rupture. The patient continued serial b‐hCGs. Thirty‐one days after the first dose of MTX, her b‐hCG was < 1 mIU/mL. TVUS showed resolution of tubal pregnancies. The patient consented to the publication of this case report. This case documents the successful treatment of spontaneous, unilateral tubal twin pregnancies with two‐step dosing of IM MTX.

Detection of uterine abnormalities using three-dimensional vaginal ultrasound in infertile women undergoing assisted reproductive techniques

Abstract Background: Uterine shape and cavity abnormalities form a common cause of subfertility, for which thorough assessment is considered as a core part in infertility evaluation. A variety of modalities (invasive and none invasive) such as hysterosalpingography, transvaginal sonography, diagnostic hysteroscopy, two-dimensional hysterosonography, and three-dimensional hysterosonography can be used for the diagnosis of uterine abnormalities. Objectives: To address the detection rate of uterine and endometrial abnormalities in infertile women undergoing assisted reproductive techniques (ART) using three-dimensional vaginal ultrasonography. Materials and Methods: A cross-sectional observational study that involved 211 subfertile women who were arranged to undergo ART for different causes of infertility. After taking their verbal consent for participation in this study, all women examined by 2D vaginal U/S for initial assessment of their pelvic anatomy then followed by three-dimensional U/S with or without saline infusion for further assessment of the uterine and endometrial cavity morphology. Women with ultrasound detected endometrial abnormalities further underwent hysteroscopic assessment, histopathological specimens were taken and were treated as recommended by their gynecologist. Results: Twenty-two percent of the studied group discovered to have uterine and/or endometrial abnormalities including endometrial polyps and uterine myomas are the most commonly detected abnormalities while congenital uterine malformation detected in 3.8% of the total patients using three-dimensional ultrasonography. Conclusion: Uterine and endometrial abnormalities are common in subfertile patients, the prevalence of uterine and endometrial abnormalities (endometrial polyps or irregularities, uterine myomas including submucous one) was 22%, whereas congenitally maldeveloped uteri were detected in 3.8% of women undergoing ART (using 3D U/S) which may have a negative impact on ART outcome.

Assessment of Cesarean Niche by Transvaginal Ultrasonography and Pelvic Magnetic Resonance Imaging

Assessment of Cesarean Niche by Transvaginal Ultrasonography and Pelvic Magnetic Resonance Imaging

A randomized clinical trial of transdermal (gel) versus oral estrogen for endometrial preparation in frozen embryo transfer cycle.

The aim of this study was to compare endometrial thickness with the use of transdermal estrogen (gel) versus oral estrogen (pills) for endometrial preparation in the frozen embryo transfer cycle and serum estrogen concentrations during the preparation cycle, side effects, and chemical and clinical pregnancy rates. This was a prospective, randomized controlled trial of women undergoing endometrial preparation for cryopreserved blastocyst transfer. A total of 88 women were randomized, of which 82 completed the study protocol. Of this group, 44 received 6 mg/day of estradiol valerate orally (pills group) and 38 received 4.5 mg/day of estradiol hemihydrate transdermally (gel group). Endometrial thickness was measured using transvaginal ultrasound between the 7 and 10th day of the cycle. Serum estradiol concentrations were measured on the day of initiating the cycle, on control transvaginal ultrasounds, and on the day of embryo transfer. Side effects were documented at each study visit. p<0.05 were adopted as statistically significant. The groups were compared using Student's t-test for continuous variables and chi-square or Fisher's exact test for categorical variables. There were no significant group differences (p>0.05) in endometrial thickness, biochemical and clinical pregnancy rates, miscarriage rate, blood estradiol concentrations, duration of estradiol administration, or cycle cancellation rates. Endometrial preparation with transdermal estrogen yielded similar reproductive outcomes to oral estrogen with fewer side effects.

Bladder perivascular epithelioid cell neoplasm: Review on clinical features of this rare tumor.

Perivascular epithelioid cell neoplasm (PEComa) is a rare mesenchymal tumor composed of histologically and immunohistochemically distinctive perivascular epithelioid cells. They can arise in various localizations such as the bladder. A total of 36 case reports regarding bladder PEComa have been described in the literature. Eleven reviews regarding this tumor have been published in literature so far primarily focusing on anatomic pathology. Through these reviews, it is known that in bladder PEComa, the melanocytic marker Human Melanoma Black-45 is expressed in 100% of cases whereas variable expression can be seen in multiple other melanocytic and myoid markers such as smooth muscle actin, Melan-A, CD117, S100, CD31, and CD34. Since current reviews mainly emphasize anatomic pathology, we perform a review focusing on the clinical aspects of PEComa at the level of the clinician. A manual electronic search of the PubMed/Medline and Web of Science Core Collection databases was conducted. Search was done on (perivascular epithelioid cell neoplasms [MeSH terms]) AND (Bladder). All case reports and reviews were encompassed until March 15, 2023, to identify studies that assessed bladder PEComa. The age of presentation is relatively low with a median age of 37 years. There is a female predominance with a female/male ratio of 1.5. The tumor shows no preference in anatomical localization within the bladder. Even involvement of the bladder neck, proximal urethra, and distal ureter has been described. The clinical presentation consists in the majority of patients of symptoms related to the urinary tract such as hematuria, dysuria, passage of urine sediment, frequency, and urgency. Other symptoms include abdominal discomfort and dysmenorrhea. In clinical examination, an abdominal mass can be found based on the size and location of the tumor. Further examination usually encompasses cystoscopy due to the hematuria and radiological investigations such as ultrasound (US), computed tomography, and magnetic resonance imaging. These radiological investigations reveal a heterogeneous solid mass with clear borders. In our center, we performed a transvaginal US additionally in a patient with bladder PEComa, which was the only investigation in our patient that concluded the mass was located in the Retzius space. For treatment, transurethral resection of the bladder tumor and partial cystectomy were both described in equal numbers. The choice of treatment depends on the localization and size of the tumor. Follow-up consists of imaging, but clear guidelines on this matter are lacking. Bladder PEComa is a rare condition and usually presents itself with nonspecific symptoms. Radiological investigations will reveal the tumor, but the final diagnosis is based on cytological and immunohistochemical features. Since bladder PEComa is an entity with uncertain malignant potential, it is important to include this entity in the differential diagnosis when a patient presents with lower abdominal discomfort and lower urinary tract symptoms in combination with a mass in the pelvic region.

A Novel Approach for Conservative Management of Placenta Accreta Spectrum Disorder Cases: Experience of a Single Surgeon: PAS Disorders and Conservative Management.

Background: This study is aimed at evaluating the conservative surgical treatment of patients with placenta accreta spectrum (PAS) disorder and at presenting the experience of a single surgeon. Materials and Methods: This retrospective study included 245 patients with placenta previa accompanied by PAS disorders operated at a university hospital between June 2013 and December 2023. The diagnosis of PAS was made by a single perinatologist using a combination of transvaginal and transabdominal ultrasonography. All patients were operated with conservative surgical technique by the same surgeon. The demographic and clinical characteristics of the patients, the anesthesia and incision types used, and the details of the surgical technique were evaluated. Results: Of the patients, 165 were operated on at the scheduled time, 80 were operated on under emergency conditions, and 232 (94.69%) of them were operated on under spinal anesthesia. All patients were operated on with a Pfannenstiel incision followed by a transverse incision to the upper border of the placenta to enter into the uterus. An average of 0.52 units of red blood cells per patient was transfused to all patients. Spontaneous intra-abdominal bleeding developed in five patients, and surgical complications occurred in eight patients. No cesarean hysterectomy was performed, and no maternal mortality was detected in any of the cases. The mean time duration of surgery was 54.44 ± 11.37 (30-90) min, and the mean length of hospital stay was 1.71 ± 1.30 (1-9) days. Conclusions: We recommend this procedure as a novel technique and a robust and safe alternative to peripartum hysterectomy and other conservative surgical management procedures for cases with complete PP accompanied with PAS. This technique preserves the uterus as well as reduces blood loss, and transfusion requirement, and thus maternal morbidity and mortality in PAS cases.

Comparative Study Between Three-Dimensional Transvaginal Ultrasonography and Hysteroscopy In The Diagnosis Of Uterine Cavity Abnormalities In Infertile Women

Comparative Study Between Three-Dimensional Transvaginal Ultrasonography and Hysteroscopy In The Diagnosis Of Uterine Cavity Abnormalities In Infertile Women

Diagnostic Validity of Transvaginal Ultrasonography in Evaluation of Abnormal Uterine Bleeding in Perimenopausal Women and Its Histopathological Correlation: A Descriptive Observational Study from a Tertiary Hospital, Kalaburagi

Diagnostic Validity of Transvaginal Ultrasonography in Evaluation of Abnormal Uterine Bleeding in Perimenopausal Women and Its Histopathological Correlation: A Descriptive Observational Study from a Tertiary Hospital, Kalaburagi

Factors associated with oocyte recovery rates during in-vitro fertilization among Nigerian women.

the availability of oocytes is fundamental to in vitro fertilization (IVF). The factors associated with optimal or suboptimal oocyte recovery rates (ORR) in low-resource settings are not well known. This study aimed to determine the factors associated with ORR by comparing demographic and IVF cycle data of women undergoing IVF in our Centre. this was a prospective study of 110 infertile women undergoing IVF at Nisa Premier Hospital, Abuja Nigeria, from October 2020 to September 2021. All women had reached the stage of oocyte retrieval or further, after receiving ovarian stimulation with our routine protocols. Treatment was monitored by serial transvaginal ultrasonography. The oocyte retrieval procedures were performed under conscious sedation, 36 hours after the ovulatory trigger. Optimal ORR was when eggs were obtained from at least 80% of follicles punctured. Sub-optimal ORR was when it was less than 80%. Data analyses utilized SPSS statistical software and a p-value of < 0.05 was considered significant. the mean age of all women was 34.1±4.9 years. Sixty-nine women (62.7%) had sub-optimal ORR while 41 (37.3%) had optimal ORR. Six women (5.5%) had no oocytes retrieved. Significantly more women with sub-optimal ORR were obese (70.6 vs 29.4%) and had higher follicle-stimulating hormone (FSH) levels (8.11 vs 6.34 miu/ml), p-value- 0.039. Women with sub-optimal ORR had higher mean prolactin levels (17.10 ± 13.93 miu/ml) than women with optimal ORR 11.43 ± 6.65 miu/ml), p-value- 0.019). Significantly more oocytes (5.99 vs 10.37, p-value 0.001), and MII oocytes (5.78 vs 7.56, p-value 0.035) were retrieved in women with optimal than sub-optimal ORR. The duration of stimulation, total amounts of gonadotropins administered, and fertilized oocytes were not significantly different among both groups (p-value >0.05). this study has shown the factors associated with ORR in our setting to be basal FSH, prolactin, and obesity.

A A retrospective observational study in assesment of role of sonography in adnexal masses and its histopathological correlation in tertiary care centre.

Background- Adnexal masses (masses of the ovary, fallopian tube, or surrounding tissues) commonly are encountered by obstetrician–gynaecologist and often present diagnostic and management dilemmas. Types of adnexal mass ranges from benign ovarian and non-ovarian to primary and secondary malignant ovarian masses. Although most adnexal masses are benign, the main goal of the diagnostic evaluation is to exclude malignancy. Transvaginal ultrasonography remains the gold standard for evaluation of adnexal masses. The management of the adnexal masses varies according to age at presentation, whether benign or malignant, acute emergency or chronic presentation. Aim- The study aimed to determine the causes of adnexal masses and correlation of ultrasonographic and histopathologic findings of the adnexal masses. Methods- This is a retrospective observational study, performed in the Department of Obstetrics and Gynaecology, in tertiary care hospital. Operative and demographic details of patients operated for adnexal masses over a period of one year was obtained from case records of patient. Results- Among 90 cases studied, 86.66%(78) cases of adnexal masses was of ovarian origin followed by 11.66%(7) was of tubal origin. Among 90 cases of adnexal masses, 91.11%(82) cases were benign , 4.44%(4) were of borderline and malignant. Most common ovarian cause of adnexal mass was endometriotic cyst(22.22%) followed by serous cyst adenoma(20%) The highest sensitivity was found for follicular cyst (87.5%) followed by dermoid and serous cyst adenoma (83.33%). Malignancy was found in 8 cases among which 6 were correctly reported by USG resulting in sensitivity of 75%. Conclusion- It was concluded from the current study findings that sonography was primary modality and best screening tool for evaluation of pelvic masses. Ultrasound has high sensitivity for correctly diagnosing benign versus malignant pelvic lesions. Sonography was observed to be best modality to differentiate between solid and cystic pelvic masses.

Conservative Management of Ectopic Pregnancy Following Depot Medroxyprogesterone Acetate Injection: A Case Report

Objectives: Ectopic pregnancy is the most common cause of maternal mortality in the first trimester of pregnancy. The use of progesterone-containing contraceptives is a risk factor for ectopic pregnancy. This study reports a rare case of ectopic pregnancy following a depot medroxyprogesterone acetate (DMPA) injection that was managed conservatively. Case Presentation: A 36-year-old woman (gravida 2) was referred to the Gynecology Clinic of the Persian Gulf Hospital, Bandar Abbas, Iran with a history of amenorrhea, vague pelvic pain, and no past medical history, except for DMPA injection, three months before the symptoms. Ectopic pregnancy was determined based on ultrasonography and beta-human chorionic gonadotropin (BHCG) evaluation. The patient was managed conservatively with serial ultrasonography and BHCG titration due to normal laboratory tests, stable clinical status, and a decline in BHCG titration. Conclusion: Amenorrhea and pelvic pain in all women of childbearing age should be considered an alarming sign of ectopic pregnancy. In case of stable hemodynamic status, the patient can be conservatively managed with serial trans-vaginal ultrasonography and evaluation of serum BHCG till the resolution of symptoms.

Reliability Of Transvaginal Ultrasound Measured Endometrial Thickness In Diagnosis Of Endometrial Cancer In Postmenopausal Women

Abstract Objective: Dilatation and curettage have been replaced by ultrasound measurement of uterine endometrial thickness (ET) especially by Transvaginal ultrasound (TVS) as a first step in the workup of women with postmenopausal bleeding for many years. Still, there is no unanimity for endometrial thickness cut-off value to define abnormality. We used an endometrial thickness of 4mm as a cut-off value in this study. Methods: This cross-sectional validation study included 120 patients who presented with postmenopausal bleeding in OPD of POF hospital from 01-12-2017 to 1-06-2018.TVS measured endometrial thickness ≥4mm was assumed positive for malignancy and ˂ 4 mm was taken negative for malignancy. The TVS findings of patients were compared with the histopathology report of endometrial sampling, which was performed in OPD by manual vacuum aspirator (MVA). Histopathology report was taken as a reference standard to confirm or refute the diagnosis of transvaginal ultrasound. Results: On TVS, 54 patients had ≥ 4mm endometrial thickness (taken positive for malignancy) while 66 patients had &lt;4 mm endometrial thickness (taken negative for malignancy). Histopathology of the endometrium (reference standard) revealed that 47 (39.17%) patients had malignancy and 73(60.83%) patients did not have malignancy. The reliability of transvaginal ultrasound (TVS) using 4mm cut-off point ET in detecting endometrial malignancy in patients presenting with uterine bleeding after menopause, keeping histopathological findings as a reference standard showed 89.36% sensitivity, 83.56%, specificity, 92.42% negative predictive value and 77.78% positive predictive value &amp; 85.83% accuracy rate. Conclusion: We concluded that there was a low probability of endometrial malignancy in women with ˂ 4 mm transvaginal ultrasound (TVS)measured endometrial thickness (ET).TVS may replace invasive endometrial sampling in cases of postmenopausal bleeding with ˂ 4mm ET.

SALINE INFUSION SONOGRAPHY: A VALID TOOL FOR DETECTION OF INTRAUTERINE PATHOLOGY IN WOMEN WITH ABNORMAL UTERINE BLEEDING

ABSTRACT:&#x0D; OBJECTIVE:&#x0D; To evaluate the diagnostic accuracy of transvaginal ultrasound and saline infusion sonography for the detection of intra-cavity lesions of uterus using histopathology on hysterectomy specimens as the gold standard.&#x0D; STUDY DESIGN:&#x0D; Cross-sectional (validation) study.&#x0D; Place &amp; duration of study:&#x0D; Department of obstetrics &amp; gynecology, Madina Teaching Hospital, Faisalabad from January 18, 2022 to September 30, 2022.&#x0D; METHODOLOGY:&#x0D; Sixty patients with abnormal uterine bleeding and postmenopausal bleeding were included in the study. All participants were evaluated by transvaginal ultrasound (TVS) and saline infusion sonography (SIS) to detect uterine cavity pathologies. The findings at TVS and SIS were compared with the findings of histopathology on hysterectomy specimens. Sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy were calculated.&#x0D; RESULTS:&#x0D; Mean age was 49.68±5.9 years. Polyps, proliferative endometrium, endometrial hyperplasia and sub mucous fibroid are noted in 32 (53.3%), 16 (26.7%), 3 (5%) and 9 (15%) patients, Sensitivity, specificity, PPV, NPV and diagnostic accuracy of TVS are 61.36%, 100%, 100%, 48.48% and 71.67% and for SIS are 88.64%, 100%, 100%, 76.19% and 91.67% respectively.&#x0D; CONCLUSION:&#x0D; SIS is highly sensitive and specific investigation to detect intra-cavity abnormalities of uterus. SIS can be used as an alternative investigation tool in low resource settings whenever hysteroscopy in not readily available.&#x0D; KEY WORDS: Uterine cavity lesions, sensitivity, specificity, saline infusion sonography&#x0D; &#x0D;

The relationship of preterm birth with fetal fibronectin level in cervicovaginal fluid and cervical lenght in ultrasonography

Objective: In this study, the compatibility between fetal fibronectin determination and the use of cervical length measured by transvaginal ultrasonography of patients who were at risk of preterm birth in the examination performed at 24-34 weeks of gestation, and patients with an increased risk of preterm birth according to the result were defined. &#x0D; &#x0D; Method: 40 patients who applied to Mustafa Kemal University Training and Research Hospital Gynecology and Obstetrics outpatient clinic between May 2021 and May 2022 were included in the study. Fibronectin results were evaluated using the liquid ELISA method taken from the vaginal secretion by a swap. Cervical lengths were evaluated as 25 mm and below, between 25-30 mm and 30 mm and above in statistical data.&#x0D; &#x0D; Results: For fFN-positive patients, the preterm delivery rate of patients with a cervical length of 25 mm and less was determined as 100%, while the rate of preterm birth was determined as 77.8% for patients with a cervical length between 25 mm and 30 mm. In addition, the preterm labor rate of fFN-positive patients with a cervical length of 30 mm and above was determined as 78.57%. &#x0D; &#x0D; Conclusion: All patients with a cervical length of 25 mm or less have a positive fFN test, and a strong correlation can be established between these two values. Accordingly, fFN positivity was found to have a higher sensitivity in determining the probability of preterm delivery compared to the cervical length ratio.

Overview of findings in patients with ectopic pregnancy: case report

Background: Ectopic pregnancy is the implantation of a fertilized egg outside the endometrial cavity of the uterus. Ectopic pregnancy is the leading cause of pregnancy-related death in the first trimester, accounting for 75% of maternal deaths in the first trimester and 9% to 13% of all pregnancy-related deaths. In the diagnosis of ectopic pregnancy, elevated serum levels of human chorionic gonadotropin (Beta-HCG) and uterine changes at early sonography are early indications for diagnostics. Magnetic resonance imaging (MRI) plays an important role in diagnosing and managing cases where ultrasound is inconclusive or when more accurate information is needed to make a proper diagnosis or to guide clinical management. Case Description: There was a 30-year-old female patient with a diagnosis of G1P1A0 at 10-11 weeks gestation who came with complaints of bleeding from the vagina. In these patients, physical examination and laboratory were examined, followed by radiological examinations with transvaginal ultrasound (TVUS) and MRI, and confirmed by histopathology study. Conclusion: MRI is not used conventionally in the diagnosis of ectopic pregnancy but can be an additional imaging modality for ultrasound. MRI is an effective diagnostic imaging alternative in cases where sonography is inconclusive or when more precise information is needed to diagnose properly or guide clinical and surgical management.

The Value of Transvaginal Ultrasonography in Management of Preterm Birth in Singletons

The Value of Transvaginal Ultrasonography in Management of Preterm Birth in Singletons

Diagnostic Accuracy of Transvaginal Ultrasound in the Evaluation of Female Infertility: A Systematic Review

Female infertility can result from issues with the fallopian tubes, uterus, and cervix. Ultrasound has become an essential component of the modern investigation of female infertility and the management of assisted conception, which is able to access endometrial and uterine factors that affect embryo implantation. To date, Transvaginal ultrasound (TVS) has become the modality of choice for the initial study of female infertility since it is widely available, cost-effective, and non-invasive. This study aims to assess the diagnostic accuracy of TVS in evaluating female infertility and how different types of abnormalities in female infertility affect the diagnostic accuracy. The systematic search in this study followed the guidelines of the Preferred Reporting Items for Systematic Reviews (PRISMA) and Meta-Analyses. The electronic databases PubMed and ScienceDirect were utilized. Papers published between 2012 and 2022 were chosen and subjected to analysis following the Quality Assessment of Diagnostic Accuracy Studies (QUADAS). In the initial search strategy, a total of 217 articles were discovered. By applying specific criteria for inclusion and exclusion, a set of five studies involving 770 patients were chosen for analysis. Forest plot analysis of these five studies evaluating sensitivity and specificity demonstrated low heterogeneity (Q = 4.574) and moderate heterogeneity (Q = 20.771) respectively. Employing a random-effects model, transvaginal ultrasound (TVS) demonstrated a favorable overall accuracy for evaluating female infertility with a pooled sensitivity of 0.79 (95% CI: 0.60, 0.99), and a specificity of 0.96 (95% CI: 0.76, 1.17). The sensitivity and specificity may vary depending on the specific abnormality being assessed. The most observed abnormalities were endometrial polyps and uterine fibroids, while uterine cancer and adenomyosis were the least frequently observed abnormalities. Findings from this study suggest that TVS offers moderate accuracy in the evaluation of female infertility. TVS is particularly valuable when used in conjunction with hysteroscopy, as it demonstrates high accuracy in detecting and characterizing abnormalities.

Krukenberg Tumors in Young Women: Computed Tomography and Magnetic Resonance Imaging Diagnosis.

The purpose of this report was to present the computed tomography (CT) and magnetic resonance imaging (MRI) features of Krukenberg tumors and to review the pertinent clinical data about the rising incidence of this malignancy among young women. This series included 8 women who ranged in age from 24 to 44 years (mean, 36.3 years). They were diagnosed to have Krukenberg tumors during a 5-year period (2011-2016). All patients were evaluated by abdominal CT and pelvic or transvaginal sonography. Five of them also had MRI of the abdomen, and 3 had positron emission tomography scans. The primary cancer was located in the stomach of 7 patients and in the colon in 1. The initial presentation was due to large pelvic mass and abdominal distention by ascites in 3 patients, gastrointestinal symptoms in 4, and small bowel obstruction by carcinoma of the ascending colon in 1 woman. Ovarian metastases were demonstrated on the initial imaging examination of 5 patients and developed as metachronous lesion during follow-up in 3 cases. Six women died 3 to 23 months (mean, 11 months) after the diagnosis. One has survived for 6 years after extensive surgery, and 1 was lost to follow-up. Krukenberg tumors are being diagnosed with an increasing frequency because of well-documented rising incidence of gastric and colorectal carcinomas among young women. Therefore, those presenting with gastrointestinal cancer should have careful imaging of their ovaries for possible metastases, and conversely, the clinical or sonographic detection of bilateral ovarian masses would require evaluation by CT or MRI of the abdomen in search for a potential primary gastrointestinal cancer. This report highlights the CT and MRI features of this neoplastic process and reviews the current concepts about its development and management.