Usefulness Of Sonographic Measurement Research Articles

Preoperative Ultrasound Indications Determine Excision Technique for Bowel Surgery for Deep Infiltrating Endometriosis: A Single, High-Volume Center

To identify bowel nodule features of deep infiltrating endometriosis (DIE) measured through preoperative ultrasound scanning that influence laparoscopic surgical strategy. A retrospective study. Malzoni Clinic-Endoscopica Malzoni Department, Center for Advanced Endoscopic Gynecological Surgery, Avellino, Italy. Patients undergoing laparoscopic surgery between January 1, 2014, and December 31, 2018, for clinically suspected DIE with previous ultrasound evaluation ≤1 month before intervention. Use of sonographic measurements to determine laparoscopic excision technique (segmental bowel resection, discoid resection, shaving) for DIE with bowel involvement.``` MEASUREMENTS AND MAIN RESULTS: Of 5051 DIE surgeries, 4983 were included; 1494 (29.9%) bowel resections (512 bowel segmental resections and 982 nodulectomies [967 shaving and 15 discoid resections]) were performed, accounting for 34.3% and 65.7% of all bowel procedures, respectively. Preoperative sonographic findings and surgical reports were collected. Sensitivity and specificity of preoperative ultrasound evaluation for all types of DIE lesions were calculated, and sonographic measurements of bowel nodules and different surgical techniques were compared. According to preoperative sonographic measurements, most nodules excised by segmental resection had a longitudinal diameter of 3 to 7 cm, none were <3 cm; all nodules excised by nodulectomy (shaving or discoid resection) had a longitudinal diameter <3 cm. Mean thickness (maximum depth of muscular layer infiltration) of identified bowel nodules estimated through ultrasound scanning was 13.4 mm ± 4.8 mm (mean ± standard deviation) and 5.8 mm ± 2.7 mm for lesions removed by segmental resection and nodulectomy, respectively, and there was a statistically significant difference between them (p <.05). Of the 512 segmental resected bowel nodules, 143 (28%) had a maximum depth ≥9 mm, 354 (69%) had 7 to 9 mm, and 15 (3%) had <7 mm (6 mm, with length >4 cm). All shaved nodules had thickness ≤7 mm. The 15 nodules excised by discoid resection (1.5% of nodulectomies) were <25 mm, but thickness ranged from 7 to 9 mm. The need for segmental resection in DIE with bowel-infiltrating nodules depends on the degree of muscular layer infiltration and corresponding thickness (muscularis rule) in addition to nodule length and can be accurately identified by preoperative ultrasound evaluation.

Can Sonographic Evaluation of Lower Uterine Segment Predict Women at Risk of Uterine Rupture / Dehiscence?

Introduction : Ultrasonography has been used to examine the scarred uterus in women who have had previous caesarean sections in an attempt to assess the risk of rupture of the scar during subsequent labour. This study aims to evaluate the usefulness of sonographic measurement of the lower uterine segment before labour in predicting the risk of intrapartum uterine rupture. Methods : This is a prospective cohort study. Eligible parturients were those with one previous caesarean section who meet the inclusion criteria and were booked for delivery at Irrua Specialist Teaching Hospital. 153 patients underwent transvaginal ultrasound examination at 35-37 weeks' gestation, and were allocated to four groups (≤2.5mm, 2.6-3.5mm, 3.6-4.5mm and ≥4.6mm) according to the thickness of the lower uterine segment. A systematic random sampling technique was used for patient selection. All labor was actively managed. Inclusion criteria included women with 1 previous transverse lower uterine segment caesarean section scar presenting in spontaneous labor, singleton fetus with vertex presentation, non-recurrent indications for previous caesarean section e.g. malpresentation such as breech presentation, fetal distress and an estimated fetal weight (EFW) of less than or equal to 3.8 kg. The exclusion criteria included Women with a previous history of uterine rupture, women with fetal macrosomia, placenta previa, multiple gestation as well as abnormalities in amniotic fluid volumes such as polyhydramnious or oligohydramnious, women with co-existing medical conditions like hypertensive disease in pregnancy, uncontrolled diabetes mellitus in pregnancy, and women whose previous caesarean section was complicated by wound sepsis or wound breakdown. Main Outcome Measure(s) : The primary outcome in this study was the association between echographic measurements of the LUS and the risk of intrapartum uterine rupture. The secondary outcomes were trial of labor outcome (successful VBAC versus repeat Cesarean section), and determination of clinical (obstetric) factors that could serve as predictors for uterine rupture or dehiscence. Results : The overall frequency of defective scar was 3.9% (2 ruptures, 4 dehiscences). The frequency of defects rose as the thickness of the lower uterine segment decreased: there were no defects among 49 women with measurements greater than 4.5 mm, 1 (1.4%) among 70 women with values of 3.6-4.5 mm, 2 (10%) among 20 women with values of 2.6-3.5 mm, and 3 (21.4%) among 14 women with values of 2.5 mm and below. With a cut-off value of 3.5 mm, the sensitivity of ultrasonographic measurement was 83.3%, the specificity was 80.3%, positive predictive value was 14.7%, and negative predictive value was 99.2% with an accuracy of 80.4%. Conclusion : The results from this study showed that the risk of a defective scar is directly related to the degree of thinning of the lower uterine segment at around 37 weeks of pregnancy. The high negative predictive value of the study may encourage obstetricians to offer a trial of labour to patients with a thickness value of 3.5 mm or greater.

Development of a nomogram to evaluate the usefulness of sonographic measurement of placental thickness for the estimation of fetal gestational age

Background: An accurate assessment of gestational age (GA) and evaluation of fetal growth is fundamental to prenatal care. Aim: To evaluate placental thickness (PT) as an indicator of GA. Subjects and Methods: A prospective study was carried out on 300 antenatal patients with known last menstrual period (LMP), 100 each in first, second, and third trimester, respectively, with GA more than 10 weeks till term in a study period of one year. Patients with GA more than 20 weeks detected with pregnancy‑induced hypertension (PIH) and/or diabetes mellitus (DM) and/or intrauterine growth retardation (IUGR) and/or hydrops fetalis and/or congenital malformation were excluded from the study. Twin pregnancy of any gestation was excluded from the study. The PT was measured at the level of insertion of the cord and the values thus measured in millimeters was correlated with GA as ascertained vis a vis the LMP. GA and PT were represented as mean and standard deviation. Correlation between them was evaluated using Pearson’s product moment correlation coefficient. Results: The study showed a positive correlation between GA and PT. PT in millimeter accurately matched the GA in weeks from 14 to 21 weeks of gestation after which it was seen to be lesser than GA by 1-4 mm. Conclusions: PT promises to be an accurate parameter for estimating fetal GA in singleton pregnancies. Keywords: Fetal Gestational age, nomogram, placental thickness

Visibility and measurement of Cesarean section scars in pregnancy: a reproducibility study

To evaluate the visibility of cesarean section (CS) scars by transvaginal sonography (TVS) in pregnant women, to apply a standardized approach for measuring CS scars and to test its reproducibility throughout the course of pregnancy. In this observational cohort study, 320 consecutive pregnant women with a previous cesarean delivery were examined to assess scar visibility by two independent examiners. TVS was carried out at 11-13, 19-21 and 34-36 weeks' gestation. A scar was defined as visible when an area of hypoechogenicity representing myometrial discontinuity at the anterior wall of the lower uterine segment was identified. In a subset of patients (n = 111), visible scars were measured by two independent examiners in three dimensions: scar width, depth and length as well as the residual myometrial thickness (RMT). Descriptive analysis was used to assess scar visibility, and the intraclass correlation coefficient (ICC) was calculated to show the strength of absolute agreement between two examiners for scar measurements. For RMT, a cut-off of 2.4 mm was used and measurement agreement was assessed using Cohen's kappa coefficient. The scar was visible in 284/320 cases (88.8%). Visible scars were significantly associated with anteverted uteri (P < 0.0001). Both examiners had 100% agreement on scar visibility at 12 and 20 weeks' gestation, while agreement was 96% at 34 weeks. The intra- and interobserver agreements for scar measurements were generally good (ICC 0.86 and 0.89, respectively). The kappa coefficient for the RMT was 0.27 in the first trimester, compared with 0.51 and 0.72 in the second and third trimesters, respectively. CS scars remain visible in the majority of women throughout pregnancy. They can be reproducibly measured in three dimensions when assessed by TVS in all trimesters of pregnancy. The agreement between two observers for CS scar measurement can be considered good for the first trimester, compared with relatively moderate agreement for the second and third trimesters.

Clinical usefulness of ultrasound assessment of detrusor wall thickness in patients with neurogenic lower urinary tract dysfunction due to spinal cord injury: urodynamics made easy?

To evaluate the clinical usefulness of sonographic measurement of detrusor wall thickness (DWT) for the prediction of risk factors in patients with neurogenic lower urinary tract dysfunction (NLUTD) due to spinal cord injury (SCI). In a prospective study, 60 consecutive patients with NLUTD due to SCI presenting for routine urodynamic assessment at a specialized SCI center underwent additional measurement of DWT at varying bladder volumes. Results of urodynamic testing were classified into favorable and unfavorable. DWT at maximum capacity was used to calculate a possible cutoff value for favorable urodynamic results. Urodynamic results were favorable in 48 patients and unfavorable in 12 patients. A DWT of 0.97 mm or less can safely (sensitivity 91.7 %, specificity 63.0 %) be used as a cutoff point for the absence of risk factors for renal damage. According to our results, DWT may be useful as an additional risk assessment for renal damage in patients with NLUTD due to SCI. However, as other parameters required for bladder management, especially detrusor overactivity, cannot be evaluated by this technique, it cannot replace urodynamic testing.

A Comparison of Sonographic Assessments and Clinical Questionnaire in the Diagnosis of HIV-Associated Lipodystrophy

The study evaluated the use of sonographic measurements as an alternative to assessments based on clinical or other imaging techniques for the diagnosis of body-fat abnormalities. The study enrolled 179 HIV-infected patients, 81 (45.3%) of them diagnosed as lipodystrophy (LD)-positive based on a clinical standard questionnaire. Association between clinical LD and sonographic measurements of face, right upper limb, subcutaneous abdomen, and visceral compartments was evaluated by multiple logistic regression. The predicted probability of the logistic model was 0.64, corresponding to a maximum sensitivity of 69.1% (58%-79%), a specificity of 94.9% (88%-98%), and to positive and negative predictive values of 92% (82%-97%) and 79% (70%-86%), respectively. Kappa measure of concordance was 65% (54%-77%). Low sensitivity poses a problem for the use of sonography to detect LD in the clinical routine as a single exam, speaking in favor of the combined use of clinical and sonographic measurements over time.

Sonographic measurement of cross‐sectional area of the median nerve in the diagnosis of carpal tunnel syndrome: Correlation with nerve conduction studies

To assess the usefulness of sonographic measurement of the median nerve cross-sectional area (CSA) in the diagnosis of carpal tunnel syndrome (CTS) and grading of its severity using nerve conduction (NC) studies as the standard. The CSA of the median nerve was measured at the tunnel inlet and outlet using the ellipse formula and automatic tracing in 72 hands with suspicion of CTS. The lack of inter-reader reliability led to excluding CSA measurements obtained at the tunnel outlet. Based on the receiver operating characteristic curves, the following cut-off points for the CSA of the median nerve at the tunnel inlet was selected: 9.8 mm and 12.3 mm(2) for the ellipse formula and 11 and 13 mm(2) for automatic tracing. For the ellipse formula, a CSA less than or equal to 9.8 mm(2) excluded CTS whereas a CSA greater than or equal to 12.3 mm(2) was diagnostic of CTS with measurements between 9.8 and 12.3 mm(2) being indeterminate and requiring NC studies. For automatic tracing, the cutoff value of 11 mm(2) was excluded because of the high percentage of false negatives, whereas CSAs greater than or equal to 13 mm(2) were diagnostic of CTS. There were no statistically significant differences in CSA measurements between the various degrees of CTS severity determined by NC studies. Sonographic measurement of median nerve CSA at the tunnel inlet is a good alternative to NC studies as the initial diagnostic test for CTS, but it cannot grade the severity of CTS as well as NC studies.

Sonography in the diagnosis of carpal tunnel syndrome.

The few papers published on the use of sonography in carpal tunnel syndrome suggest it may be a useful diagnostic test. This study aims to prospectively evaluate the use of sonographic measurements of the median nerve in the diagnosis of carpal tunnel syndrome. Patients with documented carpal tunnel syndrome and a group of asymptomatic control subjects were enrolled and underwent high-resolution sonography of the carpal tunnel. A small-footprint linear array transducer was used to scan and measure the median nerve cross-sectional area and the maximum transverse and anteroposterior diameters. Data from the patient group and the control group were compared to establish optimal diagnostic criteria for carpal tunnel syndrome. Sixty-eight carpal tunnel syndrome patients (50 women, 18 men) with 102 affected nerves and 68 nerves in 36 asymptomatic controls (23 women, 13 men) were examined. Qualitative assessment alone was found to be unreliable. All measurements showed significant differences between patients and controls. The most predictive measurement was swelling of the median nerve, which was significantly greater in carpal tunnel syndrome patients compared with controls (mean, 0.13 cm2 versus 0.07 cm2). Thus, quantitative assessment of the median nerve provides an accurate diagnostic test (sensitivity, 82%; specificity, 97%), with an area larger than 0.09 cm2 being highly predictive of carpal tunnel syndrome. We confirm that median nerve cross-sectional area measurement correlates well with the presence of carpal tunnel syndrome and is both sensitive and specific for the diagnosis.

Ultrasonographic measurement of lower uterine segment to assess risk of defects of scarred uterus

SummaryBackground Ultrasonography has been used to examine the scarred uterus in women who have had previous caesarean sections in an attempt to assess the risk of rupture of the scar during subsequent labour. The predictive value of such measurements has not been adequately assessed, however. We aimed to evaluate the usefulness of sonographic measurement of the lower uterine segment before labour in predicting the risk of intrapartum uterine rupture.Methods In this prospective observational study, the obstetricians were not told the ultrasonographic findings and did not use them to make decisions about type of delivery. Eligible patients were those with previous caesarean sections booked for delivery at our hospital. 642 patients underwent ultrasound examination at 36-38 weeks' gestation, and were allocated to four groups according to the thickness of the lower uterine segment. Ultrasonographic findings were compared with those of physical examination at deliveryFindings The overall frequency of defective scars was 4·0% (15 ruptures, 10 dehiscences). The frequency of defects rose as the thickness of the lower uterine segment decreased: there were no defects among 278 women with measurements greater than 4·5 mm, three (2%) among 177 women with values of 3·6-4·5 mm, 14 (10%) among 136 women with values of 2·6-3·5 mm, and eight (16%) among 51 women with values of 1·6-2·5 mm. With a cutoff value of 3·5 mm, the sensitivity of ultrasonographic measurement was 88·0%, the specificity 73·2%, positive predictive value 11·8%, and negative predictive value 99·3%.Interpretation Our results show that the risk of a defective scar is directly related to the degree of thinning of the lower uterine segment at around 37 weeks of pregnancy. The high negative predictive value of the method may encourage obstetricians in hospitals where routine repeat elective caesarean is the norm to offer a trial of labour to patients with a thickness value of 3·5 mm or greater.

Sonographic diagnosis of IUGR-macrosomia.

Many sonographic methods have been suggested for identification of the fetus with a growth abnormality. Clearly, optimal management depends on early diagnosis. In recent years, advances in sonography have improved the ability to identify abnormal growth patterns and evaluate fetal well-being. When abnormal fetal growth is suspected, a thorough sonographic evaluation should be performed. This evaluation includes measurements of the abdominal circumference, femur length,) BPD, HC, AC, FL, and amniotic fluid volume. If these measurements confirm the suspicion of abnormal fetal growth, careful search for anomalies is mandatory. If there is no evidence of fetal compromise that would warrant delivery, measurements should be repeated in 2-3 weeks to evaluate interval growth. The following conclusions could be drawn from this literature review: 1. Intrauterine growth retardation and macrosomia are multifactorial diseases with varying degrees of severity. It is unlikely that a single sonographic parameter will allow an accurate diagnosis of all cases. 2. The type and degree of growth retardation and macrosomia depend on the intensity and duration of the underlying disease. Thus, an ultrasound assessment performed long before delivery may be of limited value. 3. Most of the sonographic parameters reviewed in this chapter are gestational age dependent. Unfortunately, gestational age is often unknown. Gestational age independent indices such as the amniotic fluid volume, FL/AC ratio, and the rate of fetal growth should be helpful in this situation. 4. The constitutionally small infant whose only problem is low birth weight should not be expected to present with any abnormal indices other than a low EFW. On the other hand, newborns who appear to be malnourished but whose birth weight is at or slightly above the tenth percentile for gestational age, may present with abnormal indirect indices indicating growth retardation (ie, HC/AC, FL/AC, Doppler velocimetry or oligohydramnios) despite a normal estimate of fetal weight. In addition, if the diagnosis of IUGR is made only with the use of birthweight for gestational age criteria, these infants are likely to be misclassified and labelled AGA. However, an abnormal ponderal index would indicate that these neonates are growth retarded. It can be concluded from this review that the use of sonographic measurements for diagnosing IUGR or macrosomia is associated with a high specificity and a somewhat lower sensitivity. Therefore, it would seem that the current ultrasound methods are more useful for excluding the possibility of abnormal fetal growth rather than for confirming it.