3D transvaginal ultrasound

经阴道三维超声
  • 文章类型: Journal Article
    目的:使用3D阴道超声(US)检查病因不明的复发性妊娠丢失(RPL)妇女的先天性和获得性子宫异常的患病率是多少?
    结论:根据所采用的诊断标准,部分纵隔子宫的患病率在7%到14%之间,T形子宫为3%或4%,子宫腺肌病占23%,0型、1型或2型肌瘤中至少有一种为4%,至少一个子宫内膜息肉占4%。
    背景:ESHRE和皇家妇产科学院关于RPL的指南建议采用3D经阴道US来评估“子宫因子”。然而,没有发表的研究报告通过3D经阴道US评估并根据最权威的专家小组在RPL女性队列中提出的标准诊断先天性和获得性子宫异常的患病率.
    方法:这是一项回顾性队列研究,包括442名妇女,这些妇女至少有两次早孕自然流产(即无存活的宫内妊娠),他在2020年7月至2023年7月期间提到了两家大学医院的妇产科部门。
    方法:回顾了符合条件的妇女的记录。如果妇女年龄在25至42岁之间;他们没有相关的合并症;他们没有受到不孕症的影响,他们从未接受过ART;他们和他们的伴侣对全面的RPL诊断检查呈阴性;他们从未接受过计量学成形术,子宫肌瘤切除术,子宫肌瘤或腺肌瘤切除术的微创治疗。专家超声检查者独立地重新分析所有纳入患者的存储的2-和3D经阴道US图像。根据美国生殖医学学会(ASRM)2021,ESHRE/欧洲妇科内窥镜学会(ESGE)和专家先天性子宫畸形(CUME)标准报告了先天性子宫异常(CUA)。根据国际妇产科联合会(FIGO)和形态学子宫超声检查(MUSA)标准报告了获得的子宫异常。
    结果:在60岁时诊断出部分纵隔子宫(14%;95%CI:11-17%),29(7%;95%CI:5-9%),47名(11%;95%CI:8-14%)受试者,根据ESHRE/ESGE的说法,2021年ASRM和CUME标准,分别。根据ESHRE/ESGE标准,19名女性(4%;95%CI:3-7%)诊断为T形子宫,根据CUME标准,13名女性(3%;95%CI:2-5%)诊断为T形子宫。在16名女性(4%;95%CI:2-6%)中观察到边界T形子宫(当满足三个CUME标准中的两个时被诊断为T形子宫)。在4%的纳入受试者中检测到0型、1型或2型肌瘤中的至少一种(95%CI:3-6%)。在100名妇女中检测到子宫腺肌病(23%;95%CI:19-27%),并且在原发性RPL的妇女和有三个或更多妊娠损失的妇女中更为普遍。在4%的入选妇女中检测到至少一个子宫内膜息肉(95%CI:3-7%)。
    结论:对照组的缺失使我们无法研究先天性和获得性子宫异常与RPL之间是否存在关联。第二,宫腔镜检查未证实3DUS检测到的先天性和获得性子宫异常的存在和不存在.最后,本研究的结果不可避免地受到所采用分类系统的内在局限性。
    结论:患有RPL的女性中CUA的患病率因使用的分类系统而异。为了清楚起见,美国报告应始终说明子宫异常的名称以及采用的分类和诊断标准.子宫腺肌病似乎与更严重的RPL形式有关。我们研究估计的患病率以及所采用诊断标准的可重复性为前瞻性研究的设计和样本量计算提供了基础。
    背景:没有使用特定的资金。作者没有利益冲突要声明。
    背景:不适用。
    OBJECTIVE: What is the prevalence of congenital and acquired anomalies of the uterus in women with recurrent pregnancy loss (RPL) of unknown etiology examined using 3D transvaginal ultrasound (US)?
    CONCLUSIONS: Depending on the adopted diagnostic criteria, the prevalence of partial septate uterus varies between 7% and 14% and a T-shaped uterus is 3% or 4%, while adenomyosis is 23%, at least one of type 0, type 1 or type 2 myoma is 4%, and at least one endometrial polyp is 4%.
    BACKGROUND: ESHRE and the Royal College of Obstetricians and Gynaecologists guidelines on RPL recommend the adoption of the 3D transvaginal US to evaluate the \'uterine factor\'. Nevertheless, there are no published studies reporting the prevalence of both congenital and acquired uterine anomalies as assessed by 3D transvaginal US and diagnosed according to the criteria proposed by the most authoritative panels of experts in a cohort of women with RPL.
    METHODS: This was a retrospective cohort study including 442 women with at least two previous first-trimester spontaneous pregnancy losses (i.e. non-viable intrauterine pregnancies), who referred to the obstetrics and gynecology unit of two university hospitals between July 2020 and July 2023.
    METHODS: Records of eligible women were reviewed. Women could be included in the study if: they were between 25 and 42 years old; they had no relevant comorbidities; they were not affected by infertility, and they had never undergone ART; they and their partner tested negative to a comprehensive RPL diagnostic work-up; and they had never undergone metroplasty, myomectomy, minimally invasive treatments for uterine fibroids or adenomyomectomy. Expert sonographers independently re-analyzed the stored 2- and 3D transvaginal US images of all included patients. Congenital uterine anomalies (CUAs) were reported according to the American Society for Reproductive Medicine (ASRM) 2021, the ESHRE/European Society for Gynaecological Endoscopy (ESGE) and the Congenital Uterine Malformation by Experts (CUME) criteria. Acquired uterine anomalies were reported according to the International Federation of Gynecology and Obstetrics (FIGO) and the Morphological Uterus Sonographic Assessment (MUSA) criteria.
    RESULTS: The partial septate uterus was diagnosed in 60 (14%; 95% CI: 11-17%), 29 (7%; 95% CI: 5-9%), and 47 (11%; 95% CI: 8-14%) subjects, according to the ESHRE/ESGE, the ASRM 2021, and the CUME criteria, respectively. The T-shaped uterus was diagnosed in 19 women (4%; 95% CI: 3-7%) according to the ESHRE/ESGE criteria and in 13 women (3%; 95% CI: 2-5%) according to the CUME criteria. The borderline T-shaped uterus (diagnosed when two out of three CUME criteria for T-shaped uterus were met) was observed in 16 women (4%; 95% CI: 2-6%). At least one of FIGO type 0, type 1, or type 2 myoma was detected in 4% of included subjects (95% CI: 3-6%). Adenomyosis was detected in 100 women (23%; 95% CI: 19-27%) and was significantly more prevalent in women with primary RPL and in those with three or more pregnancy losses. At least one endometrial polyp was detected in 4% of enrolled women (95% CI: 3-7%).
    CONCLUSIONS: The absence of a control group prevented us from investigating the presence of an association between both congenital and acquired uterine anomalies and RPL. Second, the presence as well as the absence of both congenital and acquired uterine anomalies detected by 3D US was not confirmed by hysteroscopy. Finally, the results of the present study inevitably suffer from the intrinsic limitations of the adopted classification systems.
    CONCLUSIONS: The prevalence of CUAs in women with RPL varies depending on the classification system used. For reasons of clarity, the US reports should always state the name of the uterine anomaly as well as the adopted classification and diagnostic criteria. Adenomyosis seems to be associated with more severe forms of RPL. The prevalence rates estimated by our study as well as the replicability of the adopted diagnostic criteria provide a basis for the design and sample size calculation of prospective studies.
    BACKGROUND: No specific funding was used. The authors have no conflicts of interest to declare.
    BACKGROUND: N/A.
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  • 文章类型: Meta-Analysis
    评价并比较经阴道三维超声(3D-TVS)和磁共振成像(MRI)对子宫内膜癌(EC)患者深肌层浸润(DMI)和宫颈浸润的诊断试验(DTA)准确性及手术计划。
    本系统综述和荟萃分析研究了EC患者的MRI和3D-TVS的DTA对DMI和宫颈侵犯的影响。使用MEDLINE进行文献检索,Scopus,EMBASE,ScienceDirect,科克伦图书馆,ClinicalTrials.gov,Cochrane中央控制试验登记册,欧盟临床试验注册和世界卫生组织国际临床试验注册平台,以确定2000年1月至2021年12月之间发表的相关研究。使用诊断准确性研究质量评估-2(QUADAS-2)工具评估研究质量。
    五项研究,包括450名患者,包括在系统审查中。所有五项研究都比较了3D-TVS与MRI的DTA,三项研究比较了3D-TVS与MRI对宫颈侵犯的DTA。汇集灵敏度,使用3D-TVS检测MI的正似然比和负似然比为77%(95%CI,66-85%),分别为4.57和0.31。MRI上的MI检测值分别为80%(95%CI,73-86%),4.22和0.24。双变量回归表明3D-TVS和MRI的DTA相似(P=0.80),可以正确识别DMA。3D-TVS检测宫颈侵犯的合并诊断比值比为3.11(95%CI,2.09-4.14),MRI为2.36(95%CI,0.90-3.83)。在QUADAS-2中评估的四个领域中,大多数领域的偏倚风险较低。
    3D-TVS在评估STI和宫颈侵犯的敏感性和特异性方面表现出良好的诊断准确性。结果与MRI相当。因此,我们证实了3D-TVS在EC患者的术前分期和手术计划中的潜在作用.©2022作者由JohnWiley&SonsLtd代表国际妇产科超声学会出版的妇产科超声。
    To evaluate and compare the diagnostic test accuracy (DTA) of three-dimensional transvaginal ultrasound (3D-TVS) and magnetic resonance imaging (MRI) for deep myometrial infiltration (DMI) and cervical invasion for preoperative staging and surgery planning in patients with endometrial cancer (EC).
    This systematic review and meta-analysis investigated the DTA of MRI and 3D-TVS for DMI and cervical invasion in patients with EC. A literature search was performed using MEDLINE, Scopus, EMBASE, ScienceDirect, The Cochrane library, ClinicalTrials.gov, Cochrane Central Register of Controlled Trials, EU Clinical Trials Register and World Health Organization International Clinical Trials Registry Platform to identify relevant studies published between January 2000 and December 2021. Study quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool.
    Five studies, including a total of 450 patients, were included in the systematic review. All five studies compared the DTA of 3D-TVS vs MRI for DMI, and three studies compared the DTA of 3D-TVS vs MRI for cervical invasion. Pooled sensitivity, positive likelihood ratio and negative likelihood ratio for detecting DMI using 3D-TVS were 77% (95% CI, 66-85%), 4.57 and 0.31, respectively. The respective values for detecting DMI on MRI were 80% (95% CI, 73-86%), 4.22 and 0.24. Bivariate metaregression indicated a similar DTA of 3D-TVS and MRI (P = 0.80) for the correct identification of DMI. Pooled ln diagnostic odds ratio for detecting cervical invasion was 3.11 (95% CI, 2.09-4.14) for 3D-TVS and 2.36 (95% CI, 0.90-3.83) for MRI. The risk of bias was low for most of the four domains assessed in QUADAS-2.
    3D-TVS demonstrated good diagnostic accuracy in terms of sensitivity and specificity for the evaluation of DMI and cervical invasion, with results comparable with those of MRI. Thus, we confirmed the potential role of 3D-TVS in the preoperative staging and surgery planning in patients with EC. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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  • 文章类型: Journal Article
    OBJECTIVE: To (1) evaluate the normal development of the Sylvian fissures in the anterior coronal view of the fetal brain at 18-30 weeks\' gestation by transvaginal three-dimensional (3D) ultrasound, (2) develop reference ranges of measurements of the right and left Sylvian fissure angles during normal pregnancy at 18-30 weeks\' gestation, and (3) examine intra- and interobserver repeatability of measurements of the right and left Sylvian fissure angles.
    METHODS: This was a prospective cross-sectional study of 422 women with a singleton pregnancy attending an ultrasound-based research clinic between March and December 2017. The entry criteria for the study were appropriately grown live fetus with no suspected structural and/or chromosomal defects between 18 + 0 and 30 + 6 weeks\' gestation. Normal development of the Sylvian fissures was assessed in the anterior coronal plane of the fetal brain using transvaginal 3D volume multiplanar imaging. The coronal view was visualized as a single image from the three orthogonal views. Subsequently, the right and left Sylvian fissure angles were measured between a horizontal reference line (0°) and a line drawn along the upper side of the respective Sylvian fissure. Intra- and interobserver repeatability of the Sylvian fissure angle measurements was assessed by Bland-Altman plots. Reference equations were constructed for right and left Sylvian fissure angles for gestational age (GA) and head circumference (HC) using the Generalized Additive Models for Location Scale and Shape package.
    RESULTS: In the anterior coronal view of the fetal brain, an inward rotation of the upper portion of the Sylvian fissures was observed during the second and third trimesters of pregnancy. There was a significant negative polynomial association between the Sylvian fissure angles and GA and HC. Both Sylvian fissure angles crossed the reference line (zero), going from positive to negative, at around 25 weeks\' gestation or at HC of 22 cm. Z-score difference between the smoothed percentiles of the right and left Sylvian fissure angles indicated that median, 10th and 90th smoothed percentiles were closest and almost the same for the GA-based references between 18 and 28 weeks and for the HC-based references between 14 and 24 cm. The intraclass correlation coefficient of the right and left Sylvian fissure angle measurements between the two sonographers was excellent at 0.993 (95% CI, 0.988-0.996) and 0.991 (95% CI, 0.985-0.995), respectively. On Bland-Altman analysis, the mean difference between the two sonographers in right Sylvian fissure angle measurement was 0.4° (95% CI, -10.2 to 10.1°) and in left Sylvian fissure angle it was 1.0° (95% CI, -9.6 to 11.6°).
    CONCLUSIONS: Assessment of the Sylvian fissure angles is highly reproducible. Sylvian fissure angle reference charts can serve as a screening tool for malformations of cortical development, guiding subsequent follow-up and referral for fetal brain magnetic resonance imaging and/or assessment by an expert neurosonologist. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.
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  • 文章类型: Journal Article
    目的:通过评估皮质发育畸形(MCD)胎儿的Sylvian裂角来评估Sylvian裂隙的发育。
    方法:这是22例MCD胎儿的回顾性研究。通过数据库识别了在2010年1月至2017年12月之间在基于超声的研究诊所妊娠180至306周获得的具有存储的三维(3D)脑体积的病例。在22个胎儿中,七个人有颅外异常,比如心脏,肾,胃肠道和/或数字异常,五个有轻微的异常,比如小颌畸形,低设定的耳朵和/或单脐动脉。为了确认脑部异常的最终临床诊断,使用了尸检组织学结果或产前或产后磁共振图像.测量Sylvian裂隙角,经阴道3D容积多平面成像的胎儿大脑前冠状平面在三个正交视图中被可视化为单个图像.在水平参考线(0°)和沿相应Sylvian裂缝的上侧绘制的线之间测量了左右Sylvian裂缝的角度。两侧的Sylvian裂隙角绘制在参考范围的图表上,以周为单位。
    结果:在22个患有MCD的胎儿中,有21个(95.5%;95%CI,86.8-100.0%),一侧或两侧的Sylvian裂隙角大于正常参考的第90百分位数。有一例在顶叶有明显的局灶性MCD,但Sylvian裂隙角度正常.一例明显的单侧皮质发育不良和一例明显的单侧脑裂裂的病例,左右的Sylvian裂角之间存在明显差异。6例获得异常基因检测结果,包括四个单基因突变的病例.
    结论:这项研究表明,西尔维安裂隙,根据Sylvian裂隙角的定义,在诊断之前,大多数MCD病例的发展有所延迟。Sylvian裂角可能是随后皮质畸形发展的有力指标,在胎儿脑表面回和沟变得明显的时间点之前。需要进一步的研究来验证这些发现。©2018作者由JohnWiley&SonsLtd代表国际妇产科超声学会出版的妇产科超声。
    OBJECTIVE: To evaluate Sylvian fissure development by assessing Sylvian fissure angles in fetuses with malformation of cortical development (MCD).
    METHODS: This was a retrospective study of 22 fetuses with MCD. Cases with a stored three-dimensional (3D) brain volume acquired at 18 + 0 to 30 + 6 weeks of gestation at an ultrasound-based research clinic between January 2010 and December 2017 were identified through a database. Of the 22 fetuses, seven had an extracranial abnormality, such as cardiac, renal, gastrointestinal and/or digital anomalies, and five had a minor abnormality such as micrognathia, low-set ears and/or single umbilical artery. To confirm the final clinical diagnosis of brain abnormality, postmortem histological findings or prenatal or postnatal magnetic resonance images were used. For measurement of Sylvian fissure angle, an anterior coronal plane of the fetal brain on transvaginal 3D volume multiplanar imaging was visualized as a single image from the three orthogonal views. The right and left Sylvian fissure angles were measured between a horizontal reference line (0°) and a line drawn along the upper side of the respective Sylvian fissure. The Sylvian fissure angle on both sides was plotted on the graphs of the reference ranges for gestational age in weeks.
    RESULTS: In 21 (95.5%; 95% CI, 86.8-100.0%) of 22 fetuses with MCD, the Sylvian fissure angle on one or both sides was larger than the 90th percentile of the normal reference. There was one case with apparent focal MCD in the parietal lobe, but the Sylvian fissure angles were normal. A case with apparent unilateral cortical dysplasia and one with apparent unilateral schizencephaly had conspicuous discrepancies between the left and right Sylvian fissure angles. Abnormal genetic test results were obtained in six cases, including four cases with a mutation in a single gene.
    CONCLUSIONS: This study has shown that the Sylvian fissures, as defined by the Sylvian fissure angle, have delayed development in most MCD cases prior to the diagnosis of the condition. The Sylvian fissure angle may potentially be a strong indicator for the subsequent development of cortical malformation, before the time point at which the gyri and sulci become obvious on the fetal brain surface. Further research is required to validate these findings. © 2018 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of the International Society of Ultrasound in Obstetrics and Gynecology.
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  • 文章类型: Journal Article
    确定宫腔镜微插入物放置结束时子宫输卵管交界处可见的线圈数量是否可以预测成功的输卵管闭塞。
    队列回顾性研究(加拿大工作组分类II-2)。
    教学医院妇产科。
    从2010年到2014年,一百五十三名妇女接受了输卵管微插入物放置以进行永久性节育。当地机构审查委员会批准了这项研究。
    宫腔镜微型插入物放置3个月后,常规进行三维经阴道超声(3DTVU)检查输卵管位置。
    评估了141例患者在宫腔镜微插入物放置程序结束时在子宫输卵管连接处可见的线圈数量与3个月随访3DTVU上的装置位置之间的相关性。分析包括在宫腔镜检查期间放置的276个微型插入物。宫腔镜手术后可见的线圈的中位数为4(四分位距,3-5).根据3个月的随访3DTVU,30名患者(21.3%)的设备位置不正确,并推荐子宫输卵管造影术。在这些患者中,线圈的中位数在两个右侧(四分位间距,2-4)和左(四分位距,1-3)子宫输卵管连接。在放置程序结束时在子宫输卵管连接处可见的线圈数量是预测微插入物在3个月3DTVU确认时是否定位良好的唯一因素(赔率比,.44;95%置信区间,.28-.63)。当可见5个或更多线圈时,在随访的3DTVU上未发现错误放置的微插入物;阴性预测值为100%.没有报告怀孕。
    在微插入物放置时在子宫输卵管连接处观察到的线圈数量应被视为精确和成功的微插入物放置的重要预测因素。
    To determine whether the number of coils visualized in the uterotubal junction at the end of hysteroscopic microinsert placement predicts successful tubal occlusion.
    Cohort retrospective study (Canadian Task Force classification II-2).
    Department of obstetrics and gynecology in a teaching hospital.
    One hundred fifty-three women underwent tubal microinsert placement for permanent birth control from 2010 through 2014. The local institutional review board approved this study.
    Three-dimensional transvaginal ultrasound (3D TVU) was routinely performed 3 months after hysteroscopic microinsert placement to check position in the fallopian tube.
    The correlation between the number of coils visible at the uterotubal junction at the end of the hysteroscopic microinsert placement procedure and the device position on the 3-month follow-up 3D TVU in 141 patients was evaluated. The analysis included 276 microinserts placed during hysteroscopy. The median number of coils visible after the hysteroscopic procedure was 4 (interquartile range, 3-5). Devices for 30 patients (21.3%) were incorrectly positioned according to the 3-month follow-up 3D TVU, and hysterosalpingography was recommended. In those patients the median number of coils was in both the right (interquartile range, 2-4) and left (interquartile range, 1-3) uterotubal junctions. The number of coils visible at the uterotubal junction at the end of the placement procedure was the only factor that predicted whether the microinsert was well positioned at the 3-month 3D TVU confirmation (odds ratio, .44; 95% confidence interval, .28-.63). When 5 or more coils were visible, no incorrectly placed microinsert could be seen on the follow-up 3D TVU; the negative predictive value was 100%. No pregnancies were reported.
    The number of coils observed at the uterotubal junction at the time of microinsert placement should be considered a significant predictive factor of accurate and successful microinsert placement.
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  • 文章类型: Journal Article
    Background Due to improved ultrasound scanners, new three-dimensional (3D) modalities, and novel Anti-Müllerian hormone (AMH)-assays, the ultrasound criteria for polycystic ovarian morphology are under debate and the appropriate thresholds are often requested. Purpose To quantify the differences in estimates of ovarian volume and antral follicle count (AFC) from two-dimensional (2D) and 3D transvaginal ultrasound (TVUS) and magnetic resonance imaging (MRI). Material and Methods A cross-sectional study on 66 overweight women with polycystic ovary syndrome (PCOS) according to Rotterdam criteria. Ovarian volume and AFC were estimated from MRI, 2D TVUS, and 3D TVUS, and serum AMH levels were assessed. Bland-Altman statistics were used for comparison. Results Participants had a median age of 29 years (age range, 19-44 years) with a mean BMI of 32.7 kg/m2 (SD 4.5). Ovarian volume from 2D TVUS was 1.48 mL (95% confidence interval [CI], 0.94-2.03; P < 0.001) and 1.25 mL (95% CI, 0.62-1.87; P < 0.001) smaller than from 3D TVUS and MRI, respectively. AFC from 2D TVUS was 18% (95% CI, 13-23; P < 0.005) and 16% (95% CI, 6-25; P < 0.005) smaller than estimates from 3D TVUS and MRI, respectively. Correlations between AMH and AFC from 2D TVUS, 3D TVUS, and MRI were 0.67, 0.78, and 0.70, respectively ( P < 0.001 for all). Conclusion In an overweight PCOS population, 2D TVUS underestimated ovarian volume and AFC as compared with 3D TVUS and MRI. Serum AMH correlated best with AFC from 3D TVUS, followed by MRI and 2D TVUS. The advantage of 3D TVUS might be of minor clinical importance when diagnosing PCOS, but useful when the actual AFC are of interest, e.g. in fertility counseling and research.
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  • 文章类型: Journal Article
    OBJECTIVE: To assess the accuracy of three-dimensional (3D) transvaginal sonographic (TVS) parameters in predicting the evolution of a pregnancy of unknown location (PUL).
    METHODS: This was a prospective observational study performed at the early pregnancy unit of a university hospital from September 2008 to June 2012. Women with a positive pregnancy test without any signs of intra- or extrauterine pregnancy at their first TVS examination were considered eligible and a 3D dataset containing the entire uterus was acquired. An experienced observer analyzed all 3D datasets for assessment of the following parameters: endometrial thickness, volume, mean gray-scale index and asymmetry. Women were followed until they were classified as having: (i) non-visualized pregnancy loss (NVPL); (ii) intrauterine pregnancy (IUP); or (iii) ectopic pregnancy or persistent PUL. We compared the values of the TVS parameters across the three groups. We also assessed the area under the receiver-operating characteristics curve of the 3D-TVS parameters in comparison to that for serum β-human chorionic gonadotropin (β-hCG) ratio (48 h/baseline) to predict PUL outcome. We then evaluated whether combining the 3D-TVS parameters with serum β-hCG ratio improved the predictive accuracy for PUL outcome by performing a logistic regression analysis.
    RESULTS: During the study period 4939 consecutive pregnant women presented at the unit for their initial TVS examination and 325 (7%) were classified as having a PUL, of whom 161 women were enrolled and had a 3D scan of the uterus. However, 19 were excluded because of incomplete follow-up. Data from 142 women with PUL were therefore included in the analysis and the outcomes of these women were: NVPL in 98 (69%), IUP in 27 (19%) and ectopic pregnancy + persistent PUL in 14 + 3 = 17 (12%). Endometrial thickness, endometrial volume and the proportion of women with asymmetric endometrial shape differed significantly between the outcome groups. Endometrial thickness and volume could be used as reasonable predictors of both NVPL and IUP, whereas asymmetric endometrial shape and mean gray-scale index could be used as reasonable predictors of IUP only. The best single parameter to predict PUL outcomes was the β-hCG ratio. Regression analysis demonstrated that endometrial volume and endometrial shape asymmetry added significantly to the β-hCG ratio in predicting IUP but not NVPL.
    CONCLUSIONS: 3D-TVS markers have a low diagnostic accuracy in predicting PUL outcome. The addition of endometrial volume and shape asymmetry improves the accuracy of the β-hCG ratio in predicting IUP. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
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  • 文章类型: Comparative Study
    目的:评估3D经阴道超声(3D-TVS)与宫腔镜检查对不孕症妇女宫腔异常的诊断准确性。
    方法:本前瞻性观察性横断面研究在2013年7月至2013年12月的研究期间进行。纳入了69名不孕妇女。在每个受试者月经周期的中晚期卵泡期,每位患者均在同一天进行3D经阴道超声和宫腔镜检查。宫腔镜检查被广泛认为是调查子宫腔的金标准方法。记录宫腔特征及异常。诊断准确性,灵敏度,特异性,正预测值,负预测值,并评估了正负似然比。
    结果:所有受试者均成功进行了宫腔镜检查。69例中有22例(31.8%)经宫腔镜诊断为病理结果。有18个子宫内膜息肉,3个粘膜下肌瘤,和1个纵隔子宫。经阴道三维超声与宫腔镜相比诊断准确率为84.1%,灵敏度68.2%,91.5%特异性,79%的阳性预测值,和86%的阴性预测值。阳性和阴性似然比分别为8.01和0.3。3D-TVS成功检测到每一例粘膜下肌瘤和子宫异常。用于检测子宫内膜息肉,3D-TVS的灵敏度为61.1%,91.5%特异性,诊断准确率为83.1%。
    结论:3D-TVS对不孕妇女宫腔异常的诊断准确率为84.1%。有相当比例的不育患者有子宫腔病理学证据。宫腔镜检查是,因此,建议准确检测和诊断子宫腔病变。
    OBJECTIVE: To assess diagnostic accuracy of 3D transvaginal ultrasound (3D-TVS) compared with hysteroscopy in detecting uterine cavity abnormalities in infertile women.
    METHODS: This prospective observational cross-sectional study was conducted during the July 2013 to December 2013 study period. Sixty-nine women with infertility were enrolled. In the mid to late follicular phase of each subject\'s menstrual cycle, 3D transvaginal ultrasound and hysteroscopy were performed on the same day in each patient. Hysteroscopy is widely considered to be the gold standard method for investigation of the uterine cavity. Uterine cavity characteristics and abnormalities were recorded. Diagnostic accuracy, sensitivity, specificity, positive predictive value, negative predictive value, and positive and negative likelihood ratios were evaluated.
    RESULTS: Hysteroscopy was successfully performed in all subjects. Hysteroscopy diagnosed pathological findings in 22 of 69 cases (31.8%). There were 18 endometrial polyps, 3 submucous myomas, and 1 septate uterus. Three-dimensional transvaginal ultrasound in comparison with hysteroscopy had 84.1% diagnostic accuracy, 68.2% sensitivity, 91.5% specificity, 79% positive predictive value, and 86% negative predictive value. The positive and negative likelihood ratios were 8.01 and 0.3, respectively. 3D-TVS successfully detected every case of submucous myoma and uterine anomaly. For detection of endometrial polyps, 3D-TVS had 61.1% sensitivity, 91.5% specificity, and 83.1% diagnostic accuracy.
    CONCLUSIONS: 3D-TVS demonstrated 84.1% diagnostic accuracy for detecting uterine cavity abnormalities in infertile women. A significant percentage of infertile patients had evidence of uterine cavity pathology. Hysteroscopy is, therefore, recommended for accurate detection and diagnosis of uterine cavity lesion.
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  • 文章类型: Journal Article
    目的:人类胚胎学的良好知识不仅是对发育中的大脑进行正确的超声检查的必要条件,也是为了更好地了解涉及中枢神经系统的先天性异常的起源。3D经阴道超声检查可能是对发育中的大脑成像的有效技术。这项探索性研究的目的是证明使用3D高频阴道超声换能器对妊娠7至10周的胚胎脑进行成像用于临床研究的可行性,并为胚胎期脑的形态学提供参考。
    方法:四个9毫米的胚胎,17毫米,通过经阴道超声检查在体内分别评估23毫米和31毫米的冠部长度。我们特别关注胚胎大脑。所有患者均使用VolusonE10,BT15超声扫描仪(GEHealthcare,Zipf,奥地利),使用高频6-12MHz/256元素3D/4D经阴道换能器。扫描患者时常规进行三维超声检查。在选择最佳体积后使用多平面显示器。使用Omniview®软件对所选择的卷进行数字切片。
    结果:我们描述了从7到10孕周的四个胚胎发育大脑的形态学细节。在人类胚胎9mmCRL中,三个主要囊泡的低回声腔(前脑,中脑,菱形脑)可以在矢状切片上观察到。在人胚胎17mmCRL中,前脑分为中间间脑和两个端脑囊泡,部分被大脑的镰刀分开。在23mmCRL的人类胚胎中,大脑半球发育,并被镰状大脑完全分开。在侧脑室和第四脑室内有明显的脉络丛。在人类胚胎31毫米CRL中,腹侧丘脑是明显的,和神经节隆起,作为基底神经节的前体,在大脑半球的地板上很容易看到。
    结论:对发育中的大脑仍需要进行胚胎学研究。使用高频阴道超声换能器的3D超声检查对于临床研究具有可接受的质量的胚胎脑成像是可行的。
    OBJECTIVE: A very good knowledge of human embryology is mandatory not only for the correct sonographic assessment of the developing brain, but also for better understanding the origins of congenital anomalies involving the central nervous system. 3D transvaginal sonography may be an effective technique for imaging the developing brain. The aims of this explorative study are to demonstrate the feasibility of imaging the embryonic brain between 7 and 10 weeks of gestation for clinical studies by using a 3D high-frequency vaginal ultrasound transducer and to provide a reference for the morphology of the brain in the embryonic period.
    METHODS: Four embryos of 9 mm, 17 mm, 23 mm and 31 mm crown-rump length respectively were assessed in vivo by transvaginal sonography. We gave a special attention to the embryonic brain. All patients were examined with a Voluson E10, BT 15 ultrasound scanner (GE Healthcare, Zipf, Austria), using a high-frequency 6-12 MHz/ 256-element 3D/4D transvaginal transducer. Three-dimensional sonography was performed routinely as the patients were scanned. The multiplanar display was used after selecting the best volume. The Omni view® software was used for digitally slicing the selected volumes.
    RESULTS: We describe the morphological details of the developing brains of four embryos ranging from 7 to 10 gestational weeks. In the human embryo 9 mm CRL the hypoechogenic cavities of the three primary vesicles (prosencephalon, mesencephalon, rhombencephalon) could be observed on a sagittal section. In the human embryo 17 mm CRL the prosencephalon was divided into the median diencephalon and two telencephalic vesicles, which were partially separated by the falx cerebri. In the human embryo 23 mm CRL the cerebral hemispheres developed and they were completely separated by the falx cerebri. The choroid plexus was evident inside the lateral ventricles and the fourth ventricle. In the human embryo 31 mm CRL the ventral thalamus was evident, and the ganglionic eminence, as the precursor of the basal ganglia, was well seen on the floor of the cerebral hemispheres.
    CONCLUSIONS: Studies of embryology are still needed for a complete understanding of the developing brain. 3D sonography using a high-frequency vaginal ultrasound transducer is feasible for imaging the embryonic brain with an acceptable quality for clinical studies.
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