Donald School Journal of Ultrasound in Obstetrics and Gynecology

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2019 | July-September | Volume 13 | Issue 3

PICTURE OF THE MONTH

Toshiyuki Hata, Uiko Hanaoka, Ayumi Mori, Kenta Yamamoto, Chiaki Tenkumo, Nobuhiro Mori, Kenji Kanenishi, Hirokazu Tanaka

Superb Microvascular Imaging of Retained Placenta with Placenta Accreta Spectrum

[Year:2019] [Month:July-September] [Volume:13] [Number:3] [Pages:3] [Pages No:85 - 87]

Keywords: Retained placenta, Superb microvascular imaging,18-MHz linear probe, High-resolution ultrasound, Placenta accreta spectrum

PDF  |  DOI: 10.5005/jp-journals-10009-1600  |  Open Access |  How to cite  | 

Abstract

We present our first experience of using superb microvascular imaging (SMI) with an 18-MHz linear probe to diagnose placenta accreta spectrum (PAS) in the retained placenta after vaginal delivery. In the first case, irregular minimal invasion of the retained placenta into the anterior myometrium and a thin uterine wall were clearly noted. In the second case, SMI clearly demonstrated the loss of myometrium anterior to fundal lesions and abnormally dilated, torturous, stem villous vessels invading until the uterine serosa. SMI with the use of an 18-MHz linear probe may be a novel diagnostic tool for the diagnosis of PAS in the retained placenta after delivery.

EDITORIAL

Ulrich Honemeyer, Asim Kurjak

Fetal Neuropathology and Abnormal Motor Assessment—Fetal Akinesia Deformation Sequence: KANET is of Additional Value for the In Utero Diagnosis

[Year:2019] [Month:July-September] [Volume:13] [Number:3] [Pages:6] [Pages No:88 - 93]

Keywords: Fetal akinesia deformation sequence, Fetal behavior, Fetal gestalt, Fetal neurology, Kurjak\'s antenatal neurodevelopment test

PDF  |  DOI: 10.5005/jp-journals-10009-1601  |  Open Access |  How to cite  | 

Abstract

The fetal activity has a fundamental role in forming the fetal gestalt. Fetal movements produce biomechanical stress, with distinct biochemical effects determining the morphogenesis of the musculoskeletal apparatus. As a result of normal maturation of the fetal brainstem, and shaped by general movements (GMs) and increasing variability of highly differentiated isolated movements, the typical human fetal gestalt evolves. KANET scoring system allows quantitative and qualitative determination and analysis of fetal movements and gestalt during the second and the third trimesters. The diagnostic efficiency of KANET in detecting abnormal fetal behavior and neuromorbidity is demonstrated with two cases of fetal akinesia deformation sequence (FADS).

ORIGINAL RESEARCH

Suada Tinjiæ

Experiences and Results of the KANET Test Application in Clinical Practice in Tuzla, Bosnia and Herzegovina

[Year:2019] [Month:July-September] [Volume:13] [Number:3] [Pages:5] [Pages No:94 - 98]

Keywords: Fetal neurological development, KANET,4D ultrasound

PDF  |  DOI: 10.5005/jp-journals-10009-1595  |  Open Access |  How to cite  | 

Abstract

Background: Antenatal neurodevelopmental test (KANET) is a test based on prenatal assessment of the fetal behavior followed by four-dimensional (4D) sonography. The estimation of the fetal behavior has provided a promising ability to understand the hidden function of the fetal nervous system developmental pathway. The test was named after the first author: Kurjak antenatal neurodevelopmental test (KANET). Materials and methods: The KANET test was administered to 141 pregnant women in single pregnancy between the 28th and the 38th weeks of pregnancy. The fetal behavior was assessed using 4D ultrasound. Results: The 3D/4D ultrasound allowed the study of the fetal behavior which directly reflects the development and maturation processes of the central nervous system (CNS) of the fetus, the distinction between normal and abnormal brain development as well as prenatal neurological damage diagnosis. From 141 patients, 69% patients had a normal KANET score, 27% had borderline KANET score, and only 4% had abnormal KANET score. The results of the KANET screening showed that only high-risk pregnancies with intrauterine growth restriction (IUGR) and diabetes mellitus type I showed abnormal results for 5 patients (41%). Conclusion: This is a method that has been applied over the past 10 years and studies show that it is a powerful diagnostic tool and can be introduced into everyday clinical practice. The KANET test is able to evaluate the fetal neuroanatomy and detect neurological disorders based on the fetal behavior assessment using 4D ultrasound in the same way that the newborn is assessed postnatal.

ORIGINAL RESEARCH

Nabil Manzour, Enrique Chacon, Itsaso Areta, Isabel Carriles, Isabel Brotons, Juan Luis Alcázar

Assessment of Cervical Volume at 19–22 Weeks for Predicting a Prolonged Pregnancy

[Year:2019] [Month:July-September] [Volume:13] [Number:3] [Pages:4] [Pages No:99 - 102]

Keywords: Cervical length, Cervical volume, Post-term, Pregnancy, Volume

PDF  |  DOI: 10.5005/jp-journals-10009-1592  |  Open Access |  How to cite  | 

Abstract

Objective: To determine whether the transvaginal ultrasonographic measurement of the cervical volume at 19–22 weeks could predict a post-term pregnancy. Materials and methods: This work involves a retrospective case–control study comprising 44 women who delivered beyond 41 weeks and 87 women who delivered at term (37–40 + 6 weeks), matched by age and parity. All of them had undergone cervical length measurement and cervical volume estimation at 19–22 weeks. Results: Patients’ median of age was 35 years in term gestations and 34.5 years in prolonged pregnancies (p = 0.313). The mean of gestational age during delivery in the term gestation group was 275.41 days vs 289.34 days on prolonged gestations (p < 0.001). We did not observe differences in the mean cervical volume between term delivery (37.37 cm3, 95% CI: 34.59–40.14) and those who had post-term delivery (38.06 cm3, 95% CI: 33.34–42.77) (p = 0.788). In addition, we did not find differences in the median cervical length (39.0 mm vs 37.0 mm) (p = 0.610). Conclusion: It seems that there is no relationship between the cervical volume measured in the ultrasound of 20-week gestation and the prolongation of pregnancy beyond week 41.

ORIGINAL RESEARCH

Sushila Arya, Zuber D Mulla, Tracy N Nguyen, Sanja Plavsic Kupesic

Role of Three-dimensional Pelvic Ultrasound in the Assessment of Risk Factors for Intrauterine Device Misplacement and Dislocation

[Year:2019] [Month:July-September] [Volume:13] [Number:3] [Pages:7] [Pages No:103 - 109]

Keywords: Quality improvement, Risk factors for intrauterine device displacement, Three-dimensional ultrasound, Uterine cavity diameter,Intrauterine device displacement

PDF  |  DOI: 10.5005/jp-journals-10009-1598  |  Open Access |  How to cite  | 

Abstract

Objectives: Our objectives were to improve the quality and safety of future intrauterine device (IUD) insertion by introducing a systematic approach to identifying patients at risk for IUD misplacement and dislocation using the 3D ultrasound. Design: Risk factors for IUD misplacement and dislocation were assessed in a case-control study of patients who presented to our ultrasound clinic for IUD localization: 49 cases (women with IUD misplacement and/or dislocation) were compared to 108 controls (women with IUDs in the normal position). Adjusted odds ratios (AOR), 95% confidence intervals (CI), and p values were calculated from logistic regression models using Firth\'s penalized maximum likelihood estimation to reduce bias. Results: The most common type of IUD complication was caudal dislocation in the lower uterine segment (LUS) and/or cervix, with or without an embedment, occurring in 41 patients (83.67%). The presence of submucosal and/or intracavitary uterine fibroids (vs other fibroid location or no fibroids) was positively associated with IUD misplacement and dislocation: AOR = 19.24, 95% CI: 1.42–260.23, p = 0.03. The presence of sonographic features of adenomyosis was positively associated with IUD dislocation, AOR = 7.40, 95% CI: 2.71–20.24, p < 0.0001. Both narrow (<30 mm) and wide (>32 mm) uterine cavity transverse diameters of the fundus assessed in the coronal plane increased the odds of a displaced IUD (vs a diameter of 30–32 mm): narrow diameter AOR = 4.95 (95% CI: 1.41–17.36, p = 0.013), and wide diameter AOR = 5.44 (95% CI: 1.39–21.22, p = 0.015). The AOR for IUD dislocation for a uterine cavity length of <30 mm (vs 30 mm or greater) was 3.60, 95% CI: 1.40–9.21, p = 0.008. Copper-containing IUDs (TCu380A/ParaGard®) were displaced more frequently than other types of IUDs: AOR = 2.82, 95% CI: 1.04–7.65, p = 0.04. Conclusion: Our data confirm that 3D ultrasound is the method of choice for IUD localization and can be used for the objective selection of candidates for intrauterine contraception.

ORIGINAL RESEARCH

Tamaki Tanaka, Kenji Kanenishi, Tomoya Yamashita, Nobuhiro Mori, Toshiyuki Hata

HDlive Flow Silhouette Mode for Assessment of Tumor Vascularity in Advanced Cervical Cancer

[Year:2019] [Month:July-September] [Volume:13] [Number:3] [Pages:3] [Pages No:110 - 112]

Keywords: Tumor vascularity,Advanced cervical cancer, Gastric-type mucinous carcinoma, HDlive flow silhouette mode, Squamous cell carcinoma

PDF  |  DOI: 10.5005/jp-journals-10009-1597  |  Open Access |  How to cite  | 

Abstract

Objective: To present our experience in assessing tumor vascularity in advanced cervical cancer using the HDlive flow silhouette mode. Materials and methods: Thirteen advanced cervical cancer patients (11 squamous cell carcinoma (SCC) patients and 2 gastric-type mucinous carcinoma (GAS) patients) were studied using the HDlive flow silhouette mode. Tumor vascularity was assessed using the subjective grading system (grade I, minimal blood flow pattern; grade II, moderate blood flow pattern; and grade III, abundant blood flow pattern). Results: The number of patients with grade I was 0, that of grade II was 4 (36.4%), and that of grade III was 7 (63.6%) in the SCC group, whereas that of grade I was 2 (100%) in the GAS group (p = 0.0128). Conclusion: Tumor vascularity may differ between SCC and GAS advanced cervical cancers. A grading system using the HDlive flow silhouette mode may provide useful, additional information on the assessment of tumor vascularity in the treatment effect on advanced cervical cancers. Further studies involving a larger sample size are needed to confirm the validity of this grading system using the HDlive flow silhouette mode for the assessment of tumor vascularity in advanced cervical cancer patients.

REVIEW ARTICLE

Sonal Panchal, Chaitanya Nagori

Doppler in Myometrial Lesions

[Year:2019] [Month:July-September] [Volume:13] [Number:3] [Pages:16] [Pages No:113 - 128]

Keywords: Adenomyosis, Fibroid, Morphological uterus sonographic assessment

PDF  |  DOI: 10.5005/jp-journals-10009-1594  |  Open Access |  How to cite  | 

Abstract

Myometrium is the chief bulk-forming layer of the uterus. Abnormalities of the myometrium may lead to abnormal peristalsis and abnormalities of circulation, and both may lead to dysfunctional uterine bleeding (DUB) and/or infertility. But, many of these are detected only as incidental finding. Assessment of myometrium, therefore, requires a systematic approach, and this has been defined by morphological uterus sonographic assessment (MUSA). This helps correct localization of the lesion and also decides the surgical approach. B mode as well as Doppler plays an important role in confident differential diagnosis of the common myometrial lesions: adenomyosis and fibroids.

REVIEW ARTICLE

Sonal Panchal, Chaitanya Nagori

Doppler Basics for a Gynecologist

[Year:2019] [Month:July-September] [Volume:13] [Number:3] [Pages:10] [Pages No:129 - 138]

Keywords: Doppler, Image quality, Scanner settings

PDF  |  DOI: 10.5005/jp-journals-10009-1596  |  Open Access |  How to cite  | 

Abstract

Ultrasound is the first-line modality for the assessment of the patients with gynecological conditions and infertility. Doppler plays a very important role in the evaluation of these patients for a differential diagnosis of pathologies in patients with gynecological complaints as well as for understanding the changes occurring during the menstrual cycle and modifying the fertility treatment accordingly. However, this requires an optimum image quality, which can be achieved only by an adequate understanding of the various knobs and settings of the B mode and Doppler on the scanner. This article discusses these settings in a purely practical perspective.

REVIEW ARTICLE

Sonal Panchal, Chaitanya Nagori

Endometrial Lesions and Doppler

[Year:2019] [Month:July-September] [Volume:13] [Number:3] [Pages:14] [Pages No:139 - 152]

Keywords: Endometrial hyperplasia, Endometrial malignancy, Polyps,Endometritis

PDF  |  DOI: 10.5005/jp-journals-10009-1593  |  Open Access |  How to cite  | 

Abstract

Centrally placed in the uterus, the endometrium covers the cavity of the uterus. It changes in structure and thickness with growing age and also in different phases of the menstrual cycle. The later changes are dependent chiefly on estrogen and progesterone. Transvaginal ultrasound is the modality of choice for its assessment. Endometrial pathologies may be inflammatory, may be due to an abnormal response to hormones, or may be benign or malignant neoplasms. The endometrium has a typical vascular pattern during different phases of the menstrual cycle and also has a typical branching pattern specific to different pathologies. Doppler therefore plays a very important role in understanding and evaluating the physiological changes as well as for the differential diagnosis of endometrial pathologies. 3D ultrasound with 3D power Doppler helps for a better understanding of the endometrial pathologies.

CASE REPORT

Toshiyuki Hata, Nobuhiro Mori, Kenta Yamamoto, Kenji Kanenishi

HDlive Flow Silhouette with Glass-body Rendering Mode for Diagnosis of Tubal Serous Borderline Tumor

[Year:2019] [Month:July-September] [Volume:13] [Number:3] [Pages:2] [Pages No:153 - 154]

Keywords: Fallopian tube, Glass-body rendering mode, HDlive flow silhouette, Radiant flow, Serous borderline tumor

PDF  |  DOI: 10.5005/jp-journals-10009-1599  |  Open Access |  How to cite  | 

Abstract

The primary tubal serous borderline tumor is a very rare neoplasm of the fallopian tube. We present a case of the tubal serous borderline tumor diagnosed using the HDlive Flow silhouette with the glass-body rendering mode. Two-dimensional sonography showed a left-sided sausage-shaped cyst with low-level echoes and several mural papillae. Radiant Flow demonstrated a few penetrating intratumoral blood vessels within papillary projections. HDlive depicted a typical torturous shape of the left hydrosalpinx and several irregular papillae. The HDlive Flow silhouette with the glass-body rendering mode clearly showed numerous penetrating vessels at the base of irregular papillary projections. These findings suggest borderline tumor of the left fallopian tube. The HDlive Flow silhouette with the glass-body rendering mode provides an additional diagnostic clue for the preoperative diagnosis of a serous borderline tumor of the fallopian tube.

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