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Diagnostic performance of CT virtual hysteroscopy in 69 consecutive patients
IMAGING IN REPRODUCTIVE MEDICINE SPECIAL INTEREST GROUP
CONCLUSION: The results obtained in our series showed the value of VH in the diagnosis of the uterine pathology with excellent diagnostic accuracy in comparison with H especially in the evaluation of the uterine cavity.
O-261 Wednesday, October 27, 2010 03:45 PM DETECTION OF OPTIMAL EMBRYO PLACEMENT BY THREE DIMENSIONAL ULTRASOUND IN DONOR EGG RECIPIENTS: PREDICTION OF PREGNANCY. R. Garcıa-Guzman, J. Herna´ndez, L. Cabrera, A. Palumbo. Centro de Asistencia a la Reproduccio´n Humana de Canarias, La Laguna, S/C de Tenerife, Spain. OBJECTIVE: To test the hypothesis that implantation rate (IR) changes as a function of the precise placement of embryos in the uterine cavity, as visualized by three-dimensional ultrasound. If this is true the advantage of ultrasound-guided over clinical touch embryo transfer would be proven. DESIGN: Prospective analysis of 78 ultrasound-guided embryo transfers performed in donor egg recipients from October 2009 to March 2010 in a private IVF center. MATERIALS AND METHODS: All transfers were performed under ultrasound guidance using a soft Wallace catheter and a voluson i (GE). A 3D volume of the uterus was acquired immediately post-transfer and stored for subsequent evaluation by two blinded investigators. The following measures were recorded: in the coronal view, the distances between embryo flash and fundus, right ostium and left ostium; in the sagittal view rhe distance between fundus and internal cervical os, the distance between embryo flash and internal cervical os and endometrial thickness. IR and pregnancy rate (PR) were determined. Statistical analysis was performed using the SPSS program. RESULTS: Implantation and clinical pregnancy rates were 46.5% and 67.95% respectively. Of the 78 patients 53 became pregnant (P) and 25 did not (NP). Statistically significant differences were found in the distance between the embryo flash and the fundus (P¼9.05 4.53; NP¼6.91 3.73; P<0.05), the right ostium (P¼15.02 5.36; NP¼11.87 4.78; P <0.05) and the left ostium (P¼15.77 4.84; NP¼13.21 4.59; P <0.05). Measurements in the two groups were similar for endometrial thickness (P¼10.21 2.64; NP¼9.17 2.05); distance from fundus to internal cervical os (P¼36.47 9.1; NP¼36.24 9.68); distance from embryo flash to internal cervical os (P¼26.16 7.22; NP¼28 8.14). CONCLUSION: These data suggest that placement of embryos at approximately 9 mm from the fundus and equidistant to the tubal ostia increases implantation rate. Ultrasound guidance may enable physicians to place the embryos as close as possible to this ideal point.
O-263 Wednesday, October 27, 2010 04:15 PM THE ULTRASONOGRAPHIC APPEARANCE OF A ‘‘MANTLE SHAPE’’ IS AN OMINOUS SIGN OF THE PRESENCE OF EXTENSIVE DEEPLY INFILTRATING ENDOMETRIOSIS. L. P. Chamie, R. M. A. Pereira, A. Zanatta, A. M. Rocha, P. Serafini. Fleury Medicina e Sau´de, S~ao Paulo, Brazil; Huntington Medicina Reprodutiva, S~ao Paulo, Brazil; Disciplina de Ginecologia, Faculdade de Medicina da Universidade de S~ao Paulo, S~ao Paulo, Brazil. OBJECTIVE: to describe an ultrasonographic appearance of a mantle like-form that is associated with extensive deeply infiltrative endometriosis (DIE). DESIGN: Prospective observational study with retrospective analysis. MATERIALS AND METHODS: Infertile women with and without major pelvic pain were evaluated for DIE before treatment with a transvaginal ultrasound after bowel preparation (TVSBP) carried out by the same radiologist (LPC) using a Voluson GE 750 expert ultrasound. All women underwent diagnostic followed by extensive laparoscopic (LSC) surgery, conducted by the same surgeon (RMAP). All endometriotic lesions were removed and evaluated by experienced pathologists. Sensitivity, specificity, and likelihood ratios and probability of disease were calculated. RESULTS: 67 women (35 4 years old; mean SD) who had been infertile for a period of 1 to 6 years (2.9 1.8) underwent TVSBP and LSC. Previous IVF (2 1 attempts) and LSC (1 1) were carried out by other colleagues before these studies and interventions. TVSBP diagnosed 10 mantle shaped lesions in the anterior compartment (AC) and 20 in the posterior compartment (PC). Patients had 5 2 DIE lesions excised during LSC. Results from LSC and histopathology resulted on 10 AC and 23 PC lesions. Sensitivity, specificity, and likelihood ratios and probability of disease for TVSBP are shown in table.
Pelvic Positive Negative Probability of compartment Sensitivity Specificity likelihood ratio likelihood ratio disease Anterior Posterior
1 0.87
1 0.83
5.02 9999
0.16 0
0.149 0.307
O-262 Wednesday, October 27, 2010 04:00 PM DIAGNOSTIC PERFORMANCE OF CT VIRTUAL HYSTEROSCOPY IN 69 CONSECUTIVE PATIENTS. M. Baronio, P. Carrascosa, C. Capu~ nay, J. Vallejos, C. Sueldo, J. Carrascosa. Diagnostico Maipu, Vicente Lopez, Buenos Aires, Argentina; C.E.G.Y.R., C.A.B.A., Buenos Aires, Argentina. OBJECTIVE: CT Virtual Hysteroscopy provides a complete, minimally invasive evaluation of the the uterine cavity based on bidimensional, tridimensional and endoscopic views. The objective of the presentation is to evaluate the diagnostic accuracy of CT virtual hysteroscopy (VH) for the detection of cervical and uterine pathology in comparison to the conventional hysteroscopy (H) considered as the gold standard method. DESIGN: Comparative prospective study. MATERIALS AND METHODS: Sixty nine patients with diagnosis of infertility who underwent both VH and H were included in the study. All VH were carried out with a 64 row multidetector CT scanner using 0.9mm slice thickness; 0.45-mm reconstruction interval; 3-4 sec scan time; 120kV and 100-200 mAs. A volume of 10-20ml of a dilution of low-osmolality iodine contrast agent was instilled into the uterine cavity. After VH the conventional H was performed. Both studies were carried out in a blinded and independently way. The diagnostic accuracy of VH was calculated for the diagnosis of cervical and uterine pathology by the exact binomial method. RESULTS: For the cervical pathology, VH showed a sensitivity of 82%, specificity of 98.%, positive predictive value of 90%, and negative predictive value of 96%. For the detection of uterine pathology the sensitivity was 95%, specificity 86%, positive predictive value 96%, and negative predictive value 80%. In a global evaluation (cervix and uterus) the sensitivity was 93%, specificity 96%, positive predictive value 95% and negative predictive value 93%.
FERTILITY & STERILITYÒ
CONCLUSION: These findings show a substantially high incidence of both anterior and most significantly, posterior pelvic compartment of a mantle-like appearance of DIE. The ‘‘mantle sign’’ found in the ultrasonographic evaluation was documented by LSC and histopathology in all women with extensive DIE disease. Thereby, the observation of an ultrasonographic mantle-like appearance is a sign of severe deeply infiltrative pelvic endometriosis.
O-264 Wednesday, October 27, 2010 04:30 PM INTRAOPERATIVE THREE-DIMENSIONAL SONOHYSTEROGRAPHY: A NEW TECHNIQUE TO MONITOR HYSTEROSCOPIC METROPLASTY. J. Guerrero, R. Garcia, J. Hernandez, L. Iaconianni, A. Palumbo. Centro de Asistencia a la Reproduccio´n Humanana de Canarias, La Laguna, S/C de Tenerife, Spain; Centro Ecografico EcoB.I., Roma, Italy. OBJECTIVE: To illustrate the utility of a new technique, intraoperative tridimensional (3D) sonohisterography, to monitor non invasively the surgical correction of uterine anomalies. DESIGN: Prospective evaluation of infertility patients undergoing hysteroscopic correction of uterine anomalies in a single private infertility clinic between October 2009 and April 2010. MATERIALS AND METHODS: Twenty infertility patients with septate, subsebtate or arcuate uteri underwent operative hysteroscopy with a Wolf 5 mm compact hysteroscope using cold scissors. Intraoperatively, a voluson i was used to guide the surgery transabdominally with a 3D RAB 4-8 probe.
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CONCLUSION: The results obtained in our series showed the value of VH in the diagnosis of the uterine pathology with excellent diagnostic accuracy in comparison with H especially in the evaluation of the uterine cavity.
O-261 Wednesday, October 27, 2010 03:45 PM DETECTION OF OPTIMAL EMBRYO PLACEMENT BY THREE DIMENSIONAL ULTRASOUND IN DONOR EGG RECIPIENTS: PREDICTION OF PREGNANCY. R. Garcıa-Guzman, J. Herna´ndez, L. Cabrera, A. Palumbo. Centro de Asistencia a la Reproduccio´n Humana de Canarias, La Laguna, S/C de Tenerife, Spain. OBJECTIVE: To test the hypothesis that implantation rate (IR) changes as a function of the precise placement of embryos in the uterine cavity, as visualized by three-dimensional ultrasound. If this is true the advantage of ultrasound-guided over clinical touch embryo transfer would be proven. DESIGN: Prospective analysis of 78 ultrasound-guided embryo transfers performed in donor egg recipients from October 2009 to March 2010 in a private IVF center. MATERIALS AND METHODS: All transfers were performed under ultrasound guidance using a soft Wallace catheter and a voluson i (GE). A 3D volume of the uterus was acquired immediately post-transfer and stored for subsequent evaluation by two blinded investigators. The following measures were recorded: in the coronal view, the distances between embryo flash and fundus, right ostium and left ostium; in the sagittal view rhe distance between fundus and internal cervical os, the distance between embryo flash and internal cervical os and endometrial thickness. IR and pregnancy rate (PR) were determined. Statistical analysis was performed using the SPSS program. RESULTS: Implantation and clinical pregnancy rates were 46.5% and 67.95% respectively. Of the 78 patients 53 became pregnant (P) and 25 did not (NP). Statistically significant differences were found in the distance between the embryo flash and the fundus (P¼9.05 4.53; NP¼6.91 3.73; P<0.05), the right ostium (P¼15.02 5.36; NP¼11.87 4.78; P <0.05) and the left ostium (P¼15.77 4.84; NP¼13.21 4.59; P <0.05). Measurements in the two groups were similar for endometrial thickness (P¼10.21 2.64; NP¼9.17 2.05); distance from fundus to internal cervical os (P¼36.47 9.1; NP¼36.24 9.68); distance from embryo flash to internal cervical os (P¼26.16 7.22; NP¼28 8.14). CONCLUSION: These data suggest that placement of embryos at approximately 9 mm from the fundus and equidistant to the tubal ostia increases implantation rate. Ultrasound guidance may enable physicians to place the embryos as close as possible to this ideal point.
O-263 Wednesday, October 27, 2010 04:15 PM THE ULTRASONOGRAPHIC APPEARANCE OF A ‘‘MANTLE SHAPE’’ IS AN OMINOUS SIGN OF THE PRESENCE OF EXTENSIVE DEEPLY INFILTRATING ENDOMETRIOSIS. L. P. Chamie, R. M. A. Pereira, A. Zanatta, A. M. Rocha, P. Serafini. Fleury Medicina e Sau´de, S~ao Paulo, Brazil; Huntington Medicina Reprodutiva, S~ao Paulo, Brazil; Disciplina de Ginecologia, Faculdade de Medicina da Universidade de S~ao Paulo, S~ao Paulo, Brazil. OBJECTIVE: to describe an ultrasonographic appearance of a mantle like-form that is associated with extensive deeply infiltrative endometriosis (DIE). DESIGN: Prospective observational study with retrospective analysis. MATERIALS AND METHODS: Infertile women with and without major pelvic pain were evaluated for DIE before treatment with a transvaginal ultrasound after bowel preparation (TVSBP) carried out by the same radiologist (LPC) using a Voluson GE 750 expert ultrasound. All women underwent diagnostic followed by extensive laparoscopic (LSC) surgery, conducted by the same surgeon (RMAP). All endometriotic lesions were removed and evaluated by experienced pathologists. Sensitivity, specificity, and likelihood ratios and probability of disease were calculated. RESULTS: 67 women (35 4 years old; mean SD) who had been infertile for a period of 1 to 6 years (2.9 1.8) underwent TVSBP and LSC. Previous IVF (2 1 attempts) and LSC (1 1) were carried out by other colleagues before these studies and interventions. TVSBP diagnosed 10 mantle shaped lesions in the anterior compartment (AC) and 20 in the posterior compartment (PC). Patients had 5 2 DIE lesions excised during LSC. Results from LSC and histopathology resulted on 10 AC and 23 PC lesions. Sensitivity, specificity, and likelihood ratios and probability of disease for TVSBP are shown in table.
Pelvic Positive Negative Probability of compartment Sensitivity Specificity likelihood ratio likelihood ratio disease Anterior Posterior
1 0.87
1 0.83
5.02 9999
0.16 0
0.149 0.307
O-262 Wednesday, October 27, 2010 04:00 PM DIAGNOSTIC PERFORMANCE OF CT VIRTUAL HYSTEROSCOPY IN 69 CONSECUTIVE PATIENTS. M. Baronio, P. Carrascosa, C. Capu~ nay, J. Vallejos, C. Sueldo, J. Carrascosa. Diagnostico Maipu, Vicente Lopez, Buenos Aires, Argentina; C.E.G.Y.R., C.A.B.A., Buenos Aires, Argentina. OBJECTIVE: CT Virtual Hysteroscopy provides a complete, minimally invasive evaluation of the the uterine cavity based on bidimensional, tridimensional and endoscopic views. The objective of the presentation is to evaluate the diagnostic accuracy of CT virtual hysteroscopy (VH) for the detection of cervical and uterine pathology in comparison to the conventional hysteroscopy (H) considered as the gold standard method. DESIGN: Comparative prospective study. MATERIALS AND METHODS: Sixty nine patients with diagnosis of infertility who underwent both VH and H were included in the study. All VH were carried out with a 64 row multidetector CT scanner using 0.9mm slice thickness; 0.45-mm reconstruction interval; 3-4 sec scan time; 120kV and 100-200 mAs. A volume of 10-20ml of a dilution of low-osmolality iodine contrast agent was instilled into the uterine cavity. After VH the conventional H was performed. Both studies were carried out in a blinded and independently way. The diagnostic accuracy of VH was calculated for the diagnosis of cervical and uterine pathology by the exact binomial method. RESULTS: For the cervical pathology, VH showed a sensitivity of 82%, specificity of 98.%, positive predictive value of 90%, and negative predictive value of 96%. For the detection of uterine pathology the sensitivity was 95%, specificity 86%, positive predictive value 96%, and negative predictive value 80%. In a global evaluation (cervix and uterus) the sensitivity was 93%, specificity 96%, positive predictive value 95% and negative predictive value 93%.
FERTILITY & STERILITYÒ
CONCLUSION: These findings show a substantially high incidence of both anterior and most significantly, posterior pelvic compartment of a mantle-like appearance of DIE. The ‘‘mantle sign’’ found in the ultrasonographic evaluation was documented by LSC and histopathology in all women with extensive DIE disease. Thereby, the observation of an ultrasonographic mantle-like appearance is a sign of severe deeply infiltrative pelvic endometriosis.
O-264 Wednesday, October 27, 2010 04:30 PM INTRAOPERATIVE THREE-DIMENSIONAL SONOHYSTEROGRAPHY: A NEW TECHNIQUE TO MONITOR HYSTEROSCOPIC METROPLASTY. J. Guerrero, R. Garcia, J. Hernandez, L. Iaconianni, A. Palumbo. Centro de Asistencia a la Reproduccio´n Humanana de Canarias, La Laguna, S/C de Tenerife, Spain; Centro Ecografico EcoB.I., Roma, Italy. OBJECTIVE: To illustrate the utility of a new technique, intraoperative tridimensional (3D) sonohisterography, to monitor non invasively the surgical correction of uterine anomalies. DESIGN: Prospective evaluation of infertility patients undergoing hysteroscopic correction of uterine anomalies in a single private infertility clinic between October 2009 and April 2010. MATERIALS AND METHODS: Twenty infertility patients with septate, subsebtate or arcuate uteri underwent operative hysteroscopy with a Wolf 5 mm compact hysteroscope using cold scissors. Intraoperatively, a voluson i was used to guide the surgery transabdominally with a 3D RAB 4-8 probe.
S77