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Monitoring follicular develpment in an in vitro fertilization and embryo transfer program: Serum estrogen vs. ultrasonography
ABSTRACTS,
ULTRASONIC
IMAGING
AND TISSUE
CHARACTERIZATION
SYMPOSIUM
Assessment Program; and 3) All currently-available ultrasonic imaging systems have variable limitations which include poor signal/noise ratio, inadequate penetration, and poor duplex Doppler systems. It is not clear to the clinician whether or not this is due to our present state-of-the-art or because the clinical requirements are not quantitatively defined. This presentation will illustrate how B-scan images are used in the management of vascular patients, quality of current images, and the interpretation rendered regarding tissue characteristics. These latter entities include the arterial ulceration, calcification, occlusion, thrombus formation and aneurysm. MONITORING FOLLICULAR DEVELPMENT IN AN IN AND EMBRYO TRANSFER -- VITRO FERTILIZATION PROGRAM: SERUM ESTROGEN VS. ULTRASONOGRAPHY, Nabil F. Maklad, Department of Radiology, University of Texas Medical School, Houston, TX 77030. Many centers treating human infertility by in vitro fertilization and embryo transfer (IVF-ET) rely on measurements of serum or &nary estrogens to monitor follicular maturation. Since we have relied primarily on ultrasonography, it was of interest to compare the efficacy of the two approaches. Patients who all had tubal disease received 150 mg/day (days 5 - 9) of clomiphene citrate. Monitoring with daily ultrasonography and measurements of serum estradiol was begun on cycle day ten. In IO patients, measurements of serum estradiol were used for timing ovulation induction; hCG was given when peripheral estrogen exceeded 500pg/ml per large follicle or when the estrogen peak was reached or passed. For all other patients, ultrasonography was the primary determinant for the time of hCG administration, given on the day the largest follicle reached 20 mm in mean diameter. Laparoscopy for oocyte recovery was scheduled 36 hours after ovulation induction unless a spontaneous LH surge occurred prior to hCG administration. Of the 10 patients in the estrogen group, 7 underwent laparoscopy, 6 had oocytes recovered and inseminated and 3 underwent embryo transfer. In the ultrasound group (39 patients), 36 underwent laparoscopy, 32 had oocytes recovered, and 23 underwent embryo transfer. There were no significant differences in rates of oocyte recovery, fertilization or cleavage. Ultrasonography is, therefore, suitable for monitoring follicular maturation in an IVF-ET program. QUANTITATIVE ASSESSMENT OF ULTRASONIC CONTRAST ENHANCEMENT AFTER INJECTION OF GELATIN MICROSPHERES, Allan Gobuty, Jonathan Ophir, and Nabil Maklad, Department of Radiology, University of Texas Medical School, Houston, TN 77030. We conducted experiments which quantitated the acoustic backscatter enhancement in dog liver as a result of IV injection of gelatin microspheres. Gelatin microspheres (3 + 2 pm) were prepared by emulsifying a mixture containing calfskin gelatin and n-hexane. After drying for long term storage, aliquots acacia, were reconstituted by sonicating in water for 15 seconds or until the suspension appeared homogenous. The particle size was verified microscopically before each use. A custom C-scan water path scanner was used to collect echo amplitude data from a The size of the plane was typically 20 cm*. constant depth plane in the dog's liver. Several hundred independent samples were repeatedly collected in I minute intervals, during and after injection of contrast. and their mean value computed before, The animals were anesthetized and the livers were Four 15 kg dogs were scanned. The degassed preparation of microspheres was infused through a surgically exposed. peripheral vein at a rate of 2 cm3sp1. The C-scans plotted the measured backscatter time. in dB vs. elapsed We observed that in all cases the mean backscatter increased rapidly soon after starting infusion, and reached a level which was l-2 dB above the normal. This effect persisted unchanged 30 minutes past the end of infusion. The data shows that consistent and prolonged contrast enhancement can be achieved in peripheral injection of gelatin microsphere suspension. -- viva after Supported by National Cancer Institute Contract #NOl-CB-84236. TISSUE CHARACTERISTICS OF AMYLOID HEART DISEASE BY TWO DIMENSIONAL ECHOCAIUJIOGRAPW, C. Lestuzxi, L. Mariani, C. Burelli, F. Zardo, and D. G. L. Nicolosi, D. Pavan, Instituto Ricerche Biomediche-Ospedale CivileZanuttini, Servizio di Emodinamica, Pordenone, Italy. (TDE) were analyzed to Images obtained from 2078 consecutive echocardiograms suggestive of cardiac amyloievaluate if changes in myocardial tissue echogenicity, could be detected. TDE were performed with a Toshiba SSL-53H phased array dosis (AM), Criteria suggestive of cardiac AM were a difsector scanner (2.4 MHZ transducer). homogeneous increase in echogenicity, a finely granular texture of myocardial fuse, Thirty patients (PT) met these criteria. In none of them, AM was known or tissue.
178
ULTRASONIC
IMAGING
AND TISSUE
CHARACTERIZATION
SYMPOSIUM
Assessment Program; and 3) All currently-available ultrasonic imaging systems have variable limitations which include poor signal/noise ratio, inadequate penetration, and poor duplex Doppler systems. It is not clear to the clinician whether or not this is due to our present state-of-the-art or because the clinical requirements are not quantitatively defined. This presentation will illustrate how B-scan images are used in the management of vascular patients, quality of current images, and the interpretation rendered regarding tissue characteristics. These latter entities include the arterial ulceration, calcification, occlusion, thrombus formation and aneurysm. MONITORING FOLLICULAR DEVELPMENT IN AN IN AND EMBRYO TRANSFER -- VITRO FERTILIZATION PROGRAM: SERUM ESTROGEN VS. ULTRASONOGRAPHY, Nabil F. Maklad, Department of Radiology, University of Texas Medical School, Houston, TX 77030. Many centers treating human infertility by in vitro fertilization and embryo transfer (IVF-ET) rely on measurements of serum or &nary estrogens to monitor follicular maturation. Since we have relied primarily on ultrasonography, it was of interest to compare the efficacy of the two approaches. Patients who all had tubal disease received 150 mg/day (days 5 - 9) of clomiphene citrate. Monitoring with daily ultrasonography and measurements of serum estradiol was begun on cycle day ten. In IO patients, measurements of serum estradiol were used for timing ovulation induction; hCG was given when peripheral estrogen exceeded 500pg/ml per large follicle or when the estrogen peak was reached or passed. For all other patients, ultrasonography was the primary determinant for the time of hCG administration, given on the day the largest follicle reached 20 mm in mean diameter. Laparoscopy for oocyte recovery was scheduled 36 hours after ovulation induction unless a spontaneous LH surge occurred prior to hCG administration. Of the 10 patients in the estrogen group, 7 underwent laparoscopy, 6 had oocytes recovered and inseminated and 3 underwent embryo transfer. In the ultrasound group (39 patients), 36 underwent laparoscopy, 32 had oocytes recovered, and 23 underwent embryo transfer. There were no significant differences in rates of oocyte recovery, fertilization or cleavage. Ultrasonography is, therefore, suitable for monitoring follicular maturation in an IVF-ET program. QUANTITATIVE ASSESSMENT OF ULTRASONIC CONTRAST ENHANCEMENT AFTER INJECTION OF GELATIN MICROSPHERES, Allan Gobuty, Jonathan Ophir, and Nabil Maklad, Department of Radiology, University of Texas Medical School, Houston, TN 77030. We conducted experiments which quantitated the acoustic backscatter enhancement in dog liver as a result of IV injection of gelatin microspheres. Gelatin microspheres (3 + 2 pm) were prepared by emulsifying a mixture containing calfskin gelatin and n-hexane. After drying for long term storage, aliquots acacia, were reconstituted by sonicating in water for 15 seconds or until the suspension appeared homogenous. The particle size was verified microscopically before each use. A custom C-scan water path scanner was used to collect echo amplitude data from a The size of the plane was typically 20 cm*. constant depth plane in the dog's liver. Several hundred independent samples were repeatedly collected in I minute intervals, during and after injection of contrast. and their mean value computed before, The animals were anesthetized and the livers were Four 15 kg dogs were scanned. The degassed preparation of microspheres was infused through a surgically exposed. peripheral vein at a rate of 2 cm3sp1. The C-scans plotted the measured backscatter time. in dB vs. elapsed We observed that in all cases the mean backscatter increased rapidly soon after starting infusion, and reached a level which was l-2 dB above the normal. This effect persisted unchanged 30 minutes past the end of infusion. The data shows that consistent and prolonged contrast enhancement can be achieved in peripheral injection of gelatin microsphere suspension. -- viva after Supported by National Cancer Institute Contract #NOl-CB-84236. TISSUE CHARACTERISTICS OF AMYLOID HEART DISEASE BY TWO DIMENSIONAL ECHOCAIUJIOGRAPW, C. Lestuzxi, L. Mariani, C. Burelli, F. Zardo, and D. G. L. Nicolosi, D. Pavan, Instituto Ricerche Biomediche-Ospedale CivileZanuttini, Servizio di Emodinamica, Pordenone, Italy. (TDE) were analyzed to Images obtained from 2078 consecutive echocardiograms suggestive of cardiac amyloievaluate if changes in myocardial tissue echogenicity, could be detected. TDE were performed with a Toshiba SSL-53H phased array dosis (AM), Criteria suggestive of cardiac AM were a difsector scanner (2.4 MHZ transducer). homogeneous increase in echogenicity, a finely granular texture of myocardial fuse, Thirty patients (PT) met these criteria. In none of them, AM was known or tissue.
178