- Email: [email protected]
The diagnostic accuracy of gel instillation sonohysterography (GIS) compared with saline infusion sonohysterography (SIS); a randomized controlled trial
CONCLUSIONS: This data raises doubts about the current practice of routinely screening SW/LW for tubal patency prior to DI. Individualised treatment strategies including in vitro fertilisation therapies may be more appropriate for LW/SW who present for treatment at advanced age with reduced ovarian reserve. Hy should be a routine consideration for the subgroup of SW/LW who present with a definite history of non male factor infertility.
0.06). Protodiastolic notch were observed more frequently in uterine waveform (19 out of 24 ¼ 80%) of the study RIF group. CONCLUSIONS: Color Doppler examination of the uterine arteries represents a useful tool for screening women with a history of RIF and therefore, should be included in RIF diagnostic chart. This test provides the opportunity to identify women in whom appropriate therapeutic protocols may effectively improve the possibility for a successful pregnancy.
P-103 Tuesday, October 20, 2009
P-105 Tuesday, October 20, 2009
CLITORAL CYST: NOT A VERY RARE COMPLICATION OF FEMALE GENITAL MUTILATION. A. A. Rouzi. Obstetrics and Gynecology, King Abdulaziz University, Jeddah, Western, Saudi Arabia.
FOLLICULAR MEASUREMENTS USING A COMPUTERIZED 3D ULTRASOUND SYSTEM (SONOAVC) FOR MONITORING OVARIAN STIMULATION FOR IVF IS EFFECTIVE AND EFFICIENT. R. Sherbahn, T. Deutch. Advanced Fertility Center of Chicago, Gurnee, IL.
OBJECTIVE: To report a case series of clitoral cysts after female genital mutilation (FGM). DESIGN: Retrospective case control study. MATERIALS AND METHODS: All of the operative records from January 1998 to January 2009 at King Abdulaziz University Hospital in Jeddah, Saudi Arabia were reviewed. The records for girls and women who had suffered from clitoral cysts and had subsequently undergone surgery were identified and examined. Institutional Review Board approval was obtained. Data regarding age, clinical presentation, operating time, estimated blood loss, presence of intraoperative and postoperative complications, duration of admission to the hospital, and long-term follow-up were extracted from these specific files. RESULTS: During the study period 32 girls and women underwent surgery for clitoral cysts. The mean age was 28.1 years. The youngest being 5 years old and the oldest 91 years. All presented with increasing clitoral mass for the mean duration of 5.2 years (4.1). Fifteen women (46.9%) had a definitive history of FGM, 14 (43.8) did not know whether they had or did not have FGM, and 3 (9.3%) had a definitive no history of FGM. The mean diameter of the cyst on examination was 4.2 cm ( 2). Thirty one underwent surgical excision and one had only incision and drainage of a clitoral abscess. In some cases other surgical procedures were also performed. No short or long term complications occurred. CONCLUSIONS: Clitoral cyst is perceived to be a very rare complication of FGM. It is not. Efforts to publish the medical complications of FGM should be encouraged to facilitate abandoning the procedure.
OBJECTIVE: To study the effectiveness and efficiency of three-dimensional (3D) ultrasound assessment of follicular size during ovarian stimulation for IVF using the GE Automated Volume Count (SonoAVC) program. DESIGN: Retrospective review of IVF outcome parameters and ultrasound follicular measurements in monitoring ovarian stimulation. MATERIALS AND METHODS: Clinical pregnancy rates, total number of eggs retrieved, total mature eggs retrieved and the percentage of mature eggs were compared in 2 groups. Group 1 included all women using own eggs under age 35 having egg retrievals during the 9 month period of October 2007 through June 2008. Almost all patients in Group 1 had follicles measured using traditional 2D ultrasound assessment with averaged diameters from 2 planes. Group 2 included all women using own eggs under age 35 that had egg retrievals in the next 9 months (July 2008 through March 2009). Almost all of the patients in Group 2 had follicles measured using a 3D GE Voluson E8 machine and computer assisted follicular sizes calculated by SonoAVC software. The software calculates volumetric parameters for every follicle including the mean diameters. 23 patients were scanned with both methods and the duration of time needed for scanning and entering data into the chart was recorded for each method. Statistical analysis utilized Student’s t-test and chi-square statistics. RESULTS: The average time required to perform a scan, analyze the data and record it in the chart was slightly less with the 3D SonoAVC method (5.6 vs. 6.2 minutes). IVF Outcome Results
Group 1 (2D) Group 2 (3D) P Value
IMAGING P-104 Tuesday, October 20, 2009 IMPAIRED UTERINE PERFUSION IN INFERTILE WOMEN WITH REPEATED IVF-IMPLANTATION FAILURE AS DETECTED BY UTERINE ARTERY COLOR DOPPLER STUDY. M. E.-S. Eid, A. M. Taye. Infertility, Dr. S. Abbas Medical Center, Jeddah, Western District, Saudi Arabia; Ultrasound, Dr. S. Abbas Medical Center, Jeddah, Western District, Saudi Arabia. OBJECTIVE: Poor uterine perfusion during the period that coincides with the implantation window could play a role in the pathogenesis of repeated IVF-implantation failure (RIF). We aimed to evaluate the uterine artery blood flow indices (PI & RI), during the mid-luteal phase, in women with RIF and to compare these data with those obtained form infertile women before their first IVF trial. DESIGN: A prospective-abservational controlled study MATERIALS AND METHODS: Twenty- four infertile women having a history R 3 failed IVF trials despite multiple transfer of good quality embryos and 30 infertile controls referred for routine assessment before their first IVF trial were recruited for the study. All candidates had a normal ovarian function and a normal uterus plus endocrine disorders and autoimmune diseases were ruled out. Trans-vaginal color Doppler ultrasound examination by one examiner, who was blinded to the result of the diagnostic chart, during the mid-luteal phase of untreated cycles. The uterine artery blood flow waveform velocity was obtained. The pulsatility index (PI) and resistance index (RI) of both the left and right arteries were also calculated. RESULTS: The mean PI values for uterine arteries were significantly higher (2.88 0.45) in women with RIF in comparison to control infertile group (1.92 0.62), (P value ¼ 0.03).The mean RI values showed no statistical difference between the study and control groups (0.90 0.04) vs (0.80
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Abstracts
Egg Retrievals Mean Total Number of Oocytes Mean Number of Metaphase II Oocytes Percentage of Metaphase II Oocytes Clinical Pregnancy Rate Per Retrieval
119 12.2 9.7 79.6% 70.6%
126 11.4 9.3 81.5% 65.5%
NS NS NS NS
CONCLUSIONS: Follicular size determination for IVF ovarian stimulation with the SonoAVC system is effective and efficient. IVF outcome parameters are similar and some technician time can be saved by using SonoAVC.
P-106 Tuesday, October 20, 2009 THE DIAGNOSTIC ACCURACY OF GEL INSTILLATION SONOHYSTEROGRAPHY (GIS) COMPARED WITH SALINE INFUSION SONOHYSTEROGRAPHY (SIS); A RANDOMIZED CONTROLLED TRIAL. M. H. Emanuel, I. Tromp, M. Betlem. OB/GYN, Spaarne Hospital, Hoofddorp/Amsterdam, NL, Netherlands. OBJECTIVE: To compare the diagnostic accuracy of Gel Instillation Sonohysterography (GIS) with the diagnostic accuracy of Saline Infusion Sonohysterography (SIS). DESIGN: Prospective Randomized Controlled Trial MATERIALS AND METHODS: Between Aug 2007 and Dec 2008 103 consecutive patients with abnormal uterine bleeding and an abnormal transvaginal ultrasound were randomized for the use of Gel Instillation or Saline Infusion during Sonohysterography. Abnormalities detected during Sonohysterography were classified as pedunculated polyp, sessile polyp, pedunculated myoma (type 0), sessile myoma (type 1) and sessile myoma (type 2).
Vol. 92., No. 3, Supplement, September 2009
Hysteroscopy was used as gold standard in case of abnormalities. The primary outcome measure was diagnostic accuracy. RESULTS: In the GIS group (n¼53) 35 abnormalities were found; 31 (89%) were confirmed during hysteroscopy. In the SIS group (n¼50) 30 abnormalities were found; 22 (73%) were confirmed during hysteroscopy. Suspected pedunculated polyps were confirmed during hysteroscopy in all 8 cases, sessile polyps in 15 out of 19 cases, pedunculated myomas (type 0) in 10 out of 14, sessile myomas (type 1) in 9 out of 13 and sessile muomas (type 2) in all 11 cases. CONCLUSIONS: Gel Instillation is an alternative for Saline Infusion during Sonohysterography. Gel Instillation has a higher diagnostic accuracy than Saline Infusion during Sonohysterography.
P-107 Tuesday, October 20, 2009 THREE-DIMENSIONAL SONOHYSTEROGRAPHY (SHG) HAS IMPROVED DIAGNOSTIC ACCURACY FOR INTRAUTERINE PATHOLOGY COMPARED TO TWO-DIMENSIONAL SHG: A PROSPECTIVE PILOT STUDY IN INFERTILITY PATIENTS. P. MoraGuanche, L. Sparacino, R. Garcıa-Guzman, R. A. Bennett, J. Herna´ndez, A. Palumbo. Centro de A.Reproduccio´n Humana de Canarias, La Laguna, Tenerife, Spain; Westchester Reproductive Medicine, NY, NY. OBJECTIVE: To compare the positive predictive value (PPV) and sensitivity of two-dimensional (2D) and three-dimensional (3D) SHG for the diagnosis of intrauterine lesions. DESIGN: Prospective analysis of 111 consecutive SHG procedures and 29 hysteroscopies performed from January 2009 to April 2009 in a private infertility practice. MATERIALS AND METHODS: 111 infertility patients underwent 3D SHG as part of the infertility evaluation. All procedures were performed using a Voluson 730 Pro (General Electric). Data were analyzed comparing 2D and 3D SHG and hysteroscopy findings. PPV and sensitivity of 2D and 3D SHG were calculated. RESULTS: Of the 111 SHGs performed, 59 were normal and 52 abnormal (46.8%). The diagnosis at SHG was polyp (14), polyp þ other pathology (6), myoma (5), intrauterine adhesions (11), uterine septum or subseptum (6), subseptum þ other pathology (9), unicornuate uterus þ sinequia (1). Of the abnormals, 29 underwent hysteroscopy in our center before april 30th. In every one of the abnormal SHGs some intrauterine pathology was found (PPV 100%.). Of the 29 abnormal hysteroscopies, all had an abnormal SHG (sensitivity 100%). Compared to 2D images, the 3D coronal views of the uterus improved the diagnostic accuracy of the procedure in 31 (27.9%) of the 111 patients. When only 1 abnormality was present, the diagnosis made at 3D SHG was confirmed in 100% of cases. When 2 abnormalities were associated, and one of them was a septum or subseptum, 1 of these abnormalities was initially missed at SHG in 7 cases. However, retrospective analysis of the SHG images allowed correct identification and localization of all lesions. CONCLUSIONS: This study demonstrates that 3D SHG has a PPV and sensitivity of 100% for abnormal hysteroscopy. The 3D coronal plane allows identification of additional lesions not visible in the 2D images in a high percentage of cases and adds precision to the localization of the lesions.
P-108 Tuesday, October 20, 2009 RECOGNITION OF 2-D ULTRASOUND IMAGES OF OVARIAN CYSTS USING CONTENT-BASED IMAGE RECOGNITION (CBIR) SYSTEM. S. Krishnamurthy, A. S. M. Sohail, J. Feng, C. Martins, L. Gilbert, P. Bhattacharya. Obstetrics & Gynecology, McGill University, Montreal, QC, Canada; Computer Sciences, Concordia University, Montreal, QC, Canada. OBJECTIVE: Pattern recognition of ultrasound abnormalities requires training and experience. To date, pattern recognition used by an expert remains the standardfor differentiating benign from malignant ovarian lesions. This pilot study was undertaken to develop and test the feasibility of a computer based system for recognition and classification of 2-D ultrasound images into categories. DESIGN: Retrospective analysis of anonymous 2-D ultrasound images MATERIALS AND METHODS: A total of 63 images of benign ovarian cysts as diagnosed by the expert were utilized to train the statistical machine learning based classification technique. Two specific types of ovarian cyst images namely simple cysts (n ¼ 24) and endometriomas (n ¼ 39) were
FERTILITY & STERILITYÒ
used to keep the process uncomplicated. The cysts were characterized by their inherent patterns captured in 2-D ultrasound images that can be represented numerically using specialized image processing based feature extraction technique. For this purpose, the images were first converted into their corresponding 8-bit gray level version and feature vectors were created for each image. The extracted feature vectors were then used to train statistical machine learning based classification technique. RESULTS: The system’s ability to recognize unknown or query images was tested by feeding 57 images, categorized by the expert as simple cysts (n ¼ 24) and endometriomas (n ¼ 33) as feature vector.The machine recognized 19/24 (79%) of simple cysts and 30/33 (91%) of the endometriomas. The false negative rate for simple cysts was higher due to the heterogeneous content. CONCLUSIONS: Development of CBIR system appears to be an exciting possibility as a diagnostic aid for ovarian lesions. A larger database, standardizing the image acquisition protocol and addition of patient characteristics will reduce the errors in diagnosis and improve sensitivity and specificity. Other types of cysts such as teratomas and malignant lesions will inevitably widen the scope of its utility.
P-109 Tuesday, October 20, 2009 FOAM INFUSION SONOSALPINGOGRAPHY (FIS) OR HYSTEROSALPINGO CONTRAST SONOGRAPHY (HYCOSY) WITH FOAM. M. H. Emanuel, I. Tromp, J. Knieriem. Ob/Gyn, Spaarne Hospital, Hoofddorp/Amsterdam, NL, Netherlands. OBJECTIVE: To describe and introduce a new technique of direct imaging of the tubal passage in tubal diagnostics of tubal patency during transvaginal ultrasonography. DESIGN: Descriptive study of a new technique. MATERIALS AND METHODS: In 2007 a new technique Gel Instillation Sonohysterography (GIS) or Virtual Hysteroscopy was introduced to improve the accuracy of Transvaginal Ultrasonography of the uterine cavity and to overcome disadvantages of Saline Infusion Sonohysterography (SIS). One of the disadvantages of the use of transsonic fluids however is the poor visualization of tubal passage. For this purpose special echogenic ultrasound contrast media became commercially available. A simple and cheap alternative is presented by mixing Air with ExEmÒ gel and Saline creating Foam with Microbubbles. This Foam can be infused through the cervical adapter that was developed for GIS. RESULTS: The findings and images obtained by FIS showed an easy recognition of the tubal passage of the foam in case of tubal patency. CONCLUSIONS: Tubal patency can be easily recognized by FIS. Comparison of the findings with conventional methods like hysterosalpingography and chromopertubation during laparoscopy has to be evaluated. It seems reasonable to expect that the use of FIS will be an acceptable first step, cheap and simple screening method for tubal patency.
P-110 Tuesday, October 20, 2009 ULTRASOUND FINDINGS AND PRESENTING SYMPTOMS IN CERVICAL ECTOPIC PREGNANCY. V. I. Shavell, M. E. Abdallah, M. A. Zakaria, E. E. Puscheck, M. P. Diamond, D. C. Kmak. Division of REI, Dept of OBGYN, Wayne State University/Detroit Medical Center, Detroit, MI; Obstetrics and Gynecology, Wayne State University/Detroit Medical Center, Detroit, MI; Obstetrics and Gynecology, Michigan State University/Detroit Medical center, Detroit, MI. OBJECTIVE: To describe the ultrasound findings and signs and symptoms at presentation in patients with cervical ectopic pregnancy (CEP). DESIGN: Retrospective case series. MATERIALS AND METHODS: We identified patients with CEP treated between January 2000 and December 2008 at Hutzel Women’s Hospital in Detroit, Michigan. Chart review was performed and abstracted data included patient’s demographics, presenting symptoms, laboratory and ultrasound findings and risk factors for CEP. Whether CEP was initially misdiagnosed was documented. RESULTS: 14 patients with CEP were treated during the study period, one of which was a heterotopic pregnancy. 8 patients presented to the emergency department (ED), 4 were transferred from other hospitals and 2 were directly admitted from clinic. Patients’ age ranged from 21 to 41 years. All but one were multigravid, and 10 patients had at least one risk factor for CEP (e.g.
S119
0.06). Protodiastolic notch were observed more frequently in uterine waveform (19 out of 24 ¼ 80%) of the study RIF group. CONCLUSIONS: Color Doppler examination of the uterine arteries represents a useful tool for screening women with a history of RIF and therefore, should be included in RIF diagnostic chart. This test provides the opportunity to identify women in whom appropriate therapeutic protocols may effectively improve the possibility for a successful pregnancy.
P-103 Tuesday, October 20, 2009
P-105 Tuesday, October 20, 2009
CLITORAL CYST: NOT A VERY RARE COMPLICATION OF FEMALE GENITAL MUTILATION. A. A. Rouzi. Obstetrics and Gynecology, King Abdulaziz University, Jeddah, Western, Saudi Arabia.
FOLLICULAR MEASUREMENTS USING A COMPUTERIZED 3D ULTRASOUND SYSTEM (SONOAVC) FOR MONITORING OVARIAN STIMULATION FOR IVF IS EFFECTIVE AND EFFICIENT. R. Sherbahn, T. Deutch. Advanced Fertility Center of Chicago, Gurnee, IL.
OBJECTIVE: To report a case series of clitoral cysts after female genital mutilation (FGM). DESIGN: Retrospective case control study. MATERIALS AND METHODS: All of the operative records from January 1998 to January 2009 at King Abdulaziz University Hospital in Jeddah, Saudi Arabia were reviewed. The records for girls and women who had suffered from clitoral cysts and had subsequently undergone surgery were identified and examined. Institutional Review Board approval was obtained. Data regarding age, clinical presentation, operating time, estimated blood loss, presence of intraoperative and postoperative complications, duration of admission to the hospital, and long-term follow-up were extracted from these specific files. RESULTS: During the study period 32 girls and women underwent surgery for clitoral cysts. The mean age was 28.1 years. The youngest being 5 years old and the oldest 91 years. All presented with increasing clitoral mass for the mean duration of 5.2 years (4.1). Fifteen women (46.9%) had a definitive history of FGM, 14 (43.8) did not know whether they had or did not have FGM, and 3 (9.3%) had a definitive no history of FGM. The mean diameter of the cyst on examination was 4.2 cm ( 2). Thirty one underwent surgical excision and one had only incision and drainage of a clitoral abscess. In some cases other surgical procedures were also performed. No short or long term complications occurred. CONCLUSIONS: Clitoral cyst is perceived to be a very rare complication of FGM. It is not. Efforts to publish the medical complications of FGM should be encouraged to facilitate abandoning the procedure.
OBJECTIVE: To study the effectiveness and efficiency of three-dimensional (3D) ultrasound assessment of follicular size during ovarian stimulation for IVF using the GE Automated Volume Count (SonoAVC) program. DESIGN: Retrospective review of IVF outcome parameters and ultrasound follicular measurements in monitoring ovarian stimulation. MATERIALS AND METHODS: Clinical pregnancy rates, total number of eggs retrieved, total mature eggs retrieved and the percentage of mature eggs were compared in 2 groups. Group 1 included all women using own eggs under age 35 having egg retrievals during the 9 month period of October 2007 through June 2008. Almost all patients in Group 1 had follicles measured using traditional 2D ultrasound assessment with averaged diameters from 2 planes. Group 2 included all women using own eggs under age 35 that had egg retrievals in the next 9 months (July 2008 through March 2009). Almost all of the patients in Group 2 had follicles measured using a 3D GE Voluson E8 machine and computer assisted follicular sizes calculated by SonoAVC software. The software calculates volumetric parameters for every follicle including the mean diameters. 23 patients were scanned with both methods and the duration of time needed for scanning and entering data into the chart was recorded for each method. Statistical analysis utilized Student’s t-test and chi-square statistics. RESULTS: The average time required to perform a scan, analyze the data and record it in the chart was slightly less with the 3D SonoAVC method (5.6 vs. 6.2 minutes). IVF Outcome Results
Group 1 (2D) Group 2 (3D) P Value
IMAGING P-104 Tuesday, October 20, 2009 IMPAIRED UTERINE PERFUSION IN INFERTILE WOMEN WITH REPEATED IVF-IMPLANTATION FAILURE AS DETECTED BY UTERINE ARTERY COLOR DOPPLER STUDY. M. E.-S. Eid, A. M. Taye. Infertility, Dr. S. Abbas Medical Center, Jeddah, Western District, Saudi Arabia; Ultrasound, Dr. S. Abbas Medical Center, Jeddah, Western District, Saudi Arabia. OBJECTIVE: Poor uterine perfusion during the period that coincides with the implantation window could play a role in the pathogenesis of repeated IVF-implantation failure (RIF). We aimed to evaluate the uterine artery blood flow indices (PI & RI), during the mid-luteal phase, in women with RIF and to compare these data with those obtained form infertile women before their first IVF trial. DESIGN: A prospective-abservational controlled study MATERIALS AND METHODS: Twenty- four infertile women having a history R 3 failed IVF trials despite multiple transfer of good quality embryos and 30 infertile controls referred for routine assessment before their first IVF trial were recruited for the study. All candidates had a normal ovarian function and a normal uterus plus endocrine disorders and autoimmune diseases were ruled out. Trans-vaginal color Doppler ultrasound examination by one examiner, who was blinded to the result of the diagnostic chart, during the mid-luteal phase of untreated cycles. The uterine artery blood flow waveform velocity was obtained. The pulsatility index (PI) and resistance index (RI) of both the left and right arteries were also calculated. RESULTS: The mean PI values for uterine arteries were significantly higher (2.88 0.45) in women with RIF in comparison to control infertile group (1.92 0.62), (P value ¼ 0.03).The mean RI values showed no statistical difference between the study and control groups (0.90 0.04) vs (0.80
S118
Abstracts
Egg Retrievals Mean Total Number of Oocytes Mean Number of Metaphase II Oocytes Percentage of Metaphase II Oocytes Clinical Pregnancy Rate Per Retrieval
119 12.2 9.7 79.6% 70.6%
126 11.4 9.3 81.5% 65.5%
NS NS NS NS
CONCLUSIONS: Follicular size determination for IVF ovarian stimulation with the SonoAVC system is effective and efficient. IVF outcome parameters are similar and some technician time can be saved by using SonoAVC.
P-106 Tuesday, October 20, 2009 THE DIAGNOSTIC ACCURACY OF GEL INSTILLATION SONOHYSTEROGRAPHY (GIS) COMPARED WITH SALINE INFUSION SONOHYSTEROGRAPHY (SIS); A RANDOMIZED CONTROLLED TRIAL. M. H. Emanuel, I. Tromp, M. Betlem. OB/GYN, Spaarne Hospital, Hoofddorp/Amsterdam, NL, Netherlands. OBJECTIVE: To compare the diagnostic accuracy of Gel Instillation Sonohysterography (GIS) with the diagnostic accuracy of Saline Infusion Sonohysterography (SIS). DESIGN: Prospective Randomized Controlled Trial MATERIALS AND METHODS: Between Aug 2007 and Dec 2008 103 consecutive patients with abnormal uterine bleeding and an abnormal transvaginal ultrasound were randomized for the use of Gel Instillation or Saline Infusion during Sonohysterography. Abnormalities detected during Sonohysterography were classified as pedunculated polyp, sessile polyp, pedunculated myoma (type 0), sessile myoma (type 1) and sessile myoma (type 2).
Vol. 92., No. 3, Supplement, September 2009
Hysteroscopy was used as gold standard in case of abnormalities. The primary outcome measure was diagnostic accuracy. RESULTS: In the GIS group (n¼53) 35 abnormalities were found; 31 (89%) were confirmed during hysteroscopy. In the SIS group (n¼50) 30 abnormalities were found; 22 (73%) were confirmed during hysteroscopy. Suspected pedunculated polyps were confirmed during hysteroscopy in all 8 cases, sessile polyps in 15 out of 19 cases, pedunculated myomas (type 0) in 10 out of 14, sessile myomas (type 1) in 9 out of 13 and sessile muomas (type 2) in all 11 cases. CONCLUSIONS: Gel Instillation is an alternative for Saline Infusion during Sonohysterography. Gel Instillation has a higher diagnostic accuracy than Saline Infusion during Sonohysterography.
P-107 Tuesday, October 20, 2009 THREE-DIMENSIONAL SONOHYSTEROGRAPHY (SHG) HAS IMPROVED DIAGNOSTIC ACCURACY FOR INTRAUTERINE PATHOLOGY COMPARED TO TWO-DIMENSIONAL SHG: A PROSPECTIVE PILOT STUDY IN INFERTILITY PATIENTS. P. MoraGuanche, L. Sparacino, R. Garcıa-Guzman, R. A. Bennett, J. Herna´ndez, A. Palumbo. Centro de A.Reproduccio´n Humana de Canarias, La Laguna, Tenerife, Spain; Westchester Reproductive Medicine, NY, NY. OBJECTIVE: To compare the positive predictive value (PPV) and sensitivity of two-dimensional (2D) and three-dimensional (3D) SHG for the diagnosis of intrauterine lesions. DESIGN: Prospective analysis of 111 consecutive SHG procedures and 29 hysteroscopies performed from January 2009 to April 2009 in a private infertility practice. MATERIALS AND METHODS: 111 infertility patients underwent 3D SHG as part of the infertility evaluation. All procedures were performed using a Voluson 730 Pro (General Electric). Data were analyzed comparing 2D and 3D SHG and hysteroscopy findings. PPV and sensitivity of 2D and 3D SHG were calculated. RESULTS: Of the 111 SHGs performed, 59 were normal and 52 abnormal (46.8%). The diagnosis at SHG was polyp (14), polyp þ other pathology (6), myoma (5), intrauterine adhesions (11), uterine septum or subseptum (6), subseptum þ other pathology (9), unicornuate uterus þ sinequia (1). Of the abnormals, 29 underwent hysteroscopy in our center before april 30th. In every one of the abnormal SHGs some intrauterine pathology was found (PPV 100%.). Of the 29 abnormal hysteroscopies, all had an abnormal SHG (sensitivity 100%). Compared to 2D images, the 3D coronal views of the uterus improved the diagnostic accuracy of the procedure in 31 (27.9%) of the 111 patients. When only 1 abnormality was present, the diagnosis made at 3D SHG was confirmed in 100% of cases. When 2 abnormalities were associated, and one of them was a septum or subseptum, 1 of these abnormalities was initially missed at SHG in 7 cases. However, retrospective analysis of the SHG images allowed correct identification and localization of all lesions. CONCLUSIONS: This study demonstrates that 3D SHG has a PPV and sensitivity of 100% for abnormal hysteroscopy. The 3D coronal plane allows identification of additional lesions not visible in the 2D images in a high percentage of cases and adds precision to the localization of the lesions.
P-108 Tuesday, October 20, 2009 RECOGNITION OF 2-D ULTRASOUND IMAGES OF OVARIAN CYSTS USING CONTENT-BASED IMAGE RECOGNITION (CBIR) SYSTEM. S. Krishnamurthy, A. S. M. Sohail, J. Feng, C. Martins, L. Gilbert, P. Bhattacharya. Obstetrics & Gynecology, McGill University, Montreal, QC, Canada; Computer Sciences, Concordia University, Montreal, QC, Canada. OBJECTIVE: Pattern recognition of ultrasound abnormalities requires training and experience. To date, pattern recognition used by an expert remains the standardfor differentiating benign from malignant ovarian lesions. This pilot study was undertaken to develop and test the feasibility of a computer based system for recognition and classification of 2-D ultrasound images into categories. DESIGN: Retrospective analysis of anonymous 2-D ultrasound images MATERIALS AND METHODS: A total of 63 images of benign ovarian cysts as diagnosed by the expert were utilized to train the statistical machine learning based classification technique. Two specific types of ovarian cyst images namely simple cysts (n ¼ 24) and endometriomas (n ¼ 39) were
FERTILITY & STERILITYÒ
used to keep the process uncomplicated. The cysts were characterized by their inherent patterns captured in 2-D ultrasound images that can be represented numerically using specialized image processing based feature extraction technique. For this purpose, the images were first converted into their corresponding 8-bit gray level version and feature vectors were created for each image. The extracted feature vectors were then used to train statistical machine learning based classification technique. RESULTS: The system’s ability to recognize unknown or query images was tested by feeding 57 images, categorized by the expert as simple cysts (n ¼ 24) and endometriomas (n ¼ 33) as feature vector.The machine recognized 19/24 (79%) of simple cysts and 30/33 (91%) of the endometriomas. The false negative rate for simple cysts was higher due to the heterogeneous content. CONCLUSIONS: Development of CBIR system appears to be an exciting possibility as a diagnostic aid for ovarian lesions. A larger database, standardizing the image acquisition protocol and addition of patient characteristics will reduce the errors in diagnosis and improve sensitivity and specificity. Other types of cysts such as teratomas and malignant lesions will inevitably widen the scope of its utility.
P-109 Tuesday, October 20, 2009 FOAM INFUSION SONOSALPINGOGRAPHY (FIS) OR HYSTEROSALPINGO CONTRAST SONOGRAPHY (HYCOSY) WITH FOAM. M. H. Emanuel, I. Tromp, J. Knieriem. Ob/Gyn, Spaarne Hospital, Hoofddorp/Amsterdam, NL, Netherlands. OBJECTIVE: To describe and introduce a new technique of direct imaging of the tubal passage in tubal diagnostics of tubal patency during transvaginal ultrasonography. DESIGN: Descriptive study of a new technique. MATERIALS AND METHODS: In 2007 a new technique Gel Instillation Sonohysterography (GIS) or Virtual Hysteroscopy was introduced to improve the accuracy of Transvaginal Ultrasonography of the uterine cavity and to overcome disadvantages of Saline Infusion Sonohysterography (SIS). One of the disadvantages of the use of transsonic fluids however is the poor visualization of tubal passage. For this purpose special echogenic ultrasound contrast media became commercially available. A simple and cheap alternative is presented by mixing Air with ExEmÒ gel and Saline creating Foam with Microbubbles. This Foam can be infused through the cervical adapter that was developed for GIS. RESULTS: The findings and images obtained by FIS showed an easy recognition of the tubal passage of the foam in case of tubal patency. CONCLUSIONS: Tubal patency can be easily recognized by FIS. Comparison of the findings with conventional methods like hysterosalpingography and chromopertubation during laparoscopy has to be evaluated. It seems reasonable to expect that the use of FIS will be an acceptable first step, cheap and simple screening method for tubal patency.
P-110 Tuesday, October 20, 2009 ULTRASOUND FINDINGS AND PRESENTING SYMPTOMS IN CERVICAL ECTOPIC PREGNANCY. V. I. Shavell, M. E. Abdallah, M. A. Zakaria, E. E. Puscheck, M. P. Diamond, D. C. Kmak. Division of REI, Dept of OBGYN, Wayne State University/Detroit Medical Center, Detroit, MI; Obstetrics and Gynecology, Wayne State University/Detroit Medical Center, Detroit, MI; Obstetrics and Gynecology, Michigan State University/Detroit Medical center, Detroit, MI. OBJECTIVE: To describe the ultrasound findings and signs and symptoms at presentation in patients with cervical ectopic pregnancy (CEP). DESIGN: Retrospective case series. MATERIALS AND METHODS: We identified patients with CEP treated between January 2000 and December 2008 at Hutzel Women’s Hospital in Detroit, Michigan. Chart review was performed and abstracted data included patient’s demographics, presenting symptoms, laboratory and ultrasound findings and risk factors for CEP. Whether CEP was initially misdiagnosed was documented. RESULTS: 14 patients with CEP were treated during the study period, one of which was a heterotopic pregnancy. 8 patients presented to the emergency department (ED), 4 were transferred from other hospitals and 2 were directly admitted from clinic. Patients’ age ranged from 21 to 41 years. All but one were multigravid, and 10 patients had at least one risk factor for CEP (e.g.
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