Reproducibility of three-dimensional ultrasound diagnosis of congenital uterine anomalies.

OBJECTIVE: To examine the reproducibility of the diagnosis of congenital uterine anomalies and the repeatability of measurements of uterine cavity dimensions using three-dimensional (3D) ultrasound. METHODS: The reproducibility of diagnosis of congenital uterine anomalies was examined by re-slicing stored 3D ultrasound volumes. Each data set was evaluated by two independent observers. Assessment of uterine morphology was performed in a standardized plane, with the interstitial portions of the Fallopian tubes used as reference points. Additionally, in 35 cases of congenital uterine anomalies the width of the uterine cavity (W), fundal distortion (F) and the length of unaffected uterine cavity (C) were measured. Intraobserver and interobserver variabilities were evaluated by each observer performing all three measurements twice. RESULTS: Eighty-three 3D ultrasound volumes were examined. Both operators classified 27 uteri as normal, 33 as arcuate, 19 as subseptate and three as unicornuate. A single case of uterine anomaly was described as arcuate uterus by one operator and subseptate by another (kappa 0.97). The intraobserver variability for each of the three measurements (W, F and C) was satisfactory with limits of agreement ranging from +/-1.43 to +/-2.51 mm. The examination of the interobserver variability showed no significant differences between the two observers (F = 0.484, P > 0.05). CONCLUSION: 3D ultrasound is a reproducible method for the diagnosis of congenital uterine anomalies and for the measurement of uterine cavity dimensions.     

Anthropomorphic phantoms for assessment of strain imaging methods involving saline-infused sonohysterography

Two anthropomorphic uterine phantoms were developed that allow assessment and comparison of strain imaging systems adapted for use with saline-infused sonohysterography (SIS). Tissue-mimicking (TM) materials consist of dispersions of safflower oil in gelatin. TM fibroids are stiffer than the TM myometrium/cervix, and TM polyps are softer. The first uterine phantom has 3-mm-diameter TM fibroids distributed randomly in TM myometrium. The second uterine phantom has a 5-mm and 8-mm spherical TM fibroid, in addition to a 5-mm spherical and a 12.5-mm-long (medicine capsule-shaped) TM endometrial polyp protruding into the endometrial cavity; also, a 10-mm spherical TM fibroid projects from the serosal surface. Strain images using the first phantom show the stiffer 3-mm TM fibroids in the myometrium. Results from the second uterine phantom show that, as expected, parts of inclusions projecting into the uterine cavity will appear very stiff, whether they are stiff or soft. Results from both phantoms show that although there is a five-fold difference in the Young's moduli values, there is not a significant difference in the strain in the transition from the TM myometrium to the TM fat. These phantoms allow for realistic comparison and evolution of SIS strain imaging techniques and can aid clinical personnel to develop skills for SIS strain imaging.     

Inter- and intraobserver variability in sonographic measurement of the lower uterine segment after a previous Cesarean section.

OBJECTIVE: To evaluate the reproducibility of sonographic measurement of the lower uterine segment in pregnant women at term. METHODS: Two independent observers performed transabdominal sonography on 129 women between 36 and 38 weeks of gestation who had had a previous Cesarean section. Sonography was performed when the patients had a full and a half-full bladder; in 100 patients, the measurements were also performed transvaginally, with the patients having an empty bladder. Agreement was quantified by the intraclass correlation coefficient and, using a cut-off of 3.5 mm, by the kappa coefficient. RESULTS: The intraobserver agreement was generally high (intraclass correlation coefficient > 0.90). The interobserver agreement was higher on transvaginal (intraclass correlation coefficient, 0.94) compared with transabdominal (0.70 and 0.84, with full and half-full bladder, respectively) ultrasound. The kappa coefficient was 0.75 transvaginally, compared with 0.34 and 0.54 using the transabdominal approach, with full and half-full bladder, respectively. CONCLUSION: The agreement between two observers for sonographic transvaginal measurement of the lower uterine segment can be considered good, compared with poor to moderate agreement using the transabdominal approach.     

Reproducibility and repeatability of transabdominal uterine artery Doppler velocimetry between 10 and 14 weeks of gestation.

OBJECTIVE: To assess the intraobserver repeatability and interobserver reproducibility of Doppler flow velocity measurements of the uterine arteries in pregnant women between 10 and 14 weeks of gestation. METHODS: In this prospective study, Doppler velocimetric indices (maximum peak systolic velocity, end-diastolic velocity, peak systolic velocity/end-diastolic velocity ratio, pulsatility index and resistance index) were measured twice by the same trained observer in each uterine artery of 63 women. In 47 of these women, a second trained observer then repeated the measurements. In addition, both observers classified qualitatively the blood flow with regard to the presence or absence of an early diastolic notch. The coefficient of variation, intraclass correlation coefficients, within observer and between observers repeatability coefficient and Cohen's kappa coefficient were calculated. RESULTS: The best parameter in terms of repeatability and reproducibility in both uterine arteries was the resistance index with a low coefficient of variation and high intraclass correlation coefficient. The other parameters (pulsatility index, peak systolic velocity/end-diastolic velocity ratio, peak systolic velocity and end-diastolic velocity) performed poorly with high coefficients of variation on both sides. Agreement between the repeated observations (inter- and intraobserver) with regard to the presence or absence of an early diastolic notch was good. CONCLUSION: Doppler velocimetry of uterine artery blood flow is technically feasible between 10 and 14 weeks of gestation. This study demonstrates that this technique is prone to measurement errors. Quantitatively, the resistance index appears to be the most repeatable and reproducible measurement at this gestational age. Qualitative assessment of the waveform morphology also shows high levels of intra- and interobserver agreement.     

Intra- and interobserver reproducibility of ultrasound measurements of cervical length and width in the second and third trimesters of pregnancy.

OBJECTIVES: To determine intra- and interobserver reproducibility of ultrasound measurements of cervical length and width in the second and third trimesters of pregnancy. DESIGN: Twenty healthy women in the second or third trimester of pregnancy underwent transvaginal ultrasound examination of the cervix by two examiners. Three replicate meaurements of cervical length and width were taken by each observer for each woman. Intraobserver repeatability was expressed as the difference between the highest and lowest measurement value obtained by one observer, and as the repeatability coefficient and intraclass correlation coefficient. Interobserver reproducibility was expressed as the difference between the mean of the three measurements of each observer, limits of agreement, and interclass correlation coefficient. The repeatability coefficient/limits of agreement define the range within which 95% of the differences between two measurements by the same observer/two observers are likely to fall. RESULTS: Intra- and interobserver differences did not vary in any systematic way over the range of values measured. For cervical length measurements the repeatability coefficient was +/- 5.4 mm for Observer 1 and +/- 5.9 mm for Observer 2. The intraclass correlation coefficient for cervical length measurements was 0.93 for both observers. The corresponding coefficients for cervical width measurements were +/- 3.9 mm and +/- 7.3 mm, and 0.97 and 0.91. The interclass correlation coefficient for cervical length measurements was 0.76, the mean interobserver difference was 0.4 mm, and the limits of agreement were -10.0 mm to 10.8 mm. For cervical width measurements the interclass correlation coefficient was 0.74, the mean interobserver difference was -0.02 mm, and the limits of agreement were -12.4 mm to 12.4 mm. There was no systematic difference between the first, second and third cervical length measurements and no systematic bias between the two observers, and the results were not affected by which of the two examiners started the examination (three-way analysis of variance). The same was true of cervical width measurements. CONCLUSIONS: Our results do not support the contention that the first measurement of cervical length is the longest. There is substantial intra- and interobserver variability in the results of measurements of cervical length and width, even when experienced observers perform the measurements under standardized conditions. It is important to consider the possibility of 'measurement error' when ultrasound measurements of cervical length and width are used in clinical practice to monitor women at high risk of delivering preterm or to screen for preterm birth.     

Accuracy and Reproducibility of Sonoelastography for the Assessment of Fibroids and Adenomyosis,with Magnetic Resonance Imaging as Reference Standard

The aims of this prospective diagnostic evaluation study were (i) to estimate the inter-observer agreement and reproducibility of real-time sonoelastography and real-time gray-scale ultrasound in the measurement of uterine and fibroid volumes; (ii) to evaluate the agreement between real-time gray-scale ultrasound, sonoelastography and magnetic resonance imaging with respect to these outcomes; and (iii) to evaluate the diagnostic accuracy of sonoelastography in the diagnosis of uterine pathology on stored sonoelastography and gray-scale cine loops. Women without a history of uterine pathology and with the diagnosis intrauterine fibroids or adenomyosis were included. All participants underwent gray-scale ultrasound, sonoelastography and magnetic resonance imaging. Compression sonoelastography was found to have high inter-observer and inter-method agreement for the measurement of uterine and fibroid volumes. The addition of sonoelastography to gray-scale ultrasound seems to be useful in the differentiation between fibroids, adenomyosis and normal uteri as reflected by an increase in accuracy and diagnostic agreement.     

高强度聚焦超声消融子宫肌瘤疗效相关因素分析

目的 通过多因素及单因素相关性分析,探讨影响高强度聚焦超声消融治疗子宫肌瘤疗效的因素.方法 73例(共97个肌瘤)确诊为子宫肌瘤的患者,进行超声消融治疗.根据肌瘤大小、类型、位置、患者年龄、MRI-T2信号、MRI-T1增强信号、治疗平均功率进行分组.术后1个月通过增强MRI进行疗效评估,分为显效(消融率>50%)、有效(消融率<50%)两个等级.分析肌瘤不同大小、类型、位置、患者年龄、T2信号、T1增强信号、平均功率与疗效的关系.结果 前壁的疗效优于其他位置的治疗效果(P<0.05);T1增强信号越高疗效越差(P<0.05);T2高信号的疗效低于T2低信号和等信号.但差异无统计学意义(P>0.05);而肌瘤的大小、类型、患者的年龄与疗效无相关性.结论 通过对子宫肌瘤不同因素与疗效关系分析,可以为进一步预测疗效、指导临床应用提供依据.     

Management of fibroids should be tailored to the patient

At least one in four women will develop one or more fibroids during their lifetime. They occur most commonly in women aged 30-50 and are three times more common in women of Afro-Caribbean descent than in Caucasian women. Risk factors for fibroids include: age, nulliparity, race, family history and obesity. In two-thirds of cases there are no symptoms. If the tumours are small and not causing symptoms, they do not require treatment However, if they enlarge, they can cause abnormal bleeding, pressure on the bladderand/or bowel and the patient may have difficulty getting pregnant. Fibroids are often discovered as an incidental finding on ultrasound but may also present in the following ways: abnormal uterine bleeding and menorrhagia; infertility; pelvic mass; increasing girth; pressure symptoms (urinary frequency and/or constipation); urinary retention; acute pelvic pain due to torsion of a pedunculated fibroid. During pregnancy, fibroids enlarge and may undergo red degeneration causing pain. Medication can only be used to improve symptoms and/or shrink the fibroids prior to surgery. Women with fibroids >3 cm in diameter causing significant symptoms, pain or pressure and wishing to retain their uterus may consider myomectomy. Hysterectomy is the standard treatment for women with symptomatic fibroids who have not improved with medical treatment. If the woman's family is complete and the fibroids are multiple, hysterectomy provides a permanent cure. Uterine artery embolisation is only recommended if surgery was planned for symptomatic fibroids and if the fibroids are <20 weeks in size. Referral is recommended in the following cases: submucous fibroid and abnormal bleeding; fibroids >3 cm in diameter uterus palpable abdominally or >12 cm in size on scan; persistent intermenstrual bleeding; age >45 where treatment has failed or been ineffective. Sarcomatous change within fibroids is rare and is normally associated with rapid growth. Such cases should be referred urgently.     

Sonohysterography for distinguishing endometrial thickening from endometrial polyps in postmenopausal bleeding.

Sonohysterography, or sonographic uterine cavity visualization by uterine cavity distension, may help to distinguish true endometrial thickening from other intracavitary pathological conditions, assuming the same sonographic appearance. We examined 1.5 women with a thickened endometrium (range 10-25 mm) in sonography performed for postmenopausal bleeding. Sonohysterography revealed a polypoid structure in seven women, a normal uterine cavity in four women, and a thickened endometrium in four women. All the women underwent hysteroscopic evaluation of the uterine cavity. Hysteroscopy confirmed the sonohysterographic findings in 14 women (93.3%). Hysteroscopic resection of the polypoid structure was performed while the other patients underwent diagnostic curettage. Histological examination of the seven polypoid structures revealed benign endometrial polyps in six patients, and one pedunculated submucous fibroid. In the patients undergoing diagnostic curettage, histological examination revealed three cases of glandular hyperplasia, one of cystic (atrophic) hyperplasia, and one of papillary endometrial adenocarcinoma. Two cases were inadequate for diagnosis. The advantage of sonohysterography in distinguishing endometrial thickening from intracavitary polyps or fibroids was clearly demonstrated. This technique can help in tailoring the correct treatment in various conditions presenting as postmenopausal bleeding.     

Intraobserver and interobserver reproducibility of ultrasound measurements of endometrial thickness in postmenopausal women.

OBJECTIVES: To determine intraobserver and interobserver reproducibility of ultrasound measurements of endometrial thickness in postmenopausal women. DESIGN: Forty-eight postmenopausal women underwent transvaginal ultrasound examination by two examiners. Each observer took three replicate measurements of the endometrium in each woman. Intraobserver repeatability was expressed as the difference between the highest and lowest measurement values obtained by one observer, the repeatability coefficient, and the intraclass correlation coefficient. Interobserver reproducibility was expressed as the difference between the mean of the three measurements of each observer, limits of agreement, and interclass correlation coefficient. The repeatability coefficient and the limits of agreement define the range within which 95% of the differences between two measurements are likely to fall. Data were analyzed for all women, as well as separately for women with endometrium < or = 6 mm and > 6 mm. The agreement between observers in classifying women as having endometrium < or = 4.4 mm or > or= 4.5 mm was determined by calculating Cohen's kappa. RESULTS: In women with endometrium 6 mm were 0.99 and 0.99, 0.7 mm (0-2.9) and 1.0 mm (0.2-3.4), and 1.7 mm and 1.9 mm. In women with endometrium < or = 6 mm the interclass correlation coefficient was 0.77, and the mean interobserver difference was 0.2 mm +/- 1.8 mm (2 standard deviations), when calculations were based on the mean of three measurements per observer (+/- 1.9 mm when calculations were based on only one measurement per observer). The corresponding figures for women with endometrium > 6 mm were 0.98, 0.2 mm +/- 3.1 mm (+/- 3.2 mm). The agreement between observers in classifying women as having an endometrium < or = 4.4 mm or > or = 4.5 mm was very good (kappa 0.81). CONCLUSIONS: The reproducibility of endometrial measurements seems to be clinically acceptable and to allow reliable discrimination between postmenopausal women with endometrium < or = 4.4 mm and > or = 4.5 mm. In clinical practice, it is enough to take one endometrial measurement when performing transvaginal ultrasound examination.     

Automated edge-detection technique for measurement of brachial artery reactivity: a comparison of concordance with manual measurements

Concerns have been raised about the reproducibility of brachial artery reactivity (BAR), because subjective decisions regarding the location of interfaces may influence the measurement of very small changes in lumen diameter. We studied 120 consecutive patients with BAR to address if an automated technique could be applied, and if experience influenced reproducibility between two observers, one experienced and one inexperienced. Digital cineloops were measured automatically, using software that measures the leading edge of the endothelium and tracks this in sequential frames and also manually, where a set of three point-to-point measurements were averaged. There was a high correlation between automated and manual techniques for both observers, although less variability was present with expert readers. The limits of agreement overall for interobserver concordance were 0.13 +/- 0.65 mm for the manual and 0.03 +/- 0.74 mm for the automated measurement. For intraobserver concordance, the limits of agreement were - 0.07 +/- 0.38 mm for observer 1 and - 0.16 +/- 0.55 mm for observer 2. We concluded that BAR measurements were highly concordant between observers, although more concordant using the automated method, and that experience does affect concordance. Care must be taken to ensure that the same segments are measured between observers and serially.     

Intraobserver and interobserver reproducibility of three-dimensional gray-scale and power Doppler ultrasound examinations of the cervix in pregnant women.

OBJECTIVES: To determine intraobserver and interobserver reproducibility of three-dimensional (3D) gray-scale and power Doppler ultrasound examinations of the cervix in pregnant women. METHODS: Thirty-two pregnant women underwent transvaginal 3D gray-scale and power Doppler ultrasound examination of the cervix by two examiners. Each observer acquired two volumes, and they each analyzed their volumes twice using the commercially available software Virtual Organ Computer-aided AnaLysis (VOCAL). The variables analyzed were cervical volume (cm3), vascularization index (VI), flow index (FI) and vascularization flow index (VFI). Intraobserver repeatability was expressed as the difference between two measurement results (mean difference +/- 2 SD, i.e. limits of agreement) and as intraclass correlation coefficient (intra-CC). Interobserver agreement was expressed as the difference between the results of the two observers (limits of agreement) and as interclass correlation coefficient (inter-CC). The contribution of various factors (examiner, acquisition, analysis of acquired volume) to intrasubject variance was estimated using different analysis of variance models. All statistical analyses were performed using log-transformed data. The results presented are those obtained after antilogarithmic transformation, i.e. the results are presented as ratios between two results of the same observer, or as ratios between the results of Observer 1 and Observer 2. RESULTS: All intraobserver and interobserver log-transformed differences were normally distributed. There was no systematic bias between the two observers. Both intra- and inter-CC values were high (0.93-0.98) for all variables except FI (0.63-0.88), despite the limits of agreement being wide, especially for VI (widest range 0.4-2.4) and VFI (widest range 0.3-2.6). Acquisition explained most of the intrasubject variance of the flow indices, the contribution of examiner and analysis being unimportant. CONCLUSIONS: Given the wide range between the lower and upper limits of agreement, it would probably not be possible to detect anything but large differences or changes in cervical volume or cervical flow indices using current 3D ultrasound techniques. Because acquisition explained most of the intrasubject variance, the average of several repeated acquisitions should be used to enhance reproducibility. However, it is not worth doing more than one analysis of an acquired volume, because the effect of analysis on measurement results is small.     

The use of inversion mode and 3D manual segmentation in volume measurement of fetal fluid-filled structures: comparison with Virtual Organ Computer-aided AnaLysis (VOCAL)

OBJECTIVE: Volume measurements by three-dimensional (3D) ultrasonography are considered more accurate than those performed by two-dimensional (2D) ultrasonography. The purpose of this study was to compare the agreement of three techniques, as well as the inter- and intraobserver agreements for volume measurements of fetal fluid-filled structures. METHODS: Fifty 3D volume datasets of fetal stomachs and bladders were explored. Volume measurements were performed independently by two observers using: (1) Virtual Organ Computer-aided AnaLysis (VOCAL); (2) inversion mode; and (3) 'manual segmentation'. Reliability was evaluated using intraclass correlation coefficient (ICC), and Bland-Altman plots were generated to examine bias and agreement. The time required to complete the measurements was compared using Student's t-test or the Wilcoxon Signed Rank Test, and P-values < 0.025 or < 0.05 were considered statistically significant. RESULTS: All volume datasets could be measured using the three techniques. A high degree of reliability was observed between: (1) VOCAL and inversion mode (ICC, 0.995; 95% CI, 0.992-0.997); (2) VOCAL and manual segmentation (ICC, 0.997; 95% CI, 0.995-0.998); and (3) inversion mode and manual segmentation (ICC, 0.995; 95% CI, 0.992-0.997). There was good agreement between VOCAL and inversion mode (mean, - 2.4%; 95% limits of agreement, - 20.1 to 15.3%), VOCAL and manual segmentation (mean, - 8.3%; 95% limits of agreement, - 28.8 to 12.2%) as well as between inversion mode and manual segmentation (mean, 5.9%, 95% limits of agreement: - 14.3 to 26%). Manual segmentation and inversion mode measurements were obtained significantly faster than those by VOCAL. CONCLUSIONS: Volume measurements of fetal fluid-filled structures of relatively regular shape with inversion mode and manual segmentation are feasible. Both techniques have good agreement with VOCAL and are significantly faster than VOCAL. Inversion mode is a reliable method for volume calculations of fluid-filled organs, whereas manual segmentation can be used when volume measurements by VOCAL or inversion mode are technically difficult to obtain, such as solid structures with poorly defined borders as the volume dataset is rotated, like the uterine cervix.     

Comparison of Reproducibility of Manual and Sphere Contour Methods for the Measurement of Vascularization in Cervical Carcinoma Using the Virtual Organ Computer‐Aided Analysis II System

Objective. The purpose of this study was to investigate the reproducibility of virtual organ computer‐aided analysis II software (GE Healthcare, Milwaukee, WI), an integrated tool for 3‐dimensional power Doppler angiography (3D‐PDA), in measuring vascularization of cervical carcinoma under manual and automatic sphere contour modes. Methods. Eighty patients with cervical carcinoma were prospectively examined by observer 1 using transvaginal 3D‐PDA. For each patient, measurements of the vascularization index, flow index, and vascularization‐flow index were repeated twice under both manual and automatic sphere contour modes. Forty patients were randomly selected for another round of examination by observer 2 under the same setting. The reproducibility of vascularization measurements was assessed by the intraclass correlation coefficient (intra‐CC), interclass correlation coefficient (inter‐CC), and 95% limits of agreement (LOAs). Various analysis of variance models were used to estimate the contribution of each factor (observer, contour mode, and patient) to measurement variance. Results. For each observer, the manual contour mode outperformed the automatic sphere contour mode in reproducibility (intra‐CC, 0.96 to 0.99 versus 0.77 to 0.94). In addition, repeated measurements of the manual mode had a smaller SD and a narrower LOA. For the manual contour mode, interobserver agreement was comparable with intraobserver agreement (inter‐CC, 0.91 to 0.98, versus intra‐CC, 0.96 to 0.99). However, the interobserver agreement was significantly smaller than the intraobserver agreement for the automatic sphere contour mode (inter‐CC, 0.51 to 0.85, versus intra‐CC, 0.77 to 0.94; P = .001). Conclusions. The manual contour mode for 3D‐PDA vascular measurements has better interobserver and intraobserver reproducibility than the automatic sphere contour mode. It is especially useful for measuring tumor tissues with irregular shapes and vascularity.     

子宫肌瘤高强度聚焦超声治疗后的声像图评价

目的分析高强度聚焦超声（HIFU）治疗子宫肌瘤结束后5分钟声像图判断疗效的价值。方法272例子宫肌瘤患者299个肌瘤,分析治疗结束后5分钟肌瘤声像特点并研究其与1年后复查结果之间的关系。结果依据治疗结束后5分钟声像图特点将肌瘤分为四类：1．团块状不均高回声160个,1年后123个体积缩小≥30％,35个介于0-30％之间,有效率约98.8％。2．落雪样斑块团46个,1年后31个体积缩小≥30％,13个介于0～30％之间,有效率95．7％．3.局部片状高回声57个,1年后32个体积缩小≥30％,12个介于0-30％之间,有效率77．2％。4．低一等回声36个,1年后6个体积缩小≥30％,2个介于0～30％之间,有效率22．2％。总有效率84．9％。其中团块状不均高回声（P〈0.001）和落雪样兜块团（P〈0.05）可作为结束治疗并预估治疗有效的声像变化。结论治疗结束后5分钟声像图是评估HIFU治疗子宫肌瘤效果的有效方法。     

Endoscopic treatment of symptomatic fibroids at reproductive age and beyond

Objectives: To evaluate the feasibility of endoscopic treatment of symptomatic uterine fibroids based on patient and fibroid characteristics in reproductive, pre-menopausal and post-menopausal women.

Material and methods: The medical records of women with symptomatic uterine fibroids who underwent surgical procedures from 2010 to 2015 were retrospectively reviewed.

Results: A total of 819 patients, of which 710 (86.6%) underwent endoscopic procedures. The mean age of women who underwent laparoscopic myomectomy (LM) was 36.77?±?6.54 and hysteroscopic myomectomy (HSCM) was 43.10?±?10.26. The mean cumulative diameter of fibroids in the LM was 8.94?±?3.1 and 3.68?±?1.64?cm in the HSCM. Furthermore, LM and HCSM were performed when the mean diameter of the largest fibroid was up to 18.50 and 5.5?cm, respectively. The mean age of women in laparoscopic supracervical hysterectomy (LSH) was 46.02?±?6.13 and total laparoscopic hysterectomy (TLH) was 47.30?±?8.12. The mean cumulative diameter of fibroids in the LSH was greater than in the TLH, at 8.94?±?3.1 and 7.63?±?3.60?cm, respectively.

Conclusions: Uterus-preserving procedures are feasible, even if the largest fibroid diameter is more than 10?cm in LM and equal to 5.5?cm in HSCM. For pre- and post-menopausal women, TLH is the definitive treatment modality for uterine fibroids, and LSH represents an alternative to TLH.     

Intraobserver and interobserver variability of ovarian volume, gray-scale and color flow indices obtained using transvaginal three-dimensional power Doppler ultrasonography.

OBJECTIVE: To assess intraobserver and interobserver variability in ovarian volume and gray-scale and color flow index measurements using transvaginal, three-dimensional, power Doppler ultrasonography. METHODS: Eleven women (22 ovaries) were examined on day 8 of controlled ovarian hyperstimulation therapy, which was part of their in vitro fertilization treatment protocol. The patients were examined twice by the first observer and once by the second observer. The acquired volume datasets were analyzed using the VOCAL imaging program, enabling the assessment of ovarian volume, vascularization index (VI), flow index (FI), vascularization flow index (VFI) and mean grayness (MG). For these parameters the intraclass (intra-CC) and interclass (inter-CC) correlation coefficients, within-observer and between-observers repeatability coefficient (r) and limits of agreement were calculated. RESULTS: Both intraobserver and interobserver repeatability of ovarian volume measurements were considered very good with an intra-CC value of 1.00 and inter-CC value of 0.99, respectively. Also VI, FI, VFI and MG measurements were repeatable by a single observer, the intra-CC ranging from 0.82 to 0.91. The interobserver reproducibility was also good for VI, VFI and MG measurements (inter-CC values 0.73, 0.70 and 0.81, respectively), but for FI measurements the reproducibility was poor (inter-CC = 0.29, r = 7.87). CONCLUSIONS: In general, the intraobserver reproducibility was better than interobserver reproducibility for all parameters. The volume assessments were reproducible both by one observer and by two separate observers. The intraobserver and interobserver variabilities were acceptable for VI, VFI and MG, whereas for FI the interobserver reproducibility was poor. Our results suggest that measurement of gray-scale and color Doppler flow indices is reproducible thus allowing them to be used in clinical practice and research.     

Reproducibility in the assessment of noncalcified coronary plaque with 256-slice multi-detector CT and automated plaque analysis software

We aimed to assess intra- and inter-observer reproducibility in evaluating volume and characteristics of non-calcified coronary plaques (NCPs) using a 256-slice multi-detector computed tomography (MDCT) angiography and dedicated automated plaque analysis software in asymptomatic individuals. Forty-two NCPs from 39 patients with a vessel diameter >2 mm were evaluated using a 256-slice MDCT with dedicated automated plaque analysis software. Two independent observers analyzed the characteristics of NCPs, including plaque volume (vol), mean CT number of the NCPs in Hounsfield units (HU_mean), and remodeling index (RI). One of the observers repeated the evaluation of all datasets after an interval of at least 4 weeks. Bland–Altman analysis and concordance correlation coefficients (CCCs) were used to determine intra- and inter-observer variability. For vol measurements, the 95% limits of agreement were ?21.6 and 13.2 mm³, and ?24.6 and 20.3 mm³ for intra- and inter-observer variability, respectively. For HU_mean measurements, the 95% limits of agreement were ?22.2 and 20.8 HU, and ?21.1 and 21.0 HU for intra- and inter-observer variability, respectively. For RI measurements, the 95% limits of agreement were ?0.38 and 0.39, and ?0.51 and 0.36 for intra- and inter-observer variability, respectively. The CCCs was very high for all measurements, ranging from 0.90 to 0.98. Using 256-slice MDCT with dedicated automated plaque analysis software, intra- and inter-observer reproducibility were excellent in evaluating the volume and characteristics of NCP in asymptomatic individuals.     

桂枝茯苓胶囊联合米非司酮治疗方案在子宫肌瘤患者中的应用效果分析

目的探究桂枝茯苓胶囊联合米非司酮治疗方案对子宫肌瘤患者的临床疗效和应用。方法择选本院2018年8月至2019年8月收治的子宫肌瘤患者80例为研究对象,按随机分组原则,由计算机均分为两组,即对照组和研究组。对照组患者行单一米非司酮治疗,研究组在此基础上联合使用桂枝茯苓胶囊治疗。治疗后,分别就两组患者的子宫体积、肌瘤体积和血清性激素水平进行对比,并统计相关不良反应发生情况,评价两种方案的治疗效果。结果治疗后研究组患者的子宫体积和肌瘤体积明显小于对照组,且各项血清性激素水平优于对照组,差异有统计学意义(P<0.05)。两组患者的不良反应发生率对比结果,差异不存在统计学意义(P>0.05)。其中,研究组患者的子宫体积和肌瘤体积分别为(105.34±26.32)cm³和(35.02±15.14)cm³,而对照组分别为(115.67±26.49)cm³和(46.13±15.64)cm³,差异有统计学意义,P<0.05。结论桂枝茯苓胶囊联合米非司酮治疗方案对子宫肌瘤患者疗效显著,可有效缩小患者子宫和肌瘤体积,改善各项血清性激素水平,具有较高的临床应用价值。     

实时超声弹性成像技术鉴别诊断子宫肌瘤和子宫腺肌瘤

目的 探讨实时超声弹性成像鉴别诊断子宫肌层病变的价值。方法 40例子宫肌瘤患者和20例子宫腺肌瘤患者均在术前接受常规超声检查及实时超声弹性成像,分析子宫肌瘤和子宫腺肌瘤的弹性图像特征及应变力比值(SR)。计算组内相关系数(ICC)评估SR多次测量的重复性。结果 子宫肌瘤患者的正常肌壁与病变的SR为1.52±0.69;子宫腺肌瘤患者正常肌壁与病变的SR为0.91±0.28,差异有统计学意义(t=3.79,P=0.013)。实时超声弹性成像示子宫腺肌瘤以红与绿色为主;子宫肌瘤以较均匀一致的蓝色为主。结论 实时超声弹性成像是鉴别诊断子宫肌瘤和子宫腺肌瘤的有效方法。