Sonohysterography for ultrasonographic evaluation of tamoxifen-associated cystic thickened endometrium.

Most menopausal patients with breast cancer receive tamoxifen therapy. In these patients, TVS may show thickened, irregular cystic endometria. For better visualization of these patients' uterine cavities, we performed transvaginal sonohysterography. During vaginal ultrasonography, sterile saline was introduced by transcervical 8 French Foley catheter into the uterine cavity of 20 women who were referred with tamoxifen-associated cystic thickened endometria. In eight women, transvaginal sonohysterography provided the means to diagnose occult, free-floating endometrial polyps, whereas in 12 women, the fluid contrast augmented the diagnosis of an irregular cystic endometrial-myometrial junction. All 20 patients underwent diagnostic hysteroscopy: eight polyps, none of which were malignant, were confirmed and removed by hysteroscopic resection. Of the remaining 12 patients with an irregular endometrial-myometrial junction, endometrial curettage showed no significant pathologic findings. Transvaginal sonohysterography seems to enhance the differentiation between endometrial polyps that should be resected by operative hysteroscopy and an abnormal endometrial-myometrial junction that may benefit from biopsy sampling only.     

Intraoperative laparoscopic sonography for improved preoperative sonographic pathologic characterization of adnexal masses.

This study compares the diagnostic accuracy of laparoscopic sonography and transvaginal sonography in the evaluation of adnexal masses. Fifty-eight women underwent transvaginal sonography, which showed 69 adnexal masses, and laparoscopic ultrasonography, which showed 68 adnexal lesions. Conventional gray-scale ultrasonography (using transvaginal sonography and laparoscopic ultrasonography) was performed with morphologic characterization of internal architecture, followed by color Doppler imaging with spectral Doppler analysis where possible. A specific diagnosis was obtained with transvaginal sonography and laparoscopic ultrasonography based on a combination of imaging features. The specific diagnosis obtained with each imaging modality was compared with the final histologic diagnosis as the gold standard in 57 patients with 68 adnexal masses who underwent cystectomy or oophorectomy. The ability of laparoscopic sonography to detect the contralateral ovary and any residual ovarian tissue in the presence of a mass was also compared with transvaginal sonography. The accuracy of laparoscopic ultrasonography in the characterization of adnexal masses was 83.8% and that of transvaginal sonography was 73.5% (P < 0.05). Laparoscopic sonography showed greater morphologic detail than that obtained with transvaginal sonography, allowed more precise and specific characterization of adnexal masses, and detected additional adnexal lesions not evident on preoperative transvaginal sonography. Laparoscopic ultrasonography showed the contralateral ovary in 86.2% of patients, compared with 81.0% using transvaginal sonography (P = 0.51). In addition, laparoscopic ultrasonography was able to demonstrate the presence of residual ovarian tissue in the side affected pathologically in 76.5% of patients compared with 59.4% using transvaginal sonography (P < 0.005). Laparoscopic sonography allows more precise morphologic characterization of internal architecture and histologic diagnosis of adnexal lesions, but it is as yet unable to increase the diagnostic accuracy of borderline or malignant lesions, possibly due to the small sample size. Laparoscopic sonography is superior to transvaginal sonography in the evaluation of residual ovarian tissue in the side affected pathologically, which may help in surgical planning between cystectomy and oophorectomy, and also in the identification of the contralateral ovary, which may potentially increase the detection of bilateral pathologic conditions.     

High-Frequency Micro-Ultrasound Imaging and Optical Topographic Imaging for Spinal Surgery: Initial Experiences

High frequency micro-ultrasound (µUS) transducers with central frequencies up to 50?MHz facilitate dynamic visualization of patient anatomy with minimal disruption of the surgical work flow. Micro-ultrasound improves spatial resolution over conventional ultrasound imaging from millimeter to micrometer, but compromises depth penetration. This trade-off is sufficient during an open surgery in which the bone is removed and theultrasound probe can be placed into the surgical cavity. By fusing µUS with pre-operative imaging and tracking the ultrasound probe intra-operatively using our optical topographic imaging technology, we can provide dynamic feedback during surgery, thus affecting clinical decision making. We present our initial experience using high-frequency µUS imaging during spinal procedures. Micro-ultrasound images were obtained in five spinal procedures. Medical rationale for use of µUS was provided for each patient. Surgical procedures were performed using the standard clinical practice with bone removal to facilitate real-time ultrasound imaging of the soft tissue. During surgery, the µUS probe was registered to the pre-operative computed tomography and magnetic resonance images. Images obtained comprised five spinal decompression surgeries (four tumor resections, one cystic synovial mass). Micro-ultrasound images obtained during spine surgery delineated exquisite detailing of the spinal anatomy including white matter and gray matter tracts and nerve roots and allowed accurate assessment of the extent of decompression/tumor resection. In conclusion, tracked µUS enables real-time imaging of the surgical cavity, conferring significant qualitative improvement over conventional ultrasound.     

Contribution of morphological assessment of the vessel tree by three-dimensional ultrasound to a correct diagnosis of malignancy in ovarian masses.

OBJECTIVE: To determine whether subjective evaluation of the morphology of the vessel tree of ovarian tumors, as depicted by three-dimensional (3D) power Doppler ultrasound, can discriminate between benign and malignant ovarian tumors, and whether it improves characterization compared with using gray-scale ultrasound imaging alone. METHODS: A consecutive series of 104 women scheduled for surgical removal of an ovarian mass were examined with transvaginal two-dimensional (2D) gray-scale and 3D power Doppler ultrasound. Predetermined vessel characteristics, e.g. density of vessels, branching, caliber changes and tortuosity, were evaluated in 360 degrees rotating 3D images of the vessel tree of the tumor. Ultrasound results were compared with those of the histology of the surgical specimens. Univariate and multivariate logistic regression were used. RESULTS: There were 77 benign tumors, six borderline tumors and 21 invasive malignancies. All vascular features differed significantly between benign and malignant tumors. The areas under their receiver-operating characteristics (ROC) curves (AUCs) were in the range 0.61-0.83. The AUC of a logistic regression model containing three gray-scale ultrasound variables was 0.98. This model correctly classified all malignancies, with a false-positive rate of 10% (8/77). Adding branching of vessels in the whole tumor to the gray-scale model yielded an AUC of 0.99 and resulted in all malignancies and an additional four benign tumors being correctly classified. CONCLUSIONS: Subjective evaluation of the morphology of the vessel tree, as depicted by 3D power Doppler ultrasound, can be used to discriminate between benign and malignant ovarian tumors, but adds little to gray-scale ultrasound imaging in an ordinary population of tumors.     

Inside the beating heart: an in vivo feasibility study on fusing pre- and intra-operative imaging for minimally invasive therapy

Objective  An interventional system for minimally invasive cardiac surgery was developed for therapy delivery inside the beating heart, in absence of direct vision. Method  A system was developed to provide a virtual reality (VR) environment that integrates pre-operative imaging, real-time intra-operative guidance using 2D trans-esophageal ultrasound, and models of the surgical tools tracked using a magnetic tracking system. Detailed 3D dynamic cardiac models were synthesized from high-resolution pre-operative MR data and registered within the intra-operative imaging environment. The feature-based registration technique was employed to fuse pre- and intra-operative data during in vivo intracardiac procedures on porcine subjects. Results  This method was found to be suitable for in vivo applications as it relies on easily identifiable landmarks, and hence, it ensures satisfactory alignment of pre- and intra-operative anatomy in the region of interest (4.8 mm RMS alignment accuracy) within the VR environment. Our initial experience in translating this work to guide intracardiac interventions, such as mitral valve implantation and atrial septal defect repair demonstrated feasibility of the methods. Conclusion  Surgical guidance in the absence of direct vision and with no exposure to ionizing radiation was achieved, so our virtual environment constitutes a feasible candidate for performing various off-pump intracardiac interventions.     

Role of 3-D Transvaginal Ultrasonography in Women Undergoing in Vitro Fertilization/Intra-cytoplasmic Sperm Injection

Both 2-D and 3-D transvaginal ultrasonography are effective imaging modalities for assessment of ovarian reserve. Our aim was to compare both modalities in assessment of ovarian reserve of women undergoing in vitro fertilization/intra-cytoplasmic sperm injection (IVF/ICSI). Fifty women were scheduled according to their menstrual cycle to be examined by both 2-D and 3-D transvaginal ultrasonography. We found that the average time for computerized analysis of the 3-D ultrasound data was significantly shorter than that for analysis of the 2-D ultrasound data, for both total antral follicle count and ovarian volume. However, there were no statistically significant differences between the methods in total antral follicle count and ovarian volume. We conclude that, where available, 3-D ultrasonography can be used for assessment of ovarian reserve in addition to the biochemical marker, particularly in overcrowded in vitro fertilization centers that need to save time.     

Three-dimensional ultrasonographic and power Doppler characterization of ovarian lesions.

OBJECTIVE: To determine whether three-dimensional ultrasound (3D US) and 3D power Doppler can improve the ability to differentiate benign from malignant ovarian lesions. METHODS: Transvaginal ultrasound, transvaginal color Doppler, 3D US and 3D power Doppler were performed on 90 patients with ovarian lesions during the week prior to surgery. Four independent sonographers were blinded to the results of other ultrasound studies. RESULTS: Color Doppler studies added to transvaginal gray-scale characterization of ovarian lesions resulted in sensitivity of 88.89% and specificity of 97.53% in diagnosing ovarian malignancy. Qualitative analysis of tumor vascularity by 3D power Doppler added to morphological features obtained by 3D US is clinical pertinent and reached sensitivity and specificity of 100 and 98.76%, respectively. CONCLUSION: Three-dimensional ultrasound and power Doppler can enhance and facilitate the morphologic and functional evaluation of both benign and malignant ovarian lesions. Introduction of the 3D quantitative technique for measurements of blood flow and vascularization may increase clinical relevance of these studies.     

Transrectal ultrasonography for problem solving after transvaginal ultrasonography of the female internal reproductive tract.

OBJECTIVE: To report the value of transrectal ultrasonography of the female internal reproductive tract as a complementary problem-solving technique after transvaginal ultrasonography in selected patients. To date, transrectal ultrasonography of the female internal reproductive tract has been advocated in lieu of transvaginal ultrasonography for women in whom transvaginal ultrasonography cannot be performed for various reasons. METHODS: Ten illustrative cases are presented of women for whom transrectal ultrasonography performed after transvaginal ultrasonography provided additional clinically important information regarding the female internal reproductive tract. RESULTS: Transrectal ultrasonography was helpful in 2 scenarios: (1) women with a retroverted uterus in whom the endometrial stripe was virtually parallel to the ultrasound beam and thus could not be properly measured on transvaginal ultrasonography, and (2) women in whom normal or pathologic adnexal findings were distant from the vagina or obscured by intervening structures during transvaginal ultrasonography but were near the rectum or not obscured during transrectal ultrasonography. In 1 case, transrectal ultrasonography yielded a diagnosis of ectopic pregnancy that was missed prospectively on transvaginal ultrasonography because pain severely limited the examiner's ability to manipulate the transvaginal ultrasound transducer. CONCLUSIONS: Transrectal ultrasonography of the female internal reproductive tract can provide clinically useful information to complement transvaginal ultrasonography in selected patients.     

Three-dimensional multiplanar sonohysterography: comparison with conventional two-dimensional sonohysterography and X-ray hysterosalpingography.

The objective of this study was to assess the value of combining transvaginal sonohysterography with three-dimensional multiplanar ultrasonography to optimize assessment of the uterus. To make this assessment, we compared findings on three-dimensional sonohysterography with those on two-dimensional sonohysterography and X-ray hysterosalpingography. Of 20 women who underwent three-dimensional sonohysterography for various indications, 13 also underwent two-dimensional sonohysterography, and 12 had X-ray hysterosalpingography. We reviewed the 3 types of examinations separately and compared the standard techniques with three-dimensional sonohysterography to determine whether three-dimensional sonohysterography provided additional information. In 9 (69%) of 13 comparisons between three-dimensional sonohysterography and two-dimensional sonohysterography and in 11 (92%) of 12 comparisons between three-dimensional sonohysterography and X-ray hysterosalpingography, three-dimensional sonohysterography was advantageous. The coronal plane was most useful for displaying the relationship between lesions and the uterine cavity. Three-dimensional sonohysterography provided additional information compared with standard accepted techniques in the vast majority of women.     

Early ovarian cancer: 3-D power Doppler

Transvaginal sonography plays an important role in the assessment of the morphology of ovarian lesions. However, the accuracy of the technique is limited due to the significant number of false-positive results. Color Doppler imaging and pulsed Doppler spectral analysis enable evaluation of ovarian tumor blood flow, analysis of the distribution of blood vessels, and quantitative measurement of blood flow velocity waveforms. These parameters increase the sensitivity and specificity of ultrasound evaluation of ovarian tumors. Unfortunately, there is no consensus as to which Doppler parameters and cutoff values are the most predictive of malignancy. Three-dimensional (3-D) power Doppler ultrasound provides a new tool to evaluate features of tumor vascularity. Three-dimensional ultrasound and 3-D power Doppler imaging in patients with “positive” findings on standard ultrasound tests, which encompass annual gray-scale transvaginal sonography followed by transvaginal color Doppler ultrasound in selected cases, represent a novel approach for early and accurate detection of ovarian cancer through screening. Combined evaluations of morphology and neovascularity by 3-D power Doppler ultrasound may improve early detection of ovarian carcinoma. Contrast-enhanced 3-D power Doppler sonography facilitates visualization of adnexal tumor vessels, which may aid in differentiating benign from malignant adnexal lesions.     

The added value of transvaginal sonohysterography over transvaginal sonography alone in women with known or suspected leiomyoma.

OBJECTIVE: To assess whether sonohysterography provides added diagnostic value over transvaginal sonography in patients with suspected or known myomas by comparing diagnostic confidence, interobserver agreement, accuracy, and change in diagnoses when 2 independent observers interpreted transvaginal sonography alone and later interpreted transvaginal sonography and sonohysterography together. METHODS: Hard copy images from 72 women were interpreted independently by 2 sonologists on separate occasions, rating parameters (abnormal uterus, myoma in any location, submucous myoma, classification of location of a submucous myoma with respect to the uterine cavity, myoma remote from the cavity, adenomyosis, and focal and diffuse endometrial lesions) on a scale of 1 to 5 (1 indicated definitely no; 2, probably no; 3, uncertain; 4, probably yes; and 5, definitely yes). Correlation was made with clinical and imaging follow-up, surgery, and pathologic examination. RESULTS: The added information provided by sonohysterography resulted in improved diagnostic confidence for most parameters. Interobserver agreement was markedly improved for the diagnosis and location of submucous myomas and focal endometrial lesions. Sensitivity values for submucous myomas and focal endometrial lesions were 100% and 90% for transvaginal sonography and sonohysterography together and 100% and 70% for transvaginal sonography alone. CONCLUSIONS: We found that sonohysterography does provide additional information over transvaginal sonography alone and is an important adjunct to transvaginal sonography in symptomatic women with known or suspected myomas, particularly before surgical or medical therapy.     

The feasibility of a 'one stop' ultrasound-based clinic for the diagnosis and management of abnormal uterine bleeding.

OBJECTIVES: We have established a 'one stop' clinic for the management of women with abnormal uterine bleeding based on transvaginal sonography and saline contrast sonohysterography. This report reviews our experience with the first 93 patients attending the clinic. DESIGN AND METHODS: Patients were seen with the intention of performing a transvaginal scan, saline contrast sonohysterography, endometrial biopsy, full blood count and thyroid function tests. The findings were prospectively recorded on a computer database and a management plan formulated. RESULTS: A transvaginal scan was performed on 89 (95.7%) women, 70 (75.3%) also undergoing saline contrast sonohysterography. An endometrial biopsy was carried out in 67 (72%) women aged 40 years and above, and 79 (84.9%) had blood tests. The median age of patients was 44 (range, 21-78) years. The majority of women presented with menstrual disorders. Uterine pathology was detected on transvaginal scan in 42 (47.2%) cases. Adnexal pathology was detected in 12 (13.5%) of the patients. Endometrial biopsy detected three (4.5%) cases of endometrial atypia, and three (4.5%) cases of adenocarcinoma. A hemoglobin level of < 10 g/dL was detected in 3 (3.4%) patients. A single clinic visit was thought sufficient for 83 (89.2%) women. Medical therapy was started in 47 (50.5%) patients, 15 (16.3%) were brought back for inpatient diagnostic hysteroscopy, and nine (9.7%) were booked for operative endoscopy, while six (6.5%) had conventional surgery; the remainder were reassured. CONCLUSIONS: This study demonstrates that a 'one stop' management philosophy based on pelvic ultrasound is feasible. Our data suggest that diagnostic hysteroscopy can be decreased using this approach, and challenge the use of hysteroscopy as the first stage test.     

Does three-dimensional power Doppler ultrasound help in discrimination between benign and malignant ovarian masses?

OBJECTIVES: To determine if tumor vascularity as assessed by three-dimensional (3D) power Doppler ultrasound can be used to discriminate between benign and malignant ovarian tumors, if adding 3D power Doppler ultrasound to gray-scale imaging improves differentiation between benignity and malignancy, and if 3D power Doppler ultrasound adds more to gray-scale ultrasound than does two-dimensional (2D) power Doppler ultrasound. METHODS: One hundred and six women scheduled for surgery because of an ovarian mass were examined with transvaginal gray-scale ultrasound and 2D and 3D power Doppler ultrasound. The color content of the tumor scan was rated subjectively by the ultrasound examiner on a visual analog scale. Vascularization index (VI), flow index (FI) and vascularization flow index (VFI) were calculated in the whole tumor and in a 5-cm(3) sample taken from the most vascularized area of the tumor. Logistic regression analysis was used to build models to predict malignancy. RESULTS: There were 79 benign tumors, six borderline tumors and 21 invasive malignancies. A logistic regression model including only gray-scale ultrasound variables (the size of the largest solid component, wall irregularity, and lesion size) was built to predict malignancy. It had an area under the receiver-operating characteristics (ROC) curve of 0.98, sensitivity of 100%, false positive rate of 10%, and positive likelihood ratio (LR) of 10 when using the mathematically best cut-off value for risk of malignancy (0.12). The diagnostic performance of the 3D flow index with the best diagnostic performance, i.e. VI in a 5-cm(3) sample, was superior to that of the color content of the tumor scan (area under ROC curve 0.92 vs. 0.80, sensitivity 93% vs. 78%, false positive rate 16% vs. 27% using the mathematically best cut-off value). Adding the color content of the tumor scan or FI in a 5-cm(3) sample to the logistic regression model including the three gray-scale variables described above improved diagnostic performance only marginally, an additional two tumors being correctly classified. CONCLUSIONS: Even though 2D and 3D power Doppler ultrasound can be used to discriminate between benign and malignant ovarian tumors, their use adds little to a correct diagnosis of malignancy in an ordinary population of ovarian tumors. Objective quantitation of the color content of the tumor scan using 3D power Doppler ultrasound does not seem to add more to gray-scale imaging than does subjective quantitation by the ultrasound examiner using 2D power Doppler ultrasound.     

Laparoscopic ultrasound (LUS) in gastrointestinal surgery.

Intraoperative ultrasonography during abdominal surgery became widespread by availability of high-frequency, high-resolution transducers. It's usefulness has particularly been proven in biliar and gastrointestinal surgery. Our objective was to examine the method in laparoscopic cholecystectomy and in laparoscopic staging of malignancies of the upper gastrointestinal tract as well. Lapaoscopic ultrasound (LUS) examination was performed in 567 patients operated on because of biliary stones and in 12 patients with carcinoma in the upper part of the gastrointestinal tract. In accordance to the known criteria endoscopic retrograde cholangiopancreatography (ERCP) was performed in 89 patients, and additionally, ERCP was performed in 58 patients because of dilated common bile duct. Choledochal stones were demonstrated in 72 of the 147 patients. Laparoscopic ultrasonography demonstrated preoperatively undetected bile duct stones in 18 of these patients (12%). In 294 other patients without any criteria of bile duct stones, laparoscopic ultrasonography demonstrated bile duct stones in 11 patients (4%). Laparoscopic ultrasonography in 12 patients with proximal gastrointestinal malignancies demonstrated inoperability in all of the patients. Laparotomy could thereby be avoided. LUS examination is an ideal operative tool as it is safe, reproducible and requires no special patient preparation or positioning. The method of imaging is therefore justified for patients undergoing laparoscopic surgery because of biliary stones and gastrointestinal surgery.     

灌注法子宫声学造影诊断宫内病变

本文应用灌注法子宫声学造影诊断宫内病变７０例，并与常规的经腹和经阴道超声检查法以及病理和手术结果作对照分析。结果表明：①灌注造影可直观地显示宫腔内病变的形态和回声特点。初步作出内膜息肉，粘膜下肌瘤，增生过长或内膜癌的具体诊断。②灌注造影提高了宫内膜病变诊断的敏感性和特异性（分别为９７．６％和６６．７％，常规超声为９３．９％和４８．６％），提出灌注法子宫声学造影是诊断宫内病变的新方法，不仅提高了这一妇科常见病的诊断水平，而且可避免盲目刮宫的创伤和减少并发症，尤其对粘膜下肌瘤的诊断优于刮宫术     

A new method of transvaginal ultrasound-guided polypectomy: a feasibility study.

OBJECTIVES: A new device has been manufactured (Safe T Choice), which allows attachment of a transvaginal ultrasound probe to a specially adapted cervical tenaculum. This affords the capacity to monitor intrauterine surgical procedures without the need for hysteroscopy. The purpose of this study was to investigate the feasibility of endometrial polypectomy using this device combined with saline contrast sonohysterography (SCSH) to monitor the procedure. METHODS: Women diagnosed with an endometrial polyp on routine B-mode two-dimensional transvaginal ultrasound (TVS) were invited to join the study. Transvaginal ultrasound-guided polypectomies were carried out by a single operator. The procedure was timed from application until removal of the tenaculum. The ultrasound views were rated as satisfactory or poor. Success of the procedure was gauged by complete removal of the polyp without recourse to hysteroscopy. Women also attended for postoperative follow-up ultrasound scans to check for residual disease. RESULTS: Thirty-seven women were recruited to the study. The mean operating time was 8 min (95% CI, 5.9-10.4). The procedure was successful in 32/37 (86.5%) cases (95% CI, 75.5-97.5). In three cases (8.1%) the procedure failed because of an inability to obtain satisfactory images of the uterine cavity, and in two further cases (5.4%) the operator was unable to grasp and remove the polyp. Two patients (5.4%) bled from the tenaculum insertion site, necessitating suture for hemostasis. There were no other complications and none of the patients had evidence of residual polyp tissue at the follow-up visit. CONCLUSION: This study showed that transvaginal ultrasound-guided polypectomy is a feasible technique for the removal of endometrial polyps. Further work is required to compare outcomes and cost-effectiveness of this technique with hysteroscopic polypectomy.     

Transvaginal sonohysterographic evaluation of intrauterine adhesions

PURPOSE: We assessed the role of preoperative sonohysterography in the diagnosis of intrauterine synechiae. METHODS: Nineteen patients with a suspected diagnosis of intrauterine adhesion underwent hysterosalpingography, transvaginal sonography, and sonohysterography performed in the consultation room. The patients were then treated by hysteroscopy under laparoscopic or ultrasound guidance. RESULTS: Transvaginal sonography showed an abnormal uterine cavity in only 10 cases. The sensitivities of sonohysterography and hysterosalpingography in the diagnosis of intrauterine adhesions were both 100%. Sonohysterography showed complete correlation with hysterosalpingography. CONCLUSIONS: We recommend routine sonohysterography after transvaginal sonography in cases of suspected intrauterine synechiae.     

Comparison of sonography,sonohysterography, and hysteroscopy for evaluation of abnormal uterine bleeding.

We compared transvaginal sonography, sonohysterography, and diagnostic hysteroscopy in the evaluation of abnormal uterine bleeding, Sixty-eight women 40 or older with abnormal uterine bleeding were assigned to undergo either transvaginal sonography or sonohysterography. All subjects then had diagnostic hysteroscopy and endometrial biopsy. Patients with abnormal findings underwent operative hysteroscopy or definitive therapy. Transvaginal sonography, sonohysterography, and diagnostic hysteroscopy revealed a sensitivity of 95%, 90%, and 78%, and a specificity of 65%, 83%, and 54%, respectively. The average cost for transvaginal sonography of sonohysterography was $195 and the cost for diagnostic hysteroscopy was $675. Transvaginal sonography and sonohysterography are cost-effective alternatives and more sensitive diagnostic tests than office diagnostic hysteroscopy.     

A systematic review of the accuracy of ultrasound in the diagnosis of endometriosis.

OBJECTIVE: To evaluate transvaginal and transabdominal ultrasound scanning, with or without Doppler, as a diagnostic test for the accurate diagnosis of pelvic endometriosis. METHODS: The MEDLINE (1966-2001) and EMBASE (1980-2001) databases were searched for relevant studies, published in English. Only studies fulfilling predefined criteria were selected. An assessment of quality was made for each study, and data were then reanalyzed using likelihood ratios to determine the usefulness of the test. RESULTS: In total, 67 papers were identified using the search strategy, of which 17 described relevant studies. Of these, seven fulfilled the inclusion criteria. All seven related to the use of transvaginal gray-scale imaging in the diagnosis of ovarian endometriomata specifically, rather than endometriosis. The positive likelihood ratios ranged from 7.6 to 29.8, and the negative likelihood ratios ranged from 0.1 to 0.4. Confidence intervals were wide. One paper addressed the use of conventional color Doppler with ultrasound: the positive likelihood ratio was 1.2, with a negative likelihood ratio of 0.4. One paper assessed the use of color Doppler energy imaging, and showed a positive likelihood ratio of 33.5 and a negative likelihood ratio of 0.1. CONCLUSIONS: Transvaginal ultrasound appears to be a useful test both to make and to exclude the diagnosis of an ovarian endometrioma.     

阴道联合腹部超声在异位妊娠诊断中的应用价值

目的:探讨阴道联合腹部超声在异位妊娠诊断中的应用价值。方法:本研究选取2017年1月—2019年11月我院收治的经手术确诊的100例异位妊娠患者,所有患者术前经腹部及经阴道超声检查,比较两种检查结果。结果:经阴道超声检查对异位妊娠检出率显著高于腹部超声检查(P<0.05);腹部联合阴道超声检查对异位妊娠检出率显著高于腹部或经阴道单独超声检查(P<0.05),且误诊率及漏诊率显著低于腹部或经阴道单独超声检查(P<0.05);经阴道超声检查对异位妊娠典型影像学表现检出率显著高于腹部超声检查(P<0.05),腹部联合阴道超声检查对异位妊娠典型影像学表现检出率均显著高于腹部或经阴道单独超声检查(P<0.05)。结论:阴道联合腹部超声提升异位妊娠检出率,可推广应用。