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Aim: To determine how accurately and confidently examiners with different levels of ultrasound experience can classify adnexal masses as benign or malignant and suggest a specific histological diagnosis when evaluating ultrasound images using pattern recognition. Methods: Ultrasound images of selected adnexal masses were evaluated by 3 expert sonologists, 2 senior and 4 junior trainees. They were instructed to classify the masses using pattern recognition as benign or malignant, to state the level of confidence with which this classification was made and to suggest a specific histological diagnosis. Sensitivity, specificity, accuracy and positive and negative likelihood ratios (LR+ and LR–) with regard to malignancy were calculated. The area under the receiver operating characteristic curve (AUC) of pattern recognition was calculated by using six levels of diagnostic confidence. Results: 166 masses were examined, of which 42% were malignant. Sensitivity with regard to malignancy ranged from 80 to 86% for the experts, was 70 and 84% for the 2 senior trainees and ranged from 70 to 86% for the junior trainees. The specificity of the experts ranged from 79 to 91%, was 77 and 89% for the senior trainees and ranged from 59 to 83% for the junior trainees. The experts were uncertain about their diagnosis in 4–13% of the cases, the senior trainees in 15–20% and the junior trainees in 67–100% of the cases. The AUCs ranged from 0.861 to 0.922 for the experts, were 0.842 and 0.855 for the senior trainees, and ranged from 0.726 to 0.795 for the junior trainees. The experts suggested a correct specific histological diagnosis in 69–77% of the cases. All 6 trainees did so significantly less often (22–42% of the cases). Conclusion: Expert sonologists can accurately classify adnexal masses as benign or malignant and can successfully predict the specific histological diagnosis in many cases. Whilst less experienced operators perform reasonably well when predicting the benign or malignant nature of the mass, they do so with a very low level of diagnostic confidence and are unable to state the likely histology of a mass in most cases.

Objectives To evaluate perception of pain during Fallopian-tube patency testing by hysterosalpingo-foam sonography (HyFoSy). Methods

Oral communication abstractslead to CA vasodilatation, manifesting as easy visualization on FE. We reviewed our experience with visualization of prominent CA and outcome of these fetuses. Methods: We reviewed all cases between 2001 and 2007 in which there was unusual prominence and easy visualization of CA. Fetuses with ventricular hypoplasia or fistulous connections as a cause for coronary dilatation were excluded. CA prominence was defined as easy visualization via CD imaging starting at the origin of the aorta, with an ability to trace descent of the vessel through the ventricular septum to at least 2/3 of the length towards the apex of the heart. Results: Eleven cases were identified. FE was performed at a median of 27 (range, 20-32) weeks' gestation. Underlying disorders included: high-output cardiac failure due to anemia (two) or chorionagioma (one), tachyarrhythmia (one), truncus arteriosus with severe outflow obstruction (one), severe intrauterine growth retardation (one), lower urinary tract obstruction with massively dilated bladder (one), CMV infection (one), amniotic band with umbilical obstruction (one), porencephaly (one) and cystic hygroma (one). Hydrops fetalis was present in four. Of the 11, two are still unborn; five had intrauterine fetal demise within 2 h to 7 days after FE; two died immediately after birth, both delivered at < 35 weeks; two are currently alive -one with pulmonary hypertension that has resolved and one with neurological insult. All four fetuses identified at < 24 weeks gestation died in utero. Conclusions: Visualization of prominent CA in the fetus is a marker of severe myocardial insufficiency and predicts poor outcome.

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