Uterine cavity imaging, volume estimation and quantification of degree of deformity using automatic volume calculation: description of technique

Martins

2019

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The uterine scare after caesarean section and "niche" also called "isthmocoele" and their specific morphologic features may be associated with specific further gynecological and obstetrical complications . Abnormal uterine bleeding, subfertility, risk of scar pregnancy and uterine rupture during pregnancy and delivery are considered as potential indications for hysteroscopic or laparoscopic correction of cesarean scar; however, there is a lack of robust evidence that surgery is justified by specific niche morphology, symptoms, and risks. Despite of the lack of appropriate studies with control of untreated patients, a significant barrier to build evidence is the lack of reliable diagnostics. Recently, a step for standardization of the nomenclature and ultrasound measurements has been made . Some researchers agreed that there is not a preference for a specific ultrasound technique to be used, and transvaginal ultrasound with the sagittal and transversal view for specific niche measurements are suggested. The experts also agree that using contrast agents during the scan (normally gel or saline) have added value in the assessment of niche if fluid is not present naturally in niche . Role of three-dimensional ultrasound were not a subject of this consensus, probably because it was focused on basic niche assessment. Recently, the use of three-dimensional saline contrast sonohysterography and SonoHysteroAVC technique was described as promising in assessment of uterus and uterine cavity . We here are sharing our initial experience with three-dimensional sonohysterography and SonoHysteroAVC for niche assessment in clinical practice and research. This article is protected by copyright. All rights reserved.

Section: Techniquementioning

confidence: 97%

Section: Techniquementioning

confidence: 99%

Section: Techniquementioning

confidence: 99%

See 1 more Smart Citation

Evaluation of uterine niche by three‐dimensional sonohysterography and volumetric quantification: techniques and scoring classification system

Martins

2019

Self Cite

“…The ‘flaming tube’ sign can be combined with other modern ultrasound techniques to facilitate identification of tubal occlusion and its causes, and guide specific treatment (Figure S1).…”

Section: Techniquementioning

confidence: 99%

Hysterosalpingo‐lidocaine‐foam sonography combined with power Doppler imaging (HyLiFoSy‐PD) in tubal patency assessment: ‘flaming tube’ sign

Nastri

et al. 2017

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Two-(2D) and three-dimensional (3D) ultrasound imaging is used frequently for tubal patency testing with relatively high accuracy, particularly when performed by experts and using foam as contrast medium 1 . However, there are still some drawbacks related to the technique that preclude its worldwide use, including the cost and availability of contrast media, the procedure-related pain and the need for appropriate training to obtain competence in the performance of tubal patency testing 1 .In this article, we describe a novel technique, hysterosalpingo-lidocaine-foam sonography combined with power Doppler imaging (HyLiFoSy-PD), which allows assessment of the 'flaming tube' sign as an indicator of tubal patency. We believe that this technique offers advantages related to cost, availability and ease of image recognition; additionally, the use of lidocaine in the contrast agent could potentially reduce the pain associated with the procedure. Technique 1. Specific patient preparation is not necessary; however, offering the patient a painkiller containing paracetamol (500 mg) and codeine (30 mg) 1 h before the procedure should be considered. 2. The examination is performed between days 5 and 10 of the menstrual cycle, with the patient in gynecological position, preferably with the aid of one assistant. 3. Initially, real-time 2D and 3D ultrasound assessment of the pelvic organs is performed (in our case, using a GE Voluson E8 ultrasound system (GE Medical Systems, Zipf, Austria)). Note that the 3D technique is not essential as examination of the pelvic organs and uterine cavity and evaluation of tubal patency can be performed accurately using only real-time 2D ultrasound in machines not equipped with 3D technology.4. Following the initial ultrasound scan, the external cervical os is identified with the aid of a vaginal speculum. A sterile 5-Fr balloon catheter (Softinjector, RI.MOS, Mirandola, Italy) is introduced into the cervical canal or the uterine cavity, similarly to other uterine cavity and tubal patency contrast tests. Saline contrast sonohysterography is performed initially, using real-time 2D and 3D ultrasound to assess the uterine cavity for anomalies and lesions 1 . 5. The foam contrast agent is created by combining 3-4 mL of 2% lidocaine gel (each mL contains 20 mg of lidocaine hydrochloride, water, hypromellose, methylparaben, propylparaben and hydrochloric acid; pH is between 6.0 and 7.0), 12-13 mL of saline and 3 mL air. The use of lidocaine gel up to 10% w/w is considered to be safe for vaginal, intrauterine and intra-abdominal use 2,3 . The assistant creates the foam immediately before application, moving the mixture between two connected 20-mL syringes, until a whitish suspension is obtained (approximately 10-20 times). 6. Before injecting the contrast agent, an attempt is made to identify both uterine horns, including the intramural part of the uterine tubes in the transverse section of uterus, to be used as starting position for real-time 2D evaluation and acquisition of 3D volumes. 7. The assistan...

“…We hypothesize that visualization of the cervix using 3D‐SVC and HDlive render mode would improve the diagnostic accuracy of gynecological examination by conventional 3D ultrasound and the management of women who encounter difficulties with speculoscopy. As with other new techniques, such as SonoHysteroAVC for calculating uterine cavity volume, 3D‐SVC may improve the classification and help refine current definitions of uterocervicovaginal complex anomalies, which remain imprecise and unreliable. Additionally, the acquired 3D datasets in difficult cases can be analyzed offline by other experts to achieve a more reliable diagnosis by consensus.…”

Section: Techniquementioning

confidence: 99%

Three‐dimensional saline‐contrast sonovaginocervicography or virtual speculoscopy with HDlive: potential diagnostic tool for women with intact hymen or uterovaginocervical complex malformation

Martins

2017

Self Cite

Speculoscopy with gynecological examination is a basic method for assessment of vaginal and cervical anatomy 1 . The presence of a vaginal septum, such as an intact hymen, or an anatomical abnormality often makes it painful, difficult or impossible to carry out speculoscopy with gynecological examination. Conventional three-dimensional (3D) transvaginal (TVS), transabdominal or transrectal (TRS) sonography, which is becoming the new gold standard for classification of uterine anatomy, is unable to image accurately the ectocervix, cervical canal and vagina in such cases 1,2 . The ability to distinguish a septate cervix from a double cervix using magnetic resonance imaging (MRI) has been challenged recently 3 . The use of gel during vaginal imaging by 3D ultrasound and MRI may be helpful, but the quality of cervical imaging with gel is far from perfect 2 . Thus, reporting malformations of the cervix and vagina, in particular the distinction between a double and septate cervix, is limited by the lack of a consistent and accurate diagnostic imaging tool.Partial assessment of the cervix is possible, even in women with an intact hymen, by vaginoscopy or MRI; however, vaginoscopy provides limited information on the cervix and myometrium, MRI gives little information on the surface of the ectocervix and vagina, and both of these techniques are more expensive and less available than is ultrasound. Hence, we describe a new technique, 3D saline-contrast sonovaginocervicography (SVC), to evaluate the uterine cervix in such women. Technique 1. Specific patient preparation is not necessary, but bowel preparation might be helpful in women with an intact hymen for whom TRS should be used instead of TVS.