| 1. |
- Karlsson, Bengt, et al.
(författare)
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Transvaginal ultrasonography of the endometrium in women with postmenopausal bleeding--a Nordic multicenter study
- 1995
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Ingår i: American Journal of Obstetrics and Gynecology. - : Elsevier BV. - 1097-6868 .- 0002-9378. ; 172:5, s. 1488-1494
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: The purpose of this study was to use transvaginal ultrasonographic measurements to find the thickness of the endometrium below which the risk of endometrial abnormality in women with postmenopausal bleeding is low. STUDY DESIGN: This multicenter study was carried out at eight clinics in four Nordic countries. The study included 1168 women with postmenopausal bleeding scheduled for curettage Before the curettage was performed, the thickness of the endometrium was measured with transvaginal ultrasonography. The measurement included both endometrial layers (double-layer technique). The transvaginal ultrasonographic measurement was compared with the histopathologic diagnosis of the curettage specimens. RESULTS: In women with atrophic endometrium the mean endometrial thickness (+/- SD) was 3.9 +/- 2.5 mm. The corresponding figures for women with endometrial cancer were 21.1 +/- 11.8 mm. No malignant endometrium was thinner than 5 mm. In 30 women (2.8%) it was not possible to measure the thickness of the endometrium; one of these women had endometrial cancer. The 95% confidence limit for the probability of excluding endometrial abnormality was 5.5% when the endometrial thickness was < or = 4 mm as measured by transvaginal ultrasonography. CONCLUSION: The risk of finding pathologic endometrium at curettage when the endometrium is < or = 4 mm as measured by transvaginal ultrasonography is 5.5%. Thus in women with postmenopausal bleeding and an endometrium < or = 4 mm it would seem justified to refrain from curettage.
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| 2. |
- Sladkevicius, Povilas, et al.
(författare)
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Interobserver agreement in the results of Doppler examinations of extrauterine pelvic tumors
- 1995
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Ingår i: Ultrasound in Obstetrics & Gynecology. - : Wiley. - 1469-0705 .- 0960-7692. ; 6:2, s. 91-96
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to evaluate interobserver agreement in the results of Doppler measurements of peak systolic velocity (PSV), time-averaged maximum velocity (TAMXV) and the color content of tumor scans in extrauterine pelvic tumors. The results of transvaginal color and spectral Doppler examinations of 66 extrauterine pelvic masses obtained by two observers experienced in ultrasonography were compared. Each observer aimed to obtain the highest possible Doppler shift from arteries in the wall, septa and solid parts of each tumor. Tumor vascularization was assessed in terms of the 'tumor color score', i.e. the color content of the Doppler scan as rated for the tumor as a whole by each observer on a visual analog scale. The tumors were classified according to arbitrarily chosen cut-off limits for the tumor color score, the highest tumor TAMXV and the highest tumor PSV. Inter-class correlation coefficient values for TAMXV and PSV were < or = 0.75, whereas that for tumor color score was 0.89. Interobserver agreement was complete for the detection of color in tumors (Kappa value 1.0), excellent for the recording of arterial Doppler shift spectra from tumors (Kappa value 0.82), and moderate or good for classifying tumors based on cut-off limits for TAMXV, PSV (Kappa values ranging from 0.44 to 0.67) and tumor color score (Kappa values ranging from 0.59 to 0.66).(ABSTRACT TRUNCATED AT 250 WORDS)
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| 3. |
- Sladkevicius, Povilas, et al.
(författare)
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Reproducibility of Doppler measurements of blood flow velocity in the uterine and ovarian arteries in premenopausal women
- 1995
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Ingår i: Ultrasound in Medicine and Biology. - 0301-5629. ; 21:3, s. 313-319
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Tidskriftsartikel (refereegranskat)abstract
- Intra- and interobserver reproducibility of Doppler measurements of the pulsatility index (PI) and time-averaged maximum velocity (TAMXV) in the uterine and ovarian arteries were evaluated in examinations of healthy premenopausal women. Each woman underwent reproducibility measurements once in the late follicular phase and once in the midluteal phase. Intraobserver repeatability was assessed in examinations of 12 women, three replicate Doppler measurements being made by one observer in the same vessel. Interobserver agreement was assessed by comparing the results of Doppler measurements made by two investigators in 11 women. The intraclass correlation coefficient (Intra-CC) was 0.78 for the TAMXV in the dominant uterine artery in the follicular phase and 0.82 for the PI in the wall of the dominant follicle. For all other measurements the Intra-CC was < 0.75, indicating poor reproducibility. The interclass correlation coefficient (Inter-CC) was > 0.75 (0.79 to 0.88) for the PI and TAMXV in the dominant uterine artery in the follicular phase and for the PI of both uterine arteries in the luteal phase. For all other measurements the Inter-CC was < 0.75.
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| 4. |
- Sladkevicius, Povilas, et al.
(författare)
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Transvaginal Doppler examination for the differential diagnosis of solid pelvic tumors
- 1995
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Ingår i: Journal of Ultrasound in Medicine. - 1550-9613. ; 14:5, s. 377-5380
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Tidskriftsartikel (refereegranskat)abstract
- To evaluate the ability of transvaginal Doppler examination to discriminate between different types of solid pelvic tumors, 55 women scheduled for laparotomy because of a solid pelvic mass underwent transvaginal sonographic examination, including color and spectral Doppler techniques. Arteries in the wall and core of each mass were examined. The histological diagnoses were as follows: uterine myoma (n = 28), malignant ovarian tumor (n = 19), and benign ovarian tumor (n = 8). Pulsatility index values tended to be highest in the malignant ovarian tumors, albeit with considerable overlap with respect to the other tumor types. The respective median pulsatility index values for arteries in the wall and core of the malignant ovarian tumors were 0.93 and 0.87, versus 0.65 and 0.51 in the benign ovarian tumors and 0.80 and 0.67 in the myomas. Time-averaged maximum velocity did not differ significantly among the three types of tumor. We conclude that Doppler measurement of blood flow velocity in tumor arteries does not add substantial information to the differential diagnosis between myomas and benign or malignant solid ovarian tumors.
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| 5. |
- Sladkevicius, Povilas, et al.
(författare)
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Transvaginal gray-scale and Doppler ultrasound examinations of the uterus and ovaries in healthy postmenopausal women
- 1995
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Ingår i: Ultrasound in Obstetrics & Gynecology. - : Wiley. - 1469-0705 .- 0960-7692. ; 6:2, s. 81-90
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to elicit reference data representative of normal findings at transvaginal gray-scale and Doppler ultrasound examination of the uterus and ovaries in postmenopausal women. A total of 144 asymptomatic postmenopausal women with normal findings at clinical gynecological examination were included in the study. They underwent transvaginal sonography including Doppler measurements of blood flow velocity in the uterine and ovarian arteries. Ninety-eight (68%) women had a normal uterus and normal or non-visible ovaries at ultrasound examination, 23 (16%) had small uterine myomas but normal or non-visible adnexa, 19 (13%) had small adnexal cysts but a normal uterus, and four (3%) had both small myomas and small adnexal cysts. The median time-averaged maximum velocity (TAMXV) and pulsatility index (PI) values for the right and left uterine artery of normal uteri (n = 117) were 10.4 cm/s (range 2.2-43.0) and 10.6 cm/s (2.9-30.8), and 2.33 (0.97-5.13) and 2.35 (0.98-4.58), respectively. Median volumes of the normal right (n = 93) and left ovaries (n = 90) were 1.3 cm3 (0.4-3.7) and 1.2 cm3 (0.4-3.0), respectively, and median TAMXV and PI values for the stromal arteries in the normal right (n = 53) and left ovaries (n = 54) were 2.1 cm/s (1.3-4.6) and 2.3 cm/s (1.1-7.3), and 1.31 (0.65-2.61) and 1.26 (0.63-1.85), respectively. Our results provide a basis for gray-scale and Doppler ultrasound studies of pathological conditions in the female pelvis after the menopause.
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| 6. |
- Valentin, Lil, et al.
(författare)
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Effect of a prostaglandin E1 analogue (gemeprost) on uterine and luteal circulation in normal first trimester pregnancies. A Doppler velocimetry study
- 1995
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Ingår i: European Journal of Obstetrics, Gynecology, and Reproductive Biology. - 0301-2115. ; 59:1, s. 25-34
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To evaluate the effects of gemeprost on utero-placental and luteal circulation and on the embryo/fetus in normal first trimester pregnancies. STUDY DESIGN: Sixty-seven women with a normal first trimester pregnancy requesting termination of pregnancy for psychosocial reasons were randomly allocated to pre-operative treatment with vaginal suppositories containing placebo or gemeprost. The women underwent transvaginal color and spectral Doppler ultrasound examination before the application of the suppository, 4 h after the application of the suppository but before the abortion, and on the seventh post-operative day. Blood flow velocities in the uterine and subchorionic arteries, the intrachorionic area and arteries in the wall of the corpus luteum and the embryonic/fetal heart rate were measured. RESULTS: The median value for pulsatility index (PI) in the dominant uterine artery was 2.4 before treatment with gemeprost and 8.5 4 h after treatment (P = 0.0006); the corresponding values for time-averaged maximum velocity (TAMXV) being 27 cm/s and 10 cm/s (P = 0.0006). Four (14%) of 28 embryos/fetuses in the gemeprost group were dead 4 h after treatment with gemeprost and the median heart rate of those still alive was significantly lower than before treatment (130 vs. 163 bpm; P = 0.003). In the placebo group, the results for the uterine arteries and the embryonic/fetal heart rate did not differ significantly between the first and second ultrasound examinations. The median values for PI and TAMXV in the arteries of the corpus luteum wall at the first ultrasound examination were 0.71 and 18 cm/s, respectively, in the placebo group and 0.71 and 20 cm/s, respectively, in the gemeprost group. These values remained almost unchanged at the second and third ultrasound examinations in both groups. CONCLUSION: Gemeprost has profound effects on utero-placental circulation in the first trimester and can induce embryonic/fetal bradycardia and sometimes embryonic/fetal demise. It has no unequivocal effect on luteal circulation.
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