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16–19 September 2017, Vienna, Austria
Objectives: Uterine sarcoma is a rare disease with a poor
prognosis, and its preoperative diagnosis is difficult. The author
previously presented the finding that a tumour with high
tumour-to-subcutaneous fat signal intensity ratio on MRI T2
weighted imaging (TFSIR) and low ADC is highly suspected of
sarcoma. However, its sensitivity and specificity are not high enough
to diagnose sarcoma. The purpose of this study is to improve the
preoperative diagnostic reliability through further investigation of
previous and additional cases.
Methods: MRI was performed in 6 cases (7 tumours) of uterine
sarcoma in the last 3 years (sarcoma group), and in 31 cases of
leiomyoma in 2015 (myoma group) at the author’s hospital. TFSIR
and ADC were calculated and compared between 2 groups. The
cut-off values of these parameters to predict sarcoma were also
calculated. Finally, a preoperative prediction method using both of
these parameters was considered through the application to the 40
tumours which were examined in 2016.
Results: The sarcoma group had significantly higher TFSIR than
the leiomyoma group (p<0.01). The minimum cut-off value of
TFSIR to diagnose sarcoma was 0.515 (sensitivity: 100%, specificity:
94%). The sarcoma group had significantly lower ADC values than
the leiomyoma group (p<0.01). The maximum cut-off value of
ADC to diagnose sarcoma was 1.280 (sensitivity: 86%, specificity:
87%). All tumours with both positive TFSIR and ADC were
sarcoma (High Suspicion group). All tumours with negative TFSIR
were leiomyoma (Low Suspicion group). Tumours with positive
TFSIR and negative ADC included both sarcomas and leiomyomas
(Intermediate Suspicion group). Among 40 uterine tumours in 2016,
two (5.0%) belonged to the High Suspicion group (all sarcoma),
three (7.5%) belonged to the Intermediate Suspicion group (all
leiomyoma), and the other 35 tumours (87.5%) belonged to the
Low Suspicion group (all leiomyoma).
Conclusions: Preoperative prediction of uterine sarcoma is possible
using both TFSIR and ADC scores on MRI.
Transvaginal ultrasound (TVS) versus MRI for diagnosing
myometrial infiltration in endometrial carcinoma:
a systematic review and meta-analysis
J. Alcazar3 , B. Gastón4 , B. Navarro5 , A. Salas6 , I. Carriles6 ,
M. Aubá6 , S. Guerriero2 , M. Pascual1 , J. Minguez6
Obstetrics, Gynecology and Reproduction, Institut
Universitari Dexeus, Barcelona, Spain; 2 Department of
Obstetrics and Gynecology, University of Cagliari, Cagliari,
Italy; 3 Obstetrics and Gynecology, University of Navarra,
Pamplona, Spain; 4 Obstetrics and Gynecology, Complejo
Hospitalario de Navarra, Pamplona, Spain; 5 Obstetrics and
Gynecology, Fundación Jimenez Diaz, Madrid, Spain;
Obstetrics and Gynecology, Clinica Universidad de Navarra,
Pamplona, Spain
Objectives: To compare the diagnostic accuracy of TVUS and MRI
in for detecting myometrial infiltration in endometrial carcinoma.
Methods: An extensive search of papers comparing TVS and MRI
in assessing myometrial infiltration in endometrial cancer was
performed in Medline (Pubmed), Web of Science and Google
Scholar from January 1989 to January 2017. Only papers using
both techniques on the same set of patients were included. Quality
was assessed using QUADAS-2 tool.
Results: Our extended search identified 35 citations but we finally
examined full text of the 9 articles. The risk of bias for most studies
was low for all four domains assessed in QUADAS-2. Overall,
pooled estimated sensitivity and specificity of TVS and MRI for
diagnosing deep myometrial infiltration were 75% and 86%, and
85% and 82%, respectively. No significant differences were found
between both methods (p=0.3411). Heterogeneity was low for
sensitivity (I-squared 24.2 for TVS, I-squared 5.7 for MRI) and high
for specificity (I-squared 80.6 for TVS, I-squared 80.4 for MRI).
Short oral presentation abstracts
Conclusions: Diagnostic performance of TVS and MRI for detecting
deep myometrial infiltration is similar.
Pre-pregnancy exercise stress testing is related to normal
physiological adaptation from pre-pregnancy to
J. Man2 , L. Foo2 , G. Masini1 , C.M. McEniery3 ,
I.B. Wilkinson3 , P. Bennett2 , C. Lees2
Azienda Ospedaliero-Universitaria Careggi, Florence, Italy;
Imperial College London, London, United Kingdom;
University of Cambridge, London, United Kingdom
Objectives: It is suggested that maternal cardiovascular(CV)
changes in pregnancy are related to pregnancy outcome, specifically
failure of these important adaptive changes may result in
pre-eclampsia(PE) or fetal growth restriction (FGR). To explore
if maternal physiological CV maladaptation could be anticipated
prior to pregnancy, we investigated pre-pregnancy (PP) exercise
stress testing prior to conception, in association with subsequent
pregnancy induced CV changes.
Methods: We recruited non-smokers with no CV co-morbidities
into a pre-conception study. PP, all participants had non-invasive
measurements of cardiac output (CO), stroke volume (SV), total
peripheral resistance (TPR), heart rate (HR) and brachial blood
pressure (BP) at rest. These were repeated during and after a 3-minute
Dundee step test. Delta (δ) values were calculated between resting
and exercise measurements to deduce exercise stress response. At
22 weeks’ gestation resting CV measurements were repeated. Delta
values induced by exercise PP were related to longitudinal changes
induced by pregnancy (PP to 22wks).
Results: There were significant correlations between PP exercise
induced CV changes, and PP to 22 weeks induced CV changes for
CO, HR, BP and TPR. The strongest correlation was between the PP
δTPR during exercise & the pregnancy induced adaptation of TPR
from PP to 22 wks (r=0.669, p<0.001.) We explored if the δTPR
relationship was also present at 6 weeks gestation and found similar
results, though with weaker correlations (r=0.568, P<0.001).
Conclusions: TPR exercise response strongly correlates to physiological change in TPR from PP to mid-pregnancy (22wks). This
correlation is already present by 6 wks gestation, though to a weaker
extent. There are also weaker but significant associations between PP
exercise CO, BP and mid-pregnancy adaptation of the same parameters. Therefore, PP exercise testing may be valuable in providing
insight into normal physiological adaptation to pregnancy.
Assessment of relationship between fetal middle cerebral
artery peak systolic velocity and umbilical vein blood gas
values in diabetic pregnancies
M.S. Kutuk1 , M. Dolanbay2 , A.F. Gokmen3 , M.T. Ozgun1
Obstetrics and Gynecology, Erciyes University, Faculty of
Medicine, Kayseri, Turkey; 2 Obstetrics and Gynecology,
Erciyes University, Kayseri, Turkey; 3 Obstetrics and
Gynecology, Bezmi Alem Vakif University, Istanbul, Turkey
Objectives: To assess the relationship between peak systolic velocity
in the middle cerebral artery (MCA-PSV) and fetal hypoxia in
diabetic pregnancies requiring insulin therapy.
© The Authors 2017
© Ultrasound in Obstetrics & Gynecology 2017; 50 (Suppl. 1): 48–153.
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