Objective:?The aim of this study is to assess any potential relationship between perifollicular vascularity and occurrence of pregnancy in cases of stimulated IUI cycles using the subjective grading system by 2D trans...Objective:?The aim of this study is to assess any potential relationship between perifollicular vascularity and occurrence of pregnancy in cases of stimulated IUI cycles using the subjective grading system by 2D transvaginal power Doppler ultrasonography.?Design: A prospective cross sectional cohort study. Method: This is a prospective cross-sectional cohort study of 90 stimulated IUI treatment cycles. Selected women were prescribed clomiphene citrate combined with highly purified urinary follicle stimulating hormone. All patients underwent serial transvaginal ultrasound scans starting from day 6 to 7 of the cycle. Perifollicular Doppler blood flows were assessed in dominant follicles ≥18 mm. The patients then were categorized into 3 groups (high vascularity group {G3 & G4}, low vascularity group {G1 & G2} and mixed grades group). Other parameters measured included number of follicles ≥ 18 mm in both ovaries, endometrial thickness and estradiol (E2) level . Human chorionic gonadotropin (hCG) injection 10,000 IU IM was given to the patient when the dominant follicle reached 18 mm in diameter. At that time, the endometrium was evaluated as regards endometrial thickness. IUI was carried out using prepared/“washed” semen (husband). All patients received luteal support in the form of progesterone from day of IUI for 14 days. Serum Β-hCG was estimated 2 weeks after insemination. Results: In this study, from all 90 cases only 8 cases got pregnant with pregnancy rate of 8.88% (6 cases got pregnant in high grade vascularity group;2 cases in mixed grades group and no cases got pregnant?in low grade group). There was statistically significant difference among the 3 groups as regarding?the pregnancy rate (P value = 0.02). There is statistically significant difference in perifollicular resistance index (RI) and pulsatility index (PI) between pregnant and non pregnant cases (P value = 0.016 and 0.047 respectively). In this study, there is no statistically significant difference between pregnant and non pregnant cases as regarding endometrial thickness and E2 level at the day of hCG administration (P value = 0.39 and 0.76 respectively). Conclusion: Perifollicular blood-flow assessment by 2D transvaginal power Doppler is a good predictive for the outcome of stimulated IUI cycles.展开更多
Rheumatoid arthritis is a chronic multisystem disease of unknown cause. The characteristic feature of RA is persistent inflammatory synovitis. The natural history of disease is such that the early months of the diseas...Rheumatoid arthritis is a chronic multisystem disease of unknown cause. The characteristic feature of RA is persistent inflammatory synovitis. The natural history of disease is such that the early months of the disease are critical period during which reversible joint damage occurs. So early diagnosis of RA and appropriate drug application is the only way to save a patient from this crippling disease. In India, the cost of investigations is a significant factor for most of the patients. Ultrasonography or Power Doppler Ultra Sound (PDUS) has the advantage of being economic in spite of its sensitivity in assessing both inflammatory and destructive changes. The aim of the present study was to evaluate the diagnostic efficiency of PDUS in early rheumatoid arthritis. The study was performed with the patients attending Rheumatology Clinic. A total number of 106 patients of clinically suspected rheumatoid arthritis were studied as per selection criteria. Radiological examinations of hands were done by digital radiography and PDUS in a group of 53 patients, assessment of foot changes by PDUS and Digital Radiography were done in another similar group of 53 patients. Final diagnosis by ACR EULAR-2010 criteria is done for all the patients. The comparative study reveals that synovial vascularity as demonstrated by PDUS is much more effective in diagnosing early rheumatoid arthritis, both in hand and in feet than digital radiograph. PDUS of feet may yield earlier and better findings than hands, which is conventionally used in patients suffering from early rheumatoid arthritis.展开更多
Ankle involvement is frequent in patients with inflammatory rheumatic diseases, but accurate evaluation by physical examination is often difficult because of the complex anatomical structures of the ankle. Over the la...Ankle involvement is frequent in patients with inflammatory rheumatic diseases, but accurate evaluation by physical examination is often difficult because of the complex anatomical structures of the ankle. Over the last decade, ultrasound(US) has become a practical imaging tool for the assessment of articular and periarticular pathologies, including joint synovitis, tenosynovitis, and enthesitis in rheumatic diseases. Progress in power Doppler(PD) technology has enabled evaluation of the strength of ongoing inflammation. PDUS is very useful for identifying the location and kind of pathologies in rheumatic ankles as well as for distinguishing between inflammatory processes and degenerative changes or between active inflammation and residual damage. The aim of this paper is to illustrate the US assessment of ankle lesions in patients with inflammatory rheumatic diseases, including rheumatoid arthritis, spondyloarthritis, and systemic lupus erythematosus, focusing on the utility of PDUS.展开更多
Objectives: To evaluate the role of Doppler ultrasound in prediction and follow up during management of gestational trophoblastic neoplasia (GTN). Methods: The study was performed at Oncology Unit, Maternity Hospital,...Objectives: To evaluate the role of Doppler ultrasound in prediction and follow up during management of gestational trophoblastic neoplasia (GTN). Methods: The study was performed at Oncology Unit, Maternity Hospital, Ain Shams University in the period from November 2015 to December 2018. Forty cases of complete mole, after evacuation and follow up of serum human chorionic gonodotrophin (β-hCG) titre until it reached zero level (group I) and forty post molar GTN cases (group II) were included in the study. Doppler ultrasound of the subendometrial and intramural blood flow was done for all cases of group I and II. Doppler included two dimensional and three dimensional power Doppler indices. Group II received Methotrexate (MTX) and folinic acid in a dose of 8-day MTX-FA regimen. Doppler follow up for six months of group II concurrently with the chemotherapy regimen was done. Results: A statistically significant difference was found between group I and II regarding initial readings of all Doppler parameters. Follow up for 6 months of GTN cases revealed progressive statistically significant decrease of intramural and subendometrial three dimensional power Doppler (3DPD) indices, while there was a significant increase in two dimensional (2D) Doppler parameters. Four cases were resistant to Methotrexate chemotherapy. Cut off values were determined for prediction of GTN. Multivariate analysis revealed that the most predictive parameter was the subendometrial pulsatility index (PI), odds ratio = 10.63 (95% CI: 1.30 - 86.89). The cut-off point for sub-endometrial PI was: 2.05 (AUC, 90%;sensitivity, 88%;specificity, 76%, PPV 78%, and NPV 86%) with a diagnostic accuracy of 87%. To and Fro sign may be considered a pathognomonic intramural ultrasound sign for prediction of GTN chemo-resistance or choriocarcinoma. Conclusion: Cut off values for Doppler parameters can be used for early predication of GTN. Doppler ultrasound indices can be used during follow up of GTN cases concurrently with serum β-hCG to monitor the response to treatment.展开更多
目的探讨晚孕期频谱多普勒超声、三维能量多普勒超声(3D-PDU)及剪切波弹性成像(SWE)评估妊娠期糖尿病(GDM)患者胎盘功能的价值。方法选择GDM患者58例为GDM组,年龄24~38岁,平均年龄30.7岁;孕龄28~40周,平均孕龄34.7周;孕前身体质量指数(B...目的探讨晚孕期频谱多普勒超声、三维能量多普勒超声(3D-PDU)及剪切波弹性成像(SWE)评估妊娠期糖尿病(GDM)患者胎盘功能的价值。方法选择GDM患者58例为GDM组,年龄24~38岁,平均年龄30.7岁;孕龄28~40周,平均孕龄34.7周;孕前身体质量指数(BMI)18.3~33.7 kg/m^(2),平均BMI 23.6 kg/m^(2);空腹、口服葡萄糖后1 h、2 h血糖分别为3.97~6.58、7.45~13.17、4.62~12.82 mmol/L,平均血糖分别为5.20、9.94、8.34 mmol/L。正常孕妇70例为对照组,年龄21~42岁,平均年龄29.6岁;孕龄28~41周,平均孕龄35.1周;孕前BMI 16.2~32.0 kg/m^(2),平均BMI 22.8 kg/m^(2)。常规超声检查胎儿双顶径、头围、腹围、股骨长、胎龄、胎儿体质量、胎盘厚度、羊水量。应用频谱多普勒超声获得胎儿脐动脉(UA)、大脑中动脉(MCA)及孕妇子宫动脉(UtA)的血流参数[收缩期/舒张末期峰值速度比(S/D)、搏动指数(PI)、阻力指数(RI)],计算脑-胎盘比(CPR);通过3D-PDU获得胎盘能量指数[血管血流指数(VFI)、血流指数(FI)、血管指数(VI)];应用SWE测得胎盘中央及边缘的平均弹性模量(E)。比较两组数据,绘制受试者工作特性(ROC)曲线对各参数进行评价。结果GDM组与对照组检查时胎儿双顶径、头围、腹围、股骨长、胎龄、胎儿体质量、胎盘厚度、羊水量比较,差异均无统计学意义(P>0.05)。两组孕妇产次、分娩方式和新生儿出生体质量、Apgar 1 min和5 min评分比较,差异均无统计学意义(P>0.05)。与对照组比较,GDM组不良妊娠结局的发生率升高(25.9%vs 11.4%),UtA血流参数升高(S/D:1.94±0.30 vs 1.82±0.18;PI:0.73±0.16 vs 0.65±0.11;RI:0.48±0.06 vs 0.45±0.05),GDM组胎盘能量指数降低(VI:11.76±2.92 vs 15.81±2.98;FI:33.44±2.80 vs 34.79±2.50;VFI:3.94±1.05 vs 5.53±1.20),GDM组胎盘中央及边缘E升高(5.94±0.89 vs 4.81±0.65;6.12±1.01 vs 4.88±0.71),差异均有统计学意义(P<0.05);两组UA、MCA血流参数(S/D、PI、RI)及CPR比较,差异无统计学意义(P>0.05)。ROC曲线分析结果显示,UtA-PI、胎盘VFI、胎盘中央E在单一模态超声中诊断价值较高,三项联合评估的曲线下面积(AUC)为0.914,对GDM诊断价值较单一参数明显提高。结论频谱多普勒超声、3D-PDU、SWE可评估晚孕期GDM患者胎盘功能,多模态超声联合应用可提高诊断效能,为GDM的临床管理提供参考。展开更多
文摘Objective:?The aim of this study is to assess any potential relationship between perifollicular vascularity and occurrence of pregnancy in cases of stimulated IUI cycles using the subjective grading system by 2D transvaginal power Doppler ultrasonography.?Design: A prospective cross sectional cohort study. Method: This is a prospective cross-sectional cohort study of 90 stimulated IUI treatment cycles. Selected women were prescribed clomiphene citrate combined with highly purified urinary follicle stimulating hormone. All patients underwent serial transvaginal ultrasound scans starting from day 6 to 7 of the cycle. Perifollicular Doppler blood flows were assessed in dominant follicles ≥18 mm. The patients then were categorized into 3 groups (high vascularity group {G3 & G4}, low vascularity group {G1 & G2} and mixed grades group). Other parameters measured included number of follicles ≥ 18 mm in both ovaries, endometrial thickness and estradiol (E2) level . Human chorionic gonadotropin (hCG) injection 10,000 IU IM was given to the patient when the dominant follicle reached 18 mm in diameter. At that time, the endometrium was evaluated as regards endometrial thickness. IUI was carried out using prepared/“washed” semen (husband). All patients received luteal support in the form of progesterone from day of IUI for 14 days. Serum Β-hCG was estimated 2 weeks after insemination. Results: In this study, from all 90 cases only 8 cases got pregnant with pregnancy rate of 8.88% (6 cases got pregnant in high grade vascularity group;2 cases in mixed grades group and no cases got pregnant?in low grade group). There was statistically significant difference among the 3 groups as regarding?the pregnancy rate (P value = 0.02). There is statistically significant difference in perifollicular resistance index (RI) and pulsatility index (PI) between pregnant and non pregnant cases (P value = 0.016 and 0.047 respectively). In this study, there is no statistically significant difference between pregnant and non pregnant cases as regarding endometrial thickness and E2 level at the day of hCG administration (P value = 0.39 and 0.76 respectively). Conclusion: Perifollicular blood-flow assessment by 2D transvaginal power Doppler is a good predictive for the outcome of stimulated IUI cycles.
文摘Rheumatoid arthritis is a chronic multisystem disease of unknown cause. The characteristic feature of RA is persistent inflammatory synovitis. The natural history of disease is such that the early months of the disease are critical period during which reversible joint damage occurs. So early diagnosis of RA and appropriate drug application is the only way to save a patient from this crippling disease. In India, the cost of investigations is a significant factor for most of the patients. Ultrasonography or Power Doppler Ultra Sound (PDUS) has the advantage of being economic in spite of its sensitivity in assessing both inflammatory and destructive changes. The aim of the present study was to evaluate the diagnostic efficiency of PDUS in early rheumatoid arthritis. The study was performed with the patients attending Rheumatology Clinic. A total number of 106 patients of clinically suspected rheumatoid arthritis were studied as per selection criteria. Radiological examinations of hands were done by digital radiography and PDUS in a group of 53 patients, assessment of foot changes by PDUS and Digital Radiography were done in another similar group of 53 patients. Final diagnosis by ACR EULAR-2010 criteria is done for all the patients. The comparative study reveals that synovial vascularity as demonstrated by PDUS is much more effective in diagnosing early rheumatoid arthritis, both in hand and in feet than digital radiograph. PDUS of feet may yield earlier and better findings than hands, which is conventionally used in patients suffering from early rheumatoid arthritis.
文摘Ankle involvement is frequent in patients with inflammatory rheumatic diseases, but accurate evaluation by physical examination is often difficult because of the complex anatomical structures of the ankle. Over the last decade, ultrasound(US) has become a practical imaging tool for the assessment of articular and periarticular pathologies, including joint synovitis, tenosynovitis, and enthesitis in rheumatic diseases. Progress in power Doppler(PD) technology has enabled evaluation of the strength of ongoing inflammation. PDUS is very useful for identifying the location and kind of pathologies in rheumatic ankles as well as for distinguishing between inflammatory processes and degenerative changes or between active inflammation and residual damage. The aim of this paper is to illustrate the US assessment of ankle lesions in patients with inflammatory rheumatic diseases, including rheumatoid arthritis, spondyloarthritis, and systemic lupus erythematosus, focusing on the utility of PDUS.
文摘Objectives: To evaluate the role of Doppler ultrasound in prediction and follow up during management of gestational trophoblastic neoplasia (GTN). Methods: The study was performed at Oncology Unit, Maternity Hospital, Ain Shams University in the period from November 2015 to December 2018. Forty cases of complete mole, after evacuation and follow up of serum human chorionic gonodotrophin (β-hCG) titre until it reached zero level (group I) and forty post molar GTN cases (group II) were included in the study. Doppler ultrasound of the subendometrial and intramural blood flow was done for all cases of group I and II. Doppler included two dimensional and three dimensional power Doppler indices. Group II received Methotrexate (MTX) and folinic acid in a dose of 8-day MTX-FA regimen. Doppler follow up for six months of group II concurrently with the chemotherapy regimen was done. Results: A statistically significant difference was found between group I and II regarding initial readings of all Doppler parameters. Follow up for 6 months of GTN cases revealed progressive statistically significant decrease of intramural and subendometrial three dimensional power Doppler (3DPD) indices, while there was a significant increase in two dimensional (2D) Doppler parameters. Four cases were resistant to Methotrexate chemotherapy. Cut off values were determined for prediction of GTN. Multivariate analysis revealed that the most predictive parameter was the subendometrial pulsatility index (PI), odds ratio = 10.63 (95% CI: 1.30 - 86.89). The cut-off point for sub-endometrial PI was: 2.05 (AUC, 90%;sensitivity, 88%;specificity, 76%, PPV 78%, and NPV 86%) with a diagnostic accuracy of 87%. To and Fro sign may be considered a pathognomonic intramural ultrasound sign for prediction of GTN chemo-resistance or choriocarcinoma. Conclusion: Cut off values for Doppler parameters can be used for early predication of GTN. Doppler ultrasound indices can be used during follow up of GTN cases concurrently with serum β-hCG to monitor the response to treatment.
文摘目的探讨晚孕期频谱多普勒超声、三维能量多普勒超声(3D-PDU)及剪切波弹性成像(SWE)评估妊娠期糖尿病(GDM)患者胎盘功能的价值。方法选择GDM患者58例为GDM组,年龄24~38岁,平均年龄30.7岁;孕龄28~40周,平均孕龄34.7周;孕前身体质量指数(BMI)18.3~33.7 kg/m^(2),平均BMI 23.6 kg/m^(2);空腹、口服葡萄糖后1 h、2 h血糖分别为3.97~6.58、7.45~13.17、4.62~12.82 mmol/L,平均血糖分别为5.20、9.94、8.34 mmol/L。正常孕妇70例为对照组,年龄21~42岁,平均年龄29.6岁;孕龄28~41周,平均孕龄35.1周;孕前BMI 16.2~32.0 kg/m^(2),平均BMI 22.8 kg/m^(2)。常规超声检查胎儿双顶径、头围、腹围、股骨长、胎龄、胎儿体质量、胎盘厚度、羊水量。应用频谱多普勒超声获得胎儿脐动脉(UA)、大脑中动脉(MCA)及孕妇子宫动脉(UtA)的血流参数[收缩期/舒张末期峰值速度比(S/D)、搏动指数(PI)、阻力指数(RI)],计算脑-胎盘比(CPR);通过3D-PDU获得胎盘能量指数[血管血流指数(VFI)、血流指数(FI)、血管指数(VI)];应用SWE测得胎盘中央及边缘的平均弹性模量(E)。比较两组数据,绘制受试者工作特性(ROC)曲线对各参数进行评价。结果GDM组与对照组检查时胎儿双顶径、头围、腹围、股骨长、胎龄、胎儿体质量、胎盘厚度、羊水量比较,差异均无统计学意义(P>0.05)。两组孕妇产次、分娩方式和新生儿出生体质量、Apgar 1 min和5 min评分比较,差异均无统计学意义(P>0.05)。与对照组比较,GDM组不良妊娠结局的发生率升高(25.9%vs 11.4%),UtA血流参数升高(S/D:1.94±0.30 vs 1.82±0.18;PI:0.73±0.16 vs 0.65±0.11;RI:0.48±0.06 vs 0.45±0.05),GDM组胎盘能量指数降低(VI:11.76±2.92 vs 15.81±2.98;FI:33.44±2.80 vs 34.79±2.50;VFI:3.94±1.05 vs 5.53±1.20),GDM组胎盘中央及边缘E升高(5.94±0.89 vs 4.81±0.65;6.12±1.01 vs 4.88±0.71),差异均有统计学意义(P<0.05);两组UA、MCA血流参数(S/D、PI、RI)及CPR比较,差异无统计学意义(P>0.05)。ROC曲线分析结果显示,UtA-PI、胎盘VFI、胎盘中央E在单一模态超声中诊断价值较高,三项联合评估的曲线下面积(AUC)为0.914,对GDM诊断价值较单一参数明显提高。结论频谱多普勒超声、3D-PDU、SWE可评估晚孕期GDM患者胎盘功能,多模态超声联合应用可提高诊断效能,为GDM的临床管理提供参考。
