Tissue characterization using mean gray value analysis in deep infiltrating endometriosis

To assess whether the analysis of cyst content using mean gray value (MGV) can discriminate ovarian endometriomas from other unilocular ovarian cysts in premenopausal women. Stored three-dimensional (3D) volumes from 54 unilocular ovarian cysts diagnosed in 50 premenopausal women (mean age, 37 (range, 22-50) years) were analyzed to calculate the MGV from cyst content. Cysts with solid components or septations were excluded. MGV was calculated in all cases with the Virtual Organ Computer-aided AnaLysis technique. The B-mode presumptive diagnosis based on the examiner's subjective impression was also recorded. Sixteen of the cysts resolved spontaneously and were given a final clinical diagnosis of hemorrhagic functional cyst, while 38 cysts were removed surgically (diagnosed histologically as seven simple cysts, three hemorrhagic cysts, 20 endometriomas, five mucinous cysts and three paraovarian cysts). B-mode diagnoses were as follows: seven simple cysts, 18 hemorrhagic cysts, 24 endometriomas, three mucinous cysts and two paraovarian cysts. MGV was significantly higher in ovarian endometrioma when compared with all other kinds of cyst. The receiver-operating characteristics curve showed that using an MGV cut-off >or= 15.560 had a sensitivity of 85% and a specificity of 76.5% for diagnosing ovarian endometrioma (area under the curve, 0.831; 95% CI, 0.718-0.944). These figures were similar to those for B-mode diagnosis (sensitivity, 90%; specificity, 82%) (McNemar test, P = 1.000). Combining B-mode and MGV gave a sensitivity of 80% and a specificity of 91%. Cyst content MGV is higher in ovarian endometrioma than it is in other unilocular ovarian cysts. The diagnostic performance of MGV is similar to that of the examiner's subjective impression. The combination of both criteria achieves the highest specificity.

We aimed to evaluate the volumetric and echogenic alterations in placentas between the intrauterine growth restriction (IUGR) and normal pregnancies using three-dimensional ultrasound and virtual organ computer-aided analysis (VOCAL) software. This case–control prospective study consisted of 48 singleton pregnancies complicated by IUGR and 60 healthy singleton pregnancies matched for maternal age, gestational age and parity. Placental volume (PV) and placental volumetric mean grey values (MGV) were evaluated. PV (cm3) was analysed using the VOCAL imaging analysis program, and 3D histogram was used to calculate the volumetric MGV (%). PV was 278.50 ± 63.68 and 370.98 ± 97.82 cm3 in IUGR and control groups, respectively (p = 0.004). MGV of the placenta was 38.24 ± 8.41 and 38.24 ± 8.41 in IUGR and control groups, respectively (p = 0.30). receiver operator curve (ROC) curve analysis revealed that area under curve was 0.731 for PV. Correlation analysis revealed that PV was significantly associated with estimated fetal weight (r = 0.319, p = 0.003), biparietal diameter (r = 0.346, p = 0.002), head circumference (r = 0.269, p = 0.019), abdominal circumference (r = 0.344, p = 0.002) and femur length (r = 0.328, p = 0.004). PV was inversely related to the umbilical artery pulsatility index (r = − 0.244, p = 0.017). To the best of our knowledge, this is the first study evaluating volumetric MGV in IUGR placentas by comparing them with healthy pregnancies. Our study showed that PV diminishes significantly in IUGR pregnancies, whereas volumetric MGV does not alter significantly.

Objective: To determine reference values for the fetal cisterna magna volume by three-dimensional ultrasonography (3DUS) using the virtual organ computer-aided analysis (VOCAL) method.Methods: A cross-sectional study was conducted with 224 healthy pregnant women between 17 and 29 completed weeks. Measurement of the fetal cisterna magna volume was performed in the standard axial plane of the transverse diameter of the cerebellum through the VOCAL method with a 30° angle. For the determination of reference values, polynomial regressions with adjustments by the coefficient of determination (R2) were held. The reliability and agreement were made by the intra-class correlation coefficient (ICC) and limits of agreement of the Bland-Altman graph.Results: The average of the fetal cisterna magna volume ranged from 0.73 ± 0.25 to 3.79 ± 1.10 cm3 between 17 and 29 weeks, respectively. Correlation was observed between the fetal cisterna magna volume and the gestational age (GA), best represented by a quadratic equation: −1.918+0.0284 × GA + 0.0065 × GA2 (R2 = 0.67). It was observed good reliability and intra-observer agreement, with ICC = 0.92 and 95% limits of agreement (−49.7; 48.4). There was low inter-observer reliability and agreement, with ICC = 0.58 and 95% limits of agreement (−114.0; 80.2).Conclusion: Reference values for the fetal cisterna magna volume by 3DUS using the VOCAL method were determined and showed good agreement and intra-observer reliability.

: To test the influence of maternal age and parity on placental volume and uterine spiral vasculature volume, their mean gray value, and 3-dimensional power Doppler (3DPD) indices in normal pregnancy. : Women with a gestational age of 14-25 weeks were included in the study. Exclusion criteria included posterior placenta, structural or chromosomal anomaly, pregnancy complications, and unknown pregnancy outcome. 3D sonograms of the placenta and uterine spiral vasculature were obtained. Virtual Organ Computer-aided AnaLysis imaging software was used to calculate the volumes, mean gray value, and 3DPD indices. : The study included 199 women, the majority of whom were Filipino, Japanese, or part Hawaiian. The placental volume, uterine spiral vasculature volume, mean gray value, and 3DPD indices were similar in all women regardless of maternal age. However, uterine spiral vasculature volume was significantly larger in women younger than 25 years, compared with women 35 years of age and older. Parity influenced all placental 3DPD indices, whereas placental volume, uterine spiral vasculature volume, mean gray value, and 3DPD indices remained unaffected. : Maternal age influenced uterine spiral vasculature volume, whereas parity influenced all placental 3DPD indices.

Background Our aim was to describe the corpus luteum morphology by two-dimensional ultrasound correlated by its vascularization and volume by 3D ultrasound and study the possible relationship between serum progesterone levels and the corpus luteum morphology. Methods Thirty-eight women were included in an intrauterine insemination program (IUI) in Santa Cristina University's Hospital. All the patients were evaluated in mesoluteal phase, the day +7 after hCG administration, by two-dimensional and three-dimensional ultrasound. The volume and vascular indices of the corpus luteum were calculated off-line using virtual organ computer-aided analysis (VOCALTM) software. Results Four different morphologies were described in the corpus luteum: echo-positive, echo-negative or sonoluscent, mixed echogenicity or nonvisible. Corpus luteum with mixed echogenicity was the most frequent one with 37.5% (12 cases). The corpus luteum vascular indices change in each morphology type, but there was statistically significant association just in vascularization index between echo-negative and mixed echogenicity corpus luteum morphologies, with p = 0.034. The rest of vascular indices do not change in each morphology corpus luteum types. There was statistically significant difference in mean gray value between echo-negative and mixed echogenicity morphologies, with p = 0.007. There were no statistically significant correlations between the corpus luteum morphology and the corpus luteum volume of any of the different types. There either was no statistically significant correlation between the corpus luteum morphology and progesterone serum levels on day +7 postovulation. Conclusions The mixed echogenicity corpus luteum morphology has more vessels and more cell mass than echo-negative ones. Progesterone serum levels in mid-luteal phase has no influence in corpus luteum morphology and vascularization.

The incidence of holoprosencephaly with normal chromosomes has been estimated at between 1 in 16 000 and 1 in 53 394 live births. It has been found that during a 3-year period in the Bristol and Weston Health District there were six cases of holoprosencephaly, two of which were familial, and these cases are described. This represents an incidence of 1 in 5200 and during the preceding 3-year period the incidence in the same area was 1 in 14 520 births.

Category: Trauma Introduction/Purpose: Malreduction of distal tibio-fibular syndesmosis in ankle fractures has been reported from 20% to 52% in surgically treated patients. Current intraoperative methods, fluoroscopy and intraoperative CT, have not improved consistently this results. Recently, new indexes to determine the normal anatomy of the syndesmosis have been published using a true lateral view of the ankle to evaluate the relation of the fibula with the tibia in the sagittal plane. These studies have been made in non- injured ankles. If these measurements could be performed intra operatively, they may improve the evaluation of syndesmotic reduction. To our knowledge this indexes have been not tested in injured ankles. The purpose of this study is to assess intra- observer and inter-observer agreement in two radiological indexes by evaluating true lateral x-ray view in surgically treated patients for ankle fractures with syndesmotic injury. Methods: Retrospective study of case series. Forty-three consecutive patients who underwent open reduction and internal fixation for ankle fractures with syndesmotic screw were evaluated. The inclusion criteria were syndesmotic injury fixed with one or two screws, and having a true lateral postoperative ankle x-ray view. Two measurements were performed: Anteroposterior Tibiofibular Ratio (APTF) and Anterior Tibiofibular Ratio (ATFR). Three independent evaluators performed the measurements. The intra-class correlation was used to determine inter- and intra-observer agreement, through statistical package SPSS 20. Results: The intra-observer and inter-observer agreement in the APTF was good to very good, with intra-class correlation values between 0.77 and 0.81; The reproducibility of the ATFR was also good to very good, but with lower intra-class correlation values between 0.62 and 0.79. Conclusion: Intra- and inter-observer concordance in APTF and ATFR in operated ankle fractures with syndesmotic injury was similar to that reported in healthy ankles. This study validates, in terms of intra and inter-observer agreement, the use of these indexes in surgically treated ankle fractures with syndesmotic repair. The next step is to compare these measurements made intra-operatively with a CT scan.

The purpose of this study was to assess the reliability and validity of in vitro volume calculations by 3-dimensional ultrasonography. This observational study was performed by 2 examiners to obtain volumes of 3 objects of different shapes and sizes filled with ultrasound gel and immersed in water. The examiners used the multiplanar (5-mm interval), virtual organ computer-aided analysis (VOCAL, 30 degrees) and extended imaging (XI) VOCAL (5, 10, 15, and 20 planes) methods to estimate the volumes of each object. A paired Student t test (P) and intraclass correlation coefficients (ICCs) were used to assess reproducibility of the methods. Validity was assessed comparing the percent differences between the estimated and the real volumes using the P value, mean differences, and ICC for each method. All methods were highly reliable and valid. There were no significant differences in interobserver variability; there was a strong interobserver correlation. There were no significant differences in the percent differences between the estimated and real volumes of the objects using the 3 methods. The XI VOCAL method was superior to the multiplanar and VOCAL methods in the measurement of irregularly shaped objects. The XI VOCAL method with 10 planes estimated volumes closest to the real volumes. All 3 methods were reliable and valid; however, XI VOCAL was superior to the other methods in the measurement of irregularly shaped objects.

Objective: To explore the correlation between decreased cerebral perfusion measured from arterial spin labeling and cerebrovascular events in patients with bilateral moyamoya angiography (MMA). Methods: Twenty-seven consecutive cases with bilateral MMA, who were admitted to the neurosurgery department of Nanjing Drum Tower Hospital from April to November 2020, were included in this retrospective study. Among them, 10 were males and 17 were females, aged 35-66 (55±9) years. These patients all presented with unilateral cerebral hemisphere cerebral infarction or cerebral hemorrhage. The Wilcoxon paired signed-rank test was used to qualitatively analyze the differences in the Arterial Transit Artifact (ATA) of the bilateral cerebral hemispheres. The mean gray value, the kurtosis and skewness of gray distribution curve of bilateral cerebral hemispheres on cerebral blood flow (CBF) images with post labeling delay (PLD) of 1.5 s and 2.5 s were quantitative calculated. The relationship between ASL and cerebrovascular event was determined using binary logistics regression analysis. Results: No significant difference was observed in ATA between bilateral hemispheres on CBF images with PLDs of 1.5 s and 2.5 s (P>0.05). On the CBF images with a PLD of 1.5 s, the mean gray value of the cerebral hemisphere on the lesion side (17.50±5.88) was markly lower than that on the non-lesion side (20.80±5.51) (P<0.001), the kurtosis and skewness of gray distribution were significantly different between bilateral cerebral hemispheres (P<0.05);On the CBF images with a PLD of 2.5 s, the mean gray value and the skewness of the gray distribution on the lesion side of the cerebral hemisphere were statistically different from those on the non-lesion side (P<0.05), while the difference in kurtosis was not statistically significant between bilateral cerebral hemispheres (P>0.05). Multivariate regression analysis showed that the reduction of gray value on the side of the lesion was independently associated to the occurrence of the cerebrovascular events (ORPLD1.5=0.192, 95%CI:0.047-0.783;ORPLD2.5=0.175, 95%CI:0.050-0.615). Conclusion: The decreased perfusion detected by ASL is independently associated with cerebrovascular events in patients with MMA.

To compare XI VOCAL™ (eXtended Imaging VOCAL) for three-dimensional (3D) ultrasound measurement of placental volume with the multiplanar technique and VOCAL™ (Virtual Organ Computer-aided AnaLysis). 3D volume data of 32 fetuses at 11–14 weeks' gestation were acquired. The placental volume was calculated using XI VOCAL™ (5, 10, 15 and 20 slices), multiplanar (1-mm interval) and VOCAL™ technique (12, 18 and 30 degrees of rotation). The placental volume was measured twice and by two observers. The intraobserver variability was low in all three techniques. The interobserver variability was also low for all the three techniques except VOCAL™ (30) and XI VOCAL™ (5 slices). There was a significant difference between the paired measurements by VOCAL™ (30) or XI VOCAL™ (5 slices). The intraclass correlation coefficient between XI VOCAL™ (10 slices) and VOCAL™ (18) was 0.894 while that between XI VOCAL™ (15 slices) and VOCAL™ (12) was 0.944. In the Bland-Altman plot, there were no significant difference between paired measurements by the two methods (a) XI VOCAL™ (10 slices) and VOCAL™ (18), (b) XI VOCAL™ (15 slices) and VOCAL™ (12), and (c) multiplanar (1-mm interval) and XI VOCAL™ (15 slices). However, the mean difference between paired measurements by XI VOCAL™ (10 slices) and multiplanar (1-mm interval) was 11.00 (0.44 to 21.55) ml which was significant but the mean difference between paired measurements by VOCAL™ (18) and multiplanar (1-mm interval) was not significant. For the measurement of placental volume at 11–14 weeks' gestation, XI VOCAL™ (15 slices) can be used interchangeably with the multiplanar technique (1-mm interval), or VOCAL™ (12).

In general, magnetic resonance (MR) diffusion-weighted imaging (DWI) has shown potential in clinical settings. In testicles parenchyma, the DW imaging helps differentiate and characterize benign from malignant lesions. Placement and size of the region of interest (ROI) may affect the ADC value. Therefore, the aim of this study was to investigate the intra- and interobserver variability in testicular tumors when measuring ADC using various types of regions of interest (ROI). Two observers performed the ADC measurements in testicular lesions based on three ROI methods: (1) whole volume, (2) round, and (3) small sample groups. Intra- and interobserver variability was analyzed for all ROI methods using intraclass correlation coefficients (ICC) and bland-altman plots. The two observers performed the measurements twice, three months apart. A total of 26 malignant testicle tumors were included. Interobserver agreement was excellent in tumor length (ICC = 0.98) and tumor width (ICC = 0.98). In addition, intraobserver agreement was excellent in tumor length (ICC = 0.98) and tumor width (ICC = 0.99). The whole volume interobserver agreement in the first reading was excellent (ICC = 0.93). Round ADC had an excellent (ICC = 0.93) and fair (ICC = 0.58) interobserver agreement, in the first and second reading, respectively. Interobserver agreement in ADC small ROIs was good (ICC = 0.87), and good (ICC = 0.78), in the first and second reading, respectively. Intraobserver agreement varied from fair, good to excellent agreement. The ROI method showed varying inter- and intraobserver agreement in ADC measurement. Using multiple small ROI conceded the highest interobserver variability, and, thus, the whole volume or round seem to be the preferable methods.

Differentiating osteoporotic vertebral fractures (OVF) from metastatic vertebral fractures (MVF) is difficult. A magnetic resonance imaging (MRI)-based score (META score) aiming to differentiate OVF and MVF was recently published; however, an independent agreement assessment is required before the score is used. We performed such independent agreement evaluation, including raters with different levels of training. Sixty-four patients with confirmed OVF or MVF were evaluated by six raters (three spine surgeons and three orthopaedic residents) using the META score. We used the intra-class correlation coefficient (ICC) to evaluate inter- and intra-observer agreement and the kappa statistic (κ) to determine the agreement for individual score criteria. We calculated the area under the receiver-operating characteristic curve (AUC) to establish the score accuracy. The inter-observer agreement was poor [ICC = 0.22 (0.12-0.33)]; spine surgeons [ICC = 0.75 (0.66-0.83)] had better agreement than that of residents [ICC = 0.06 (- 0.07 to 0.23)]. The intra-observer agreement was poor [ICC = 0.15 (- 0.04 to 0.30)]; both spine surgeons [ICC = 0.21 (0.05-0.41)] and residents exhibited poor agreement [ICC = - 0.06 (- 0.40 to 0.20)]. The agreement for each specific criterion varied from κ = 0.24 to κ = 0.38. The AUC was 0.57 (0.64 for spine surgeons and 0.51 for residents, p < 0.01). The inter-observer agreement using the META score was adequate for spine surgeons but not for residents; the intra-observer agreement was poor. These results do not support the standard use of the META score to differentiate OVF and MVF. These slides can be retrieved under Electronic Supplementary Material.

THU0533 A SINGLE MRI DIXON SEQUENCE TO ASSESS DISEASE ACTIVITY AND CARTILAGE IN EARLY RHEUMATOID HANDS: ONE SEQUENCE TO ASSESS THEM ALL?

We provide a study comparison between two-dimensional measurement and volumetric (3D) segmentation of the lateral ventricles and brain structures in fetuses with isolated and non-isolated ventriculomegaly with 3D virtual organ computer-aided analysis (VOCAL) ultrasonography vs. magnetic resonance imaging (MRI) analyzed with 3D-Slicer software. In this cross-sectional study, 40 fetuses between 20 and 38 gestational weeks with various degrees of ventriculomegaly were included. A total of 71 ventricles were measured with ultrasound (US) and with MRI. A total of 64 sonographic ventricular volumes, 80 ventricular and 40 fetal brain MR volumes were segmented and analyzed using both imaging modalities by three observers. Sizes and volumes of the ventricles and brain parenchyma were independently analyzed by two radiologists, and interobserver correlation of the results with 3D fetal ultrasound data was performed. The semiautomated rotational multiplanar 3D VOCAL technique was performed for ultrasound volumetric measurements. Results were compared to manually extracted ventricular and total brain volumes in 3D-Slicer. Segmentation of fetal brain structures (cerebral and cerebellar hemispheres, brainstem, ventricles) performed independently by two radiologists showed high interobserver agreement. An excellent agreement between VOCAL and MRI volumetric and two-dimensional measurements was established, taking into account the intraclass correlation coefficients (ICC), and a Bland–Altman plot was established. US and MRI are valuable tools for performing fetal brain and ventricular volumetry for clinical prognosis and patient counseling. Our datasets could provide the backbone for further construction of quantitative normative trajectories of fetal intracranial structures and support earlier detection of abnormal brain development and ventriculomegaly, its timing and progression during gestation.

Objective This study aimed to evaluate the reproducibility of nine reference planes used in orientation of as-received cone-beam computed tomography (CBCT) images in all three dimensions. Materials and Methods The study was conducted on CBCT images of 15 adult subjects (mean age 21.2 ± 5.8 years). The anonymized CBCT images were oriented using five different methods created from nine reference planes by two experienced orthodontists. For each subject, pitch, yaw, and roll changes with five orientation methods were recorded twice by each observer. Statistical Analysis The inter- and intraobserver agreement was tested using intraclass correlation (ICC) and Bland–Altman plot. The intra- and interobserver error was analyzed using paired t-test. Analysis of variance and paired t-test were used to analyze the differences among the various pitch, roll, and yaw orientation planes. Results Inter- and intraobserver agreement (ICC, 0.9) was excellent for all the nine reference planes. The interobserver reliability showed statistically significant differences for four planes namely Frankfort horizontal plane constructed on right side (p = 0.014) and left side (p = 0.000), transorbital plane (p = 0.001), and midsagittal plane on top view (p = 0.036); however, the mean differences were clinically insignificant. Conclusion The landmark-based nine reference planes used in this study to orient CBCT images showed good reproducibility. Therefore, these reference planes can be used to orient CBCT images and can be incorporated into automated software.