| 1. Thoma ME, McLain AC, Louis JF, et al. Prevalence of infertility in the United States as estimated by the current duration approach and a traditional constructed approach. Fertil Steril. 2013; 99(5):1324-1331 e1321. |
Review/Other-Dx |
7,643 participants |
To estimate the prevalence of infertility using a current duration approach for comparison with a traditional constructed measure. |
Infertility prevalence was approximately twofold higher using the current duration approach (15.5%; 95% CI, 8.6%–27.5%) vs the constructed measure (7.0%; 95% CI, 6.2%–7.8%). Both methods identified similar patterns of increasing age, lower education, nulliparity, and history of gynecologic disorders as being associated with measures of impaired fecundity, whereas opposing patterns were seen for racial/ethnic identification and poverty status. |
4 |
| 2. Hull MG, Glazener CM, Kelly NJ, et al. Population study of causes, treatment, and outcome of infertility. Br Med J (Clin Res Ed). 1985; 291(6510):1693-1697. |
Review/Other-Dx |
708 patients |
To study the incidence and range of causes of infertility in a representative British population, at least among those reaching specialist clinics; the estimated need for treatment; and its success. |
Failure of ovulation (amenorrhea or oligomenorrhoea) occurred in 21% of cases and was successfully treated (2 year conception rates of 96% and 78%). Tubal damage (14%) had a poor outlook (19%) despite surgery. Endometriosis accounted for infertility in 6%, although seldom because of tubal damage, cervical mucus defects or dysfunction in 3%, and coital failure in up to 6%. Sperm defects or dysfunction were the commonest defined cause of infertility (24%) and led to a poor chance of pregnancy (0%–27%) without donor insemination. Obstructive azoospermia or primary spermatogenic failure was uncommon (2%) and hormonal causes of male infertility rare. Infertility was unexplained in 28% and the chance of pregnancy (overall 72%) was mainly determined by duration of infertility. In vitro fertilization could benefit 80% of cases of tubal damage and 25% of unexplained infertility-that is, 18% of all cases, representing up to 216 new cases each year per million of the total population. |
4 |
| 3. Healy DL, Trounson AO, Andersen AN. Female infertility: causes and treatment. Lancet. 1994; 343(8912):1539-1544. |
Review/Other-Dx |
N/A |
To review the causes and treatment of female infertility. |
No results stated in abstract. |
4 |
| 4. Legro RS, Myers ER, Barnhart HX, et al. The Pregnancy in Polycystic Ovary Syndrome study: baseline characteristics of the randomized cohort including racial effects. Fertil Steril. 2006; 86(4):914-933. |
Experimental-Tx |
626 patients |
To report the baseline characteristics and racial differences in the PCOS phenotype from a large multicenter clinical trial. |
There were no significant differences in baseline variables between treatment groups. The overall mean (+/-standard deviation) age of the subjects was 28.1 +/- 4.0 years, and the mean body mass index was 35.2 kg/m2 (+/-8.7). Polycystic ovaries were present in 90.3% of the subjects, and the mean volume of each ovary was 10 cm3 or more. Of the subjects, 7% had ovaries that were discordant for polycystic ovaries morphology. At baseline, 18.3% of the subjects had an abnormal fasting glucose level (>100 mg/dL). Asians tended to have a milder phenotype, and whites and African Americans were similar in these measures. |
1 |
| 5. Dewailly D, Lujan ME, Carmina E, et al. Definition and significance of polycystic ovarian morphology: a task force report from the Androgen Excess and Polycystic Ovary Syndrome Society. Hum Reprod Update. 20(3):334-52, 2014 May-Jun. |
Review/Other-Dx |
N/A |
To analyse the available literature and determine whether we can now achieve a new consensus on the definition of polycystic ovarian morphology (PCOM). |
Studies addressing women recruited from the general population and studies comparing control and polycystic ovary syndrome (PCOS) populations with appropriate statistics were convergent towards setting the threshold for increased follicle number per ovary (FNPO) at >/=25 follicles, in women aged 18-35 years. These studies suggested maintaining the threshold for increased ovarian volume (OV) at >/=10 ml. Critical analysis of the literature showed that OV had less diagnostic potential for PCOM compared with FNPO. The review did not identify any additional diagnostic advantage for other ultrasound metrics such as specific measurements of ovarian stroma or blood flow. Even though serum concentrations of anti-Mullerian hormone (AMH) showed a diagnostic performance for PCOM that was equal to or better than that of FNPO in some series, the accuracy and reproducibility issues of currently available AMH assays preclude the establishment of a threshold value for its use as a surrogate marker of PCOM. PCOM does not associate with significant consequences for health in the absence of other symptoms of PCOS but, because of the use of inconsistent definitions of PCOM among studies, this question cannot be answered with absolute certainty. |
4 |
| 6. Villarroel C, Merino PM, Lopez P, et al. Polycystic ovarian morphology in adolescents with regular menstrual cycles is associated with elevated anti-Mullerian hormone. Hum Reprod. 26(10):2861-8, 2011 Oct. |
Observational-Dx |
74 patients |
To determine the relationship between PCOM and anti-Mullerian hormone (AMH), inhibin B, testosterone and insulin levels in healthy girls during the second decade of life. |
PCOM was present in 33.8% of the subjects. Girls with PCOM had higher AMH levels than girls without PCOM (72.5 +/- 6.1 versus 33.4 +/- 2.6 pmol/l; P < 0.0001) and lower FSH levels (5.4 +/- 0.3 versus 6.2 +/- 0.2 mUI/ml; P < 0.036). Similar levels of inhibin B, androgens and LH were observed in girls with and without PCOM. PCOM prevalence and AMH levels were not associated with age (P = 0.745 and 0.2, respectively) or BMI-SDS (P = 0.951 and 0.096, respectively). AMH levels positively correlated with the of 2-5 mm follicle number. AMH levels >/= 60.15 pmol/l had a sensitivity and specificity of 64.0 and 89.8%, respectively, to diagnose PCOM (area under the curve = 0.873). |
4 |
| 7. D'Hooghe TM, Debrock S, Hill JA, Meuleman C. Endometriosis and subfertility: is the relationship resolved? Semin Reprod Med. 2003; 21(2):243-254. |
Review/Other-Dx |
N/A |
To review arguments to support the hypothesis that there is a causal relationship between the presence of endometriosis and subfertility. |
No results stated in abstract. |
4 |
| 8. Senapati S, Barnhart K. Managing endometriosis-associated infertility. Clin Obstet Gynecol. 2011; 54(4):720-726. |
Review/Other-Dx |
N/A |
To review management techniques of endometriosis-related infertility. |
Endometriosis is associated with infertility; however, the etiology of this association is unclear, thus complicating management. Several mechanisms of pathogenesis have been proposed; however, no one theory has been implicated. Medical therapy can be helpful in managing symptoms, but does not improve pregnancy rates. The role of surgical treatment remains controversial. There is little data regarding ovulation induction treatments for endometriosis only, whereas superovulation with intrauterine insemination has shown modest improvement in pregnancy rates in women who may have endometriosis. The most effective treatment for endometriosis-associated infertility is in vitro fertilization. Recent focus on proteomics and genetics of the disease may aid in optimizing treatment options. |
4 |
| 9. Woodward PJ, Sohaey R, Mezzetti TP Jr. Endometriosis: radiologic-pathologic correlation. [Review] [74 refs]. Radiographics. 21(1):193-216; questionnaire 288-94, 2001 Jan-Feb. |
Review/Other-Dx |
N/A |
To review the epidemiology, pathogenesis, staging, and clinical features of endometriosis. |
Endometriosis is an important gynecologic disorder primarily affecting women during their reproductive years. Pathologically, it is the result of functional endometrium located outside the uterus. It may vary from microscopic endometriotic implants to large cysts (endometriomas). The physical manifestations are protean, with some patients being asymptomatic and others having disabling pelvic pain, infertility, or adnexal masses. Symptoms do not necessarily correlate with the severity of the disease. US features are variable and can mimic those of other benign and malignant ovarian lesions. Low-level internal echoes and echogenic wall foci are more specific US features for endometriomas. MRI improves diagnostic accuracy, with endometriotic cysts typically appearing with high signal intensity on T1-weighted images and demonstrating "shading" on T2-weighted images. The ovaries are the most common sites affected, but endometriosis can also involve the gastrointestinal tract, urinary tract, chest, and soft tissues. Small implants and adhesions are not well evaluated radiologically; therefore, laparoscopy remains the standard of reference for diagnosis and staging. |
4 |
| 10. Spaczynski RZ, Duleba AJ. Diagnosis of endometriosis. Semin Reprod Med. 2003; 21(2):193-208. |
Review/Other-Dx |
N/A |
To discuss the available diagnostic tools, their advantages, and their limitations for endometriosis. |
The most frequent clinical presentations of endometriosis include dysmenorrhea, pelvic pain, dyspareunia, infertility, and pelvic mass. However, the correlation between these symptoms and the stage of endometriosis is poor. Currently available laboratory markers are of limited value. At present, the best marker, serum CA-125, is usually elevated only in advanced stages and therefore not suitable for routine screening. TVS and MRI are often helpful, particularly in detection of endometriotic cysts. Recently, transrectal US and MRI were shown to be valuable in detection of deep infiltrating lesions, especially in the rectovaginal septum. Although direct assessment of endometriotic foci at laparoscopy may be viewed as a “gold standard” for identifying endometriosis, the correlation of laparoscopic observations with histological findings is often low. Ultimately, diagnosis of endometriosis requires a careful clinical evaluation in combination with judicious use and critical interpretation of laboratory tests, imaging techniques, and, in most instances, surgical staging combined with histological examination of excised lesions. |
4 |
| 11. Simpson WL Jr, Beitia LG, Mester J. Hysterosalpingography: a reemerging study. [Review] [16 refs]. Radiographics. 26(2):419-31, 2006 Mar-Apr.Radiographics. 26(2):419-31, 2006 Mar-Apr. |
Review/Other-Dx |
N/A |
To review the imaging technique and possible complications of HSG. We also discuss and illustrate a variety of abnormalities of the uterus and fallopian tubes that can be assessed with HSG. |
HSG is a valuable tool in the evaluation of the uterus and fallopian tubes. Radiologists should become familiar with HSG technique, the interpretation of HSG images, and possible complications of this procedure. |
4 |
| 12. Stephenson M, Kutteh W. Evaluation and management of recurrent early pregnancy loss. Clin Obstet Gynecol. 2007; 50(1):132-145. |
Review/Other-Dx |
N/A |
To review the evaluation and management techniques of recurrent early pregnancy loss. |
Recurrent pregnancy loss affects up to 5% of couples trying to establish a family. Evaluation classically begins after 3 consecutive miscarriages of <10 weeks of gestation but may be warranted earlier if a prior miscarriage was found to be euploid, or if there is concomitant infertility and/or advancing maternal age. The evaluation begins with an extensive history and physical, followed by a diagnostic screening protocol. Management must be evidence-based; unproven treatments should be avoided. If no factor is identified, many couples will still eventually have a successful pregnancy outcome with supportive therapy alone. |
4 |
| 13. Roman E. Fetal loss rates and their relation to pregnancy order. J Epidemiol Community Health. 1984; 38(1):29-35. |
Review/Other-Dx |
N/A |
To discuss the problems and biases of various types of analyses with reference to real data and the model of Golding. |
No results stated in abstract. |
4 |
| 14. Practice Committee of the American Society for Reproductive Medicine.. Evaluation and treatment of recurrent pregnancy loss: a committee opinion. Fertil Steril. 98(5):1103-11, 2012 Nov. |
Review/Other-Dx |
N/A |
To present a committee opinion about the evaluation and treatment of recurrent pregnancy. |
No results stated in abstract. |
4 |
| 15. Grimbizis GF, Camus M, Tarlatzis BC, Bontis JN, Devroey P. Clinical implications of uterine malformations and hysteroscopic treatment results. [Review] [77 refs]. Hum Reprod Update. 7(2):161-74, 2001 Mar-Apr. |
Review/Other-Dx |
N/A |
To review the clinical implications of uterine malformations and hysteroscopic treatment results. |
No results stated in abstract. |
4 |
| 16. Chan YY, Jayaprakasan K, Tan A, Thornton JG, Coomarasamy A, Raine-Fenning NJ. Reproductive outcomes in women with congenital uterine anomalies: a systematic review. Ultrasound Obstet Gynecol. 2011; 38(4):371-382. |
Meta-analysis |
9 studies |
A systematic review to evaluate the association between different types of congenital uterine anomaly and various reproductive outcomes. |
Meta-analysis showed that arcuate uteri were associated with increased rates of second-trimester miscarriage (RR, 2.39; 95% CI, 1.33–4.27, P=0.003) and fetal malpresentation at delivery (RR, 2.53; 95% CI, 1.54–4.18; P<0.001). Canalization defects were associated with reduced clinical pregnancy rates (RR, 0.86; 95% CI, 0.77–0.96; P=0.009) and increased rates of first-trimester miscarriage (RR, 2.89; 95% CI; 2.02–4.14; P<0.001), preterm birth (RR, 2.14; 95% CI, 1.48–3.11; P<0.001) and fetal malpresentation (RR, 6.24; 95% CI, 4.05–9.62; P<0.001). Unification defects were associated with increased rates of preterm birth (RR, 2.97; 95% CI, 2.08–4.23; P<0.001) and fetal malpresentation (RR, 3.87; 95% CI, 2.42–6.18; P<0.001). |
M |
| 17. Deans R, Abbott J. Review of intrauterine adhesions. J Minim Invasive Gynecol. 2010; 17(5):555-569. |
Review/Other-Dx |
N/A |
To review the literature on symptomatic and asymptomatic intrauterine adhesions. |
Seven classification systems are described, with no universal acceptance of any one system and no validation of any of them. Hysteroscopy is the mainstay of both diagnosis and treatment, with medical treatments having no role in management. There is a wide range of treatment techniques with no controlled comparative studies, and assessments are descriptive and report fertility and menstrual outcomes, with more severe adhesions having the worst clinical outcomes. One of the most important features of treatment is prevention of recurrence, with the best available evidence demonstrating that newly developed adhesion barriers such as hyaluronic acid show promise for preventing new adhesions. |
4 |
| 18. March CM, Israel R, March AD. Hysteroscopic management of intrauterine adhesions. Am J Obstet Gynecol. 1978; 130(6):653-657. |
Review/Other-Dx |
65 patients |
To assess patients who underwent hysteroscopic evaluation and treatment. |
Of the patients who have completed surgical and hormonal therapy, 98% have normal spontaneous menses. Follow-up examination of the endometrial cavity was normal in 32/34 patients. 7/10 patients who wished to conceive and who had no other infertility factors have done so. The pregnancies have been uncomplicated. Hysteroscopy is the method of choice to diagnose, classify, treat, and follow-up patients with Asherman's syndrome. |
4 |
| 19. Harada T, Khine YM, Kaponis A, Nikellis T, Decavalas G, Taniguchi F. The Impact of Adenomyosis on Women's Fertility. [Review]. Obstet Gynecol Surv. 71(9):557-68, 2016 Sep. |
Review/Other-Dx |
N/A |
To discuss the hypothesis and epidemiology of adenomyosis, diagnostic techniques, clinical evidence of correlation between adenomyosis and infertility, proposed mechanism of infertility in women with adenomyosis, different treatment strategies and reproductive outcomes, and assisted reproductive technology outcome in women with adenomyosis. |
No results stated in abstract. |
4 |
| 20. Jaslow CR, Carney JL, Kutteh WH. Diagnostic factors identified in 1020 women with two versus three or more recurrent pregnancy losses. Fertil Steril. 93(4):1234-43, 2010 Mar 01. |
Observational-Dx |
1020 patients |
To determine whether the frequency of abnormal results for evidence-based diagnostic tests differed among women with recurrent pregnancy loss (RPL) based on the number of prior losses (n = 2, 3, or > or =4) and to determine whether abnormal results for additional investigative diagnostic tests differed in prevalence among women with different numbers of pregnancy losses. |
The prevalence of abnormal results for evidence-based and investigative diagnostic tests did not differ among women with different numbers of pregnancy losses. |
4 |
| 21. Practice Committee of the American Society for Reproductive Medicine.. Diagnostic evaluation of the infertile female: a committee opinion. [Review]. Fertil Steril. 103(6):e44-50, 2015 Jun. |
Review/Other-Dx |
N/A |
To provide a critical review of the current methods and procedures for the evaluation of the infertile female |
No results stated in abstract. |
4 |
| 22. Burns J, Policeni B, Bykowski J, et al. ACR Appropriateness Criteria® Neuroendocrine Imaging. J Am Coll Radiol 2019;16:S161-S73. |
Review/Other-Dx |
N/A |
Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for neuroendocrine imaging. |
No results stated in abstract. |
4 |
| 23. Sadowski EA, Ochsner JE, Riherd JM, et al. MR hysterosalpingography with an angiographic time-resolved 3D pulse sequence: assessment of tubal patency. AJR Am J Roentgenol. 2008; 191(5):1381-1385. |
Review/Other-Dx |
17 patients |
To determine if tubal patency can be assessed by MR HSG using a clinically available MR angiographic sequence (3-D time-resolved imaging of contrast kinetics). |
MR HSG effectively shows tubal patency and can be considered when both conventional HSG and standard MRI are necessary for the evaluation of women with infertility, such as in women with suspected uterine anomalies or extrauterine disease. |
4 |
| 24. Silberzweig JE. MR hysterosalpingography compared with conventional hysterosalpingography. AJR Am J Roentgenol. 2009; 192(6):W350. |
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4 |
| 25. Leonhardt H, Hellstrom M, Gull B, et al. Ovarian morphology assessed by magnetic resonance imaging in women with and without polycystic ovary syndrome and associations with antimullerian hormone, free testosterone, and glucose disposal rate. Fertil Steril. 101(6):1747-56.e1-3, 2014 Jun. |
Observational-Dx |
58 patients with PCOS; 31 control patients |
To characterize ovarian morphology and perfusion by magnetic resonance imaging (MRI) in women with and without polycystic ovary syndrome (PCOS) and to investigate associations with antimullerian hormone (AMH), free T, and glucose disposal rate (GDR). |
Antral follicles of 1-3 and 4-6 mm, but not 7-9 mm, were more numerous, and total AFC (1-9 mm) was higher in women with PCOS. Ovarian volume was larger in women with PCOS. AMH and free T were higher and GDR was lower in women with PCOS. All values were more deranged in classic compared with nonclassic PCOS. There was a positive correlation between AMH and AFC, 1-3 mm (r = 0.81), and between AMH and total AFC (r = 0.87). In receiver operating characteristic analyses, the area under the curve was 0.89 for total AFC, 0.86 for AMH, and 0.90 for free T. PCOS was independently associated with AFC and free T but not with AMH or GDR when adjusted for age and body mass index. |
4 |
| 26. Brown M, Park AS, Shayya RF, Wolfson T, Su HI, Chang RJ. Ovarian imaging by magnetic resonance in adolescent girls with polycystic ovary syndrome and age-matched controls. J Magn Reson Imaging. 38(3):689-93, 2013 Sep. |
Observational-Dx |
21 controls; 19 PCOS girls |
To compare ovarian morphology in adolescent girls with and without polycystic ovary syndrome (PCOS) using magnetic resonance imaging (MRI). |
Mean antral follicle count (AFC) per ovary and ovarian volume were substantially greater in PCOS subjects compared to non-PCOS subjects. Mean follicle size was similar between groups. Follicles exceeding 10 mm were seen in 2/19 PCOS subjects versus 9/21 non-PCOS subjects. Consistently higher follicle counts were detected in images obtained at 2 mm compared to 6-mm slice thickness. |
3 |
| 27. de Crespigny LC, O'Herlihy C, Robinson HP. Ultrasonic observation of the mechanism of human ovulation. Am J Obstet Gynecol. 1981; 139(6):636-639. |
Review/Other-Dx |
9 patients |
To determine the precise time of ovulation and to document follicular changes immediately prior to, during, and after rupture. |
There were no demonstrable changes in the size of appearance of the follicle over a period of up to 7 hours prior to its rupture. In one of the four subjects in whom follicular collapse was witnessed, the follicle emptied completely within less than 1 minute. In two of the other three subjects, there was an initial rapid loss of fluid followed by a flower release of the remaining contents. This latter process took 7 minutes in the first patient and 35 minutes in the second patient. The slow phase of follicular collapse may well be an important aspect in the release of the ovum. The corpus hemorrhagicum was seen to develop within 1 hour of ovulation. |
4 |
| 28. Hendriks DJ, Mol BW, Bancsi LF, Te Velde ER, Broekmans FJ. Antral follicle count in the prediction of poor ovarian response and pregnancy after in vitro fertilization: a meta-analysis and comparison with basal follicle-stimulating hormone level. Fertil Steril. 2005; 83(2):291-301. |
Meta-analysis |
11 studies on antral follicle count and an updated total of 32 studies on basal follicle-stimulating hormone |
To assess the predictive performance of the antral follicle count as a test for ovarian reserve in in vitro fertilization patients and to compare this performance with that of basal follicle-stimulating hormone level. |
The estimated summary ROC curves showed antral follicle count to perform well in the prediction of poor ovarian response. Also, prediction of poor ovarian response seemed to be more accurate with antral follicle count compared with basal follicle-stimulating hormone. The estimated summary ROC curves for the prediction of nonpregnancy indicated a poor performance for both antral follicle count and basal follicle-stimulating hormone. |
M |
| 29. Sharara FI, McClamrock HD. The effect of aging on ovarian volume measurements in infertile women. Obstet Gynecol. 94(1):57-60, 1999 Jul. |
Observational-Dx |
109 women |
To test the hypothesis that aging is associated with a decrease in ovarian volume, and that the follicle stimulating harmone (FSH) level and volume are correlated inversely. |
The mean age (+/- standard deviation) was 32.6+/-4.7 years. The mean FSH was 6.9+/-2.4 international units per liter (IU/L). The mean ovarian volume was 6.0+/-4.7 cm3. There were no significant differences between the median volumes of the left and right ovaries in individual subjects (4.6 and 4.8 cm3, respectively; interquartile range 3.0-7.3 and 3.1-7.9; P = .79). There was a significant positive correlation between age and FSH level (R = .372, P<.001), but not between age and ovarian volume (R = .039, P = .69). A significant relation was noted between FSH and the number of follicles (H = 20.8, P<.001), but not between FSH and volume (R = .102, P = .29). There was a significant decrease in the number of follicles and a higher cycle cancellation rate in women with volume smaller than 3 cm3 compared with those with volume greater than 3 cm3. |
3 |
| 30. Fondin M, Rachas A, Huynh V, et al. Polycystic Ovary Syndrome in Adolescents: Which MR Imaging-based Diagnostic Criteria?. Radiology. 285(3):961-970, 2017 12. |
Observational-Dx |
110 patients |
To evaluate the validity and reproducibility of magnetic resonance (MR) imaging-based ovarian morphologic measurements for diagnosis of polycystic ovary syndrome (PCOS) in adolescents. |
All criteria except sphericity index and absence of a dominant follicle were significantly associated with the level of suspicion of PCOS (P </= .05). The AUCs for FPO-9 (0.78; 95% confidence interval [CI]: 0.68, 0.87), FPO-5 (0.73; 95% CI: 0.62, 0.83), and OV (0.77; 95% CI: 0.68, 0.87) were significantly greater than 0.5; that was not true for sphericity index (AUC, 0.58; 95% CI: 0.47, 0.70). Sensitivity and specificity for peripheral distribution of follicles were 33% (95% CI: 19%, 49%) and 95% (95% CI: 85%, 99%), respectively; for absence of a dominant follicle, they were 90% (95% CI: 76%, 97%) and 27% (95% CI: 16%, 41%), respectively. Reproducibility was almost perfect for OV (ICC, 0.89), substantial for absence of a dominant follicle (kappa, 0.74), moderate for FPO-9 (ICC, 0.54) and FPO-5 (ICC, 0.61), and fair for peripheral distribution of follicles (kappa, 0.37). |
3 |
| 31. Zaidi J, Campbell S, Pittrof R, et al. Ovarian stromal blood flow in women with polycystic ovaries--a possible new marker for diagnosis?. Hum Reprod. 10(8):1992-6, 1995 Aug. |
Observational-Dx |
88 women |
To assess ovarian stromal blood flow in women with polycystic ovaries. |
A subjective assessment of the intensity and quantity of coloured areas in the ovarian stroma appeared to be greater in both groups 2 and 3 compared with group 1. Mean (SEM) ovarian stromal peak systolic blood flow velocity (Vmax) was 16.88 (1.79) and 16.89 (2.36) cm/s in groups 2 and 3 respectively. These velocities were significantly greater than the mean (SEM) ovarian stromal Vmax of group 1; 8.74 (0.68) cm/s (P < 0.001). Mean (SEM) ovarian stromal time averaged maximum velocity (TAMX) was 10.55 (0.91) and 10.89 (1.80) cm/s in groups 2 and 3 respectively, both significantly greater than mean ovarian stromal TAMX of group 1, (P < 0.001). There was no significant difference in pulsatility index (PI) between the three groups. There thus appears to be significantly greater ovarian stromal blood flow velocity in women with polycystic ovaries as detected by colour and pulsed Doppler ultrasound. |
3 |
| 32. Pache TD, Wladimiroff JW, Hop WC, Fauser BC. How to discriminate between normal and polycystic ovaries: transvaginal US study. Radiology. 1992; 183(2):421-423. |
Observational-Dx |
29 women |
To determine cutoff levels for the size and number of ovarian follicles and ovarian echogenecity and volume in women with PCOS by means of TVS. |
Median values of the mean size and number of follicles and ovarian volume were, respectively, 5.1 mm, 5.0, and 5.9 mL in control subjects and 3.8 mm, 9.8, and 9.8 mL in patients. Ovarian stroma echogenicity was normal in 26 control subjects (90%) and moderately increased in 3 control subjects (10%), whereas it was markedly increased in 28 patients (54%), moderately increased in 21 patients (40%), and normal in 13 patients (6%). The sensitivity and specificity of moderately or markedly increased echogenicity of ovarian stroma in the diagnosis of polycystic ovaries was 94% and 90%, respectively. The greatest power of discrimination between normal and polycystic ovaries was obtained with combined measurement of follicular size and ovarian volume (sensitivity, 92% [48/52 patients]; specificity, 97% [28/29 control subjects]). |
3 |
| 33. Henig I, Prough SG, Cheatwood M, DeLong E. Hysterosalpingography, laparoscopy and hysteroscopy in infertility. A comparative study. J Reprod Med. 1991; 36(8):573-575. |
Observational-Dx |
193 patients |
To further assess the significance and accuracy of HSG during an infertility evaluation by comparing the radiologic findings on HSG to those from laparoscopy and hysteroscopy. |
193 patients underwent a complete infertility evaluation at our center. HSG was performed during the proliferative phase and was followed by laparoscopy and hysteroscopy, when indicated, during the same or next cycle. False-positive findings on HSG were noted in 5.1% of the patients. In 21%, adnexal adhesions and pelvic endometriosis were identified during surgery in spite of normal HSG. HSG is as accurate as laparoscopy in the diagnosis of tubal disease. However, laparoscopy excels HSG in the diagnosis of pelvic pathology. |
3 |
| 34. Imaoka I, Wada A, Matsuo M, Yoshida M, Kitagaki H, Sugimura K. MR imaging of disorders associated with female infertility: use in diagnosis, treatment, and management. [Review] [53 refs]. Radiographics. 23(6):1401-21, 2003 Nov-Dec. |
Review/Other-Dx |
N/A |
To provide an overview of the capabilities and potential of MRI for diagnosis, treatment, and management of female infertility. |
MRI has extended the usefulness of imaging in evaluation of pelvic disorders associated with female infertility. Although laparoscopy, hysteroscopy, HSG, and TVS are the most effective techniques for evaluation of pelvic disorders related to female infertility, MRI is used in a variety of clinical settings in diagnosis, treatment, and management. The applications of MRI include evaluation of the functioning uterus and ovaries, visualization of pituitary adenomas, differentiation of MDA, and accurate noninvasive diagnosis of adenomyosis, leiomyoma, and endometriosis. In addition, MRI helps predict the outcome of conservative treatment for adenomyosis, leiomyoma, and endometriosis and may lead to selection of better treatment plans and management. Finally, MRI may serve as an adjunct to diagnostic laparoscopy and HSG in patients with hydrosalpinx, peritubal adhesions, or pelvic adhesions related to endometriosis. |
4 |
| 35. Togashi K, Nishimura K, Kimura I, et al. Endometrial cysts: diagnosis with MR imaging. Radiology. 1991; 180(1):73-78. |
Observational-Dx |
374 patients |
To further evaluate the potential of MRI in diagnosing endometrial cysts and in differentiating them from other gynecologic masses in a large series of patients with a clinically suspected adnexal mass. |
A suggestive diagnosis of endometrial cyst was made when a cyst that was hyperintense on T1-weighted images exhibited homogeneous hyperintensity on T2-weighted images. A definitive diagnosis was made when a cyst that was hyperintense on T1-weighted images exhibited hypointense signal on T2-weighted images (shading) or when the lesion consisted of multiple hyperintense cysts on T1-weighted images (multiplicity) regardless of the signal intensity on T2-weighted images. Surgery was performed in 293 patients, and confirmation was obtained in 354 lesions. MRI enabled accurate diagnosis of 77 of 86 endometrial cysts and exclusion of the diagnosis of endometrial cyst in 263 of 268 other gynecologic masses with or without internal hemorrhage. The overall diagnostic sensitivity, specificity, and accuracy were 90%, 98%, 96%, respectively. |
3 |
| 36. Sugimura K, Okizuka H, Imaoka I, et al. Pelvic endometriosis: detection and diagnosis with chemical shift MR imaging. Radiology. 1993; 188(2):435-438. |
Observational-Dx |
35 patients |
To assess the usefulness of fat-saturation MRI for the detection of endometrial cysts, with laparoscopy or laparotomy as the standard of reference. |
Fat-saturation MRI for detection and characterization of pelvic endometriosis was prospectively investigated in 35 women with a clinical diagnosis of the disease. Large endometrioma was diagnosed when the lesion was >1 cm in diameter and hyperintense on T1- and T2-weighted images. Small endometrioma was diagnosed when a well-demarcated hyperintense lesion <1 cm in diameter was seen on T1-weighted or fat-saturated T1-weighted images. Surgery performed after MRI revealed a normal pelvis in 6 patients, endometriosis in 26 (33 large and 19 small endometriomas), and other cystic lesions in 3. Conventional T1- and T2-weighted imaging accurately demonstrated 27/33 large endometriomas and 2/19 small endometriomas. Fat-saturation T1-weighted imaging in combination with conventional technique accurately demonstrated 30/33 large and 9/19 small endometriomas. |
2 |
| 37. Corwin MT, Gerscovich EO, Lamba R, Wilson M, McGahan JP. Differentiation of ovarian endometriomas from hemorrhagic cysts at MR imaging: utility of the T2 dark spot sign. Radiology. 271(1):126-32, 2014 Apr. |
Observational-Dx |
56 Women |
To determine sensitivity and specificity of the T2 dark spot sign in helping to distinguish endometriomas from other hemorrhagic adnexal lesions. |
Sixteen of 45 endometriomas (36%), zero of 25 hemorrhagic cysts, and two of four neoplasms (50%) (all serous cystadenomas) demonstrated T2 dark spots. Forty-two of 45 endometriomas (93%), 12 of 25 hemorrhagic cysts (48%), and four of four neoplasms (100%) demonstrated T2 shading. Sensitivity, specificity, positive predictive value, and negative predictive value of T2 dark spots for differentiating endometriomas from other hemorrhagic cystic ovarian masses were 36% (95% confidence interval [CI]: 19.8, 51.3), 93% (95% CI: 83.9, 100), 89% (95% CI: 63.9, 98.1), and 48% (95% CI: 34.8, 61.8), respectively, and for T2 shading, they were 93% (95% CI: 84.0, 100), 45% (95% CI: 27.8, 61.9), 72% (95% CI: 58.9, 83.0), and 81% (95% CI: 53.7, 95.0), respectively. |
3 |
| 38. Guerriero S, Alcazar JL, Pascual MA, et al. Deep Infiltrating Endometriosis: Comparison Between 2-Dimensional Ultrasonography (US), 3-Dimensional US, and Magnetic Resonance Imaging. J Ultrasound Med. 37(6):1511-1521, 2018 Jun. |
Observational-Dx |
159 Women |
To evaluate the diagnostic accuracy of 2-dimensional (2D) and 3-dimensional (3D) transvaginal ultrasonography (US) in comparison with magnetic resonance imaging (MRI) for identification of deep infiltrating endometriosis. |
ntestinal deep infiltrating endometriosis was identified by 2DUS in 56 of 66 patients, by 3DUS in 59 of 66, and by MRI in 61 of 66. A receiver operating characteristic curve analysis showed optimal results for 2DUS, 3DUS, and MRI (areas under the curve, 0.86, 0.915, and 0.935, respectively) with a statistically significant difference between 2DUS and MRI (P?=?.0103), even when the 95% confidence interval showed an overlap. Other posterior deep infiltrating endometriosis was identified by 2DUS in 55 of 75 patients, by 3DUS in 65 of 75, and by MRI in 66 of 75. A receiver operating characteristic curve analysis showed very good results for 2DUS, 3DUS, and MRI (areas under the curve, 0.801, 0.838, and 0.857) with no statistically significant differences. In the 12 women with deep infiltrating endometriosis in the anterior location, the nodules were correctly identified by 2DUS in 3 of 12 patients, by 3DUS in 5 of 12, and by MRI in 6 of 12. |
3 |
| 39. Bazot M, Darai E, Hourani R, et al. Deep pelvic endometriosis: MR imaging for diagnosis and prediction of extension of disease. Radiology. 232(2):379-89, 2004 Aug. |
Observational-Dx |
195 Patients |
To prospectively evaluate the accuracy of magnetic resonance (MR) imaging for the preoperative diagnosis of deep pelvic endometriosis and extension of the disease. |
Pelvic endometriosis was confirmed at pathologic examination in 163 (83.6%) of 195 patients. Endometriomas, peritoneal lesions, and deep pelvic endometriosis were diagnosed on the basis of surgical findings, alone or combined with pathologic findings, in 111 (68.1%), 83 (50.9%), and 103 (63.2%) of 163 patients, respectively. Torus uterinus and USL were the most frequent sites of deep pelvic endometriosis. The sensitivity, specificity, positive and negative predictive values, and accuracy of MR imaging for deep pelvic endometriosis were 90.3% (93 of 103), 91% (84 of 92), 92.1% (93 of 101), 89% (84 of 94), and 90.8% (177 of 195), respectively. The sensitivity, specificity, and accuracy, respectively, of MR imaging for the diagnosis of endometriosis in specific sites were as follows: USL, 76% (57 of 75), 83.3% (100 of 120), and 80.5% (157 of 195); vagina, 76% (16 of 21), 95.4% (166 of 174), and 93.3% (182 of 195); rectovaginal septum, 80% (eight of 10), 97.8% (181 of 185), and 96.9% (189 of 195); rectosigmoid, 88% (53 of 60), 97.8% (132 of 135), and 94.9% (185 of 195); and bladder, 88% (14 of 16), 98.9% (177 of 179), and 97.9% (191 of 195). |
3 |
| 40. Macario S, Chassang M, Novellas S, et al. The value of pelvic MRI in the diagnosis of posterior cul-de-sac obliteration in cases of deep pelvic endometriosis. AJR Am J Roentgenol. 199(6):1410-5, 2012 Dec. |
Observational-Dx |
150 patients |
To define relevant MRI signs allowing preoperative diagnosis of posterior cul-de-sac obliteration in patients with deep pelvic endometriosis. |
Sixty-three patients were included in the study. Posterior cul-de-sac obliteration was diagnosed in 43 patients at laparoscopy. The mean sensitivity, specificity, and accuracy of each sign and impression of posterior cul-de-sac obliteration were, respectively, as follows: sign 1, 24.4%, 77.5%, 41.3%; sign 2, 97.1%, 83.7%, 92.8%; sign 3, 95.0%, 88.7%, 93.1%; sign 4, 30.2%, 97.5%, 51.6%; sign 5, 83.7%, 91.2%, 86.1%; and impression of posterior cul-de-sac obliteration, 91.9%, 91.2%, 91.7%. Interobserver concordance varied from 0.26 to 0.81 with best results obtained with the combination of signs 2, 3, and 5. Best concordances for junior radiologist evaluations were obtained with assessment of sign 3. |
2 |
| 41. Kataoka ML, Togashi K, Yamaoka T, et al. Posterior cul-de-sac obliteration associated with endometriosis: MR imaging evaluation. Radiology. 2005;234(3):815-823. |
Observational-Dx |
57 patients |
To retrospectively evaluate the accuracy of magnetic resonance (MR) imaging in depicting posterior cul-de-sac obliteration in patients with endometriosis. |
Laparotomy or laparoscopy revealed posterior cul-de-sac obliteration in 30 patients. Overall, the four radiologists had mean accuracies of 89.0% and 76.3% for diagnosing endometrial implants and adhesions, respectively, at MR imaging. Overall, the radiologists achieved mean sensitivity, specificity, accuracy, and positive and negative predictive values of 68.4%, 76.0%, 71.9%, 76.6%, and 68.5%, respectively, in diagnosing posterior cul-de-sac obliteration. The best accuracy (mean value, 64.5%) was obtained with the finding of fibrotic plaque in the uterine serosal surface. Readers agreed on the observations 63.2%–91.2% of the time. For the impression of the presence or absence of posterior cul-de-sac obliteration, interobserver agreement varied between substantial and moderate: Mean interobserver agreement was 78.4% (range, 70.2%–84.2%), and mean was 0.57 (range, 0.40–0.67). Mean accuracy of MR imaging for diagnosing posterior cul-de-sac obliteration was 71.9%. |
2 |
| 42. Groszmann YS, Benacerraf BR. Complete evaluation of anatomy and morphology of the infertile patient in a single visit; the modern infertility pelvic ultrasound examination. [Review]. Fertil Steril. 105(6):1381-93, 2016 06. |
Review/Other-Dx |
N/A |
To propose a two-dimensional and three-dimensional ultrasound to examine the appearance and shape of the endometrium, endometrial cavity, myometrium, and junctional zone, to assess form€ullerian duct anomalies fibroids, adenomyosis, and polyps. |
No results stated in abstract. |
4 |
| 43. Carbognin G, Guarise A, Minelli L, et al. Pelvic endometriosis: US and MRI features. Abdom Imaging. 2004; 29(5):609-618. |
Review/Other-Dx |
N/A |
To describe the protean US and MRI appearances of endometrial foci as encountered in daily experience. |
Although US remains the imaging modality of choice in the radiologic evaluation of female patients with pelvic pain, the role of MRI in the evaluation of abdominal pain is expanding. In the young patient, MRI may be performed if a gynecologic disorder is not suspected at first, especially if US findings are equivocal or the abnormality extends beyond the field of view of the sonographic probe. Moreover, MRI is useful whenever further characterization of pelvic disorder is required. In fact, many causes of pelvic disorders and of endometriosis in particular demonstrate characteristic MRI findings. For these reasons, in this work we describe the protean US and MRI appearances of endometrial foci as encountered in daily experience. |
4 |
| 44. Schlief R, Deichert U. Hysterosalpingo-contrast sonography of the uterus and fallopian tubes: results of a clinical trial of a new contrast medium in 120 patients. Radiology. 1991; 178(1):213-215. |
Observational-Dx |
120 patients |
To determine the feasibility, diagnostic efficacy, and patient tolerance of a new diagnostic modality, hysterosalpingo-contrast sonography. |
All patent tubes were diagnosed correctly with hysterosalpingo-contrast sonography, results comparing well with findings at HSG or laparoscopy. With B-mode scanning only, sensitivity was 88% for the right tube and 90% for the left; specificity was 100% for each tube. The supplementary use of Doppler techniques (duplex, color Doppler) provided additional information in special cases of suspected tubal occlusion and led to an improvement in diagnostic accuracy. |
3 |
| 45. Luciano DE, Exacoustos C, Luciano AA. Contrast ultrasonography for tubal patency. [Review]. J Minim Invasive Gynecol. 21(6):994-8, 2014 Nov-Dec. |
Review/Other-Dx |
N/A |
To describe a newer method, hysterosalpingo– contrast sonography (HyCoSy), for evaluation of the uterus and fallopian tubes. |
No results stated in abstract. |
4 |
| 46. Moro F, Tropea A, Selvaggi L, Scarinci E, Lanzone A, Apa R. Hysterosalpingo-contrast-sonography (HyCoSy) in the assessment of tubal patency in endometriosis patients. Eur J Obstet Gynecol Reprod Biol. 186:22-5, 2015 Mar. |
Observational-Dx |
1452 patients |
To investigate the accuracy of hysterosalpingo-contrast-sonography (HyCoSy) in the assessment of tubal patency in these women. |
A total of 1452 women underwent HyCoSy and 126 of them received a laparoscopy within 6 months from the HyCoSy. Of the 126 women, 42 (33.3%) had a diagnosis of pelvic endometriosis and 84 (66.7%) had no endometriosis. In the endometriosis population, HyCoSy showed a sensitivity, specificity, PPV, NPV, Lh+ and Lh- of 85% (95% CI 62-96), 93% (95% CI 82-97), 81% (95% CI 58-94), 94% (95% CI 84-98), 12.6 (95% CI 4.8-33) and 0.15 (95% CI 0.05-0.4) respectively. In the non-endometriosis group, HyCoSy showed a sensitivity, specificity, PPV, NPV, LR+ and LR- of 85% (95% CI 65-95), 93% (95% CI 87-96), 71% (95% CI 53-85), 97% (95% CI 92-99), 13.2 (95% CI 6.9-25) and 0.15 (95% CI 0.06-0.3) respectively. The diagnostic accuracy of HyCoSy was 91% in the endometriosis group and 92% in the non-endometriosis patients. |
3 |
| 47. Fedele L, Bianchi S, Portuese A, Borruto F, Dorta M. Transrectal ultrasonography in the assessment of rectovaginal endometriosis. Obstet Gynecol. 1998; 91(3):444-448. |
Observational-Dx |
140 women |
To evaluate the validity of transrectal US in the assessment of rectovaginal endometriosis. |
34 women had endometriosis infiltrating the rectovaginal septum confirmed by combined operative and pathologic findings. US showed a sensitivity and specificity of 97% and 96%, respectively, in the diagnosis of the presence of rectovaginal endometriosis. The sonographer identified infiltration of the rectal and vaginal walls correctly in all cases in whom it was present, but also reported rectal infiltration in 3 cases not confirmed by the surgeon and pathologist. The sensitivity and specificity in the diagnosis of uterosacral ligament infiltration were 80% and 97%, respectively. |
3 |
| 48. Alborzi S, Rasekhi A, Shomali Z, et al. Diagnostic accuracy of magnetic resonance imaging, transvaginal, and transrectal ultrasonography in deep infiltrating endometriosis. Medicine (Baltimore). 97(8):e9536, 2018 Feb. |
Observational-Dx |
317 patients |
To determine the diagnostic accuracy of pelvic magnetic resonance imaging (MRI), transvaginal sonography (TVS), and transrectal sonography (TRS) in diagnosis of deep infiltrating endometriosis (DIE).This |
Of 317 patients being included in the present study, 252 tested positive for DIE. The sensitivity, specificity, positive predictive value, and negative predictive value of TVS was found to be 83.3%, 46.1%, 85.7%, and 41.6%, respectively. These variables were 80.5%, 18.6%, 79.3%, and 19.7% for TRS and 90.4%, 66.1%, 91.2%, and 64.1% for MRI, respectively. MRI had the highest accuracy (85.4%) when compared to TVS (75.7%) and TRS (67.8%). The sensitivity of TRS, TVS, and MRI in uterosacral ligament DIE was 82.8%, 70.9%, and 63.6%, respectively. On the contrary, specificity had a reverse trend, favoring MRI (93.9%, 92.8%, and 89.8% for TVS and TRS, respectively). |
3 |
| 49. Benacerraf BR, Groszmann Y, Hornstein MD, Bromley B. Deep infiltrating endometriosis of the bowel wall: the comet sign. J Ultrasound Med. 34(3):537-42, 2015 Mar. |
Observational-Dx |
35 patients |
To evaluate the appearance of deep infiltrating endometriosis of the bowel wall in the cul-de-sac and determine the characteristic appearance of these lesions. |
Ten of these patients had surgical confirmation of bowel wall endometriosis after the scan, and another 4 patients had surgical evidence of endometriosis from prior surgery. All of the patients who underwent surgery subsequent to sonography had confirmation of their bowel wall infiltrative endometriosis. Sonographically, the bowel lesions were solid, focal, and tubular with slightly irregular margins and in most cases a thinner section or a "tail" at one end, resembling a comet. |
3 |
| 50. Saba L, Guerriero S, Sulcis R, et al. MRI and "tenderness guided" transvaginal ultrasonography in the diagnosis of recto-sigmoid endometriosis. J Magn Reson Imaging. 35(2):352-60, 2012 Feb. |
Observational-Dx |
59 patients |
To compare the diagnostic accuracy of magnetic resonance imaging (MRI) and "tenderness-guided" transvaginal ultrasonography (tg-TVUS) in the identification of recto-sigmoid endometriosis. |
The prevalence of recto-sigmoid endometriosis was 51%. The specificity, sensitivity, and positive and negative likelihood ratio (LR+ and LR-) were 90%, 73%, 7.089 and 0.297, respectively, for MRI and 86%, 73%, 5.317 and 0.309, respectively, for tg-TVUS. The presence of a high T1 signal spot was an excellent specific finding (100%) but was associated with a low sensitivity (30%). Inter-technique concordance using the Cohen statistic indicated a kappa value of 0.658 (+/- 0.098 SD). According to the logistic regression equation obtained, the use of both tg-TVUS and MRI allows optimal diagnostic performance. |
2 |
| 51. Hudelist G, English J, Thomas AE, Tinelli A, Singer CF, Keckstein J. Diagnostic accuracy of transvaginal ultrasound for non-invasive diagnosis of bowel endometriosis: systematic review and meta-analysis. [Review]. Ultrasound Obstet Gynecol. 37(3):257-63, 2011 Mar. |
Meta-analysis |
10 studies |
To critically analyze the diagnostic value of transvaginal sonography (TVS) for non-invasive, presurgical detection of bowel endometriosis. |
Out of 188 papers, a total of 10 studies fulfilled predefined inclusion criteria involving 1106 patients with suspected endometriosis. The prevalence of bowel endometriosis varied from 24 to 73.3%. positive likelihood ration (LR+) ranged from 4.8 to 48.56 and negative likelihood ratio (LR-) ranged from 0.02 to 0.36, with wide confidence intervals. Pooled estimates of sensitivities and specificities were 91 and 98%; LR+ and LR- were 30.36 and 0.09; and positive and negative predictive values were 98 and 95%, respectively. Three of the studies used bowel preparations to enhance the visibility of the rectal wall; one study directly compared the use of water contrast vs. no prior bowel enema, for which the LR- was 0.04 and 0.47, respectively. |
M |
| 52. Abrao MS, Goncalves MO, Dias JA Jr, Podgaec S, Chamie LP, Blasbalg R. Comparison between clinical examination, transvaginal sonography and magnetic resonance imaging for the diagnosis of deep endometriosis. Hum Reprod. 22(12):3092-7, 2007 Dec. |
Observational-Dx |
104 endometriosis patients |
To evaluate the capacity of digital vaginal examination, transvaginal ultrasound (TVUS) and magnetic resonance imaging (MRI) to diagnose rectosigmoid and retrocervical involvement. |
Endometriosis was histologically confirmed in 98 of 104 (94.2%) patients. With respect to the rectosigmoid and retrocervical sites, respectively, digital vaginal examination had a sensitivity of 72 and 68%, specificity of 54 and 46%, positive predictive value (PPV) of 63 and 45%, negative predictive value (NPV) of 64 and 69% and accuracy of 63 and 55%. For TVUS, sensitivity was 98 and 95%, specificity 100 and 98%, PPV 100 and 98%, NPV 98 and 97% and accuracy 99 and 97%. MRI had a sensitivity of 83 and 76%, specificity of 98 and 68%, PPV of 98 and 61%, NPV of 85 and 81% and accuracy of 90 and 71%. |
3 |
| 53. Patel MD, Feldstein VA, Chen DC, Lipson SD, Filly RA. Endometriomas: diagnostic performance of US. Radiology. 1999; 210(3):739-745. |
Observational-Dx |
226 women |
To determine the diagnostic performance of specific US features in discriminating endometriomas from other adnexal masses. |
There were 40 endometriomas. Diffuse low-level internal echoes were present in 38 (95%) endometriomas and 40 (19%) nonendometriomas (positive likelihood ratio, 5). The positive likelihood ratio for the diagnosis of endometrioma increased to 8 if masses with neoplastic features at gray-scale US were excluded, allowing identification of 30 endometriomas (75%). The presence of multilocularity or hyperechoic wall foci further increased the positive likelihood ratio to 48, allowing the identification of 18 endometriomas (45%). |
2 |
| 54. Berger JP, Rhemrev J, Smeets M, Henneman O, English J, Jansen FW. Limited Added Value of Magnetic Resonance Imaging After Dynamic Transvaginal Ultrasound for Preoperative Staging of Endometriosis in Daily Practice: A Prospective Cohort Study. J Ultrasound Med. 38(4):989-996, 2019 Apr. |
Observational-Dx |
363 patients |
To assess the added value of magnetic resonance imaging (MRI) after dynamic transvaginal ultrasound (TVUS) in the diagnostic pathway for preoperative staging of pelvic endometriosis. |
The sensitivity and specificity for the history, pelvic examination, and dynamic TVUS were 93.7% and 55.6% (P < .001), respectively; when MRI findings were included, the sensitivity and specificity were 85.9% and 62.5%. Adding MRI routinely to the diagnostic procedure of endometriosis did not significantly improve the sensitivity or specificity. |
3 |
| 55. Luttjeboer F, Harada T, Hughes E, Johnson N, Lilford R, Mol BW. Tubal flushing for subfertility. Cochrane Database Syst Rev. 2007; (3):CD003718. |
Review/Other-Dx |
12 trials |
To evaluate the effect of flushing a woman's fallopian tubes with oil- or water-soluble contrast media on subsequent fertility outcomes in couples with infertility. |
12 trials involving 2,079 participants were included. Tubal flushing with oil-soluble media vs no intervention was associated with a significant increase in the odds of live birth (Peto OR 2.98, 95% CI, 1.40 to 6.37) and of pregnancy (Peto OR 3.30, 95% CI, 2.00 to 5.43). For the comparison of tubal flushing with oil-soluble media vs tubal flushing with water-soluble media, the increase in the odds of live birth for tubal flushing with oil-soluble vs water-soluble media (Peto OR 1.49, 95% CI, 1.05 to 2.11) was based on 2 trials where statistical heterogeneity was present and the higher quality trial showed no significant difference; there was no evidence of a significant difference in the odds of pregnancy (Peto OR 1.21, 95% CI, 0.95 to 1.54). The addition of oil-soluble media to flushing with water-soluble media showed no evidence of a significant difference in the odds of pregnancy (Peto OR 1.28, 95% CI, 0.92 to 1.79) or live birth (Peto OR 1.06, 95% CI, 0.64 to 1.77). There was no serious adverse event reported. |
4 |
| 56. ETHIODOL® Brand of Ethiodized Oil Injection [package insert]. Savage Laboratories, A division of Nycomed US Inc., Melville, NY; 2014. http://www.guerbet-us.com/fileadmin/user_upload/usa_home/customer_care_center/documents/Ethiodol-pi.pdf. |
Review/Other-Dx |
N/A |
No abstract available. |
No abstract available. |
4 |
| 57. Swart P, Mol BW, van der Veen F, van Beurden M, Redekop WK, Bossuyt PM. The accuracy of hysterosalpingography in the diagnosis of tubal pathology: a meta-analysis. Fertil Steril. 1995; 64(3):486-491. |
Meta-analysis |
20 studies |
To assess the value of HSG in diagnosing tubal patency and peritubal adhesions using laparoscopy with chromopertubation as the gold standard. |
For tubal patency the reported sensitivity and specificity differed between studies. In a subset of studies that evaluated HSG and laparoscopy independently, a point estimate of 0.65 for sensitivity and 0.83 for specificity was calculated. For peritubal adhesions a summary ROC curve could be estimated. |
M |
| 58. Tukeva TA, Aronen HJ, Karjalainen PT, Molander P, Paavonen T, Paavonen J. MR imaging in pelvic inflammatory disease: comparison with laparoscopy and US. Radiology.1999; 210(1):209-216. |
Observational-Dx |
30 patients |
To assess the value of MRI in the diagnosis of pelvic inflammatory disease and to compare MRI with TVS and laparoscopy. |
Pelvic inflammatory disease was laparoscopically proved in 21 (70%) patients. The MRI diagnosis agreed with that obtained with laparoscopy in 20 (95%) of the 21 patients with pelvic inflammatory disease. The imaging findings for pelvic inflammatory disease were as follows: fluid-filled tube, pyosalpinx, tubo-ovarian abscess, or polycystic-like ovaries and free pelvic fluid. Findings at TVS agreed with those at laparoscopy in 17 (81%) of the 21 patients with pelvic inflammatory disease. The sensitivity of MRI in the diagnosis of pelvic inflammatory disease was 95%, the specificity was 89%, and the overall accuracy was 93%. For TVS, the corresponding values were 81%, 78%, and 80%. |
1 |
| 59. Czeyda-Pommersheim F, Kalb B, Costello J, et al. MRI in pelvic inflammatory disease: a pictorial review. [Review]. Abdom Radiol. 42(3):935-950, 2017 03. |
Review/Other-Dx |
N/A |
To provide a pictorial review of MRI in pelvic inflammatory disease. |
No results stated in abstract. |
4 |
| 60. Outwater EK, Siegelman ES, Chiowanich P, Kilger AM, Dunton CJ, Talerman A. Dilated fallopian tubes: MR imaging characteristics. Radiology. 208(2):463-9, 1998 Aug. |
Observational-Dx |
38 patients |
To determine the magnetic resonance (MR) imaging characteristics of hydrosalpinx and the accuracy of MR imaging for distinguishing hydrosalpinx from other adnexal masses. |
On a per patient basis, the blinded readers correctly identified dilated fallopian tubes in 31 of 41 study patients and correctly excluded dilated tubes in a mean 34 of 38 control subjects. On T1-weighted images, hyperintense tubal fluid was significantly correlated with the presence of endometriosis in the pelvis at surgery (P < .002, chi 2). |
3 |
| 61. Ludwin I, Ludwin A, Wiechec M, et al. Accuracy of hysterosalpingo-foam sonography in comparison to hysterosalpingo-contrast sonography with air/saline and to laparoscopy with dye. Hum Reprod. 32(4):758-769, 2017 04 01. |
Observational-Dx |
132 women; 259 Fallopian tubes |
To describe the diagnostic accuracy of 2D (dimentional)/3D hysterosalpingo-foam sonography (HyFoSy) and 2D/3D-high-definition flow Doppler (HDF)-HyFoSy in comparison to laparoscopy with dye chromotubation (as the reference method) and 2D air/saline-enhanced hysterosalpingo-contrast sonography (HyCoSy) (as the initial index test) |
2D-Air/saline-HyCoSy, 2D/3D-HyFoSy and 2D/3D-HDF-HyFoSy indicated that 46 (17.8%), 27 (10.4%) and 24 (9.2%) of the 259 tubes were occluded, respectively; additionally, inconclusive results were obtained for 8 (3%), 5 (1.9%) and 3 (1.2%) tubes, respectively. The reference method revealed 18 (6.9%) occluded Fallopian tubes. 2D-Air/saline-HyCoSy had a high negative predictive value (NPV) (99.5%) that was similar to that of 2D/3D-HyFoSy (99%) and 2D/3D-HDF-HyFoSy (99.6%) (P > 0.05), but had a very low positive predictive value (PPV) (30.4%). The use of 2D/3D-HyFoSy, especially 2D/3D-HDF-HyFoSy, which had a significantly higher PPV (48% and 71%, P < 0.05 and P < 0.01; respectively), resulted in fewer false positive and inconclusive findings than the use of 2D-air/saline-HyCoSy. The negative and positive likelihood ratio (LR- and LR+) was 0.14 and 14.8, respectively, for 2D/3D-HyFoSy, 0.06 and 32.1, respectively, for 2D/3D-HDF-HyFoSy, and 0.08 and 6.9, respectively, for 2D-air/saline-HyCoSy. The number of inconclusive or positive results per patient was significantly fewer with 2D/3D-HyFoSy (odds ratio, OR = 0.5, CI = 0.3-0.95, P < 0.05) and 2D/3D-HDF-HyFoSy (OR = 0.4, 95% CI = 0.2-0.8, P < 0.01) than with 2D-air/saline-HyCoSy. |
2 |
| 62. Piccioni MG, Riganelli L, Filippi V, et al. Sonohysterosalpingography: Comparison of foam and saline solution. J Clin Ultrasound. 45(2):67-71, 2017 Feb. |
Experimental-Dx |
37 infertile women |
To compare sonohysterosalpingography (sono-HSG) with foam instillation (HyFoSy) versus saline solution (HyCoSy) in the evaluation of tubal patency. |
Sono-HSG findings in tubal patency assessment obtained in the HyFoSy group were concordant with laparoscopic results in 94.4% of cases, with a sensitivity of 87.5% and a specificity of 100%, whereas in the HyCoSy group, concordance occurred in only 57.8% of examinations, with a sensitivity of 50% and a specificity of 66.6%. |
3 |
| 63. Wheeler JE. Pathology of fallopian tube. In: Blaustein A, ed. Blaustein's pathology of the female genital tract. 2nd ed. New York: Springer-Verlag; 1984:393-411. |
Review/Other-Dx |
N/A |
Book chapter. |
Book chapter. |
4 |
| 64. Strandell A. Treatment of hydrosalpinx in the patient undergoing assisted reproduction. Curr Opin Obstet Gynecol. 2007; 19(4):360-365. |
Review/Other-Dx |
N/A |
To present evidence for the effectiveness of different treatment options. |
Theories explaining the mechanisms behind the impaired outcome of in-vitro fertilization still focus on the hydrosalpingeal fluid. Gamete and embryotoxic effects have been demonstrated, but it is not a consistent finding. Endometrial receptivity may be altered by the reduced expression of cytokines and integrins important to implantation, and reduced endometrial and subendometrial blood flows may play a role. The rationale for treatments to improve the results of in-vitro fertilization is based on interruption of the leakage of hydrosalpinx fluid into the uterine cavity. Laparoscopic salpingectomy has been evaluated in a large randomized trial and proved effective in restoring birth rates. Proximal tubal ligation may also be effective according to one smaller randomized trial. Other suggested methods such as transvaginal drainage have been poorly investigated. |
4 |
| 65. Sokalska A, Timmerman D, Testa AC, et al. Diagnostic accuracy of transvaginal ultrasound examination for assigning a specific diagnosis to adnexal masses. Ultrasound Obstet Gynecol. 34(4):462-70, 2009 Oct. |
Observational-Dx |
1,066 women |
To determine the sensitivity and specificity of subjective evaluation of gray-scale and Doppler US findings (here called pattern recognition) when used by experienced US examiners with regard to making a specific diagnosis of adnexal masses. |
A total of 1,066 women were included, of whom 800 had a benign mass and 266 a malignant mass. A specific diagnosis based on US findings was suggested in 899 (84%) tumors. The specificity was high for all diagnoses (range, 94%–100%). The sensitivity was highest for benign teratoma/dermoid cysts (86%, 100/116), hydrosalpinges (86%, 18/21), peritoneal pseudocysts (80%, 4/5) and endometriomas (77%, 153/199), and lowest for functional cysts (17%, 4/24), paraovarian/parasalpingeal cysts (14%, 3/21), benign rare tumors (11%, 1/9), adenofibromas (8%, 3/39), simple cysts (6%, 1/18) and struma ovarii (0%, 0/5). The positive and negative likelihood ratios of pattern recognition with regard to dermoid cysts, hydrosalpinges and endometriomas were 68.2 and 0.14, 38.9 and 0.15, and 33.3 and 0.24, respectively. Dermoid cysts, hydrosalpinges, functional cysts, paraovarian cysts, peritoneal pseudocysts, fibromas/fibrothecomas and simple cysts were never misdiagnosed as malignancies by the US examiner, whereas more than 10% of inflammatory processes, adenofibromas and rare benign tumors including struma ovarii were misdiagnosed as malignancies. |
3 |
| 66. Pellerito JS, McCarthy SM, Doyle MB, Glickman MG, DeCherney AH. Diagnosis of uterine anomalies: relative accuracy of MR imaging, endovaginal sonography, and hysterosalpingography. Radiology. 1992; 183(3):795-800. |
Observational-Dx |
26 patients |
To compare the relative accuracy of MRI (n = 26), endovaginal US (n = 14), and HSG (n = 20) in the classification of MDA. |
There were 24 cases of surgically proved anomaly, and 2 patients had normal uteri (1 with a vaginal septum). MRI allowed diagnosis of 24/24 cases (accuracy, 100%), and endovaginal US was correct in 11/12 cases (accuracy, 92%). HSG was correct in only 4 cases. In the diagnosis of septate uterus, MRI demonstrated sensitivity and specificity of 100% and EVS demonstrated a sensitivity of 100% and a specificity of 80%. Both MRI and endovaginal US demonstrated a sensitivity and specificity of 100% in distinguishing those anomalies that did not require surgery. |
2 |
| 67. Knopman J, Copperman AB. Value of 3D ultrasound in the management of suspected Asherman's syndrome. J Reprod Med. 2007; 52(11):1016-1022. |
Observational-Dx |
54 infertile patients |
To assess the value of 3-D US in the management of patients with suspected Asherman's syndrome. |
Intrauterine adhesions were demonstrated on 3-D US and HSG in all cases and confirmed by hysteroscopy. However, 3-D US had a sensitivity of 100% and HSG a sensitivity of 66.7% for correctly grading the extent of intrauterine adhesions. In 61.1% of cases in which HSG results were inconsistent with hysteroscopy, lower uterine segment outflow obstruction was present, and HSG misclassified findings as severe Asherman's with complete cavity obstruction. Postoperatively, 90% of patients conceived. |
3 |
| 68. Salle B, Gaucherand P, de Saint Hilaire P, Rudigoz RC. Transvaginal sonohysterographic evaluation of intrauterine adhesions. J Clin Ultrasound. 1999; 27(3):131-134. |
Observational-Dx |
19 patients |
To assess the role of preoperative SHG in the diagnosis of intrauterine synechiae. |
TVS showed an abnormal uterine cavity in only 10 cases. The sensitivities of SHG and HSG in the diagnosis of intrauterine adhesions were both 100%. SHG showed complete correlation with HSG. |
3 |
| 69. Roma Dalfo A, Ubeda B, Ubeda A, et al. Diagnostic value of hysterosalpingography in the detection of intrauterine abnormalities: a comparison with hysteroscopy. AJR Am J Roentgenol. 2004; 183(5):1405-1409. |
Observational-Dx |
78 patients |
To evaluate the diagnostic accuracy of HSG in comparison with hysteroscopy in the detection of intrauterine abnormality in infertile patients. |
HSG showed a sensitivity of 81.2% compared with that of hysteroscopy and a specificity of 80.4%, with a PPV of 63.4% and a NPV of 83.7%. HSG also had a false-negative rate of 90% and a false-positive rate of 21.8%. Overall agreement between the 2 procedures was 73%. |
3 |
| 70. Soares SR, Barbosa dos Reis MM, Camargos AF. Diagnostic accuracy of sonohysterography, transvaginal sonography, and hysterosalpingography in patients with uterine cavity diseases. Fertil Steril. 2000; 73(2):406-411. |
Observational-Dx |
65 patients |
To evaluate the diagnostic accuracy of SHG in uterine cavity diseases in infertile patients, comparing its results with those of HSG and TVS. |
SHG had the same diagnostic accuracy as the gold standard for polypoid lesions and endometrial hyperplasia, with no equivocal diagnosis. HSG showed a sensitivity of 50% and a PPV of 28.6% for polypoid lesions and a sensitivity of 0% for endometrial hyperplasia. TVS had both sensitivity and PPV of 75% for polypoid lesions and endometrial hyperplasia. For uterine malformations, SHG had a sensitivity of 77.8%, whereas TVS and HSG both had a sensitivity of 44.4%. SHG and HSG had a sensitivity of 75% in the detection of intrauterine adhesions and respective PPVs of 42.9% and 50%. TVS showed sensitivity and PPV of 0% for this diagnosis. |
2 |
| 71. Tamai K, Togashi K, Ito T, Morisawa N, Fujiwara T, Koyama T. MR imaging findings of adenomyosis: correlation with histopathologic features and diagnostic pitfalls. Radiographics. 2005; 25(1):21-40. |
Review/Other-Dx |
N/A |
To provide definition of adenomyosis and pathologic considerations, clinical information, diagnosis, a wide variety of MRI findings of adenomyosis, pseudolesions masquerading as adenomyosis, unusual appearances, differential diagnosis of adenomyosis, and problems related to malignancy. |
MRI is a highly accurate noninvasive modality for diagnosing adenomyosis. Although the typical MRI findings are well established, adenomyosis actually differs markedly in pathologic features, in growth patterns, in responses to hormonal activity, and in responses to its treatment. |
4 |
| 72. Deshmukh SP, Gonsalves CF, Guglielmo FF, Mitchell DG. Role of MR imaging of uterine leiomyomas before and after embolization. [Review]. Radiographics. 32(6):E251-81, 2012 Oct. |
Review/Other-Dx |
N/A |
To review the role of MRI for the detection and evaluation of leiomyomas. |
MRI is the most accurate imaging technique for detection and evaluation of leiomyomas and therefore has become the imaging modality of choice before and after uterine fibroid embolization. As leiomyomas enlarge, they may outgrow their blood supply, resulting in various forms of degeneration that change their appearance. Leiomyomas are classified as submucosal, intramural, or subserosal. Submucosal and subserosal leiomyomas may be pedunculated, thus simulating other conditions. Understanding the MRI appearance of leiomyomas allows differentiation from other entities. The superior tissue contrast of MRI allows diagnosis of leiomyomas with a high level of confidence, ultimately leading to a decrease in the number of surgeries performed and thus reducing healthcare expenditures. MRI findings that influence the planning of uterine fibroid embolization include the location, size, number, and vascular supply of leiomyomas. In addition, MRI can be used to assess the success of uterine fibroid embolization and evaluate for potential complications. |
4 |
| 73. Homer HA, Li TC, Cooke ID. The septate uterus: a review of management and reproductive outcome. Fertil Steril. 2000; 73(1):1-14. |
Review/Other-Dx |
N/A |
To review the literature on the diagnosis, prevalence, and treatment of the septate uterus, with special reference to hysteroscopic metroplasty and its effect on reproductive outcome. |
Reliable diagnosis of the septate uterus depends on accurate assessment of the uterine fundal contour. At present, the combined use of laparoscopy and hysteroscopy is the gold standard for diagnosis, although recent reports of 2-D, transvaginal, contrast US and of 3-D US appear promising. The prevalence of the septate uterus is increased in women with repeated pregnancy loss. A meta-analysis of published retrospective data comparing pregnancy outcome before and after hysteroscopic septoplasty indicated a marked improvement after surgery. |
4 |
| 74. Bacelar AC, Wilcock D, Powell M, Worthington BS. The value of MRI in the assessment of traumatic intra-uterine adhesions (Asherman's syndrome). Clinical Radiology. 1995; 50(2):80-83. |
Review/Other-Dx |
4 patients |
To review 4 patients with Asherman's syndrome in which the evaluation by MRI had an important role in complementing the diagnosis established by hysteroscopy and in aiding their subsequent management. |
MRI can play an important role in the evaluation of patients with Asherman's syndrome especially those with involvement of the internal cervical os. |
4 |
| 75. Dueholm M, Lundorf E, Hansen ES, Ledertoug S, Olesen F. Evaluation of the uterine cavity with magnetic resonance imaging, transvaginal sonography, hysterosonographic examination, and diagnostic hysteroscopy. Fertil Steril. 2001; 76(2):350-357. |
Observational-Dx |
106 women |
To evaluate and compare the diagnostic accuracy of MRI, TVS, hysterosonographic examination, and hysteroscopy in the evaluation of the uterine cavity. |
The overall sensitivity was MRI 0.76, TVS 0.69, hysterosonographic examination 0.83, and hysteroscopy 0.84. The specificity was MRI 0.92, TVS 0.83, hysterosonographic examination 0.90, and hysteroscopy 0.88 (MRI, hysterosonographic examination, hysteroscopy vs TVS <0.05). Polyps were missed in 9/12 cases at MRI, 7 at TVS, 4 at hysterosonographic examination, and 2 at hysteroscopy (MRI vs hysteroscopy, and TVS vs hysteroscopy <0.05). The sensitivity for identification of submucous myomas was MRI 1.0, TVS 0.83, hysterosonographic examination 0.90, and hysteroscopy 0.82; the specificity was MRI 0.91, TVS 0.90, hysterosonographic examination 0.89, and hysteroscopy 0.87 (MRI vs TVS, and MRI vs hysteroscopy). MRI was significantly more precise than TVS, hysterosonographic examination, and hysteroscopy in determining submucous myoma in-growth (2-way ANOVA <0.05). |
2 |
| 76. Cil AP, Tulunay G, Kose MF, Haberal A. Power Doppler properties of endometrial polyps and submucosal fibroids: a preliminary observational study in women with known intracavitary lesions. Ultrasound Obstet Gynecol. 35(2):233-7, 2010 Feb. |
Observational-Dx |
49 patients; 32 with endometrial polyps and 17 with submucosal fibroids |
To compare power Doppler flow mapping characteristics of endometrial polyps and submucosal fibroids and analyze whether two different power Doppler characteristics, single-vessel pattern and rim-like vessel pattern, can help to differentiate these focal endometrial lesions. |
Included in the final analysis were 49 patients with histological confirmation of the type of endometrial lesion: 32 with endometrial polyps and 17 with submucosal fibroids. Power Doppler signals were observed in 47 of these; they were not observed in 2 patients with endometrial polyps. Of the 32 with endometrial polyps, 26 (81.3%) endometrial polyps showed a single-vessel pattern, 3 (9.4%) showed a multiple-vessel pattern and one (3.1%) showed a scattered-vessel pattern. Of the 17 with submucosal fibroids, 12 (70.6%) showed a rim-like vessel pattern, 3 (17.6%) showed a multiple-vessel pattern and 2 (11.8%) showed a single-vessel pattern. Single-vessel pattern was associated with 2 false-positive cases, but there were no false-positive cases for rim-like vessel pattern. The sensitivity, specificity and PPV and NPV for single-vessel pattern in diagnosing endometrial polyps were 81.2%, 88.2%, 92.9% and 71.4% and for rim-like pattern in diagnosing submucosal fibroids they were 70.6%, 100%, 100% and 86.5%, respectively. |
3 |
| 77. Sharma K, Bora MK, Venkatesh BP, et al. Role of 3D Ultrasound and Doppler in Differentiating Clinically Suspected Cases of Leiomyoma and Adenomyosis of Uterus. J Clin Diagn Res. 9(4):QC08-12, 2015 Apr. |
Observational-Dx |
100 patients |
To evaluate the role of 3D Ultrasound and Doppler in differentiating clinically suspected cases of leiomyoma and adenomyosis of uterus. |
On imaging, while using morphological criteria and Doppler for diagnosing leiomyoma, it was found that "peripheral vascularity" was seen in 52 (89%) cases, which was the highest. Similarly while diagnosing adenomyosis it was, the criteria "central vascularity" was seen in 28 cases (93%) and "ill defined junctional zone in 3D ultrasound" was seen in 26 cases (86%), which was also observed to be highest. With the cut off values taken for PI,RI and Vmax, diagnosis of leiomyoma was found to be 93.4% sensitive, 95.6% specific and with a positive predictive value of 97.6% and negative predictive value of 88.6%. Diagnosis of adenomyosis showed a sensitivity of 95.6%, specificity of 93.4% and a positive predictive value of 88.6% and negative predictive value of 97.6%. Imaging dignosed the co-existence of both the conditions correctly in 8 (66%) cases. |
3 |
| 78. O'Neill MJ. Sonohysterography. Radiol Clin North Am. 2003; 41(4):781-797. |
Review/Other-Dx |
N/A |
To review the technique, indications, and diagnostic findings during SHG. |
No results stated in abstract. |
4 |
| 79. Acholonu UC, Silberzweig J, Stein DE, Keltz M. Hysterosalpingography versus sonohysterography for intrauterine abnormalities. JSLS. 2011; 15(4):471-474. |
Observational-Dx |
149 patients |
To compare HSG to SHG for the detection of polyps, cavitary fibroids, adhesions, and septae in infertile patients. |
The sensitivity of HSG and SHG was 58.2% and 81.8%, respectively. The specificity for HSG and SHG was 25.6% and 93.8%. The differences in sensitivity and specificity were both statistically significant. HSG had a general accuracy of 50.3%, while SHG had a significantly higher accuracy of 75.5%. |
3 |
| 80. Farquhar C, Ekeroma A, Furness S, Arroll B. A systematic review of transvaginal ultrasonography, sonohysterography and hysteroscopy for the investigation of abnormal uterine bleeding in premenopausal women. Acta Obstet Gynecol. Scand. 2003; 82(6):493-504. |
Review/Other-Dx |
19 studies |
Systematic review to determine the accuracy of TVUS, sonohysterography and diagnostic hysteroscopy for examining abnormal uterine bleeding in premenopausal women. |
A positive test result with sonohysterography diagnosed submucous fibroids with a pooled likelihood ratio of 29.7 (17.8, 49.6). A positive test result with hysteroscopy diagnosed submucous fibroids with a pooled likelihood ratio of 29.4 (13.4, 65.3), and any intrauterine pathology with a pooled likelihood ratio of 7.7 (4.3, 13.7). A negative test result with hysteroscopy for diagnosing any intrauterine pathology had a pooled likelihood ratio of 0.07 (0.04, 0.15). All three diagnostic tests were moderately accurate in detecting intrauterine pathology. However, sonohysterography and hysteroscopy performed better than TVUS in detecting submucous fibroids. |
4 |
| 81. Ludwin A, Pitynski K, Ludwin I, Banas T, Knafel A. Two- and three-dimensional ultrasonography and sonohysterography versus hysteroscopy with laparoscopy in the differential diagnosis of septate, bicornuate, and arcuate uteri. J Minim Invasive Gynecol. 2013; 20(1):90-99. |
Observational-Dx |
117 women |
To estimate the diagnostic accuracy and to compare the diagnostic value of 3-D-SHG, 3-D-TVS, 2-D-SHG, and 2-D-TVS (initial and expert diagnosis) in the differential diagnosis of septate, bicornuate, and arcuate uteri. |
Hysteroscopy performed in conjunction with laparoscopy detected 23 arcuate, 60 septate, 22 bicornuate, and 12 normal uteri. 3-D-SHG showed perfect diagnostic accuracy (100.0%) in general detection of uterine abnormalities, compared with initial 2-D-TVS (77.8%), expert 2-D-TVS (90.6%), 2-D-SHG (94.0%), and 3-D-TVS (97.4%). In the overall diagnosis of uterine anomalies, all of the diagnostic methods had statistically significantly better diagnostic value than initial 2-D-TVS (P<.001), whereas 3-D-SHG was the only method that was better than expert 2-D-TVS (P<.001). |
3 |
| 82. El-Sherbiny W, El-Mazny A, Abou-Salem N, Mostafa WS. The diagnostic accuracy of two- vs three-dimensional sonohysterography for evaluation of the uterine cavity in the reproductive age. Journal of Minimally Invasive Gynecology. 22(1):127-31, 2015 Jan. |
Observational-Dx |
120 women |
To compare 2-dimensional sonohysterography (2D SHG) vs 3-dimensional sonohysterography (3D SHG) using saline solution infusion, with outpatient hysteroscopy as the gold standard, for evaluation of the uterine cavity in women of reproductive age. |
For 2D SHG, sensitivity was 71.2%; specificity, 94.1%; positive predictive value, 90.2%; negative predictive value, 81.0%; and overall accuracy, 84.2%. For 3D SHG, sensitivity was 94.2%; specificity, 98.5%; positive predictive value, 98.0%; negative predictive value, 95.7%; and overall accuracy, 96.7%. Thus, 3D SHG was superior to 2D SHG (p = .02) and comparable with outpatient hysteroscopy (p = .12) for diagnosis of intrauterine lesions. |
3 |
| 83. Loverro G, Nappi L, Vicino M, Carriero C, Vimercati A, Selvaggi L. Uterine cavity assessment in infertile women: comparison of transvaginal sonography and hysteroscopy. Eur J Obstet Gynecol Reprod Biol. 2001; 100(1):67-71. |
Observational-Dx |
134 infertile women |
To evaluate the diagnostic accuracy of TVS in detecting uterine cavity abnormalities in infertile patients, with reference to hysteroscopy as the gold standard method. |
There was 1 failed insertion of hysteroscope. Hysteroscopy diagnosed pathological findings in 58/133 cases (44%). TVS was in agreement with 50/58 (86%) of the pathological findings diagnosed at hysteroscopy. As a test for the detection of uterine cavity abnormalities, TVS in comparison with hysteroscopy had 84.5% sensitivity and 98.7% specificity, 98.0% PPV and 89.2% NPV. |
3 |
| 84. Bermejo C, Martinez Ten P, Cantarero R, et al. Three-dimensional ultrasound in the diagnosis of Mullerian duct anomalies and concordance with magnetic resonance imaging. Ultrasound Obstet Gynecol. 2010; 35(5):593-601. |
Observational-Dx |
286 women |
To demonstrate the value of 3-D US in the diagnosis of uterine malformations and its concordance with MRI. |
Using 3-D US we diagnosed: 1 case with uterine agenesis; 10 with unicornuate uterus, 4 of which also underwent MRI; 6 with didelphic uterus, 1 of which had MRI; 45 with bicornuate uterus, 12 of which had MRI; 125 with septate uterus (18 with 2 cervices), 42 of which had MRI (6 with 2 cervices); 96 with arcuate uterus, 3 of which had MRI; and 3 with diethylstilbestrol iatrogenic uterine malformations, all of which had MRI. Among the 65 which underwent MRI, the diagnosis was: 4 cases with unicornuate uterus, 10 with bicornuate uterus (2 with 2 cervices), 45 with septate uterus (5 with 2 cervices), 3 with arcuate uterus and 3 with diethylstilbestrol-related uterine malformations. The concordance between 3-D US and MRI was very good (kappa index, 0.880 (95% CI, 0.769–0.993)). Discrepancies in diagnosis between the 2 techniques occurred in 4 cases. There was very good concordance in the diagnosis of associated findings (kappa index, 0.878 (95% CI, 0.775–0.980)), this analysis identifying differences in 2 cases. |
3 |
| 85. Bocca SM, Abuhamad AZ. Use of 3-dimensional sonography to assess uterine anomalies. J Ultrasound Med. 2013; 32(1):1-6. |
Review/Other-Dx |
N/A |
To assess the use of 3-D US to determine uterine anomalies. |
3-D US is a simple, quick, and noninvasive technique for detecting and diagnosing uterine anomalies without the use of ionizing radiation or the iodine contrast agents needed for HSG, as well for differentiating intracavitary, submucosal, intramural, and subserosal abnormalities. It appears to be at least as accurate as MRI in the diagnosis of uterine anomalies with less expense and more tolerability. |
4 |
| 86. El-Sherbiny W, Nasr AS. Value of 3-dimensional sonohysterography in infertility work-up. J Minim Invasive Gynecol. 2011; 18(1):54-58. |
Observational-Dx |
180 women |
To compare the diagnostic value of 2-D and 3-D SHG and outpatient hysteroscopy in detecting intrauterine lesions in infertile women. |
Sensitivity, specificity, PPV, NPV, and accuracy of 2-D-SHG and 3-D-SHG were compared with outpatient hysteroscopy in detecting intrauterine lesions. For 2-D-SHG, sensitivity was 0.70 (95% CI, 0.49–0.85), specificity was 1.0 (95% CI, 0.96–1.0), PPV was 1.0 (95% CI, 0.79–1.0), NPV was 0.95 (95% CI, 0.9–0.97), and accuracy was 95.5%. For 3-D-SHG, sensitivity was 0.92 (95% CI, 0.74–0.98), specificity was 1.0 (95% CI, 0.97–1.0), PPV was 1.0 (05% CI, 0.83–1.0), NPV was 0.98 (95% CI, 0.95–0.99), and accuracy was 98.8%. For outpatient hysteroscopy, sensitivity was 1.0 (95% CI, 0.85–1.0), specificity was 1.0 (95% CI, 0.97–1.0), PPV was 1.0 (95% CI, 0.84–1.0), NPV was 1.0 (0.97–1.0), and accuracy was 100%. Thus, 3-D-SHG is comparable to outpatient hysteroscopy in diagnosing intrauterine lesions (P=.23), and both are superior to 2-D-SHG (P<0.001). |
3 |
| 87. Deutch TD, Abuhamad AZ. The role of 3-dimensional ultrasonography and magnetic resonance imaging in the diagnosis of mullerian duct anomalies: a review of the literature. J Ultrasound Med. 2008; 27(3):413-423. |
Review/Other-Dx |
N/A |
To review the published literature and determine the roles that MRI and endovaginal 3-D US play in the diagnosis of MDA. |
MRI and 3-D US are highly sensitive and specific in identifying women with MDAs. MRI is 100% to 28.6% sensitive and 100% to 66% specific in correctly categorizing MDAs. 3-D US is 100% to 98% sensitive and 100% specific in correctly categorizing MDAs. |
4 |
| 88. American College of Radiology. ACR Appropriateness Criteria® Radiation Dose Assessment Introduction. Available at: https://www.acr.org/-/media/ACR/Files/Appropriateness-Criteria/RadiationDoseAssessmentIntro.pdf. |
Review/Other-Dx |
N/A |
To provide evidence-based guidelines on exposure of patients to ionizing radiation. |
No abstract available. |
4 |
