104
of the cycle) and with human menopausal gonadotropin (8th day
to llth day). The vascular impedance of the ovary carrying the
dominant follicles was monitored by endovaginal pulsed Doppler
flow measurement. Simultaneously, serum levels of LH, E2 and
17-OHP were assayed. Contrary to controls, women with polycys-
tic ovary syndrome or hypogonadotropic amenorrhea showed de-
creased hormone levels and no lowering of the vascular imped-
ance. In controls, the lower pulsatility index is caused by
neovascularization around the dominant follicle and by E~-induced
vasodilatation in the ovarian artery.
Ultrasound and
Endovaginal Doppler Findings
after First-Trimester Abortion
N. Dillon, C. Q. Case, I. M. Ramos, S.K. Holland,
K. J. W. Taylor
Radiology 1993;186:87-91
(K.J.W. Taylor, Department of Diagnostic Radiol-
ogy, Yale University School of Medicine, 333 Ce-
dar St., TE-2, New Haven, CT 06510)
Endovaginal ultrasound imaging and color Doppler flow imag-
ing techniques were used to evaluate the uterus and its contents
and to establish characteristics of a normal post-abortion appear-
ance in 19 women who underwent elective first-trimester abor-
tions. Twenty-two examinations were performed between 2 and 7
days after the procedure. Thirteen of the 22 examinations (59%)
showed different amounts of intrauterine material of varying
echogenicity. Seven of the 22 examinations (32%) showed a thick
endometrial stripe, and only two showed a normal stripe. Color
Doppler flow imaging demonstrated typical peritrophoblastic flow
in four of eight patients on the second and third days after the
abortions were performed. After the third day, flow was observed
in only two of 11 patients, and intrauterine material was also seen.
These results indicate that intrauterine material and low-imped-
ance flow are frequently observed after an abortion and do not
necessarily indicate clinically important retained products of con-
ception.
Validity of Pulsatility and Resistance Indices in
Classification of Adnexal Tumors with Transvag-
inal Color Doppler Ultrasound
A. P.
Tekay, Jouppila
Ultrasound Obstet Gynecol 1992;2:338-344
(A. Tekay, Department of Obstetrics and Gyne-
cology, University of Oulu, 90220 Oulu, Finland)
Transvaginal pulsed color
Doppler ultrasound was used to ex-
amine 72 patients with
pelvic mass preoperatively. Tumor mor-
a D.
phology was assessed, prominent areas of vascularization within
the tumor were observed and the pulsatility index and the resis-
Downloaded from jdm.sagepub.com at NANYANG TECH UNIV LIBRARY on April 24, 2015
tance index of tumor and uterine arteries were measured. Flow
velocity waveforms with low pulsatility are considered to reflect
neovascularization. The ultrasound diagnoses were compared
with histopathological or cytological diagnoses. There were 61
benign, eight malignant and three borderline cases. In 75% of the
malignant and 23% of the benign tumors, an intratumoral flow
with a low pulsatility was detectable. The mean pulsatility index of
tumor blood vessels was 1.2 in benign, 0.7 in malignant and 0.6 in
borderline neoplasms. The corresponding mean resistance index
values were 0.6, 0.5 and 0.5. The differences were not significant
and the overlap between the malignant and benign lesions was
large. The pulsatility index and resistance index of uterine arteries
were significantly decreased in malignant tumors. The results
show that, using a cut-off resistance index value of 0.6, the sensi-
tivity and specificity of color Doppler in the detection of malignant
and potentially malignant tumors were 82% and 72%, respectively.
However, a practical cut-off level for either pulsatility or resistance
indices, that could assist in differentiating between malignant or
benign lesions, does not seem to exist.
The Clinical Significance of Resolving Polyhy-
dramnios
B. Rochelson, J. Wagner, S. Shmoys
Ultrasound Obstet Gynecol 1992;2:321-323
(B. Rochelson, 1320 Stony Brook Road, Stony
Brook, NY 11790)
Polyhydramnios is associated with multiple maternal and fetal
abnormalities. Although the risks of persistent polyhydramnios
are well described, the clinical implications of polyhydramnios that
resolves prior to delivery are not. Thirty-four non-diabetic patients
with resolving polyhydramnios were studied. An amniotic fluid
index of ~20 was used to define polyhydramnios. Antepartum and
postpartum outcomes were compared with those patients with
persistent polyhydramnios, and a control group of 102 singleton
term deliveries. Patients with resolving polyhydramnios did not
have a significant increase in congenital anomalies. An 8% inci-
dence of congenital anomalies was noted in patients with persis-
tent polyhydramnios; this was significant compared with controls
(p < 0.05). Idiopathic resolving polyhydramnios was associated
with a higher mean birth weight (p < 0.05) than controls, with
significantly more babies weighing more than 4200 g. An increase
in placental thrombus formation was noted in patients with idio-
pathic resolving and persistent polyhydramnios compared to the
control group (~~ < 0.01). The etiology of this is unclear. Obstetri-
cians should be aware of the risk of macrosomia and the possibility
of placental disease in these fetuses.
The Role of Sonographically Guided Aspiration
in the Clinical Management of Ovarian Cysts
Dordoni, S. Zaglio, S. Zucca, G. Favalli
J Ultrasound Med 1993;12:27-31