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To determine the diagnostic performance of two-dimensional (2D) ultrasound parameters, three-dimensional (3D) power Doppler and contrast-enhanced indices in detecting residual disease in locally advanced cervical cancer patients triaged to neoadjuvant treatment followed by radical surgery.Between October 2010 and June 2014, we screened 108 women with histologically documented locally advanced cervical cancer Stage IB2-IVA, of whom 88 were included in the final analysis. 2D ultrasound parameters, 3D power Doppler and contrast-ultrasound parameters were assessed 5 weeks after the end of neoadjuvant chemoradiation therapy. The pathological response was defined as complete (absence of any residual tumor after treatment) or partial (including microscopic and/or macroscopic residual tumor at pathology examination). The two response groups were compared and receiver-operating characteristics (ROC) curves generated to determine the best cut-off value of sonographic tumor diameter to predict residual disease. Histology was considered as reference.Complete pathological response to chemoradiation was observed in 40 (45.5%) patients and partial response in 48 (54.5%). The presence of residual disease, as confirmed at pathology examination, was detected by 2D grayscale ultrasound with a sensitivity of 64.6% and specificity of 65%. Color Doppler examination in the cases with lesions visualized on grayscale imaging detected the presence of residual disease, confirmed at pathology, with a sensitivity of 87.1% and specificity of 21.4%. The best area under the ROC curve (0.817) was for the detection of pathological residual disease of at least 6 mm in diameter, using a cut-off value of 12 mm for the largest tumor diameter assessed using 2D grayscale ultrasound (sensitivity, 95%; specificity, 70.6%). Neither 3D vascular indices nor contrast-ultrasound parameters obtained for lesions suspected at ultrasound following chemoradiation differed significantly between patients with histological complete and those with partial response.Our results show that grayscale and color Doppler ultrasound have a low level of diagnostic performance in detecting residual disease after neoadjuvant chemoradiation in patients with locally advanced cervical cancer. The best performance was achieved in detection of macroscopic (≥ 6 mm) residual disease. Copyright © 2018 ISUOG. Published by John WileySons Ltd.

Objective Chemoradiation-based neoadjuvant treatment followed by radical surgery is an alternative therapeutic strategy for locally advanced cervical cancer (LACC) –stage ≥ IB2 (except of IIA1)– but ultrasound variables used to predict neoadjuvant partial response are not well defined. The goal of this study was to prospectively analyze the potential role of transvaginal ultrasound (TVUS) in early predicting pathologically assessed residual disease in a large, single-institution series of LACC patients triaged to neoadjuvant treatment followed by radical surgery. Methods Between October 2010 and June 2014, 108 women with histologically documented LACC were screened and 88 of them were included in the final analysis. Tumor volume, 3D power Doppler indices and contrast parameters were obtained before (baseline examination) and after two weeks of treatment (early examination). The pathological response was defined as complete (absence of any residual tumor after treatment) or partial, including both microscopic and macroscopic residual tumor at pathological examination. Comparisons between the two groups (complete response group versus partial response group) were made with Mann–Whitney-test or Wilcoxon-test and χ2-test, as appropriate. Receiver–operating characteristic (ROC) curves were generated for statistically significant ultrasound variables on univariate analysis to evaluate their diagnostic ability to predict pathological partial response. Results Complete and partial pathological responses to neoadjuvant therapy were documented in 40 (45.5%) and 48 (54.5%) patients respectively. At baseline examination, tumor volume did not differ between patients with a complete and those with a partial response. However, after two weeks of neoadjuvant treatment, the tumor volume was significantly higher in patients with partial response than in those with complete response (p = 0.019). Among the 3D vascular indices, vascularization index (VI) was significantly lower in partial response group than in complete response group both before and two weeks after treatment (p = 0.037 and p = 0.024 respectively). In the contrast analysis, a lower tumor peak enhancement (PE) as well as a lower tumor Wash in Rate (WiR), and a longer tumor Rise Time (RT) were observed at baseline examination in women with partial response than in those with complete response (p = 0.006, p = 0.003, p = 0.038, respectively). No difference was found in terms of contrast parameters at early examination. Receiver operating characteristic (ROC) curve analysis of baseline parameters showed that the best cut-off for predicting pathological partial response was 41.5% for VI (sensitivity 63.6% and specificity 66.7%); 16123.5 for tumor PE (sensitivity 47.9% and specificity 84.2%); 7.8 s for tumor RT (sensitivity 68.8% and specificity 57.9%); and 4902 for tumor WiR (sensitivity 77.1% and specificity 60.5%). ROC curves of early parameters showed that the best cut-off for predicting pathological partial response was 18.1 cm3 for tumor volume (sensitivity 71% and specificity 60%) and 39.5% for VI (sensitivity 63% and specificity 74%). Conclusions Ultrasound and contrast parameters differ between patients with complete response and those with partial response before and after two weeks of neoadjuvant treatment. However, neither ultrasound parameters performed before treatment nor those performed two weeks after treatment have shown a cut-off value with acceptable sensitivity and specificity for predicting pathological partial response to neoadjuvant therapy.

Objectives To compare two-dimensional (2D) and three-dimensional (3D) transvaginal ultrasound with magnetic resonance imaging (MRI) as the gold standard in assessment of parametrial infiltration of cervical cancer and to determine if all parts of the cervix are equally assessable with ultrasound. Methods Patients with macroscopically evident and histologically confirmed cervical cancer were staged using International Federation of Gynecology and Obstetrics (FIGO) criteria and underwent MRI and 2D and 3D ultrasound examination before treatment. When assessing parametrial infiltration with 3D ultrasound and MRI, the cervix was (virtually) divided into three cylinders (cranial, middle and caudal) of equal size and each cylinder was then divided into six sectors in a clockwise manner following a consensus between radiologists and ultrasound examiners. The presence and the extent of parametrial invasion were recorded for each sector. Results of 2D ultrasound, 3D ultrasound and MRI were compared and reported in terms of percentage agreement and kappa value. Results A total of 29 consecutive patients were included in the study. The percentage agreement between 2D ultrasound and MRI in assessing parametrial infiltration (yes or no) was 76% (kappa, 0.459) and that between 3D ultrasound and MRI was 79% (kappa, 0.508). The results of 2D ultrasound showed the following agreement with those of MRI: 90% for the ventral parametrium (kappa, 0.720), 72% for the right lateral parametrium kappa, 0.494), 69% for the left lateral parametrium (kappa, 0.412) and 58.5% for the dorsal parametrium (kappa, 0.017). The results of 3D ultrasound showed the following agreement with those of MRI: 62.5% for the ventral parametrium (kappa, 0.176), 81% for the right lateral parametrium (kappa, 0.595), 70% for the left lateral parametrium (kappa, 0.326) and 52% for the dorsal parametrium (kappa, 0.132). The best agreement between 3D ultrasound and MRI was for the middle cervical cylinder (76%; kappa, 0.438) and the poorest agreement was for the caudal cylinder (42%; kappa, 0.125). Conclusion The results of 2D and 3D ultrasound showed similar moderate agreement with MRI; 2D and 3D ultrasound examinations are less costly and more readily available than MRI and should be considered in the preoperative work-up for cervical cancer. Copyright (C) 2014 ISUOG. Published by John Wiley & Sons Ltd. (Less)

Objectives To prospectively assess the diagnostic performance of transvaginal ultrasound and magnetic resonance imaging (MRI), using histology as the gold standard, with regard to the presence, size, and extent of invasive cervical cancers and the detection of metastatic lymph nodes. Methods This was a prospective study designed to examine patients with invasive cervical cancer by means of ultrasonography and MRI within 1 week before surgery. We included patients with early cervical cancer planned for primary surgery and patients with locally advanced cervical cancer planned for surgery after neoadjuvant treatment. Results An invasive cervical cancer tumor was confirmed in the 33 patients triaged for primary surgery. A residual tumor mass was documented in 27 out of 35 patients (77%) who underwent surgery after neoadjuvant treatment, with no residual tumor in eight (23%) cases. Transvaginal ultrasound and MRI examinations showed the presence of the tumor mass in 56/60 (93%) and in 53/60 (88%) cases, respectively. Ultrasound and MRI detected the depth of stromal invasion to be greater than two-thirds with a sensitivity of 100% (16/16) and 94% (15/16) (P = 1) and a false-positive rate of 25% (13/52) and 15% (8/52) (P = 0.58), respectively. Both ultrasound and MRI provided low sensitivities (3/5, 60% and 2/5, 40% respectively, P = 1) and the same false-positive rate (7/63, 11%) for the presence of parametrial infiltration. One of the 11 patients with metastatic lymph nodes was detected at ultrasound examination (sensitivity 9%) with no false-positive cases, while MRI correctly identified three positive cases (sensitivity 27%, 3/11) with two false-positive cases (false positive rate 4%, 2/55). Conclusions Ultrasound and MRI had similar sensitivity and specificity with regard to the parameters investigated. Ultrasound has the advantages over MRI of low cost, widespread availability and of being a relatively quick procedure. Ultrasound should be considered as a suitable diagnostic method in the preoperative work-up of cervical cancer. Copyright © 2009 ISUOG. Published by John Wiley & Sons, Ltd.

Purpose We assessed the usefulness of color Doppler imaging in the diagnosis and monitoring of arterial complications after liver transplantation. Methods Subjects were 142 liver transplant recipients who underwent serial color Doppler sonographic evaluations of the hepatic arteries after surgery. Patients with abnormal sonographic findings underwent subsequent angiography. Results Eighteen subjects experienced 20 hepatic arterial complications (13 thromboses and 7 stenoses). In 7 of the 13 thrombosis incidents, hepatic arterial obstruction occurred within a month of surgery and was evident from the absence of Doppler signals; angiography confirmed the absence of hepatic arterial perfusion in these cases. In the other 6 thrombosis cases, the thrombosis developed 3 or more months after surgery and became apparent from the absence of color Doppler signals at the level of the main arterial trunk and the presence of intraparenchymal “tardus parvus” waveforms. In these cases, angiography showed obstruction of the main arterial trunk and the development of compensatory collateral vessels. In 3 of the 7 cases of stenosis, high flow velocities were recorded at the site of the narrowing, and intrahepatic tardus parvus waveforms were present. In the other 4 stenosis cases, the site of stenosis could not be identified, but intraparenchymal tardus parvus waveforms were recorded. Conclusion The use of color Doppler sonography allows the early diagnosis of hepatic arterial complications after liver transplantation. Tardus parvus waveforms indicated severe impairment of hepatic arterial perfusion, from either thrombosis or severe stenosis. The presence of these waveforms enhanced the accuracy of color Doppler diagnosis (100% positive predictive value), and their detection should prompt angiography. © 2000 John Wiley & Sons, Inc. J Clin Ultrasound 28:373–380, 2000.

E. Epstein1, A. Testa2, A. Gaurilcikas3, A. Di Legge2, L. Ameye4, V. Atstupenaite5, A. Valentini6, B. Gui6, N. Wallengren7, S. Pudaric7, A. Cizauskas8, A. Masback9, G. Zannoni10, P. Kannisto11, M. Zikan12, I. Pinkavova12, A. Burgetova13, P. Dundr14, K. Nemejcova14, D. Cibula12, D. Fischerova12 1Obstetrics and Gynecology, Karolinska University Hospital, Stockholm, Sweden; 2Oncology, Catholic University of Sacred Heart, Rome, Italy; 3Obstetrics and Gynecology, Lithuanian University of Health Sciences, Kaunas, Lithuania; 4Department of Electrical Engineering, ESAT-SCD, Katholieke Universiteit, Leuven, Belgium; 5Radiology, Lithuanian University of Health Sciences, Kaunas, Lithuania; 6Radiology, Catholic University of Sacred Heart, Rome, Italy; 7Radiology, Skane University Hospital, Lund, Sweden; 8Pathology, Lithuanian University of Health Sciences, Kaunas, Lithuania; 9Pathology, Skane University Hospital, Lund, Sweden; 10Pathology, Catholic University of Sacred Heart, Rome, Italy; 11Obstetrics and Gynecology, Skane University Hospital, Lund, Sweden; 12Gynecological Oncology Centre, First Faculty of Medicine and General University Hospital, Charles University, Prague, Czech Republic; 13Radiology, First Faculty of Medicine and General University Hospital, Charles University, Prague, Czech Republic; 14Pathology, First Faculty of Medicine and General University Hospital, Charles University, Prague, Czech Republic