Conclusions: Heterogeneous signal intensity and dark intraplacental bands seen in T2 weighted sequences are the most accurate MRI signs for identifying abnormally invasive placenta.

Oral poster abstracts S-BOT (p = 0.05). M-BOT had echogenic fluid more than S-BOT, but this difference did not reach statistical significance. Only in 5/11 tumors (45%) a significant blood flow was documented. 11/23 (47%) tumors were correctly triaged for oncology-related surgery procedure based on clinical and sonographic evaluation. Conclusions: Echogenic fluid, multilocularity and a larger diameter is more typical to M-BOT. Papillary projections are more often associated with S-BOT. Correct triage for an oncology-related surgery, based on these factors, seem less successful than expected. Objective: The purpose of this study was to evaluate the intraobserver and interobserver agreement for identifying adnexal malignancy using color flow location in indeterminate masses after a gray-scale transvaginal sonography. Methods: Digitally stored color Doppler sonographic images, from a consecutive series of 130 women with an adnexal mass submitted to surgery after transvaginal sonography were evaluated by 6 different examiners with different degree of experience. Only consecutive cystic mass in which the gray-scale echo architecture was not suggestive of benign histology was included in the study. Solid excrescences or solid portions of the tumor were evaluated for vascular flow with color Doppler sonography. A mass was graded malignant if flow was shown within the excrescences or solid areas (central flow) and benign if there was no flow or only peripheral. Intraobserver and interobserver agreement according with the level of experience were assessed by calculating the kappa index. Results: Of the 130 consecutive cases with indeterminate findings at gray-scale evaluation, definitive histologic diagnoses were as follows: 80 (61.5%) benign and 50 (38.5%) malignant masses. Intraobserver agreement was good or very good for all examiners with different degree of experience (kappa ranging from 0.721 to 0.888). Interobserver agreement was good to moderate for all operators (kappa ranging from 0.478 to 0.714), irrespective of degree of experience. A correct classification was obtained by all assessors in 52% of malignant masses. Only ten masses (7.7%) were incorrectly classified by all the assessors. Conclusions: The use of color Doppler in the evaluation of flow location for the detection of adnexal malignancy seems to be reproducible method even in moderate experienced examiners. OP24.08 OP24.09Transrectal ultrasound in the evaluation of locally advanced cervical cancer after neoadjuvant chemotherapy Objective: We compared accuracy of transrectal ultrasound (TRUS) and magnetic resonance (MRI) in evaluation of locally advanced cervical cancer after neoadjuvant chemotherapy (NACT) in this study. Total 36 women with histologically verified cervical cancer stage IB2, incipient IIB and deep stromal invasion with response to NACT were included in this study. All patients were treated with ifosfamide/cisplatin chemotherapy followed by radical hysterectomy at our department in years [2004][2005][2006][2007][2008]. The histologica...

Objective To assess the clinical usefulness of a structured reporting system based on ultrasound findings for management of adnexal masses.Methods This was a prospective multicenter study comprising 432 adnexal masses in 372 women (mean age, 44.0 (range, 13-78) (NPV), positive likelihood ratio (LR+) and negative likelihood ratio (LR−) of GI-RADS classification for identifying adnexal masses at high risk of malignancy, considering GI-RADS 4 and 5 as being malignant.Results Of the 432 tumors, 112 were malignant and 320 benign. The GI-RADS classification rate was as follows: 92 (21%) cases; 184 (43%) cases; 40 (9%) cases;(27%)

Objective. The purpose of this study was to describe a new reporting system called the Gynecologic Imaging Reporting and Data System (GI-RADS) for reporting findings in adnexal masses based on transvaginal sonography. Methods. A total of 171 women (mean age, 39 years; range, 16-77 years) suspected of having an adnexal mass were evaluated by transvaginal sonography before treatment. Pattern recognition analysis and color Doppler blood flow location were used for determining the presumptive diagnosis. Then the GI-RADS was used, with the following classifications: GI-RADS 1, definitively benign; GI-RADS 2, very probably benign; GI-RADS 3, probably benign; GI-RADS 4, probably malignant; and GI-RADS 5, very probably malignant. Patients with GI-RADS 1 and 2 tumors were treated expectantly. All GI-RADS 3, 4, and 5 tumors were removed surgically, and a definitive histologic diagnosis was obtained. The GI-RADS classification was compared with final histologic diagnosis. Results. A total of 187 masses were evaluated. The prevalence rate for malignant tumors was 13.4%. Overall GI-RADS classification rates were as follows: GI-RADS 1, 4 cases (2.1%); GI-RADS 2, 52 cases (27.8%); GI-RADS 3, 90 cases (48.1%); GI-RADS 4, 13 cases (7%); and GI-RADS 5, 28 cases (15%). The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 92%, 97%, 85%, 99%, and 96%, respectively. Conclusions. Our proposed reporting system showed good diagnostic performance. It is simple and could facilitate communication between sonographers/ sonologists and clinicians. Key words: adnexal mass; reporting system; sonography. ransvaginal sonography (TVS) has become the first-step imaging technique for characterizing adnexal masses. When used by experienced examiners, this technique achieves high sensitivity for identifying ovarian cancer, and it has been shown to be useful for selecting the best surgical approach. [1][2][3] However, despite the tremendous progress in the diagnostic capability of TVS, a large multicenter study reported that the false-positive rate could be as high as 24%. 4 One explanation for this high false-positive rate may be operator experience, as has been shown in a recent randomized trial.5 Another reason could be a problem in the transmission of information about findings from the sonologist or sonographer to the clinician who makes final decision. As a matter of fact, reports describing sonographic findings are sometimes confusing.

Use of Bowel Preparation and an Acoustic Window With Intravaginal Gel: Preliminary Resultsndometriosis is defined as the presence of endometrial tissue, glands, and stroma outside the uterine cavity. The actual prevalence of this disease is not known, but it is estimated that 1% to 8% of women have endometriosis, 1 with prevalence ranging from 15% to 70% in infertile women. 2,3 The clinical presentation varies independently from extension of the disease, and it manifests a number of symptoms characterized by secondary dysmenorrhea, chronic pelvic pain, intermenstrual pain, dyspareunia, dyschezia, intermittent diarrhea, hematochezia, and, in severe cases, bowel obstruction. 2 Mauricio León, MD, Humberto Vaccaro, MD, Juan Luis Alcázar, MD, PhD, Jaime Martinez, MD, Jorge Gutierrez, MD, Fernando Amor, MD, Alberto Iturra, MD, Hugo Sovino, MD Received January 23, 2013, from the Department of Obstetrics and Gynecology, Ultrasound and Human Reproduction Unit, Indisa Clinic, Santiago, Chile (M.L., J.M., J.G., A.I., H.S.); Ultrasonic Panorámico, Santiago, Chile (M.L., H.V., F.A., A.I.) Objectives-The purpose of this study was to assess the diagnostic performance of extended transvaginal sonography for diagnosing deep infiltrating endometriosis.Methods-A prospective study was conducted comprising 51 women (mean age, 32.9 years; range, 23-43 years) with suspected deep infiltrating endometriosis based on clinical symptoms. All women underwent extended transvaginal sonography, which included assessment of 2 pelvic compartments (anterior compartment: bladder and distal ureters; and posterior compartment: posterior vaginal fornix, retrocervical area, pouch of Douglas, and rectosigmoid). The sliding sign for detecting pouch of Douglas obliteration was also assessed. All patients received bowel preparation before sonographic examinations. A single examiner performed all examinations. All women underwent laparoscopic surgery, and histologic confirmation of endometriosis was done. The sensitivity, specificity, positive likelihood ratio (LR+) and negative likelihood ratio (LR-) were calculated.Results-Some women had more than 1 lesion, giving a total of 55 histologically confirmed lesions (rectosigmoid, n = 13; vagina, n = 5; retrocervical, n = 32; bladder, n = 5). The sensitivity, specificity, and LR+ for rectosigmoid involvement were 100%, 93%, and 14.0, respectively. The sensitivity, specificity, LR+, and LR-for vaginal involvement were 60%, 98%, 30.0, and 0.41. The sensitivity, specificity, LR+, and LR-for retrocervical involvement were 84%, 96%, 19.4, and 0.16. The sensitivity, specificity, and LR-for bladder involvement were 20%, 100%, and 0.80. The sensitivity, specificity, LR+, and LR-of the sliding sign for diagnosing pouch of Douglas obliteration were 89%, 92%, 10.7, and 0.12.Conclusions-Except for bladder involvement, extended transvaginal sonography has good diagnostic performance for deep infiltrating endometriosis.