Evaluation of the cervix tissue homogeneity by ultrasound elastography in infertile women for the prediction of embryo transfer ease: a diagnostic accuracy study

Abstract

BackgroundUltrasound elastography is a non-invasive medical imaging technique able to quantitatively characterize the stiffness of a given tissue. It has been shown to predict the risk for cervical insufficiency and preterm delivery, and to allow differentiation of malignancy from normal tissue. The present study sought to evaluate whether cervical tissue dishomogeneity, as assessed by cervical ultrasound elastography, may predict the embryo transfer (ET) ease in infertile women undergoing IVF/ICSI.MethodsWe evaluated 154 infertile patients with no history of previous ET or intrauterine insemination. Cervical stiffness was evaluated in six regions of interest (ROI), compared two by two to obtain strain ratio (SR) values. Since a SR value of 1 was suggestive of tissue homogeneity, we computed 1-SR/SR-1 values to obtain a measure of the degree of cervical tissue dishomogeneity that we named “dishomogeneity index” (DI). Ultrasound-guided ET was performed by an expert operator blinded to the results of cervical elastography. The prediction ability of elastography on ET ease was evaluated by binary logistic regression, and the predictive accuracy of the independent variables was quantified with area under the curve (AUC) estimates derived from receiver operating characteristic (ROC) curve.ResultsET resulted to be easy in 99 out of 154 patients (64,2%), difficult in 54 patients (35%), and impossible in one. DI values in cervical medial lips region correctly classified 86.9% of patients, according to binary logistic regression, with a sensitivity of 81.4% and a specificity of 89,9%, positive likelihood ratio (LR) 8.07 and negative LR of 0.21. A DI cut-off value of 0.29 predicted a difficulty of ET with a sensitivity of 88,9% and a specificity of 85%.ConclusionsCervical ultrasound elastography, by allowing the identification of cervical tissue dishomogeneity, may be of help in predicting the ET ease in infertile women candidates to IVF/ICSI.

Effect of Stifle Flexion Angle on the Repeatability of Real-Time Elastosonography of the Patellar Ligament in Medium- to Large-Breed Dogs

“…Appropriate elastosonography image quality was confirmed by the absence of artifacts, when the elastogram and B-mode ultrasound images matched and a green spring was produced, representing a real-time feedback of accurate image acquisition as previously reported. 23,24 The elastosonography images were evaluated post-processing and the borders of the patellar ligament were manually drawn in the B-mode image, while being simultaneously copied onto the elastosonography image (►Fig. 2), thus making the visible portion of the patellar ligament the region or interest.…”

Diagnostic accuracy of cervical elastography in predicting preterm delivery

“…Recently, some physicians have used this new tool to assess cervical lesions. [13] Stanziano et al [14] found that cervical ultrasound elastography, by identifying cervical tissue inhomogeneity, may be helpful to predict embryo transfer ease in infertile women candidates to embryo transfer or intracytoplasmic sperm injection. Many radiologists or obstetricians have applied this technique to predict labor induction success.…”

Hysteroscopic cervical features associated with difficult embryo transfer in unselected patients undergoing in vitro fertilization

“…ET can be complicated by tortuosity and/or stenosis of the cervical canal. In contrast to OH, cervical ultrasound elastography is less effective in predicting the ease of ET [ 32 ], and our results suggested that ultrasound was less effective in predicting cervical lesions.…”