Introdução: A contagem de folículos antrais (AFC) tornou-se uma ferramenta importante na avaliação da reserva ovariana. Vários estudos têm demonstrado uma relação entre a contagem de folículos antrais por ecografia transvaginal 2D e o hormônio anti- Mülleriano. Poucos estudos têm sido feitos estudando o papel da ecografia transvaginal 3D SonoAVC, particularmente em mulheres inférteis. A contagem de folículos na ecografia 2D convencional, como é conhecida, tem limitações como a variabilidade intra e inter-observadores e o tempo gasto no exame no caso de múltiplos folículos. Com a contagem automatizada dos folículos fornecida pelo software 3D Sono AVC, o tempo gasto é menor e a variabilidade entre observadores pode ser diminuída ou eliminada. Objetivos: Avaliar a contagem de folículos antrais pela nova tecnologia 3DSonoAVC em mulheres inférteis e sua relação com a ecografia transvaginal 2D convencional e a dosagem sérica do hormônio anti-Mülleriano. Métodos: Estudo prospectivo transversal, onde avaliamos um grupo de 43 mulheres inférteis com idade entre 25 e 40 anos, coletados entre abril e setembro de 2015, em um centro de reprodução assistida privado em Porto Alegre, Rio Grande do Sul, Brasil. Os dados das pacientes incluíram a idade, o IMC e causa da infertilidade. No dia 3 do ciclo, os níveis séricos de AMH, FSH, CA 125, prolactina, TSH, E2, foram medidos e o número de folículos antrais (2-9) medidos pela ecografia. Foi realizada uma varredura ecográfica transvaginal com 3D SonoAVC e o 2D. Resultados: As medianas (amplitude de variação) dos níveis séricos de AMH, FSH, CA 125, prolactina, TSH, E2, foram 2,98 (0,02-15,8), 9,45 (5-9.4) 14,0 (6-35) 13,6 (5.2-29.4) 2,1 (0.61- 5,99) 46,2 (4,0-79), respectivamente, e a contagem de folículos antrais foi de 15,7 (3-35) com 2D e 17,0 (3-45) com o 3D. O tempo médio gasto para a realização da medição dos folículos pela ecografia 2D foi de 275 ±109 s e pelo 3DSonoAVC foi de 103 ± 57 s, (p<0.0005). A idade e a contagem de folículos pelo 2D tiveram um coeficiente de correlação negativo, r= -0,3 (p = 0,028). A idade e a contagem pelo 3D SonoAVC tiveram um r = - 0,29 (p = 0,031). A correlação de HAM com a contagem de folículos apresentou um coeficiente, r = 0,675 (p <0,01) com 2D e r = 0,659 (p <0,001) com o 3DSonoAVC. As duas contagens pelo 2D e 3D SonoAVC, mostraram uma correlação positiva forte, r = 0,983 (p <0,001). O volume ovariano correlacionado com o HAM mostrou um r = 0,510 (p <0,001). O volume do ovário se mostrou fortemente correlacionado com o número de folículos, r = 0,809 (p <0,01). Na avaliação dos folículos <6 mm e HAM, se identificou um r = 0,537 (p <0,001) com o 2D e r = 0,510 (p <0,001) com o 3D SonoAVC. Conclusão: O estudo sugere que existe uma forte correlação entre o 3D SonoAVC e o 2D na contagem de folículos antrais. A contagem dos folículos antrais por ambos os métodos foi positivamente correlacionada com os níveis séricos do hormônio anti- Mülleriano. O 3D SonoAVC se mostrou significativamente mais rápido que o 2D na contagem de folículos. / Introduction: The counting of antral follicles (AFC) has become an important tool in the assessment of ovarian reserve. Several studies have shown a relationship between the antral follicle count by conventional 2D transvaginal sonography and serum anti- Müllerian hormone. Few studies have been done studying the role of 3D SonoAVC technology, particularly in infertile women. The follicle count in the conventional 2D ultrasound, as known, has limitations as the intra- and inter-observer variability and increasing the time of performing the test in case of multiple follicles. With automated technology follicle count provided by the software 3DSono AVC, the time spent is less, and the variability between observers can be decreased or eliminated. Objectives: Evaluate the antral follicle count the new 3D technology (SonoAVC) in infertile women and its relationship with conventional 2D transvaginal ultrasound and serum anti-Müllerian hormone. Methods: This is a cross-sectional, prospective study, where they were evaluated a group of 43 infertile women aged less than 40 years, collected between April and September 2015 at a private fertility clinic in Porto Alegre, south Brazil. Patient data including age, BMI, cause of infertility. On cycle day 3, serum levels of AMH, FSH, CA 125, Prolactin, TSH, E2, were measured and the number of antral follicles (2-9 mm) estimated at ultrasound. Was performed a double scanning with transvaginal ultrasound 2D and 3D SonoAVC. Results: Median (range) serum levels of AMH, FSH, Ca 125, Prolactin, TSH, E2, were 2.98(0.02-15.8), 9.45(5-9.4)14.0(6-35)13.6(5.2-29.4)2.1(0.61-5.99)46,2(4.0-79), respectively, and antral follicle count was 15.7(3-35) with 2D and 17,0(3-45) with 3D. The average time taken to carry out the measurement of the follicles by 2D ultrasound was 275 ± 109 and the 3DSonoAVC was 103 ± 57 s., (p <0.0005). The age and the total count of follicles 2D had a negative correlation coefficient, r= -0.3 (p = 0.028). Age and 3D antral follicles count had r= -0.29 (p = 0.031).The dosage AMH was correlated with the total number of early antral follicles, r= 0.675 (p <0.01) with 2D and r=0.659 (p <0.001) with 3D. The two count, 2D and 3D SonoAVC, showed a strongly positive correlation, r=0.983 (p <0.001) Ovarian volume correlated with AMH dosage, r=0.510 (p <0.001). The ovarian volume is strongly correlated with follicle count, r=0.809 (p <0.01). In the evaluation of the follicles <6 mm and AMH, r=0.537 (p <0.001) in 2D and r= 0.510 (p <0.001) in 3D. Conclusion: The study suggests that there is a strong correlation between the 3D and 2D SonoAVC the antral follicle count. The counting of antral follicles by both methods was positively correlated with serum levels of anti-Müllerian hormone. 3D SonoAVC was significantly faster than in 2D follicle count.

Made available in DSpace on 2014-06-12T16:25:02Z (GMT). No. of bitstreams: 2 arquivo2066_1.pdf: 3090209 bytes, checksum: e0b760046ce4fa4fd2c09d83583976e3 (MD5) license.txt: 1748 bytes, checksum: 8a4605be74aa9ea9d79846c1fba20a33 (MD5) Previous issue date: 2008 / A fim de avaliar a repercussão da hipertensão porta nos índices de resistência arterial e na drenagem venosa ovariana e uterina, foram estudadas vinte portadoras de esquistossomose mansônica na forma hepatoesplênica submetidas à esplenectomia e ligadura da veia gástrica esquerda (grupo I) e um grupo similar de pacientes não submetidas à cirurgia (grupo II). Os parâmetros foram comparados com vinte voluntárias sadias (grupo III). Todos os grupos foram submetidos a um exame ultra-sonográfico transvaginal com Doppler colorido pelo mesmo observador, no 22º dia do ciclo menstrual (fase lútea média). O índice de resistência de Pourcelot foi usado como referencia (RI=S-D/S). Não houve diferença significante no que diz respeito às médias dos índices de resistência arterial ovariano entre os grupos. A média dos índices de resistência da artéria uterina direita foi significantemente maior no grupo II. Observou-se também uma tendência, no que diz respeito à artéria uterina esquerda. As médias dos calibres das veias ovarianas foram significantemente maiores nos grupos com a doença esquistossomótica (operadas ou não) quando comparadas com o controle. As pacientes operadas (grupo I) tiveram as médias dos calibres das veias uterinas significantemente maiores do que os outros grupos. Índices de resistência arterial significantemente mais baixos foram observados na periferia do corpo lúteo, quando comparados com as artérias ovarianas contra laterais. A média dos calibres das veias ovarianas foi significantemente maior no lado esquerdo do grupo II. Os resultados mostram que a irrigação arterial ovariana de portadoras de esquistossomose mansônica na forma hepatoesplênica é similar quando comparada com o grupo sadio. A hipertensão portal em portadoras de doença esquistossomótica na forma hepatoesplênica não altera o fenômeno natural do aumento de fluxo sangüíneo arterial no ovário onde ocorre a ovulação. A drenagem venosa ovariana é feita com maior dificuldade nas pacientes esquistossomóticas quando comparada com o controle. A estase venosa é significantemente maior nos ovários do lado esquerdo no grupo II. Na irrigação arterial uterina, os índices de resistência são significantemente mais altos no grupo II. Existe maior estase venosa uterina no grupo I, quando comparada com os outros grupos

The effects of energy balance on hormonal patterns and recovered oocytes were evaluated in 20 lactating Holstein cows during two trial periods (fall/spring). Cows were randomly selected and assigned to one of two dietary treatments formulated so that cows consumed 3.6% BW (HE- 1.78 mcal/kg; n=6 in fall, n=5 in spring) and 3.2% BW (LE-1.52 mcal/kg; n= 5 in fall, n=4 in spring). Body weight and body condition score (BCS) were recorded prior to parturition and weekly throughout the fall trial. Ultrasound guided transvaginal follicular aspirations were conducted twice weekly between d 30 and 100 of lactation. Follicle size and number were recorded. Follicular fluid (FF) was aspirated from the largest follicle, and serum samples were collected for hormone assay (IGF-1; estradiol (E2); progesterone (P4, serum ); LH and FSH). Oocytes were collected and graded based upon cumulus density and ooplasm homogeneity, then fertilized and cultured in vitro. Milk yield averaged 41.64 ± .3 kg/d (mean ± SE) for HE and 32.8 ± .3 kg/d for LE. There was a significant cubic day postpartum by treatment interaction for milk yield. Dry matter intake and BW treatment by week interactions were significant for the cubic and linear components, respectively. Oocyte numbers increased linearly from d 30 to 100 postpartum. HE cows produced more good + oocytes (1.5 ± .2 ) than LE cows (1.4 ± .1). Follicles less than or equal to 5 mm predominated throughout the study (6.4 ± 3.0). However, greater numbers of follicles 10 to 14 mm and greater than or equal to 15 mm were found in the fall (1.98 ± .08 and .50 ± .06) than spring (1.11 ± .3 and .23 ± .07). Follicular fluid IGF-1 was higher in HE (2.3 ± .2 ng/ml) than in LE cows (1.6 ± .2 ng/ml). Mean basal serum FSH concentration was lower at 28 d postpartum (173 ± 8 pg/ml) compared to later (521 ± 25 at d 60 and 650 ± 25 pg/ml at d 110). Serum P4 peaked at 35 d postpartum, with HE cows having 1 ng/ml higher P4 than LE cows. Low dietary energy reduced milk yield, DMI, BCS, FF IGF-1 and serum P4 and had a negative impact on oocyte quality. / Master of Science

The development of oocytes of differing quality retrieved using transvaginal follicular aspiration (TVFA) and following DNA injection was examined. Eight cows were subjected to twice weekly TVF A for 16 wk. Oocytes retrieved were graded and placed in an in-vitro maturation, fertilization and co-culture (IVMIIVFIIVC) program. Two thirds of oocytes were injected with DNA. Good quality oocytes from slaughtered cows (SH) were obtained once monthly and processed the same way. Good quality TVF A oocytes had a higher mean development score than poor quality oocytes, but not different from that of good quality SH oocytes. Good quality TVF A oocytes produced more viable embryos (31.7% blastocysts) than poor quality oocytes or SH oocytes (12.8% and 20.4% blastocysts, respectively). Embryo development following injection of DNA was the same for oocytes for each source-quality group (TVF A-good, 8.4; TVF A-poor, 5.5; SH-good, 6.3 % blastocysts). Development of good quality TVFA oocytes increased during the last 9 wk of the 16 wk collection period. Poor oocyte development increased slightly to 9 wk and then decreased. Development of TVF A oocytes injected with DNA did not vary during the experiment. However, development of controls increased from a mean score of2.50 at wk 1 to 4.17 at wk 16. Oocytes from TVFA produced more PCR positive blastocysts (95.0%) than SH oocytes (61.5%). More calves were born from the transfer of embryos injected with DNA from TVF A oocytes (3/5) than from SH oocytes (116), although not statistically significant. One calf was PCR positive in bone-marrow, but was negative in other tissues. The use of oocytes obtained by TVF A may improve the efficiency of producing transgenic cattle. / Master of Science

Made available in DSpace on 2016-01-26T12:51:37Z (GMT). No. of bitstreams: 1 gustavohenriquedeoliveira_dissert.pdf: 1016056 bytes, checksum: b6eb4d4fc07821695de5cff5b5d6909b (MD5) Previous issue date: 2010-12-09 / To evaluate the importance of cervical gland area (CGA) to predict spontaneous preterm birth (SPB). Method: A prospective study was performed from October 2008 to September 2009 of 102 singleton pregnancies at 20 and 24 weeks. A transvaginal ultrasound during the routine morphological scan investigated: the cervical length, CGA, its thickness and signs of cervical funneling. A preterm birth is defined as one that occurs at less than 37 weeks gestation. Ultrasound and clinical variables were submitted to univariate analysis by calculations of descriptive statistics, the Student t-test, percentages, and two-dimensional associative arrays evaluated using the Fisher exact test and odds ratio. The level of significance was set at 5%. Results: Of the 102 patients, four were lost in the follow up and seven were excluded as delivery was induced prematurely; ten patients presented spontaneous preterm births and 81 at term. The mean maternal age was 28.8 years old (18-41 years) without significant difference between the spontaneous preterm birth and term groups. There were statistical differences in the mean (33.9 vs. 36.1 cm), median (33.5 vs. 37.0 cm) and spread (standard deviation: 9.6 vs. 7.0) of the cervical length between the two groups. Risk factors for SPB gave an odds ratio of 15.06. All patients presented a CGA with a mean thickness of 8.4 mm (5.1 to 15 mm SD: 3.1) for SPB and 8.9 mm (3.0 to 13.9 mm SD: 2.3) for term individuals. Conclusion: The results suggest that the presence or absence and thickness of CGA are not correlated to SPB even in clinically or ultrasonographically high-risk patients. Further studies are necessary to reevaluate the parameters used to predict SPB. / Avaliar a importância do eco glandular endocervical (EGE) na predição de parto prematuro espontâneo (PPE). Método: Estudo prospectivo de 102 gestações únicas, entre 20-24 semanas, de outubro/2008 a setembro/2009. Na ecografia morfológica, o exame transvaginal avaliou: comprimento do colo uterino, EGE, espessura e sinal do afunilamento. Foi considerado PPE interrupção antes de 37 semanas de gestação. As avaliações ultrassonográfica e clínica foram submetidas à análise univariada pelos cálculos de estatísticas descritivas, teste t de Student, distribuições percentuais, tabelas associativas para análises bidimensionais, teste exato de Fisher e odds ratio no nível de significância de 5%. Resultados: Das 102 pacientes, quatro perderam seguimento, sete foram excluídas por parto prematuro induzido, dez pacientes apresentaram PPE e 81 parto a termo (PT). A idade materna média foi de 28,8 anos (18-41 anos), sem diferença nos dois grupos (PPE e PT). No comprimento do colo observaram-se diferenças na média (33,9 x 36,1 cm), mediana (33,5 x 37,0 cm) e na dispersão (desvio padrão 9,6 x 7,0). Fatores de risco para PPE mostraram odds ratio de 15,06. Todas as pacientes apresentaram EGE, com espessura média de 8,4 mm (5,1 a 15 mm - desvio padrão 3,1) para PPE, e de 8,9 mm (3,0 a 13,9 mm - desvio padrão de 2,3) para PT. Conclusão: Os resultados indicam que a presença, ausência ou espessura do EGE não se correlacionou com PPE, mesmo naquelas pacientes com alto risco clínico e/ou ultrassonográfico de PPE. São necessárias novas pesquisas para reavaliação dos parâmetros indicadores de PPE.

Conselho Nacional de Desenvolvimento Científico e Tecnológico / Este estudo teve como objetivo verificar, através de uma revisão sistemática de ensaios clínicos aleatorizados, os benefícios da estimulação elétrica funcional endovaginal ou dos tratamentos conservadores às pacientes com incontinência urinária de esforço, e demonstrar qual modalidade de tratamento conservador apresenta melhores resultados na terapêutica dessas mulheres: a estimulação elétrica funcional endovaginal, em comparação com os cones vaginais ou a realização de exercícios perineais. Para tanto, foram realizadas buscas nas principais bases de dados científicos, por estudos que atendessem a pergunta da pesquisa, tipo de intervenção e tipo de participantes selecionados. Destes, foram selecionados 7 estudos que foram submetidos à análise dos revisores, que avaliaram os seguintes desfechos: episódios de perda urinária, quantificação das perdas urinárias através do pad-test, força da musculatura perineal, qualidade de vida, volume residual, capacidade cistométrica máxima, melhora dos sintomas, satisfação e cura. Todas as terapias pesquisadas apresentaram melhora dos sintomas da incontinência urinária de esforço; no entanto, segundo os desfechos avaliados, apresentaram diferença no resultado comparativo. Quanto às perdas urinárias, ao pad-test e à força da musculatura perineal, a realização dos exercícios pélvicos obteve os melhores resultados. Já a terapia por estimulação elétrica endovaginal e a terapia com os cones apresentaram resultados semelhantes, não sendo encontrada diferença significativa em nenhum dos desfechos analisados. De acordo com os achados obtidos nesta revisão sistemática, entendemos que o tratamento pela estimulação elétrica traz benefícios às pacientes com incontinência urinária de esforço. Os exercícios pélvicos demonstraram ser a terapia que reduz mais significativamente os sintomas ocasionados por esta condição / This study aimed to verify, through a systematic review of randomized clinical trials, if the endovaginal functional electrical stimulation provides or not benefits to patients with stress urinary incontinence, and show what kind of conservative treatment produces better results in the treatment of these women: endovaginal functional electrical stimulation, vaginal cones or perineal exercises. To do so, we searched in major scientific databases for studies that met the research question, type of intervention and type of selected participants. Of these, seven studies were selected and analyzed by the reviewers who assessed the following outcomes: frequency of urinary leakage, quantification of urinary leakage through the pad-test, perineal muscle strength, quality of life, residual volume, maximum cystometric capacity, improvement, satisfaction and healing. All therapies surveyed showed improvement of symptoms of stress urinary incontinence; however, according to the outcome parameters, they showed differences in the comparative result. As for urinary leakage, the pad-test and strength of the perineal muscles, the pelvic exercises achieved the best results. The electrical stimulation therapy and transvaginal cone therapy showed similar results, no significant difference was found in any of the outcomes. According to the findings of this systematic review, we believe that treatment by electrical stimulation is beneficial to patients with stress urinary incontinence. The pelvic exercises have proven to be the therapy that more significantly reduces the symptoms caused by this condition

Conselho Nacional de Desenvolvimento Científico e Tecnológico / Este estudo teve como objetivo verificar, através de uma revisão sistemática de ensaios clínicos aleatorizados, os benefícios da estimulação elétrica funcional endovaginal ou dos tratamentos conservadores às pacientes com incontinência urinária de esforço, e demonstrar qual modalidade de tratamento conservador apresenta melhores resultados na terapêutica dessas mulheres: a estimulação elétrica funcional endovaginal, em comparação com os cones vaginais ou a realização de exercícios perineais. Para tanto, foram realizadas buscas nas principais bases de dados científicos, por estudos que atendessem a pergunta da pesquisa, tipo de intervenção e tipo de participantes selecionados. Destes, foram selecionados 7 estudos que foram submetidos à análise dos revisores, que avaliaram os seguintes desfechos: episódios de perda urinária, quantificação das perdas urinárias através do pad-test, força da musculatura perineal, qualidade de vida, volume residual, capacidade cistométrica máxima, melhora dos sintomas, satisfação e cura. Todas as terapias pesquisadas apresentaram melhora dos sintomas da incontinência urinária de esforço; no entanto, segundo os desfechos avaliados, apresentaram diferença no resultado comparativo. Quanto às perdas urinárias, ao pad-test e à força da musculatura perineal, a realização dos exercícios pélvicos obteve os melhores resultados. Já a terapia por estimulação elétrica endovaginal e a terapia com os cones apresentaram resultados semelhantes, não sendo encontrada diferença significativa em nenhum dos desfechos analisados. De acordo com os achados obtidos nesta revisão sistemática, entendemos que o tratamento pela estimulação elétrica traz benefícios às pacientes com incontinência urinária de esforço. Os exercícios pélvicos demonstraram ser a terapia que reduz mais significativamente os sintomas ocasionados por esta condição / This study aimed to verify, through a systematic review of randomized clinical trials, if the endovaginal functional electrical stimulation provides or not benefits to patients with stress urinary incontinence, and show what kind of conservative treatment produces better results in the treatment of these women: endovaginal functional electrical stimulation, vaginal cones or perineal exercises. To do so, we searched in major scientific databases for studies that met the research question, type of intervention and type of selected participants. Of these, seven studies were selected and analyzed by the reviewers who assessed the following outcomes: frequency of urinary leakage, quantification of urinary leakage through the pad-test, perineal muscle strength, quality of life, residual volume, maximum cystometric capacity, improvement, satisfaction and healing. All therapies surveyed showed improvement of symptoms of stress urinary incontinence; however, according to the outcome parameters, they showed differences in the comparative result. As for urinary leakage, the pad-test and strength of the perineal muscles, the pelvic exercises achieved the best results. The electrical stimulation therapy and transvaginal cone therapy showed similar results, no significant difference was found in any of the outcomes. According to the findings of this systematic review, we believe that treatment by electrical stimulation is beneficial to patients with stress urinary incontinence. The pelvic exercises have proven to be the therapy that more significantly reduces the symptoms caused by this condition

Objectives: Preoperative ultrasound including assessment of local extent of disease in uterus, adnexal involvement and pelvic spread is recommended staging examination in patients with endometrial cancer. It is routinely based on subjective assessment by experienced sonographists. The main aim of the study was to assess if the objective methods based on simple measurements and calculations have diagnostic performance comparable to that of subjective evaluation in detection of deep myometrial invasion. Two traditional objective techniques were tested - (1) deepest invasion / normal myometrium width ratio proposed by Gordon and (2) tumor / uterine anteroposterior diameter ratio introduced by Karlsson. Methods: The prospective diagnostic accuracy study was initiated at Gynecologic Oncology Centre. All consecutive patients with histologically verified endometrial cancer undergoing transvaginal or transrectal sonography using predefined study protocol followed by surgical staging procedure were prospectively enrolled . Local staging of each endometrial tumor was subjectively evaluated by one of experienced sonographists, myometrial invasion was assessed as deep (≥ 50 %) or superficial (˂ 50 %) and cervical stromal involvement as present or absent. Concurrently, the depth of myometrial invasion was...

Die vorzeitige Reifung der Zervix steht im engen Zusammenhang mit den komplexen Mechanismen der Frühgeburtlichkeit. Die transvaginalsonographische Evaluation der Zervix ermöglicht im Gegensatz zur digitalen Tastuntersuchung eine objektive Dokumentation des Befundes nach Visualisierung der Zervix. Dies gilt insbesondere für die exakte Messung der Zervixlänge und die Beurteilung des Os internum. Veränderungen wie eine Trichterbildung, ein Fruchtblasenprolaps oder eine (a)-symptomatische vorzeitige Zervixreifung können sichtbar gemacht und im Trend beurteilt werden. Die transvaginalsonographische Befunderhebung ist leicht erlernbar, objektiv und gut reproduzierbar. In ersten Teil der vorliegenden Arbeit wurde untersucht, in wieweit bei einem low-Risk Kollektiv vorzeitige Reifungszeichen der Zervix vor anderen Frühgeburtsmarkern zu beobachten sind. Die Zervixbeurteilung mit 22 oder 32 SSW konnte nicht als valider Frühgeburtsmarker für ein Screening im strikten low-Risk Kollektiv festgesetzt werden. Auch die rechtzeitige und sichere Diagnose einer drohenden Frühgeburt bei symptomatischen oder asymptomatischen Schwangeren mit vorzeitiger Zervixreifung ist bislang nicht verlässlich möglich. Im zweiten Teil dieser Arbeit wurde bei einem high-Risk Kollektiv von Patientinnen mit vorzeitigen Wehen und Zervixreifung die Aussagekraft der transvaginalsonographische Zervixbiometrie untersucht. Die Zervixbiometrie begründet sich auf der Tatsache, dass die Reifezeichen der Zervix, wie Verkürzung der Zervixlänge, Öffnung des inneren Muttermundes und Dilatation des Zervikalkanals, bei nahenden Geburtswehen unabhängig von der Schwangerschaftsdauer zunehmen. Nach diesen Ergebnissen kann der Einsatz der TVS zur frühzeitigen Erkennung einer drohenden Frühgeburt empfohlen werden. Ihr Nutzen liegt in der Identifizierung von symptomatischen und asymptomatischen Patientinnen mit hohem Frühgeburtsrisiko. Ihnen sollte eine Maximaltherapie angeboten werden. Auf der anderen Seite können Patientinnen erkannt werden, deren Frühgeburtsrisiko gering ist. Sie können ambulant betreut und engmaschig kontrolliert werden. Insbesondere bei Patientinnen mit blandem sonographischen Zervixbefund, die bereits ein höheres Gestationsalter erreicht haben, rechtfertigen die guten negativ prädiktiven Werte eine großzügigere ambulante und abwartetende Betreuung. Damit können die Ergebnisse der Studie zu allgemeingültigen Standards zur besseren Risikobeurteilung der symptomatischen Patientinnen beitragen. / The premature cervical ripening has a close connection with the complex mechanism of premature delivery. The transvaginal sonographic evaluation of the cervix enables, unlike the digital examination, an objective documentation of the evidence after visualisation of the cervix. This goes especially for the exact measurement of cervical length and the assessment of the internal os. Changes like funneling, prolapse of the amniotic sac or an (a-)symptomatic premature cervical ripening can be visualised and assessed. The transvaginal sonographic evaluation is easily learned, objective and well reproducible. In the first part of the paper it was examined how far in a low risk group premature ripening signs of the cervix can be observed before other premature delivery markers. The cervix assessment with 22 or 32 weeks of gestation could not be fixed as valid premature delivery marker for a screening in the strict low risk group. Also the timely and sure diagnosis of an imminent premature delivery in symptomatic and asymptomatic pregnant women with premature cervix ripening is not reliably possible until now. In the second part of this paper the meaningfulness of the transvaginal sonographic cervix biometry was examined in a high risk group of patients with premature labour pains and cervix ripening. The cervix biometry is based on the fact that the signs of cervix ripening as shortening of cervix length, opening of the internal os and dilatation of the cervix canal increase when delivery pains are approaching, regardless of the duration of pregnancy. According to these results the use of transvaginal sonography for the early detection of an imminent premature delivery can be recommended. Its benefit lies in the identification of symptomatic and asymptomatic patients with a high risk of premature delivery. A maximum therapy should be offered them. On the other side, patients with a low premature delivery risk can be recognized. They can be treated as an outpatient and controlled closely. Especially in patients with a moderate sonographic cervix result, who have already reached a higher gestational age the good negative predictive values justify a more generous ambulant and expectant care. Because of that, the results of the study can contribute to generally applicable standards for a better risk assessment of symptomatic patients.

Για τις Ευρωπαίες γυναίκες ο καρκίνος του σώματος της μήτρας αποτελεί το τέταρτο συχνότερο νεόπλασμα και την δέκατη σε σειρά αιτία θανάτου από καρκίνο. Ανεξάρτητα από το εάν η διακολπική υπερηχογραφία (TVS) αποτελεί δόκιμο μέσο διαλογής (screening) για την ανίχνευση ενδομητρικού καρκίνου σε ασυμπτωματικές μετεμμηνοπαυσιακές γυναίκες, εντούτοις κυριαρχεί στους διαγνωστικούς αλγόριθμους διερεύνησης κάθε μητρορραγίας προς αποκλεισμό του καρκίνου αυτού. Παράλληλα με τα πιθανά οφέλη από την ενσωμάτωση τεχνικών Υπερηχοϋστερογραφίας (SIS) και Doppler στην ενδομητρική απεικόνιση, η δισδιά- στατη “gray scale” διακολπική υπερηχογραφία οφείλει μεγάλο μέρος της προόδου της στην ώθηση από τις εξελίξεις της τεχνολογίας. Μετά την εισαγωγή των διακολπικών ηχοβολέων πολλαπλών συχνοτήτων (multifrequency) και της “αρμονικής” (harmonic) απεικόνισης, τα σύγχρονα υπερηχογραφικά μηχανήματα διαθέτουν επιλογές λογισμι- κού για ενίσχυση της ανάλυσης της αντίθεσης δομών, λεπτών ρυθμίσεων για εξέταση διαφορετικών τύπων ιστών, πολλαπλού εύρους εστίασης, μετάδοσης της δέσμης σε πλάγια διεύθυνση ως προς το ακουστικό παράθυρο, κ.α. Τα παραπάνω, καθώς και φίλτρα μείωσης του θορύβου βελτιστοποιούν την απεικόνιση του ενδομητρίου διευκολύνοντας την αποτίμησή του, ακόμη και στα χέρια άπειρων εξεταστών. Το πάχος της διπλής ενδομητρικής στιβάδας αποτελεί ιστορικά τον πλέον αδιαμφισβήτητο ποσοτικό δείκτη ενδομητρικού καρκίνου, ειδικά στην παρουσία μετεμμηνοπαυσιακής μητρορραγίας. Η συνδυασμένη μελέτη της ενδομητρικής μορφο- λογίας και πάχους παρέχει περισσότερες πληροφορίες, ειδικά στην αποτίμηση της “γκρίζας ζώνης” των 4-10 χιλιοστών ενδομητρικού πάχους, αν και τα ευρήματα των “μορφολογικών” αυτών μελετών δεν υπήρξαν πάντα σταθερά. Με δεδομένη τη σημασία της μορφολογίας στην αποτίμηση του ενδομητρικού ιστού, και αποσκοπώντας στην υπέρβαση του υποκειμενικού χαρακτήρα της ποιοτικής εκτίμησης της υπερηχογραφικής εικόνας, θα ήταν χρήσιμη η εφαρμογή αυτοματοποιημένων τεχνικών που αξιολογούν αντικειμενικά μορφολογικά χαρακτη- ριστικά, όπως η υποβοηθούμενη από υπολογιστή ανάλυση υφής, (“computerized texture analysis”). Στις ψηφιακές εικόνες, η υφή αντικατοπτρίζει τονικές (ένταση των εικονο- στοιχείων) και δομικές (χωρική κατανομή της έντασης των εικονοστοιχείων) ιδιότητες. Η “ανάλυση υφής” αναφέρεται σε αλγόριθμους που ποσοτικοποιούν περιεχόμενο και στοιχεία υφής που πιθανόν, ή όχι, να γίνονται αντιληπτά με το γυμνό μάτι. Δεδομένου ότι στην ιατρική απεικόνιση οι εικόνες περιλαμβάνουν πολλαπλές ιδιότητες των βιολογικών δομών, η ανάλυση υφής των εικόνων αυτών παρέχει ποσοτικές πληροφο- ρίες σχετικές με τα χαρακτηριστικά, τη μορφολογία και τις ιδιότητες των δομών αυτών. Σχήματα ταξινόμησης στηριζόμενα στην υφή έχουν χρησιμοποιηθεί με επιτυχία σε ποικιλία υπερηχογραφικών εφαρμογών. Η βασισμένη σε υπολογιστή αποτίμηση εικόνων του ενδομητρίου έχει βρει κυρίως εφαρμογή στη Υποβοηθούμενη Αναπαραγωγή, αλλά δεν έχει χρησιμοποιηθεί για τη διάγνωση ενδομητρικών κακοηθειών στην δισδιάστατη υπερηχογραφία. Σκοπός της διδακτορικής αυτής διατριβής είναι η αξιολόγηση του εφικτού της υποβοηθούμενης από υπολογιστή ανάλυσης υφής του ενδομητρικού ιστού όπως απεικονίζεται σε δισδιάστατες “gray scale” υπερηχογραφικές εικόνες. Περαιτέρω, διερευνήθηκε το αποτέλεσμα μιας τεχνικής επεξεργασίας βασισμένης σε μετασχη- ματισμό κυματίου (wavelet) στη διαδικασία τμηματοποίησης και χαρακτηρισμού του ενδομητρικού ιστού. / Cancer of the corpus uteri represents the fourth commonest neoplasm among European women and the tenth most common cause of death attributed to cancer. Irrespective whether the use of transvaginal ultrasonography (TVS) as a screening tool for detecting endometrial cancer in asymptomatic postmenopausal women is warranted, TVS dominates most diagnostic algorithms in assessing metrorrhagias to exclude this cancer. Alongside the potential benefits stemming from the integration of Saline Infusion Sonography) and Doppler modalities in endometrial imaging, gray scale TVS showed remarkable advances in the previous decades, largely attributed to the evolution in computer sciences. Following the introduction of multifrequency transvaginal probes and harmonic imaging, modern scanners are equipped with software options that enhance the resolution or the contrast between different structures, fine tune while assessing different types of tissue, implement different depth of focusing, transmit the ultrasonic beam in oblique directions to the acoustic window; all these features, in addition to de-speckle filters optimize the endometrial depiction, facilitating its assessment, even in the hands of moderately skilled operators. Double stripe endometrial thickness has illustrated a remarkable robustness over time as a quantitative indicator of endometrial cancer, especially in the presence of postmenopausal bleeding. The combined consideration of endometrial morphology and thickness has proven particularly beneficial, especially in the assessment of the 4-10 mm endometrial thickness “grey zone”, although the findings of the “morphologic” studies haven’t always been consistent. Given the importance of morphology in assessing endometrial tissue, and aiming to overcome the inherent subjectivity of the qualitative consideration of ultrasonic images, implementation of automated techniques assessing objective morphologic features such as “computerized texture analysis” would be beneficial. In digital images, texture reflects tonal (intensities of image pixels) and structural (spatial distribution of pixel intensities) properties. Texture analysis refers to algorithms that quantify texture content that may, or may not, be visually perceived. Since medical images capture various properties of biological structures, texture analysis of medical images can provide quantitative metrics relevant to structure, morphology and status of biological tissues. Texture based classification schemes have been successfully implemented in a variety of ultrasound applications. Computerized TVS assessment of endometrial morphology, has been applied mainly in assisted reproduction techniques; however, computerized texture analysis has not been implemented for diagnosing endometrial malignancies in grey scale TVS. The aim of this study is to investigate the feasibility of computerized texture analysis in characterizing endometrial tissue as depicted in 2D grey scale TVS images. Furthermore, we assess the effect of a wavelet-based image processing technique in the segmentation and subsequent characterization tasks of endometrial tissue.