M J Kudla

Medical University of Silesia in Katowice, Catowice, Silesian Voivodeship, Poland

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Publications (25)62.1 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: The aim of our study was to determine the agreement between two different methods for calculating the mean vascularization index (VI) of ovarian stroma using spatio-temporal image correlation-high definition flow (STIC-HDF) technology. Stored 4-D STIC-HDF volume data for ovaries of 34 premenopausal women were assessed retrospectively. We calculated the mean VI from the VI values derived for each 3-D volume within the STIC sequence. Then, the examiner subjectively selected the two volumes with the highest and lowest color signals, respectively. We averaged these two values. Agreement between VI measurements was estimated by calculating intra-class correlation coefficients. The intra-class correlation coefficient for the VI was 0.999 (95% confidence interval: 0.999-1.000). The mean time needed to calculate the mean VI using the entire 4-D STIC sequence was significantly longer than the mean time needed to calculate the average value from the volumes with the highest and lowest color signals determined by the operator (p < 0001). We conclude that there is significant agreement between the two methods. Calculating the average VI from the highest and lowest values is less time consuming than calculating the mean VI from the complete STIC sequence.
    Ultrasound in medicine & biology 08/2013; DOI:10.1016/j.ultrasmedbio.2013.05.010 · 2.10 Impact Factor
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    J L Alcázar, M J Kudla
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    ABSTRACT: To compare spatiotemporal image correlation-high definition flow (STIC-HDF) indices from spherical samples of ovary between women with polycystic ovary syndrome (PCOS) and normal women. This was a prospective case-control study of premenopausal women with a diagnosis of PCOS according to the Rotterdam criteria and of healthy, regularly menstruating, premenopausal women (controls) matched for age (< 35 years) and body mass index. Women were assessed in the follicular phase of the menstrual cycle by 4D STIC-HDF transvaginal ultrasound. Based on 1-cm(3) spherical sampling, we calculated for each woman the vascularization index (VI) for the most vascularized part of the ovarian stroma in all three-dimensional volumes of the 4D STIC-HDF sequence. The maximum (VI(sys) ) and minimum (VI(diast) ) values were assumed to represent systole and diastole, respectively, and the mean VI for all frames from one cardiac cycle was calculated. Based on these three VI values, we calculated the following indices: volumetric systolic/diastolic ratio (vS/D), volumetric resistance index (vRI) and volumetric pulsatility index (vPI), and compared them between study and control groups. The study included 32 PCOS women (mean age, 29.6 years) and 32 controls (mean age, 30.4 years). Mean VI(sys) (26.246% vs 8.136%, P < 0.0001) and mean VI(diast) (22.242% vs 5.997%, P < 0.0001) were significantly higher in PCOS women compared with controls. Median vS/D (1.15 vs 1.33, P < 0.001), mean vRI (0.17 vs 0.30, P < 0.001) and median vPI (0.14 vs 0.28, P < 0.001) were significantly lower in PCOS women compared with controls. 4D STIC-HDF indices from 1-cm(3) spherical samples of the ovaries were different between PCOS women and controls, suggesting lower impedance to flow in ovarian stromal vessels in PCOS women. Copyright © 2012 ISUOG. Published by John Wiley & Sons, Ltd.
    Ultrasound in Obstetrics and Gynecology 10/2012; 40(4):470-5. DOI:10.1002/uog.11187 · 3.14 Impact Factor
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    M. J. Kudla, J. Alcazar
    Ultrasound in Obstetrics and Gynecology 09/2012; 40(S1). DOI:10.1002/uog.11261 · 3.14 Impact Factor
  • Marek J Kudla, Juan Luis Alcázar
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    ABSTRACT: To describe and assess the interobserver reproducibility of a new method for evaluation of ovarian vascularization using spatiotemporal image correlation-high definition flow (STIC-HDF). Stored 4-dimensional (4D) STIC-HDF volume data from 39 healthy pre-menopausal fertile women (aged <35 years) examined in the follicular part of the menstrual cycle by transvaginal sonography were assessed by two different examiners blinded from each other (one in Spain the other in Poland). Using 1-cm(3) spherical sampling, the vascularization index (VI) from the most vascularized part of the ovarian stroma was calculated at two different moments of the cardiac cycle (systole and diastole). System settings were kept constant for all patients (pulse repetition frequency, 0.6 kHz; gain, 0.2) with a depth of 40 mm. Analysis was performed offline using 4D software on a personal computer. On the basis of VI and vascularization-flow index (VFI) values during systole and diastole, 4 new 4D indices were defined: 4D systolic/diastolic volumetric index (4D-SDVI = VI(syst)/VI(diast)), 4D hemodynamic volumetric index (4D-HVI = [VI(syst) + VI(diast)]/[VI(syst) - VI(diast)]), 4D systolic/diastolic vascularization-flow index (4D-SDVFI = VFI(syst)/VFI(diast)), and 4D hemodynamic vascularization-flow index (4D-HVFI = [VFI(syst) + VFI(diast)]/[VFI(syst)- VFI(diast)]). Reproducibility of measurements was estimated by calculating the intraclass correlation coefficient (ICC). The systolic VI, diastolic VI, 4D-SDVI, 4D-HVI, systolic VFI, diastolic VFI, and 4D-HVFI showed good reproducibility (ICC, 0.992, 0.994, 0.879, 0.915, 0.995, 0.995, and 0.893, respectively). The 4D-SDVFI showed moderate reproducibility (ICC, 0.797). We describe 4 new 4D vascular indices for assessing tissue vascularization using STIC-HDF technology. Assessment of ovarian vascularization using this STIC-HDF spherical sampling is reliable. The calculation of these new indices is reproducible between two different examiners.
    Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine 01/2012; 31(1):73-80. · 1.53 Impact Factor
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    J. Alcazar, M. J. Kudla
    Ultrasound in Obstetrics and Gynecology 10/2011; 38(S1). DOI:10.1002/uog.9975 · 3.14 Impact Factor
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    M. J. Kudla, J. Alcazar
    Ultrasound in Obstetrics and Gynecology 10/2011; 38(S1). DOI:10.1002/uog.9436 · 3.14 Impact Factor
  • Marek J Kudla, Juan Luis Alcázar
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    ABSTRACT: The purpose of this study was to describe a new method for assessing ovarian vascularization using spatiotemporal image correlation (STIC)-high-definition flow (HDF). Thirty healthy premenopausal fertile women were assessed in the follicular part of the menstrual cycle by transvaginal sonography. A 4-dimensional STIC-HDF volume was obtained from the nondominant ovary to assess 3-dimensional (3D) vascular indices (vascularization index [VI] and flow index [FI]) during one cardiac cycle in each women. Using 1-cm(3) spherical sampling, we calculated the VI and FI from the most vascularized part of the ovarian stroma at two different moments of the cardiac cycle (systole and diastole). System settings were kept constant for all of the patients (pulse repetition frequency, 0.9 kHz; gain, 0.8; and depth, 40 mm). We calculated the VI and FI ratios between systole and diastole. The mean VI during systole (11.485%; SD, 6.7%) was significantly higher than during diastole (8.653%; SD, 5.6%; P < .0001). The mean FI values during systole (47.799 [unitless]; SD, 5.8) and diastole (47.791; SD, 6.0) were nearly identical (P = .993). The VI ratio was 1.35 (95% confidence interval, 1.28-1.42), which means that the mean VI was 35% higher during systole compared to diastole, whereas the FI during systole and diastole remained constant (FI ratio, 1.00; 95% confidence interval, 0.96-1.04). There was a high correlation between VI values during systole and diastole (r(2) = 0.94), whereas this correlation was weaker for the FI (r(2) = 0.45). The STIC-HDF method allows assessment of 3D vascular indices throughout the cardiac cycle. Vascularization index calculation is affected by the moment of the cardiac cycle during which the measurement is taken. However, it seems that FI calculation is not affected by the cardiac cycle in the normal nondominant ovary.
    Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine 10/2010; 29(10):1469-74. · 1.53 Impact Factor
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    M J Kudla, J Alcazar
    Ultrasound in Obstetrics and Gynecology 10/2010; 36(S1):98. DOI:10.1002/uog.8073 · 3.14 Impact Factor
  • Juan Luis Alcázar, Marek J Kudla
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    ABSTRACT: The purpose of this study was to determine whether there are differences in 3-dimensional (3D) vascular indices when calculated using high-definition flow imaging (HDF) and power Doppler imaging (PD). Twenty-five consecutive asymptomatic premenopausal women (mean age, 31 years; range, 28-33 years) without a history of gynecologic disease who attended routine gynecologic checkups were included in the study. All women had regular menstrual cycles, and none had uterine or myometrial disease detected on basal transvaginal sonography. All women underwent 3D transvaginal sonography. In each patient, a first volume using conventional PD was obtained, immediately followed by a second volume using HDF. Volumes were stored and subsequently analyzed for calculating 3D vascular indices (vascularization index [VI], flow index [FI], and vascularization-flow index [VFI]) from the endometrium. The median VI, FI, and VFI were significantly higher when calculated using HDF compared with conventional PD (P < .05). Three-dimensional vascular indices calculated using HDF are higher than those calculated using conventional PD.
    Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine 05/2010; 29(5):761-6. · 1.53 Impact Factor
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    M J Kudla, J L Alcázar
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    ABSTRACT: To assess whether, when using spherical sampling with Virtual Organ Computer-Aided Analysis (VOCAL) for calculating three-dimensional (3D) power Doppler angiography (PDA) indices, the sphere volume affects performance in the prediction of malignancy in vascularized cystic-solid or solid adnexal masses. One hundred and thirty-eight women (mean +/- SD age, 51.8 +/- 14.1 years) diagnosed as having vascularized cystic-solid or solid adnexal masses on B-mode and two-dimensional (2D) power Doppler ultrasound were evaluated by 3D-PDA prior to surgery. Five women had bilateral masses, giving a total number of 143 masses analyzed. Vascularization was assessed using VOCAL software. 3D-PDA vascular indices (vascularization index (VI), flow index (FI) and vascularization flow index (VFI)) from the most vascularized area within papillary projections and solid areas were calculated automatically using spherical sampling. Five different volumes of sphere were used (1 cm(3), 2 cm(3), 3 cm(3), 4 cm(3) and 5 cm(3)) in each case. A definitive histological diagnosis was obtained in each case after surgical tumor removal. One hundred and seventeen (82%) masses were malignant and 26 (18%) were benign. Morphological evaluation revealed 34 (24%) unilocular solid masses, 49 (34%) multilocular solid masses and 60 (42%) mostly solid masses. The 1-cm(3) sphere could be used in 100% of the cases, the 2-cm(3) sphere could be used in 98.2% of the cases and the 3-5-cm(3) spheres could be used in 97.2% of the cases. The median VI, FI and VFI for all sphere volumes were significantly higher in malignant compared with non-malignant tumors. Receiver-operating characteristics curve analysis showed that VI and VFI, independently of sphere volume, were better predictors of malignancy than was FI. The best cut-off values for the 3D-PDA indices differed depending on sphere volume. VI was significantly more specific than were VFI and FI. Sphere volume does not affect the performance of 3D-PDA. We recommend the use of different cut-off values for 3D-PDA indices for discriminating between benign and malignant adnexal masses, depending on the sphere volume used. Use of VI is preferable due to its higher specificity.
    Ultrasound in Obstetrics and Gynecology 05/2010; 35(5):602-8. DOI:10.1002/uog.7601 · 3.14 Impact Factor
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    Marek J Kudla, Dirk Timmerman
    Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine 02/2010; 29(2):317-9. · 1.53 Impact Factor
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    M Kudla, J L Alcázar
    Ultrasound in Obstetrics and Gynecology 12/2009; 34(6):732-4. DOI:10.1002/uog.7462 · 3.14 Impact Factor
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    J Alcazar, M J Kudla
    Ultrasound in Obstetrics and Gynecology 09/2009; 34(S1):44. DOI:10.1002/uog.6592 · 3.14 Impact Factor
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    J Alcazar, M J Kudla
    Ultrasound in Obstetrics and Gynecology 09/2009; 34(S1):231. DOI:10.1002/uog.7198 · 3.14 Impact Factor
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    Ultrasound in Obstetrics and Gynecology 09/2009; 34(S1):49. DOI:10.1002/uog.6608 · 3.14 Impact Factor
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    M J Kudla, J Alcazar
    Ultrasound in Obstetrics and Gynecology 09/2009; 34(S1):261. DOI:10.1002/uog.7301 · 3.14 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The purpose of this study was to assess the vascular indices generated by 3-dimensional (3D) power Doppler angiography by evaluating the cyclic changes in the vascularity of normal ovaries, including those that were ovulating, nonovulating, and hormonally suppressed. In this prospective longitudinal observational study, a cohort of premenopausal regularly menstruating women with no known ovarian disease underwent 3D power Doppler imaging every 2 to 3 days for the duration of 1 menstrual cycle. Four indices were generated: vascularization index (VI), flow index (FI), vascularization-flow index (VFI), and mean grayness. Comparisons of vascularity were made between ovulating, nonovulating, and hormonally suppressed ovaries. Normal ranges were established and graphed longitudinally. Eighteen participants (36 ovaries) ages 28 to 45 years underwent an average of 10 examinations, yielding 368 acquired ovarian volumes for analysis. Seven participants used hormonal contraception. The VI, FI, and VFI were closely correlated (Pearson product moment correlation coefficients, 0.52-0.95). The vascular indices of ovulating ovaries were significantly higher than those of nonovulating ovaries (VI, FI, and VFI, all P < .001), with the largest discrepancies during the luteal phase. Hormonally suppressed ovaries had significantly lower vascularity throughout the cycle (VI, P < .002; FI, P < .001; VFI, P < .007). The vascular indices of all groups appeared to drop during the late follicular period and then rise again. The VI would suffice as the principal vascular parameter for 3D power Doppler analysis. Preovulatory scans may be more useful for distinguishing pathologic vascularization. Hormonally suppressed ovaries have significantly lower vascularity throughout the cycle. Normal-appearing ovaries with vascular indices above the normal ranges established by these data may warrant further investigation.
    Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine 08/2009; 28(8):1043-52. · 1.53 Impact Factor
  • Marek Kudla, Juan Luis Alcazar
    01/2009; DOI:10.5005/jp-journals-10009-1008
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    ABSTRACT: An epithelial ovarian cancer cell line constitutively expressing the androgen receptor was created to evaluate the mechanism and effects of androgen receptor activation on epithelial ovarian cancer cell invasion. Immunocytochemistry and Western blot analyses confirmed androgen receptor expression. Boyden chamber invasion assays were performed using cells treated with the androgen receptor ligands medroxyprogesterone acetate or dihydrotestosterone. The matrix metalloproteinases associated with invasion were investigated using zymographic assays. Androgen receptor-mediated invasion is ligand dependent. While both medroxyprogesterone acetate and dihydrotestosterone signal through androgen receptor, medroxyprogesterone acetate is more effective at stimulating invasion of epithelial ovarian cancer cells. Unlike the wild-type epithelial ovarian cancer cells, this increase in invasion in androgen receptor + epithelial ovarian cancer cells does not seem to be dependent on matrix metalloproteinase 2 or 9 activation. Although classified as a progestin, medroxyprogesterone acetate has significant androgenic activity unique from the pure androgen dihydrotestosterone. Our studies suggest that pharmacologic doses of medroxyprogesterone acetate may actually increase the invasive potential of epithelial ovarian cancer cells.
    Reproductive sciences (Thousand Oaks, Calif.) 11/2008; 15(8):846-52. DOI:10.1177/1933719108323446 · 2.18 Impact Factor
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    Ultrasound in Obstetrics and Gynecology 08/2008; 32(3):369-369. DOI:10.1002/uog.5803 · 3.14 Impact Factor

Publication Stats

63 Citations
62.10 Total Impact Points

Institutions

  • 2007–2013
    • Medical University of Silesia in Katowice
      • Department of Obstetrics and Gynecology
      Catowice, Silesian Voivodeship, Poland
    • Silesian University of Technology
      Gleiwitz, Silesian Voivodeship, Poland
  • 2009–2012
    • University of Silesia in Katowice
      Catowice, Silesian Voivodeship, Poland
  • 2010
    • Clínica Universidad de Navarra
      Madrid, Madrid, Spain