C. Exacoustos

University of Rome Tor Vergata, Roma, Latium, Italy

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Publications (149)313.72 Total impact

  • Danielle E Luciano, Caterina Exacoustos, Anthony A Luciano
    Journal of Minimally Invasive Gynecology 06/2014; · 1.61 Impact Factor
  • Caterina Exacoustos, Lucia Manganaro, Errico Zupi
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    ABSTRACT: Endometriosis affects between 5 and 45% of women in reproductive age, is associated with significant morbidity, and constitutes a major public health concern. The correct diagnosis is fundamental in defining the best treatment strategy for endometriosis. Therefore, non-invasive methods are required to obtain accurate diagnoses of the location and extent of endometriotic lesions. Transvaginal sonography and magnetic resonance imaging are used most frequently to identify and characterise lesions in endometriosis. Subjective impression by an experienced sonologist for identifying endometriomas by ultrasound showed a high accuracy. Adhesions can be evaluated by real-time dynamic transvaginal sonography, using the sliding sign technique, to determine whether the uterus and ovaries glide freely over the posterior and anterior organs and tissues. Diagnosis is difficult when ovarian endometriomas are absent and endometriosis causes adhesions and deep infiltrating nodules in the pelvic organs. Magnetic resonance imaging seems to be useful in diagnosing all locations of endometriosis, and its diagnostic accuracy is similar to those obtained using ultrasound. Transvaginal ultrasound has been proposed as first line-line imaging technique because it is well accepted and widely available. The main limitation of ultrasound concerns lesions located above the rectosigmoid junction owing to the limited field-of-view of the transvaginal approach and low accuracy in detecting upper bowel lesions by transabdominal ultrasound. A detailed non-invasive diagnosis of the extension in the pelvis of endometriosis can facilitate the choice of a safe and adequate surgical or medical treatment.
    Best practice & research. Clinical obstetrics & gynaecology. 05/2014;
  • Claudia Tosti, Errico Zupi, Caterina Exacoustos
    Women's health (London, England). 05/2014; 10(3):225-227.
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    ABSTRACT: To assess the accuracy of transvaginal sonography (TVS) in defining size and location of deep infiltrating endometriosis (DIE) with laparoscopic/histologic confirmation. Prospective observational study. University hospital. One hundred four women with suspected DIE on the basis of TVS. Patients with DIE underwent TVS evaluation before laparoscopic surgery. An accurate mapping of the extent of the disease was recorded during TVS and at laparoscopy. This new mapping system was developed to assess the extent of endometriosis by measuring the size and depth of the lesions at the various pelvic locations. Surgical and histologic confirmation of the ultrasonographic data to evaluate the presence and location of DIE and creation of a new mapping methodology for detecting DIE by TVS. Depending on the different location of the lesions, the accuracy of TVS ranged from 76%-97%. The lowest sensitivity (59%) and accuracy (76%) were obtained for TVS in the diagnosis of vaginal endometriosis, whereas the greatest accuracy (97%) was shown in detecting bladder lesions and Douglas obliteration. This new ultrasound mapping system is accurate for detecting the extent of DIE and may be useful for preoperative planning and intraoperative management of symptomatic patients with DIE.
    Fertility and sterility 04/2014; · 3.97 Impact Factor
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    ABSTRACT: Objectives:Deep infiltrating endometriosis (DIE) represents the most complex form of endometriosis and its treatment is still challenging. The coexistence of DIE with other appearances of endometriosis stimulates new studies to improve the preoperative diagnosis. Adenomyosis is a clinical form that shares several symptoms with DIE. The present study investigated the possible presence of adenomyosis in a group of women with DIE and its impact on pre- and postoperative symptoms.Materials and Methods:A group of women (n = 121) undergoing laparoscopic treatment for DIE were enrolled. Clinical and ultrasound evaluations were performed as preoperative assessment. The ultrasonographical appearances of DIE and of adenomyosis were recorded by 2-dimensional ultrasound. The following symptoms were considered: dysmenorrhea, dyspareunia, abnormal uterine bleeding, bowel, and urinary symptoms. Pain was evaluated by the visual analog scale system and menstrual bleeding was assessed by the use of the pictorial blood assessment chart. In a subgroup of women (n = 55), a follow-up evaluation (3-6 months after surgery) was done.Results:A relevant number of patients with DIE showed adenomyosis (n = 59; 48.7%); in this group, dysmenorrhea (P = .0019), dyspareunia (P = .0004), and abnormal uterine bleeding (P < .001) were statistically higher than that in the group with only DIE. After surgery, painful symptoms improved in the whole group but remained significantly higher (P < .001) in the group with adenomyosis.Conclusions:Deep infiltrating endometriosis is frequently associated with adenomyosis, significantly affecting pre- and postoperative symptoms and thus influencing the follow-up management.
    Reproductive sciences (Thousand Oaks, Calif.) 02/2014; · 2.31 Impact Factor
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    ABSTRACT: To describe the clinical history and ultrasound findings in women with decidualized endometriomas surgically removed during pregnancy. In this retrospective study, women with a histological diagnosis of decidualized endometrioma during pregnancy who had undergone preoperative ultrasound examination were identified from the databases of seven ultrasound centers. The ultrasound appearance of the tumors was described on the basis of ultrasound images, ultrasound reports and research protocols (when applicable) by one author from each centre using the terms and definitions of the International Ovarian Tumor Analysis (IOTA) group. In addition, two authors reviewed together available digital ultrasound images and used pattern recognition to describe the typical ultrasound appearance of decidualized endometriomas. Eighteen women were identified. Median age was 34 years, range 20-43. Median gestational age at surgical removal of the decidualized endometrioma was 18 weeks, range 11-41. Seventeen women (94%) were asymptomatic, one presented with pelvic pain. In three of the 18 women an ultrasound diagnosis of endometrioma had been made before pregnancy. The original ultrasound examiner was uncertain whether the mass was benign or malignant in ten (55%) women and suggested a diagnosis of benignity in nine (50%) women, borderline in eight women (44%), and invasive malignancy in one (6%) woman. All but one (17/18) decidualized endometrioma contained at papillary projection, and in all but one (16/17) at least one of the papillary projections was vascularized at power or color Doppler examination. The number of cyst locules varied between one (n = 11) and four. No woman had ascites. When using pattern recognition most decidualized endometriomas (14/17, 82%) were described as manifesting vascularized rounded papillary projections with a smooth contour in an ovarian cyst with one or a few cyst locules and ground glass or low level echogenicity of the cyst fluid. Rounded vascularized papillary projections with smooth contour within an ovarian cyst with cyst contents of ground glass or low level echogenicity are typical of surgically removed decidualized endometriomas in pregnant women most of whom are asymptomatic.
    Ultrasound in Obstetrics and Gynecology 02/2014; · 3.56 Impact Factor
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    ABSTRACT: A panel of 29 experts in the field of endometriosis express their opinion on management options regarding a 35 years old patient, currently not desiring pregnancy, with moderate pelvic pain, and with an ultrasonographic diagnosis of bilateral endometriomas. Many questions that this paradigmatic patient may pose to the clinician are addressed, and all clinical scenarios are discussed. A decision algorithm derived from this discussion is also proposed.
    Journal of Minimally Invasive Gynecology 01/2014; · 1.61 Impact Factor
  • Caterina Exacoustos, Lucia Manganaro, E. Zupi
    [Show abstract] [Hide abstract]
    ABSTRACT: Endometriosis affects between 5 and 45% of women in reproductive age, is associated with significant morbidity, and constitutes a major public health concern. The correct diagnosis is fundamental in defining the best treatment strategy for endometriosis. Therefore, non-invasive methods are required to obtain accurate diagnoses of the location and extent of endometriotic lesions. Transvaginal sonography and magnetic resonance imaging are used most frequently to identify and characterise lesions in endometriosis. Subjective impression by an experienced sonologist for identifying endometriomas by ultrasound showed a high accuracy. Adhesions can be evaluated by real-time dynamic transvaginal sonography, using the sliding sign technique, to determine whether the uterus and ovaries glide freely over the posterior and anterior organs and tissues. Diagnosis is difficult when ovarian endometriomas are absent and endometriosis causes adhesions and deep infiltrating nodules in the pelvic organs. Magnetic resonance imaging seems to be useful in diagnosing all locations of endometriosis, and its diagnostic accuracy is similar to those obtained using ultrasound. Transvaginal ultrasound has been proposed as first line-line imaging technique because it is well accepted and widely available. The main limitation of ultrasound concerns lesions located above the rectosigmoid junction owing to the limited field-of-view of the transvaginal approach and low accuracy in detecting upper bowel lesions by transabdominal ultrasound. A detailed non-invasive diagnosis of the extension in the pelvis of endometriosis can facilitate the choice of a safe and adequate surgical or medical treatment.
    Best Practice & Research Clinical Obstetrics & Gynaecology 2,01 Impact Factor. 01/2014;
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    ABSTRACT: INTRODUCTION: The uterine junctional zone (JZ) alterations are correlated with adenomyosis. An accurate evaluation of the JZ may be obtained by three-dimensional (3D) transvaginal sonography (TVS). The aim of the present prospective study was to assess the value of 3D TVS detectable alterations of the JZ in patients with pelvic endometriosis (diagnosed by laparoscopy and histology) and to compare these findings to those without pelvic endometriosis. Materials & methods: 82 patients scheduled for laparoscopy underwent prior surgery 2D and 3D TVS. Uterine multiplanar sections obtained by 3D TVS were used to evaluate JZ features. During laparoscopy an accurate staging of pelvic endometriosis was performed. JZ thickness and JZ alterations were correlated with stage of endometriosis. RESULTS: Of the 82 patients 59 patients had endometriosis at laparoscopy and histology. The maximum thickness of JZ (JZ max) in patients with endometriosis was significantly greater than in patients without endometriosis (6.5±1.9 vs 4.8±1.0mm p<0.001).The features of JZ appeared similar at different stages, whereas they are statistically different if correlated to patients without endometriosis. CONCLUSIONS: JZ thickness and its alterations are different in patients with endometriosis compared to those without endometriosis and are not correlated to ASRM stages. Since these JZ ultrasound features are mostly associated with adenomyosis, a correlation between endometriosis and JZ hyperplasia and adenomyosis could be hypothesized. Non invasive evaluation of the JZ may be useful in identifying those women affected by endometriosis also in early stage of the disease when there are no other sonographic signs of pelvic endometriosis.
    American journal of obstetrics and gynecology 06/2013; · 3.28 Impact Factor
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    ABSTRACT: Objective To evaluate the characteristics of the uterine junctional zone (JZ) by three-dimensional (3D) transvaginal sonography (TVS) in women with recurrent miscarriage (RM) as compared to normal fertile controls. Study design : The thickness and the morphology of the JZ were evaluated in 75 women with a history of RM due to different causes and in 20 fertile women without a history of miscarriages or pelvic disease. All patients included in the study were selected among those who attended the outpatient clinic of “Tor Vergata” University. The JZ characteristics were evaluated in the midluteal phase of the cycle on the uterine coronal section obtained by 3D TVS. Results Patients with RM showed a JZ maximum thickness significantly increased when compared to that observed in control group (5.8 ± 0.7 vs 5.0 ± 1.1 mm). When grouped according to the different causes of RM, all groups of patients with RM showed an increased JZ thickness when compared to fertile women, with the exception of those with anti-phospholipid antibody syndrome, probably due to the small number of cases with this pathology. Conclusions A thickened JZ could be an independent indicator of the risk of miscarriage and may represent an important contributing factor to some causes of RM. These observations may offer new perspectives for the screening and treatment of patients with RM. Although further studies are needed to ascertain if the reduction of the JZ thickness can determine a better pregnancy outcome, 3D TVS evaluation of the JZ could provide the opportunity to identify women in which appropriate therapeutic protocols can improve the possibility of successful pregnancy.
    European journal of obstetrics, gynecology, and reproductive biology 01/2013; · 1.97 Impact Factor
  • Ultrasound in Obstetrics and Gynecology 09/2012; 40(S1). · 3.56 Impact Factor
  • Ultrasound in Obstetrics and Gynecology 09/2012; 40(S1). · 3.56 Impact Factor
  • Ultrasound in Obstetrics and Gynecology 09/2012; 40(S1). · 3.56 Impact Factor
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    Ultrasound in Obstetrics and Gynecology 09/2012; 40(S1). · 3.56 Impact Factor
  • Ultrasound in Obstetrics and Gynecology 09/2012; 40(S1). · 3.56 Impact Factor
  • Ultrasound in Obstetrics and Gynecology 09/2012; 40(S1). · 3.56 Impact Factor
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    ABSTRACT: Objective: To evaluate the feasibility of transvaginal hystero-salpingo-contrast-sonography (TVS HyCoSy) with a new automated three dimensional coded contrast imaging software (3D CCI) (GE Healthcare, Zipf, Austria) in the evaluation of tubal patency and visualization of tubal course. Methods: Patients undergoing TVS HyCoSy with automated 3D CCI software were prospectively evaluated. First, to evaluate the feasibility of the 3D visualization of tubal course we did two consecutive volume acquisitions while injecting contrast agent (SonoVue, Bracco International, Amsterdam, The Netherlands). Then we performed a conventional 2D real time HyCoSy to confirm tubal status by detection of saline and air bubbles moving through the tube and around the ovaries. The visualization with CCI of the contrast agent around the ovaries, the side effects and pain during and after the procedure were also evaluated. Results: 126 patients (for a total of 252 tubes) underwent 3D CCI HyCoSy followed by 2D real time HyCoSy. After both procedures (3D and 2D evaluations), bilateral tubal patency was observed in 111 patients, bilateral tubal occlusion in 4 patients and unilateral tubal patency in 11 patients. Concordance rate for tubal status between first and second 3D volume acquisition and the final 2D real time evaluation was 84% and 97% respectively. A pain score >5 (0-10 VAS scale) was recorded in 58% of patients during procedure but a pain score ≤ 5 was recorded in 85.7 % of patients immediately after the procedure. Conclusions: TVS HyCoSy with automated 3D CCI technology retains the advantages of conventional 2D HyCoSy while overcoming the disadvantages. Automated 3D volume acquisition permits the visualization of the tubal course by creating images of the tubes on the coronal view and obtaining a volume, so the tubal course can be evaluated in space. This allows less experienced operators to easily evaluate the tubal course. Copyright © 2012 ISUOG. Published by John Wiley & Sons, Ltd.
    Ultrasound in Obstetrics and Gynecology 05/2012; · 3.56 Impact Factor
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    Ultrasound in Obstetrics and Gynecology 10/2011; 38(S1). · 3.56 Impact Factor
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    ABSTRACT: To correlate with histopathological features the adenomyosis-induced morphological alterations of the outer myometrium and the inner myometrium ('junctional zone', JZ) detectable on two- (2D) and three-dimensional (3D) transvaginal ultrasound imaging (TVS), and to evaluate their diagnostic accuracy for adenomyosis. Premenopausal patients scheduled for hysterectomy for benign pathology were enrolled in this prospective study. Before hysterectomy all patients underwent detailed 2D-TVS and 3D volume acquisition of the entire uterus. The major sonographic signs of adenomyosis were noted. On the multiplanar coronal and longitudinal views obtained by 3D-TVS we measured the maximum and minimum JZ thickness from the basal endometrium to the internal layer of the outer myometrium (JZmax, JZmin), the difference between them (JZdif = JZmax - JZmin) and the ratio JZmax/total maximum myometrial thickness. Results of these examinations were correlated blindly to the presence of adenomyosis on histological specimens. A total of 72 premenopausal patients underwent 2D- and 3D-TVS before hysterectomy. The histological prevalence of adenomyosis was 44.4% (32/72 patients). In diagnosing adenomyosis, the presence of myometrial cysts was the most specific 2D-TVS feature (specificity, 98%; accuracy, 78%) and heterogeneous myometrium was the most sensitive (sensitivity, 88%; accuracy, 75%). The 3D-TVS markers JZdif ≥ 4 mm and JZ infiltration and distortion had high sensitivity (88%) and the best accuracy (85% and 82%, respectively). For 2D-TVS and 3D-TVS, respectively, the overall accuracy for diagnosis of adenomyosis was 83% and 89%, the sensitivity was 75% and 91%, the specificity was 90% and 88%, the positive predictive value was 86% and 85% and the negative predictive value was 82% and 92%. The coronal section of the uterus obtained by 3D-TVS permits accurate evaluation and measurement of the JZ, and its alteration has good diagnostic accuracy for adenomyosis.
    Ultrasound in Obstetrics and Gynecology 04/2011; 37(4):471-9. · 3.56 Impact Factor
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    ABSTRACT: The objective of the study was to assess the accuracy of hysterosalpingo-contrast sonography (HyCoSy) in establishing tubal patency or blockage and evaluating the uterine cavity by comparing it with hysteroscopy laparoscopy (HLC) or hysterosalpingography (HSG). This study was a chart review evaluating infertility patients and patients who had undergone hysteroscopic sterilization who underwent both HyCoSy and HLC or HyCoSy and HSG at private offices associated with university hospitals. Sensitivity, specificity, positive predictive value, and negative predictive value of HyCoSy were calculated. HyCoSy compared with HLC had a sensitivity of 97% and specificity of 82%, and HyCoSy compared with HSG was 100% concordant. Uterine cavities evaluated by sonohysterography and hysteroscopy were 100% concordant. HyCoSy is accurate in determining tubal patency and evaluating the uterine cavity, suggesting it could supplant HSG not only as the first-line diagnostic test in an infertility workup but also in confirming tubal blockage after hysteroscopic sterilization.
    American journal of obstetrics and gynecology 01/2011; 204(1):79.e1-5. · 3.28 Impact Factor

Publication Stats

610 Citations
313.72 Total Impact Points

Institutions

  • 1996–2014
    • University of Rome Tor Vergata
      • Dipartimento di Biologia
      Roma, Latium, Italy
  • 1995–2012
    • Università degli Studi Europea di Roma
      Roma, Latium, Italy
  • 2010
    • Sapienza University of Rome
      • Department of Gynecology-Obstetrics & Urology
      Roma, Latium, Italy
  • 1988–1993
    • Catholic University of the Sacred Heart
      • • Institute of Clinical Obstetrics and Gynecology
      • • School of Obstetrics and Gynecology
      Milano, Lombardy, Italy
  • 1989
    • The Catholic University of America
      Washington, Washington, D.C., United States