Thierry Van den Bosch

• Universitair Ziekenhuis Leuven

Objective Adhesions between the uterus, bladder and anterior abdominal wall are associated with clinical sequelae, including chronic pelvic pain and dyspareunia, and can also yield complications during surgery. The transvaginal sonographic (TVS) sliding bladder sign is a minimally invasive diagnostic tool to evaluate the presence of vesicouterine a...

Objectives The reported prevalence of adenomyosis ranges widely due to different study populations, diagnostic tests and criteria. Categorizing the severity of disease may prove important. This study aims to develop a semi‐quantifiable sonographic method to grade the severity of adenomyosis and assess the feasibility and interobserver reliability o...

Introduction Imaging fibroid vascularity may predict fibroid growth and aid to determine most appropriate therapy. Microvascular (MV) flow imaging is relatively new and is able to detect slow flow in small vessels. Data on feasibility, reproducibility, and reliability of MV‐flow imaging in fibroids is lacking. The purpose of our study was to determ...

Objectives Adhesions between the uterus, bladder, and anterior abdominal wall are associated with chronic pelvic pain, infertility, and dyspareunia. The transvaginal sonographic (TVS) sliding bladder sign is a minimal invasive diagnostic tool to evaluate the presence of these adhesions. This study aims to determine the predictive value and intra- a...

Background: Uterine niches in the Caesarean section scar are seen in approximately half of women with a history of caesarean delivery. Whilst a structured ultrasound assessment of caesarean defects has been described, there is no consensus on a structured hysteroscopic evaluation. Objectives: To propose a methodology for a structured hysteroscopic...

The International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) and International Deep Endometriosis Analysis (IDEA) group, the European Endometriosis League (EEL), the European Society for Gynaecological Endoscopy (ESGE), ESHRE, the International Society for Gynecologic Endoscopy (ISGE), the American Association of Gynecologic Laparos...

Introduction: ultrasonography in the first trimester of pregnancy offers an early screening tool to identify high risk pregnancies. Artificial intelligence (AI) algorithms have the potential to improve the accuracy of diagnosis and assist the clinician in early risk stratification. Objective: to conduct a systematic review of the use of AI in ul...

Background Uterine fibroids are benign monoclonal tumors originating from the smooth muscle cells of the myometrium, constituting the most prevalent pathology within the female genital tract. Uterine sarcomas, although rare, still represent a diagnostic challenge and should be managed in centers with adequate expertise in gynecological oncology. Ob...

In this study, we conducted a comparative analysis of demographic, histopathological, and sonographic characteristics between pre- and postmenopausal women diagnosed with endometrial cancer, while also examining sonographic and anthropometric features in ‘low’ and ‘intermediate/high-risk’ cases, stratified by menopausal status. Our analysis, based...

Objectives: To estimate the ability of the International Endometrial Tumor Analysis (IETA)-1 polynomial regression model to estimate the risk of endometrial cancer and other intracavitary uterine pathology in women without abnormal uterine bleeding. Methods: This is a retrospective study, in which we validated the IETA-1 model on the IETA-3 stud...

Our aim was to compare the inter-rater agreement about transvaginal ultrasonography (TVS) with magnetic resonance imaging (MRI) with regard to diagnosing adenomyosis and for assessing various predefined imaging features of adenomyosis, in the same set of women. The study cohort included 51 women, prospectively, consecutively recruited based on a cl...

Our aim was to compare the inter-rater agreement of Transvaginal ultrasonography (TVS) with Magnetic Resonance Imaging (MRI) regarding diagnosing adenomyosis and for various predefined imaging features of adenomyosis in the same set of women. MRIs were assessed by four experienced radiologists and 2D TVS videoclips and 3D ultrasound volumes were as...

Importance: Approximately 60% of women develop a uterine niche after a cesarean delivery (CD). A niche is associated with various gynecological symptoms including abnormal uterine bleeding, pain, and infertility, but there is little consensus in the literature on the distinction between the sonographic finding of a niche and the constellation of a...

Objectives: To develop a model that can discriminate between different etiologies of abnormal uterine bleeding. Design: The International Endometrial Tumor Analysis (IETA) 1 study is a multicenter observational diagnostic study in 18 bleeding clinics in 9 countries. Consecutive women with abnormal vaginal bleeding presenting for ultrasound exami...

Objective To investigate the association between personal history, anthropometric features and lifestyle characteristics and endometrial malignancy in women with abnormal vaginal bleeding. Methods Prospective observational cohort assessed by descriptive and multivariable logistic regression analyses. Three features—age, body mass index (BMI; calcu...

Objective: To update the Morphological Uterus Sonographic Assessment (MUSA) definitions of adenomyosis if deemed necessary, and to reach consensus on the updated definitions METHODS: A modified Delphi procedure among European gynecologists with expertise in ultrasound diagnosis of adenomyosis was performed. To identify MUSA features that might nee...

Uterine disorders are often presented with overlapping symptoms. The microvasculature holds specific information important for diagnosing uterine disorders. Conventional sonography is an established diagnostic technique in gynecology, but is limited by its inability to image the microvasculature. Contrast-enhanced ultrasound (CEUS), is capable of i...

Objective To assess the safety, adequacy and accuracy of transvaginal ultrasound-guided tru-cut biopsy of pelvic masses. Methods We performed a retrospective analysis of consecutive women who underwent transvaginal ultrasound-guided tru-cut biopsies between June 2014 and October 2018 at the Department of Obstetrics and Gynecology of the University...

Objective To illustrate the obstetrical outcome after B-Lynch sutures and ligation of the uterine arteries. Case A 26-year-old nulliparous woman. A caesarean section performed for obstructed labour was complicated by uterine atony. A B-Lynch uterine compression suture technique was used combined with ligation of the ascending branches of the uteri...

Background Appendicitis is a frequent cause of abdominal pain. Symptoms may be atypical, and the appendix may not be visualised through abdominal ultrasonography. This case report illustrates the important role transvaginal ultrasound examination may have in the diagnostic workup of abdominal pain. Methods A case report focussing on imaging throug...

Uterine cancer is the most and second most common gynecological malignancy in developed and developing countries, respectively. The majority of endometrial cancers are diagnosed early due to the presence of abnormal uterine bleeding. The existing literature however contains only little data regarding the prevalence of such symptoms compared to pati...

Objectives To evaluate the diagnostic accuracy of transvaginal ultrasound (TVS) to predict overall deep endometriosis (DE) and DE locations by applying the IDEA terminology. Methods This was an international, multicentre prospective diagnostic accuracy study involving 9 centres across 6 countries (Aug 2018‐Nov 2019). Consecutive participants were...

STUDY QUESTION What recommendations can be provided to improve terminology for normal and ectopic pregnancy description on ultrasound? SUMMARY ANSWER The present ESHRE document provides 17 consensus recommendations on how to describe normally sited and different types of ectopic pregnancies on ultrasound. WHAT IS KNOWN ALREADY Current diagnostic...

Objective: To describe the ultrasound features of different endometrial and other intracavitary pathologies in pre- and postmenopausal women presenting with abnormal uterine bleeding using the International Endometrial Tumor Analysis (IETA) terminology. Methods: Prospective observational multicenter study of 2856 consecutive women presenting wit...

Background: To illustrate the technical feasibility and diagnostic value of including the assessment of the bladder and the ureters during a standard transvaginal ultrasound examination. Methods: We present four cases illustrating ureter and bladder pathology diagnosed by transvaginal ultrasound. Results: In a first case, transvaginal ultrason...

Gynaecological Ultrasound Scanning - by Kanna Jayaprakasan February 2020

Background: Adenomyosis is a benign uterine disorder where endometrial glands and stroma are pathologically demonstrated within the uterine myometrium. The pathogenesis involves sex steroid hormone abnormalities, inflammation, fibrosis and neuroangiogenesis, even though the proposed mechanisms are not fully understood. For many years, adenomyosis...

Purpose of review: Uterine cancer comprises endometrial carcinoma and the uterine sarcoma. Endometrial carcinomas are the most frequent variant and have early symptoms and a solid diagnostic work up, resulting in a rather fair prognosis. However, in case of advanced stage disease and relapse, treatment options are limited and prognosis is impaired...

Objectives: To develop a pre-operative risk model using endometrial biopsy results, clinical and ultrasound variables to predict the individual risk of lymph node metastases in women with endometrial cancer. Methods: A mixed effects logistic regression model was developed on 1501 prospectively included women with endometrial cancer subjected to...

Objectives: To describe clinical and ultrasound characteristics of urinary bladder malignancies diagnosed on transvaginal ultrasound in women presenting with suspected gynecological problems. Methods: This is a multicenter retrospective study of women with histological diagnosis of urinary bladder malignancy that was suspected on transvaginal ul...

Background: Possible transtubal spillage of malignant cells is a major concern in fluid instillation sonography, as it is in hysteroscopy. This study aims to compare the transtubal flow of gel and saline and validate the clinical hypothesis that application of fluids with higher viscosity causes less spillage. Methods: Randomized controlled in v...

Uterine sarcomas are rare but very aggressive. Uterine myomas, on the other hand, are the most common benign tumors of the uterus. Currently there is no diagnostic technique available to distinguish them with certainty. This study aimed to summarize the published literature concerning protein-based biomarkers in the peripheral blood that can assist...

This report describes a case of a uterine cystic myometrial lesion in a 16‐year‐old adolescent girl presenting with pelvic pain and severe progressively worsening dysmenorrhoea. Patient’s symptoms, ultrasound and MRI were suggestive of juvenile cystic adenomyosis (JCA). Medical treatment and alcohol sclerotherapy had a moderate and transient effect...

Objectives: To validate ultrasound measurements and subjective ultrasound assessment (SA) to detect deep myometrial invasion (MI), and cervical stromal invasion (CSI) in patients with endometrial cancer and to compare their performance between low and high-grade endometrial cancer, and to validate published prediction models to identify high-risk...

With interest we read the correspondence of Bamberg et al.1 and Scioscia et al.2 about the randomized controlled trial of the first authors concerning the uterine niche after caesarean section (CS).3 They state that at the time of the trial it was not established which technique should be used in the evaluation of a caesarean scar or niche in daily...

Objectives To evaluate the intra‐ and inter‐rater agreement for myometrial lesions using Morphologic Uterus Sonographic Assessment terminology. Methods Thirteen raters with high (n = 6) or medium experience (n = 7) assessed 30 3‐dimensional ultrasound clips with (n = 20) and without (n = 10) benign myometrial lesions. Myometrial lesions were repor...

Benign disease of the uterus include uterine fibroids, adenomyosis and endometrial polyps. These pathologies may remain asymptomatic or cause considerable morbidity. Ultrasonography plays a pivotal role in the diagnosis. The treatment is primarily surgical for polyps (operative hysteroscopy with polypectomy) and in selected cases of fibroids (hyste...

Objectives: The aim is to estimate agreement between two-dimensional transvaginal ultrasound (2D-TVS) and three-dimensional volume contrast imaging (3D-VCI) in diagnosing deep myometrial invasion (MI) and cervical stromal involvement (CSI) of endometrial cancer and to compare the two methods regarding inter-rater reliability and diagnostic accurac...

Objective: To develop a uniform classification and standardized reporting system of ultrasound findings of adenomyosis using the Morphological Uterus Sonographic Assessment (MUSA) criteria. Method: The opinion presented in this manuscript was built based on a thorough discussion among all authors, including a Delphi procedure. Selected images an...

Objectives: To generate a uniform, internationally recognized guideline for detailed uterine niche evaluation by ultrasonography in non-pregnant women using a modified Delphi method amongst international experts. Methods: Fifteen international gynecological experts were recruited by their membership of the European niche taskforce group. All exp...

Study question: What would be a potential impact of implementing the new ESHRE/European Society of Gynaecological Endoscopy (ESGE) female genital anomalies classification system on the management of women with previous diagnosis of arcuate uteri based on the modified American Society for Reproductive Medicine (ASRM) criteria? Summary answer: A s...

Transvaginal ultrasonography has become the primary test in the diagnosis of pelvic endometriosis and adenomyosis. A review of the literature on the diagnostic accuracy of ultrasonography in pelvic endometriosis and adenomyosis, as well as a comparison with magnetic resonance imaging, will be presented. Criteria for diagnosis of an endometrioma acc...

Die sonographische Untersuchung des Uterus gehört zu den am häufigsten durchgeführten Untersuchungen des gynäkologischen Alltags. Im Kinder- und Jugendlichenalter kann die Erkennung und korrekte Einordnung von genitalen Fehlbildungen von Bedeutung sein. In der Prämenopause steht die funktionelle Beurteilung des Endometriums und Myometriums im Vorde...

In 2015, the MUSA group published a consensus paper on how to report the myometrium and myometrial lesion at ultrasound examination. Myometrial lesions are mostly benign including fibroids and adenomyosis, while malignant myometrial lesions or sarcomas are rare.

Objectives: To assess interobserver reproducibility in detecting tubal ectopic pregnancies by reading data sets from 3-dimensional (3D) transvaginal ultrasonography (TVUS) and comparing it with real-time 2-dimensional (2D) TVUS. Methods: Images were initially classified as showing pregnancies of unknown location or tubal ectopic pregnancies on r...

This Consensus Opinion summarizes the main aspects of several techniques for performing ovarian antral follicle count (AFC), proposes a standardized report and provides recommendations for future research. AFC should be performed using a transvaginal ultrasound (US) probe with frequency ≥ 7 MHz. For training, we suggest a minimum of 20-40 supervise...

Adenomyosis and fibroids are the two most common myometrial lesions. Fibroids or leiomyomas are usually well-defined lesions consisting of myometrial tissue, while adenomyosis is defined as endometrial tissue within the myometrium (Figs. 5.1 and 5.2). Both lesions may affect fertility and pregnancy outcome by impairing myometrial contractility and...

Objectives: To describe the sonographic features of endometrial cancer in relation to stage, grade, and histological type using the International Endometrial Tumor Analysis (IETA) terminology. Methods: Prospective multicenter study on 1714 women with endometrial cancer undergoing a standardized transvaginal grayscale and Doppler ultrasound exami...

Objectives: To estimate intra- and inter-rater agreement and reliability with regard to describing ultrasound images of the endometrium using the International Endometrial Tumor Analysis (IETA) terminology. Methods: Four expert and four non-expert raters assessed video clips of transvaginal ultrasound examinations of the endometrium from 99 wome...

Objective: To compare ultrasonographic features of uterine lesions with the findings at macroscopy and microscopy. Methods: Case series of ten consecutive women undergoing a hysterectomy for uterine pathology. A preoperative transvaginal ultrasound examination was performed. After hysterectomy, the uterus was re-evaluated by 3D in vitro ultrason...