Facts, Views & Vision
in ObGyn

Journal of the European Society for Gynaecological Endoscopy

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Optimizing the ultrasound visualization of the endometrial-myometrial junction (EMJ)

A. Votino1,2, T. Van den Bosch>1, A.J.F. Installé3,4, D. Van Schoubroeck1, J. Kaijser1, Y. Kacem2, B. De Moor3,4, C. Van Pachterbeke2, D. Timmerman1

1Department of Obstetrics and Gynaecology, University Hospitals KULeuven, Leuven, Belgium.
2Brugmann Departments of Obstetrics and Gynaecology, University Hospital Brugmann, Brussels, Belgium.
3KU Leuven, Department of Electrical Engineering ESAT, STADIUS Centre for Dynamical Systems, Signal Processing and Data Analytics, Leuven, Belgium.

4iMinds Medical IT, Leuven, Belgium

Correspondence at: thierryvandenbosch1901@gmail.com

Keywords:

Ultrasonography, uterus, endometrial-myometrial junction, volume contrast imaging (VCI), 3D ultrasound, adenomyosis


Published online: Mar 31 2015

Abstract

Objectives: The aim of this study was to find the best 3D reconstruction technique to visualize the endometrial-myometrial junction (EMJ).
Methods: Retrospective observational study on 240 stored 3D volumes of 80 patients. The first author reconstructed the 2D midcoronal image without volume contrast imaging (VCI), with VCI set at 4 mm and with VCI set at 2 mm. Three images per patient (240 images) were saved and integrated in the web-based electronic data capture software Clinical Data Miner (CDM) (http://cdm.esat.kuleuven.be). Five experienced gynaecologists analysed the images shown in random order. They scored the image quality (good, moderate, poor, insufficient) and described the EMJ of these images using IETA terminology (regular, irregular, interrupted, not defined). One of the examiners (CVP) also re-evaluated the same set of images after 12 days to assess intra-observer variability.
Results: The use of VCI significantly improved the recorded subjective image quality. The Fleiss‘ kappa coefficient for evaluating the inter-observer variability of the EMJ description using coronal view without VCI, with VCI at 4 mm and VCI at 2 mm were 0.36 ± 0.05, 0.34 ± 0.05 and 0.42 ± 0.05, respectively. The corresponding figures for the intra-observer variability were 0.58 ± 0.08, 0.36 ± 0.08 and 0.68 ± 0.07, respectively.
Discussion: In this study on 3D reconstructed coronal images of the uterine cavity, the 2 mm VCI slices gave the best quality images of the EMJ.