3–7 September 2006, London, UK Oral communication abstracts Conclusion: Ultrasound-guided polypectomy is comparable to hys- teroscopic resection in terms of success and safety. Ultrasound- guided procedure is likely to be more cost-effective due to shorter operating times and lower cost of consumables. OC117 Transvaginal ultrasound (TVUS) and sonohysterography (SHG) in the preoperative staging of submucous fibroids G. Serafini 1 , F. Prefumo 2 , L. Crocetti 2 , N. G. Gandolfo 1 , N. M. Gandolfo 1 1 Ospedale Santa Corona, Pietra Ligure, Italy, 2 Istituto Giannina Gaslini, Universit ` a di Genova, Italy Objectives: To assess the diagnostic accuracy of TVUS and SHG in the preoperative staging of submucous fibroids. Methods: Forty-eight women with submucous fibroids diagnosed on TVUS were assessed with SHG within 30 days from surgical treatment. Fibroids were staged according to the angle between the fibroid margins and the endometrium: G0, < 20 ◦ ; G1, 20–90 ◦ ; G2 > 90 ◦ . Results were compared with findings at operative hysteroscopy or on pathological examination of the uterus. Results: TVUS allowed staging of the fibroid in 18/48 cases (38%). SHG changed staging in 3 out of these 18 cases (17%). In those 30 women where TVUS did not allow staging of the fibroid, SHG was successful in 26. Overall, SHG was considered diagnostic in 44/48 cases (92%). In all of these 44, the accuracy of staging was confirmed. In 4 cases, SHG was considered non diagnostic due to technical difficulties in obtaining sufficient distension of the endometrial cavity. No patient experienced severe pain, vasovagal reactions or infection. Conclusion: SHG performs better than simple TVUS in the preoperative staging of submucous fibroids. SHG showed complete concordance with hysteroscopic and pathological findings. OC118 Use of sonovue for myoma embolization monitoring H. Marret , S. Sauget, A. Bleuzen, B. Giraudeau, D. Herbreteau, F. Tranquart Bretonneau University Hospital, France Objective: To investigate the usefulness of contrast-enhanced ultrasound with real-time imaging technique in the assessment of vascular patterns from myomas before and after uterine artery embolization. Methods: Before and after embolization, 38 patients with unique or multiple myomas were prospectively evaluated with sonography before and after injection of SonoVue (2.4 ml). Results: Enhancement patterns markedly vary among the patients from an absence of enhancement for the whole lesion to a complete (90%) and rapid enhancement (80%) after injection. Most of the time, the vessels surrounding the myoma appear first, followed by the normal myometrium and then by the whole lesion, living very often anechogenic zones corresponding to central necrosis of the myoma. Washout is typically complete after 3 minutes and helps us to identify some tiny myomas which are not visible on conventional sonography for a perfect matching with MRI detection. Secondly it is remarkable that most of the endometrium parts clearly demonstrate an early washout after contrast injection. After embolisation, all lesions presented an absence of enhancement when enhancement from the normal myometrium varied from absence to normal pattern. If embolization technique was the same for all patients particularly for the moment to end the particles injection, it was surprising to see the differences of myometrium microvascularization only 24 hours after the procedure. Conclusion: Contrast-enhanced ultrasound improves the detection of myomas as well as the follow-up under specific treatment like embolization. It will also help us to better understand the mechanism of success or failure for embolisation and maybe could reduce the amount of particles injected by determining the endpoint of the procedure in order to treat the myomas while preserving the myometrium. OC119 Gel Instillation, a new technique for Sonohysterography (G.I.S.) M. H. Emanuel 1 , N. Exalto 1 , L. A. M. van Raamsdonk 2 , K. ter Borg 3 1 Department of Obsetrics and Gynecology, Spaarne Hospital Hoofddorp, Netherlands, 2 Department of Clinical Pharmacology Spaarne Hospital Hoofddorp, Netherlands, 3 Technical University Delft, Netherlands Objective: To modify the technique of saline infusion sonohys- terography (SIS) in order to improve images and to overcome inconveniences and discomfort due to fluid leakage and pain. Material and Methods: Gel instillation sonohysterography (G.I.S.) was performed transvaginally (Aloka ProSound SSD 3500) as an office procedure on the 250 consecutive patients with an abnormal or inconclusive transvaginal ultrasound. A special application device was designed at an OB/GYN department of an university affiliated training hospital and an industrial design department of a technical university. A cheap and easy to handle device was developed with a back-flow valve and flexible cervical adaptation, preventing leakage of gel to the vagina. Instead of saline a sterile clear viscous gel containing hydroxyethyl cellulose and glycerine was used. These substances are well known for a long time and are considered safe for intracavitary use in the human body. Results: The ultrasonographic properties of the gel appeared comparable to saline. With a median of only 4 ml an optimal distension could be achieved (range 2–10 ml). Due to a much slower leakage velocity as compared to saline, ultrasonographic examination of the uterine cavity was possible for several minutes even after removal of the instillation device. This was of extreme importance in 3D-imaging. Conclusion: Gel instillation is an alternative for saline infusion and can be used effectively and safely for sonohysterography. GIS offers a more stable filling of the uterine cavity allowing better detailed 3D-examination without inconveniences for both patient and ultrasonographer. OC120 3D invert mode sonography versus 2D saline infusion sonohysterography in the diagnosis of endometrial anomalies G. Nazzaro , A. Stile, P. Laviscio, A. D’Ambra, G. De Placido, M. Locci University of Naples Federico II, Italy Objective: In this study we compared the diagnostic accuracy of two sonographic techniques, three dimensional (3D) sonographic inversion rendering mode, a 3D software able to invert anechoic into echogenic voxels, and bidimensional (2D) saline sonohysterography (SIS), in the diagnosis of endometrial anomalies (polyps, submucous fibroids, uterine malformations). Methods: 20 patients with previous diagnosis of endometrial anomaly at the 2D transvaginal sonography were referred to our department. All patients were submitted to 3D invert mode sonography during the midlutheal phase. Following, patients were submitted to 2D SIS. Diagnostic hysteroscopy was performed in all patients. Results: Ten endometrial polyps, five submucous fibroids, two partial uterine septa and three cases of arcuate uterus were easily recognized either by 3D sonography or 2D SIS. Diagnosis was hysteroscopically confirmed. Conclusion: Our study shows that the diagnostic accuracy of the 3D invert mode and of the 2D SIS in case endometrial anomalies Ultrasound in Obstetrics & Gynecology 2006; 28: 359–411 393