17th World Congress on Ultrasound in Obstetrics and Gynecology Oral poster abstracts order to counsel patients for a new pregnancy or planning a second metroplasty. OP11.06 The role of Contrast-HyCoSy for tubal patency in an infertility program C. Lanzani , F. P. G. Leone, V. Savasi, T. Bignardi, M. Ratti, A. Crepaldi, E. Ferrazzi Department of Obstetrics and Gynecology, DSC L. Sacco, University of Milan, Italy Objectives: To compare the efficacy of multi-step hysterosalpingo contrast sonographic (HyCoSy)-based triage for the assessment of tubal patency with X-ray hysterosalpingography (HSG) and laparoscopy (LPS) in an outpatient office infertility program. Methods: Infertile patients are routinely examined by HyCoSy during the proliferative phase to asses tubal patency. The first step was based on a 2D-HyCoSy using saline mixed with air. If tubal patency was doubtful, patients underwent a 2D-HyCoSy using Sonovue (Bracco Diagnostics, Inc.) as contrast media and Contrast-Tuned Imaging. In doubtful cases this second procedure was performed during the same examination with the same catheter (8Fr–Nelaton). These cases underwent as confirmative test either HSG or LPS. Sensitivity and specificity of this multi-step HyCoSy compared to HSG and LPS was calculated by statistical analysis. Results: In 68 patients tubal patency was assessed at saline–air HyCoSy (69%). We report the results of this multi-step HyCoSy in the remaining 30 doubtful cases (59 tubes) compared to HSG (34 tubes)–LPS (25 tubes) (Table). The six discordant occluded tubes proved patent at LPS, similarly the one discordant patent at HyCoSy was found occluded at LPS. Therefore sensitivity and specificity of contrast-HyCoSy when compared to HSG were both 100%. Sensitivity and specificity at LPS were 87% and 60%, respectively. Contrast HyCoSy vs HSG–LPS Patent Occluded Patent 32 1 Occluded 6 17 Not able to examine 2 1 Conclusions: According to our results a multi-step sonographic- based triage for the evaluation of tubal patency could replace HSG in the vast majority of cases. The first-step usage of air – saline reduces the costs of the triage. A prudent use of LPS could be indicated in doubtful cases when tubes are found to be occluded on contrast HyCoSy or based on other clinical factors. OP11.07 Transvaginal sonographic mapping of pelvic adhesions in women with chronic pelvic pain M. E. Romanini , G. Larciprete, A. Amadio, E. Bertonotti, C. Amoroso, C. Exacoustos, D. Arduini ‘‘Tor Vergata’’ University, Rome, Italy Objectives: To compare transvaginal sonography (TVS) with laparoscopy in the diagnosis of pelvic adhesions in patients with chronic pelvic pain (CPP). Methods: Twenty-two patients with CPP underwent TVS up to 7 days prior to laparoscopic surgery. An accurate mapping of adhesions was performed at sonographic examination and during laparoscopy. The mapping was based on a detailed list of locations which described the adhesions in terms of presence or absence on different sides of the ovaries and the uterus, and in the pouch of Douglas, on the bladder, rectum, bowels and utero-sacral and broad ligaments. Adhesions were evaluated by TVS with abdominal palpation and by the visualization of thin septa between organs. The laparoscopist was blind to the result of TVS adhesions mapping and performed during surgery an accurate description of the site of pelvic adhesions. Furthermore the site of adhesions was correlated with the type of pain referred by the patients (dyspaurenia, urinary urgency, back pain, dyschezia, etc). Results: A correlation between TVS and laparoscopic findings was found. The concordance rates for ovarian adhesions with the uterus and the broad ligament were, respectively, 90% and 89%. Also for uterine adhesions within the peritoneum or the pouch of Douglas the diagnostic concordance was high (91%). Bowel adhesions to the ovaries or uterus can be suspected by the fixation and tenderness during palpation of the tissue surrounding the uterus and ovaries. Filmy adhesions between bowels and peritoneum were often overlooked, sensitivity being 34%. Conclusions: Non-invasive adhesion mapping by TVS in patients with CPP helps to explain the type of pain also. OP11.08 Transvaginal ultrasound versus magnetic resonance in the study of under-diagnosed endometriosis: adenomyosis and deep endometriosis F. Cammilli, F. Rizzello , E. Castellacci, C. Riviello, M. E. Coccia Dipartimento di Ginecologia, Perinatologia e Riproduzione Umana, Universit ` a degli studi di Firenze, Italy Objectives: To evaluate the accuracy of TVS vs. magnetic resonance imaging (MRI) for the diagnosis of adenomyosis and recto-vaginal endometriosis. Methods: Twelve patients with adenomyosis and 20 with endometriosis of the recto-vaginal septum were selected and followed by TVS and MRI before surgery. Results: Sonographic features of adenomyosis include myometrial heterogeneity, asymmetric thickening of myometrium, cysts, linear striations, and an ill-defined endometrium; recto-vaginal endometriosis appears as an infiltration of the recto-vaginal septum by endometriotic nodules or linear striations. The larger nodules can adhere to the anterior rectal wall. MRI showed the typical well- known appearance. TVS diagnosis of adenomyosis and recto-vaginal endometriosis is possible, but it has to be searched for, is not easy to do and could be operator dependent. Conclusions: The specific features of adenomyosis and recto-vaginal endometriosis on TVS give a non-invasive diagnosis with a high degree of accuracy, thereby reducing the costs and delays associated with MRI and avoiding unnecessary invasive procedures. OP11.09 New ultrasound markers for the diagnosis of adenomyosis in infertile population I. Aboujaoude , N. Helou Aboujaoude Hospital, Lebanon Objectives: Adenomyosis is associated with infertility and with implantation failure in IVF. So there is a need to find new ultrasound markers to screen infertile patients for adenomyosis. We present clinical and new ultrasound markers and compare them with MRI in a prospective study. Methods: Sixty infertile patients were prospectively followed by studying the following four markers: (1) premenstrual bleeding or spotting; (2) uterine pain on bimanual examination; (3) the hyperechoic halo between the endometrium and the myometrium; and (4) the number of hyperechogenic round cysts in the isthmus sticking to the cervical canal. All patients underwent MRI to confirm the presence of adenomyosis. The patients were divided into two groups - in Group A the mean junctional zone (JZ) on MRI was ≥ 492 Ultrasound in Obstetrics & Gynecology 2007; 30: 456–546