title: Transvaginal ultrasound assessment of uterine scar after previous caesarean section: comparison with 3T-magnetic resonance diffusion tensor imaging.
abstract: OBJECTIVE
  This study aimed to evaluate 3-T magnetic resonance imaging in the analysis of caesarean scars in women with prior caesarean section (pCS) and investigate the potential added value of diffusion tensor imaging (3T-MR-DTI) with fibre tracking reconstruction, compared with transvaginal ultrasound (TVUS).
  
  
  METHODS
  Thirty women who had previously undergone elective CS in a singleton pregnancy at term were examined (19 women with one pCS formed group 1 and 11 women with two pCS formed group 2). Patients underwent TVUS and 3T-MR-DTI within 2 days. Twelve women with prior vaginal delivery served as controls and underwent only 3T-MR. Uterine fibre architecture was depicted by MR-DTI with 3D tractography reconstruction providing quali-quantitative analysis of fibre, described as the reduction of number of longitudinal fibres that run through the uterine scar.
  
  
  RESULTS
  Six subjects were excluded. According to 3T-MR morphology, scars were described as linear (n = 12) and retracting (n = 12); disagreement with TVUS was 54 %. The thickness of myometrium at the scar level was found to be significantly greater with 3T-MR compared to TVUS in linear scars (p = 0.01). No difference was found among retracting scars. In controls, according to 3T-MR-DTI, longitudinal myometrial fibres running in the anterior wall were similar to those in the posterior wall at same level -2 %; -27 % + 22 %). In groups 1 and 2 there was significant reduction in anterior fibres compared to posterior ones (-53 %; -77 % - 34 %; p = 0.0001). Among retracting scars, fibre reduction was significantly higher compared to linear scars, p < 0.016.
  
  
  CONCLUSIONS
  The added value of 3T-MR with DTI lies in the prompt evaluation of muscle fibre remaining at scar level.
authors.affiliation: Department of Radiology, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124, Modena, Italy, federica.fiocchi@gmail.it.
authors.forename: Federica
authors.initials: F
authors.lastname: Fiocchi
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Petrella
authors.forename: Luca
authors.initials: L
authors.lastname: Nocetti
authors.forename: Serena
authors.initials: S
authors.lastname: Currà
authors.forename: Guido
authors.initials: G
authors.lastname: Ligabue
authors.forename: Tiziana
authors.initials: T
authors.lastname: Costi
authors.forename: Pietro
authors.initials: P
authors.lastname: Torricelli
authors.forename: Fabio
authors.initials: F
authors.lastname: Facchinetti
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000009:adverse effects; D002921:Cicatrix / Q000000981:diagnostic imaging* / Q000209:etiology / Q000473:pathology*; D038524:Diffusion Magnetic Resonance Imaging; D056324:Diffusion Tensor Imaging; D005260:Female; D006801:Humans; D014463:Ultrasonography; D014621:Vagina
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