title: Optimizing the ultrasound visualization of the endometrial-myometrial junction (EMJ).
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Obstetrics and Gynaecology, University Hospitals KULeuven, Leuven, Belgium. ; Brugmann Departments of Obstetrics and Gynaecology, University Hospital Brugmann, Brussels, Belgium.
authors.forename: A
authors.initials: A
authors.lastname: Votino
authors.affiliation: Department of Obstetrics and Gynaecology, University Hospitals KULeuven, Leuven, Belgium.
authors.forename: T
authors.initials: T
authors.lastname: Van den Bosch
authors.affiliation: KU Leuven, Department of Electrical Engineering ESAT, STADIUS Centre for Dynamical Systems, Signal Processing and Data Analytics, Leuven, Belgium. ; iMinds Medical IT, Leuven, Belgium.
authors.forename: A J F
authors.initials: AJ
authors.lastname: Installé
authors.affiliation: Department of Obstetrics and Gynaecology, University Hospitals KULeuven, Leuven, Belgium.
authors.forename: D
authors.initials: D
authors.lastname: Van Schoubroeck
authors.affiliation: Department of Obstetrics and Gynaecology, University Hospitals KULeuven, Leuven, Belgium.
authors.forename: J
authors.initials: J
authors.lastname: Kaijser
authors.affiliation: Brugmann Departments of Obstetrics and Gynaecology, University Hospital Brugmann, Brussels, Belgium.
authors.forename: Y
authors.initials: Y
authors.lastname: Kacem
authors.affiliation: KU Leuven, Department of Electrical Engineering ESAT, STADIUS Centre for Dynamical Systems, Signal Processing and Data Analytics, Leuven, Belgium. ; iMinds Medical IT, Leuven, Belgium.
authors.forename: B
authors.initials: B
authors.lastname: De Moor
authors.affiliation: Brugmann Departments of Obstetrics and Gynaecology, University Hospital Brugmann, Brussels, Belgium.
authors.forename: C
authors.initials: C
authors.lastname: Van Pachterbeke
authors.affiliation: Department of Obstetrics and Gynaecology, University Hospitals KULeuven, Leuven, Belgium.
authors.forename: D
authors.initials: D
authors.lastname: Timmerman
keywords: 3D ultrasound; Ultrasonography; adenomyosis; endometrial-myometrial junction; uterus; volume contrast imaging (VCI)