title: Reliability of new three-dimensional ultrasound technique for pelvic hiatal area measurement.
abstract: OBJECTIVE
  To assess the reproducibility of a new technique for three-/four-dimensional (3D/4D) ultrasound imaging of the pelvic floor: OmniView™ volume contrast imaging (VCI) for measurement of the pelvic hiatal area on maximum contraction and Valsalva maneuver. In addition, we aimed to study the intermethod agreement between the new technique and the 3D/4D render method.
  
  
  METHODS
  We acquired one static 3D and two dynamic 4D transperineal volumes (one obtained during contraction and one during Valsalva maneuver) from 35 nulliparous asymptomatic healthy volunteers and 35 women with symptoms of pelvic floor dysfunction. Each 3D dataset was analyzed using the OmniView-VCI technique to measure the pelvic hiatal area at rest, on maximum contraction and on maximum Valsalva. Analysis was performed twice by the same operator and once by another operator in order to assess intra- and interobserver reproducibility. All measurements were repeated by one operator using the 3D/4D render method to evaluate the intermethod agreement. Reproducibility and intermethod agreement were studied by means of intraclass correlation coefficients (ICC) and the Bland-Altman method.
  
  
  RESULTS
  Measurement of hiatal area using the OmniView-VCI technique showed excellent intraobserver and interobserver reproducibility in both asymptomatic and symptomatic women at rest, on contraction and on Valsalva maneuver. In addition, excellent agreement was demonstrated between OmniView-VCI and 3D/4D render in both groups (ICCs on Valsalva in asymptomatic and symptomatic women were 0.894 and 0.975, respectively). No systematic difference was noted in any of the reliability studies performed.
  
  
  CONCLUSIONS
  OmniView-VCI is a reliable method for pelvic hiatal area measurement. Both rendering mode and OmniView-VCI can be used interchangeably for assessing pelvic hiatal area. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.
authors.affiliation: Department of Obstetrics and Gynecology, Sant'Orsola Malpighi University Hospital, University of Bologna, Bologna, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Youssef
authors.affiliation: Department of Obstetrics and Gynecology, Sant'Orsola Malpighi University Hospital, University of Bologna, Bologna, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Montaguti
authors.affiliation: Department of Obstetrics and Gynecology, Sant'Orsola Malpighi University Hospital, University of Bologna, Bologna, Italy.
authors.forename: O
authors.initials: O
authors.lastname: Sanlorenzo
authors.affiliation: Department of Obstetrics and Gynecology, Sant'Orsola Malpighi University Hospital, University of Bologna, Bologna, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Cariello
authors.affiliation: Department of Obstetrics and Gynecology, Sant'Orsola Malpighi University Hospital, University of Bologna, Bologna, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Salsi
authors.affiliation: Department of Obstetrics and Gynecology, Sant'Orsola Malpighi University Hospital, University of Bologna, Bologna, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Morganelli
authors.affiliation: Department of Obstetrics and Gynecology, Sant'Orsola Malpighi University Hospital, University of Bologna, Bologna, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Azzarone
authors.affiliation: Department of Obstetrics and Gynecology, Sant'Orsola Malpighi University Hospital, University of Bologna, Bologna, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Pilu
authors.affiliation: Department of Obstetrics and Gynecology, Sant'Orsola Malpighi University Hospital, University of Bologna, Bologna, Italy.
authors.forename: N
authors.initials: N
authors.lastname: Rizzo
mesh_terms: D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000295:instrumentation* / Q000379:methods; D015588:Observer Variation; D017773:Pelvic Floor / Q000000981:diagnostic imaging*; D011247:Pregnancy; D015203:Reproducibility of Results; D014463:Ultrasonography / Q000295:instrumentation* / Q000379:methods
keywords: 3D ultrasound; 4D ultrasound; OmniView; levator ani muscle; pelvic floor; volume contrast imaging