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Licensed Unlicensed Requires Authentication Published by De Gruyter February 7, 2013

Reliability of quantitative elastography of the uterine cervix in at-term pregnancies

  • Arrigo Fruscalzo EMAIL logo , Johannes Steinhard , Ambrogio Pietro Londero , Christiane Fröhlich , Bart Bijnens , Walter Klockenbusch and Ralf Schmitz


Aims: To evaluate the intra-operator reliability of tissue Doppler imaging-based quantitative cervical elastography in at-term pregnancies.

Methods: Three series of two cycles of manual gentle compression-relaxation of the cervix were performed by one gynecologist in 11 consecutive at-term pregnancies through the vaginal probe. The compression movements should be sufficient to obtain the maximal compression of the anterior portion of the cervical tissue, until the posterior portion begins to be dislocated. Strain values were assessed on the entire thickness of the anterior cervical lip. The influence of strain type (Lagrangian vs. natural) and the extent of compression exerted (difference among the two cycles of compression-relaxation) were evaluated.

Results: Strain measurement was influenced by the extent of compression, as well as by the strain type. The strain measured during the cycle with larger cervical compression, using the natural strain preset, showed a superior reliability [mean strain among patients: 0.68±0.18; mean of differences among three measures: 0.07±0.06; intraclass correlation coefficient (ICC) consistency: 0.90]. The strain measured using the Lagrangian strain preset showed overall a low reliability (ICC consistency: 0.04).

Conclusions: Quantitative cervical elastography performed in at-term pregnancies, under standardized conditions, has a high reliability.

Corresponding author: Arrigo Fruscalzo, Frauenklinik, Mathias-Spital Rheine, St. Franziskus-Hospital, Hohenzollernring 72, 48145 Münster, Germany, Tel.: +49 0251/9353917, Fax: +49 0251/9354072


[1] Bercoff J, Chaffai S, Tanter M, Sandrin L, Catheline S, Fink M, et al. In vivo breast tumor detection using transient elastography. Ultrasound Med Biol. 2003;29:1387–96.10.1016/S0301-5629(03)00978-5Search in Google Scholar

[2] Bijnens BH, Cikes M, Claus P, Sutherland GR. Velocity and deformation imaging for the assessment of myocardial dysfunction. Eur J Echocardiogr. 2009;10:216–26.10.1093/ejechocard/jen323Search in Google Scholar

[3] Bishop EH. Pelvic scoring for elective induction. Obstet Gynecol. 1964;24:266–268.Search in Google Scholar

[4] Crane JM. Factors predicting labor induction success: a critical analysis. Clin Obstet Gynecol. 2006;49:573–84.10.1097/00003081-200609000-00017Search in Google Scholar

[5] D’Hooge J, Heimdal A, Jamal F, Kukulski T, Bijnens B, Rademakers F, et al. Regional strain and strain rate measurements by cardiac ultrasound: principles, implementation and limitations. Eur J Echocardiogr. 2000;1:154–70.10.1053/euje.2000.0031Search in Google Scholar

[6] Fruscalzo A, Schmitz R. Quantitative cervical elastography in pregnancy. Ultrasound Obstet Gynecol. 2012;40:612.10.1002/uog.12320Search in Google Scholar

[7] Fruscalzo A, Schmitz R, Klockenbusch W, Steinhard J. Reliability of cervix elastography in late first and second trimester of pregnancy. Ultraschall Med. 2012;33:1–7.10.1055/s-0031-1299330Search in Google Scholar

[8] Garfield RE, Chwalisz K, Shi L, Olson G, Saade GR. Instrumentation for the diagnosis of term and preterm labour. J Perinat Med. 1998;26:413–36.10.1515/jpme.1998.26.6.413Search in Google Scholar

[9] Garra BS. Imaging and estimation of tissue elasticity by ultrasound. Ultrasound Q. 2007;23:255–68.10.1097/ruq.0b013e31815b7ed6Search in Google Scholar

[10] Glassman W, Byam-Smith M, Garfield RE. Changes in rat cervical collagen during gestation and after antiprogesterone treatment as measured in vivo with light-induced autofluorescence. Am J Obstet Gynecol. 1995;173:1550–6.10.1016/0002-9378(95)90648-7Search in Google Scholar

[11] Hatfield AS, Sanchez-Ramos L, Kaunitz AM. Sonographic cervical assessment to predict the success of labor induction: a systematic review with meta-analysis. Am J Obstet Gynecol. 2007;197:186–92.10.1016/j.ajog.2007.04.050Search in Google Scholar PubMed

[12] Iams JD, Goldenberg RL, Meis PJ, Mercer BM, Moawad A, Das A, et al. The length of the cervix and the risk of spontaneous premature delivery. National Institute of Child Health and Human Development Maternal Fetal Medicine Unit Network. N Engl J Med. 1996;334:567–72.10.1056/NEJM199602293340904Search in Google Scholar PubMed

[13] Nightingale KR, Palmeri ML, Nightingale RW, Trahey GE. On the feasibility of remote palpation using acoustic radiation force. J Acoust Soc Am. 2001;110:625–34.10.1121/1.1378344Search in Google Scholar PubMed

[14] Ophir J, Alam SK, Garra B, Kallel F, Konofagou E, Krouskop T, et al. Elastography: ultrasonic estimation and imaging of the elastic properties of tissues. Proc Inst Mech Eng H. 1999;213:203–33.10.1243/0954411991534933Search in Google Scholar PubMed

[15] Palmeri ML, Nightingale KR. What challenges must be overcome before ultrasound elasticity imaging is ready for the clinic? Imaging Med. 2011;3:433–44.10.2217/iim.11.41Search in Google Scholar PubMed PubMed Central

[16] Parra-Saavedra M, Gomez L, Barrero A, Parra G, Vergara F, Navarro E. Prediction of preterm birth using the cervical consistency index. Ultrasound Obstet Gynecol. 2011;38: 44–51.10.1002/uog.9010Search in Google Scholar PubMed

[17] Shi L, Shi SQ, Saade GR, Chwalisz K, Garfield RE. Changes in cervical resistance and collagen fluorescence during gestation in rats. J Perinat Med. 1999;27:188–94.10.1515/JPM.1999.026Search in Google Scholar PubMed

[18] Smith R. Parturition. N Engl J Med. 2007;356:271–83.10.1056/NEJMra061360Search in Google Scholar PubMed

[19] Sotiriadis A, Papatheodorou S, Kavvadias A, Makrydimas G. Transvaginal cervical length measurement for prediction of preterm birth in women with threatened preterm labor: a meta-analysis. Ultrasound Obstet Gynecol. 2010;35:54–64.10.1002/uog.7457Search in Google Scholar PubMed

[20] Sutherland GR, Hatle L, Claus P, D’hooge J, Bijnens B. Doppler myocardial imaging, A textbook. Hasselt-Belgium: BSWK Scientific Consulting and Publishing; 2006. p. 5–18.Search in Google Scholar

[21] Word RA, Li XH, Hnat M, Carrick K. Dynamics of cervical remodeling during pregnancy and parturition: mechanisms and current concepts. Semin Reprod Med. 2007;25:69–79.10.1055/s-2006-956777Search in Google Scholar PubMed

The authors stated that there are no conflicts of interest regarding the publication of this article.

Received: 2012-8-6
Accepted: 2013-1-4
Published Online: 2013-02-07
Published in Print: 2013-07-01

©2013 by Walter de Gruyter Berlin Boston

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