Ultrasonography RSS : Gourt

Use of 4-dimensional sonography in the measurement of fetal great vessels in mediastinum to distinguish true-from false-positive coarctation of the aorta.

Use of 4-dimensional sonography in the measurement of fetal great vessels in mediastinum to distinguish true-from false-positive coarctation of the aorta. J Ultrasound Med. 2010 Feb;29(2):325-6 Authors: Rizzo G, Arduini D, Capponi A PMID: 20103809 [PubMed - in process]

The expanded amnion sign: evidence of early embryonic death * reply.

The expanded amnion sign: evidence of early embryonic death * reply. J Ultrasound Med. 2010 Feb;29(2):323-4 Authors: Wax JR, Pinette MG, Filly RA PMID: 20103808 [PubMed - in process]

Hematocolpometra due to an imperforate hymen presenting with back pain: sonographic diagnosis.

Hematocolpometra due to an imperforate hymen presenting with back pain: sonographic diagnosis. J Ultrasound Med. 2010 Feb;29(2):321-2 Authors: Drakonaki EE, Tritou I, Pitsoulis G, Psaras K, Sfakianaki E PMID: 20103807 [PubMed - in process]

Prenatal diagnosis of harlequin ichthyosis using 3- and 4-dimensional sonography.

Prenatal diagnosis of harlequin ichthyosis using 3- and 4-dimensional sonography. J Ultrasound Med. 2010 Feb;29(2):317-9 Authors: Kudla MJ, Timmerman D PMID: 20103806 [PubMed - in process]

Gastroschisis and bladder herniation: case report and literature review.

Gastroschisis and bladder herniation: case report and literature review. J Ultrasound Med. 2010 Feb;29(2):313-6 Authors: Werner EF, Paik D, Han C, Weems M, Sfakianaki AK PMID: 20103805 [PubMed - in process]

Prenatal features of omphalocele and absent ductus venosus: case with a favorable postnatal outcome.

Prenatal features of omphalocele and absent ductus venosus: case with a favorable postnatal outcome. J Ultrasound Med. 2010 Feb;29(2):307-11 Authors: Tanaka A, Kondo Y, Hidaka N, Yumoto Y, Fujita Y, Fukushima K, Wake N PMID: 20103804 [PubMed - in process]

Prenatal sonographic findings in human disorganization syndrome.

Prenatal sonographic findings in human disorganization syndrome. J Ultrasound Med. 2010 Feb;29(2):301-5 Authors: Wax JR, Pinette MG, Smith R, Cartin A, Butler S, Blackstone J PMID: 20103803 [PubMed - in process]

Megacystis associated with an umbilical cord cyst: a sonographic feature of a patent urachus in the first trimester.

Megacystis associated with an umbilical cord cyst: a sonographic feature of a patent urachus in the first trimester. J Ultrasound Med. 2010 Feb;29(2):295-300 Authors: Sepulveda W, Rompel SM, Cafici D, Carstens E, Dezerega V OBJECTIVE: The purpose of this series was to report the first-trimester sonographic findings, antenatal course, and outcome in fetuses with a patent urachus. METHODS: We conducted a review of ultrasound reports and medical charts from 3 pregnancies complicated by a congenital patent urachus detected in the first trimester. RESULTS: All 3 fetuses had megacystis and an umbilical cord cyst close to the fetal abdominal insertion that was detected in the first trimester. In 2 cases, the megacystis resolved spontaneously while the umbilical cord cyst worsened in appearance; among them, massive edema of the umbilical cord was documented in 1, and evidence of partial bladder exstrophy was detected in the third trimester in the other. Both cases required neonatal surgery with no complications. In the remaining case, the fetus died in the early second trimester. Postmortem examination confirmed the diagnosis of a patent urachus, an allantoic cyst, and thrombosis of the umbilical vessels. CONCLUSIONS: Megacystis is a warning sign of a patent urachus in the first trimester. The prognosis of this condition is generally good; however, fetal death can occur secondary to compression of umbilical vessels due to the expanding allantoic cyst. PMID: 20103802 [PubMed - in process]

Prenatal diagnosis of vascular rings.

Prenatal diagnosis of vascular rings. J Ultrasound Med. 2010 Feb;29(2):287-94 Authors: Jain S, Kleiner B, Moon-Grady A, Hornberger LK OBJECTIVES: The purpose of this series was to identify vascular rings prenatally on fetal echocardiograms. METHODS: We reviewed the fetal echocardiograms and clinical histories of 9 patients with a diagnosis of vascular rings at our institution from 2004 to 2009. Eight patients had a prenatal diagnosis by fetal echocardiography. One other patient who had undergone fetal echocardiography had a diagnosis of a vascular ring and a cervical arch only postnatally. RESULTS: Among the 8 patients with a prenatal diagnosis (4 with a double aortic arch and 4 with a right aortic arch [RAA], an aberrant left subclavian artery, and a left ductus arteriosus [LDA]), the vascular ring was isolated in 4 and associated with other structural congenital heart disease in 4. In all 8 patients with a prenatal diagnosis, the vascular ring was identified by cephalad transducer sweeps from a 3-vessel view (3VV) with and without color Doppler imaging, which revealed vascular structures coursing around the trachea. Seven of these patients had postnatal confirmation of the abnormality (there was 1 pregnancy termination without autopsy). The only known vascular ring missed at fetal echocardiography but diagnosed after birth was that associated with a cervical RAA (which could not be visualized in cross-sectional sweeps) and an LDA evaluated only late in pregnancy. Only 3 of the 8 postnatally treated neonates had clinical symptoms of the vascular ring, and 5 underwent surgical division of the ring. CONCLUSIONS: Vascular rings can be largely identified before birth with cephalad sweeps from the 3VV with attention to the relationship of the aortic and ductal arches to the trachea on fetal echocardiograms. PMID: 20103801 [PubMed - in process]

Umbilical cord cysts: evaluation with different 3-dimensional sonographic modes.

Umbilical cord cysts: evaluation with different 3-dimensional sonographic modes. J Ultrasound Med. 2010 Feb;29(2):281-5 Authors: Bonilla F, Raga F, Villalaiz E, Osborne N, Castillo JC, Bonilla-Musoles F OBJECTIVE: The purpose of this series was to determine whether the use of different 3-dimensional (3D) sonographic modes allows better definition of umbilical cord cysts and pseudocysts in utero. METHODS: Two cases of umbilical cord cysts and 1 of a pseudocyst were analyzed and compared with 2-dimensional (2D), 3D, angiopower Doppler, tomographic ultrasound imaging (TUI), virtual organ computer-aided analysis (VOCAL), and automatic volume calculation (AVC) sonographic modes. All cases were followed during pregnancy. A karyotype analysis was also obtained. RESULTS: Three-dimensional sonography, TUI, and VOCAL allowed clear visualization and evaluation of the sizes, locations, and numbers of umbilical cord cysts. A clear differentiation between a pseudocyst and the yolk sac was obtained with AVC and angiopower Doppler sonography. The 3D sonographic surface mode allowed better visualization of other accompanying fetal malformations. CONCLUSIONS: Three-dimensional sonography allows for a more accurate diagnosis and provides a clearer visualization of malformations than 2D imaging. Cysts and pseudocysts can be defined much more accurately by using the different modes described here. PMID: 20103800 [PubMed - in process]

Clinical findings of multiple pregnancy with a complete hydatidiform mole and coexisting fetus.

Clinical findings of multiple pregnancy with a complete hydatidiform mole and coexisting fetus. J Ultrasound Med. 2010 Feb;29(2):271-80 Authors: Lee SW, Kim MY, Chung JH, Yang JH, Lee YH, Chun YK OBJECTIVE: The aim of this series was to evaluate the clinical features, management, and outcomes of multiple pregnancy with a complete hydatidiform mole and coexisting fetus (CHMCF). METHODS: Between 1998 and 2008, we investigated 6 women with a diagnosis of a CHMCF. The gestational age at diagnosis, symptoms, serum b-human chorionic gonadotropin levels, cytogenetic and molecular analysis findings, complications, routes of delivery, and pregnancy outcomes were assessed. RESULTS: All cases were diagnosed before 14 weeks' gestation by sonography. Only 1 ended with the delivery of a live-born neonate, whereas the other 5 cases required termination of pregnancy (TOP) before 21 weeks' gestation because of severe maternal complications (eg, preeclampsia, thyrotoxicosis, lung metastasis, and heavy bleeding) or intrauterine fetal death. The pathologic diagnosis of a complete hydatidiform mole was confirmed in all cases. Two patients required methotrexate for treatment of persistent trophoblastic disease (PTD). CONCLUSIONS: On the basis of our experience, in cases with a normal karyotype and no gross fetal abnormalities on sonography, we carefully recommend continuation of pregnancy as long as maternal complications are absent or controllable. However, updated treatment criteria are still needed, and intensive maternal follow-up is necessary in the postpartum period because maternal complications during pregnancy and PTD after TOP are not uncommon. PMID: 20103799 [PubMed - in process]

Role of sonographic automatic volume calculation in measuring fetal cardiac ventricular volumes using 4-dimensional sonography: comparison with virtual organ computer-aided analysis.

Role of sonographic automatic volume calculation in measuring fetal cardiac ventricular volumes using 4-dimensional sonography: comparison with virtual organ computer-aided analysis. J Ultrasound Med. 2010 Feb;29(2):261-70 Authors: Rizzo G, Capponi A, Pietrolucci ME, Arduini D OBJECTIVE: The purpose of this study was to compare the agreement and reliability of virtual organ computer-aided analysis (VOCAL) and sonographic automatic volume calculation (sonoAVC) for measurements of ventricular volume from fetal heart data sets acquired by 4-dimensional sonography with spatiotemporal image correlation (STIC). METHODS: We studied 45 volumes from fetuses with normal (n = 30) and abnormal (n = 15) hearts. Spatiotemporal image correlation data sets were frozen in end systole and end diastole, and ventricular volumes were measured with VOCAL and sonoAVC. The stroke volume was calculated from these measurements. Reliability and agreement of the two techniques were evaluated with intraclass correlation coefficients (ICCs), and proportionate Bland-Altman plots were constructed. The time necessary to complete the measurements with either technique was compared. Intraobserver and interobserver agreement of measurements was calculated. RESULTS: All data sets could be measured with both techniques. A high degree of reliability was observed between VOCAL and sonoAVC (left ventricular stroke volume ICC, 0.978; 95% confidence interval [CI], 0.957-0.989; right ventricular stroke volume ICC, 0.985; 95% CI, 0.972-0.992). The time necessary to measure the stroke volume was significantly shorter with sonoAVC (2.8 versus 11.7 minutes; P < .0001) than with VOCAL. Bland-Altman tests showed no clinically significant mean percent differences between stroke volume measurements obtained from each ventricle by the same observer or by 2 independent observers using either VOCAL or sonoAVC. CONCLUSIONS: There was good agreement between cardiac volumes measured with VOCAL and sonoAVC. Sonographic automatic volume calculation represents a rapid technique for estimating fetal stroke volume and promises to become the method of choice. PMID: 20103798 [PubMed - in process]

A method to visualize 3-dimensional anatomic changes in the cervix during pregnancy: a preliminary observational study.

A method to visualize 3-dimensional anatomic changes in the cervix during pregnancy: a preliminary observational study. J Ultrasound Med. 2010 Feb;29(2):255-60 Authors: Lang CT, Iams JD, Tangchitnob E, Socrate S, House M OBJECTIVE: The purpose of this study was to develop a method to visualize 3-dimensional (3D) anatomic changes in the cervix and lower uterine segment during the antepartum period. METHODS: An observational study of patients with both uncomplicated and complicated pregnancies was performed. To visualize 3D anatomic changes, solid models were constructed from 3D sonographic data. Model construction followed a 3-step protocol. First, 3D transvaginal sonographic data of the cervix and lower uterine segment were obtained. Second, sonographic data were exported to a medical image-processing program, which was used to align 3D sonographic data obtained from a single patient at different time points. Last, sonographic data were used to guide construction of solid models using mechanical design software. Anatomic changes were visualized by comparing solid models constructed from sonographic data obtained at different time points. RESULTS: From 16 patients who consented, 5 patients were selected for this study. Two to 4 models were derived from each of the 5 patients at 15 to 38 weeks' gestation. To show anatomic changes in the cervix and lower uterine segment, solid models from different time points in the same patient were superimposed. A total of 16 solid models were constructed. In addition, 3D changes associated with second-trimester cervical failure and successful therapeutic cerclage were shown. CONCLUSIONS: A method to visualize 3D cervical changes is presented, revealing complex anatomic changes in the lower uterine segment, cervical stroma, and cervical mucosa as pregnancy progresses. PMID: 20103797 [PubMed - in process]

The amniotic wrinkle: a pitfall in evaluating amniotic fluid for twins.

The amniotic wrinkle: a pitfall in evaluating amniotic fluid for twins. J Ultrasound Med. 2010 Feb;29(2):249-54 Authors: Finberg HJ OBJECTIVE: The sonographic analysis of amniotic fluid in twin pregnancies can be complex and difficult, particularly when one twin has oligohydramnios or anhydramnios. This article describes a pitfall, the "amniotic wrinkle," which can lead to the erroneous impression that both twins have adequate fluid when one actually has little or none. METHODS: Sonograms of twin pregnancies in which the sonographer's initial assessment was of adequate fluid for each twin but imaging by the author on the same day showed one twin to have oligohydramnios were analyzed to identify recurring image patterns related to the intertwin membrane that may create this misleading impression. RESULTS: With oligohydramnios of one twin, the intertwin membrane may become redundant, folding on itself, creating an amniotic wrinkle: a short linear structure extending perpendicularly away from the twin with decreased amniotic fluid in toward the amniotic space of the other twin. A variation of this occurs when this fetus moves an extremity into the fold, with the two layers of the fold apposing each other between the limb and torso or between two limbs. An additional pattern is also described: an intrauterine sling or "cocoon" in which a fetus appears to be suspended within the amniotic space of the other twin. CONCLUSIONS: To avoid pitfalls in assessing amniotic fluid for twins, the intertwin membrane should be shown in every image that is used to document fluid ascribed to each twin, and images at right angles to the initial image can help identify an amniotic wrinkle. PMID: 20103796 [PubMed - in process]

Supratentorial abnormalities in the Chiari II malformation, IV: the too-far-back ventricle.

Supratentorial abnormalities in the Chiari II malformation, IV: the too-far-back ventricle. J Ultrasound Med. 2010 Feb;29(2):243-8 Authors: Filly MR, Filly RA, Barkovich AJ, Goldstein RB OBJECTIVE: The sonographic diagnosis of fetal myelomeningocele (MMC) has improved mainly because the diagnostic focus has shifted from observation of the spinal abnormality to observation of cranial abnormalities. We describe an abnormality in the position of the occipital horn in fetuses with MMC. The occipital horn appears to be too posterior in location when compared to healthy fetuses. METHODS: We searched for all cases in which fetal MMC was sonographically detected from 1999 to 2009. Random controls from normal pregnancies were identified. We then measured the shortest distance of the edge of the occipital horn to the occipital bone in fetuses with MMC compared to healthy fetuses. Only fetuses with MMC who had normal-size ventricles were included. RESULTS: A total of 91 fetuses with MMC were identified. Twenty-six fetuses had a normal ventricle size. The gestational age range in this cohort was 18 weeks 5 days to 30 weeks 0 days. The comparison group of 39 healthy fetuses all had normal ventricles and had a gestational age range of 18 weeks 3 days to 35 weeks 2 days. After adjusting for gestational age, the statistical analysis showed that fetuses with MMC had significantly shorter measured distances from the posterior edge of the occipital horn to the occipital bone than healthy fetuses (P = .003). CONCLUSIONS: The occipital horn both appears to be and measures closer to the occipital bone in fetuses with MMC compared to healthy fetuses. PMID: 20103795 [PubMed - in process]

The yolk stalk sign: evidence of death in small embryos without heartbeats.

The yolk stalk sign: evidence of death in small embryos without heartbeats. J Ultrasound Med. 2010 Feb;29(2):237-41 Authors: Filly MR, Callen PW, Yegul NT, Filly RA OBJECTIVE: The purpose of this study was to assess the positive predictive value for confirming early embryonic death in the clinical sonographic scenario wherein an embryo is identified without a visible heartbeat; the embryonic crown-rump length (CRL) is 5 mm or less; and the embryo is not immediately adjacent to the yolk sac. METHODS: A retrospective study of 882 first-trimester sonograms was performed among women who had an intrauterine pregnancy of uncertain viability based on 1 or more sonographic findings (eg, no visible heartbeat in an embryo with a CRL of < or =5 mm). Eight hundred six cases met the inclusion criteria. RESULTS: Among the cohort of 806 cases, 520 (64.5%) had an identifiable embryo. One hundred fifty-nine of these embryos had no demonstrable heartbeat and a CRL of 5 mm or less. The CRLs of these embryos ranged from 1.7 to 5.4 mm. This cohort's sonograms were reviewed to determine whether there was a separation between the embryo and yolk sac. Twenty-one cases were discovered. Recall that as a retrospective study, no specific effort was made to show this finding. Thus, a computation of the sensitivity of this finding would result in an underestimate of indeterminate magnitude. All of these cases were subsequently proven to be failed pregnancies. CONCLUSIONS: The positive predictive value of the "yolk stalk sign" in determining early pregnancy failure for an embryo with a CRL of 5 mm or less and no visible heartbeat was 100% in this cohort. PMID: 20103794 [PubMed - in process]

Do race-specific definitions of short long bones improve the detection of down syndrome on second-trimester genetic sonograms?

Do race-specific definitions of short long bones improve the detection of down syndrome on second-trimester genetic sonograms? J Ultrasound Med. 2010 Feb;29(2):231-5 Authors: Harper LM, Gray D, Dicke J, Stamilio DM, Macones GA, Odibo AO OBJECTIVE: The purpose of this study was to determine whether the use of race-specific definitions of short femur and humerus lengths improves Down syndrome detection. METHODS: This was a retrospective cohort study over 16 years. For each self-reported maternal race (white, African American, Hispanic, and Asian), we evaluated the efficiency of Down syndrome detection using published race-specific formulas compared with a standard formula for short femur and humerus lengths (observed versus expected lengths < or =0.91 and < or =0.89, respectively). The sensitivity, specificity, and 95% confidence intervals for each parameter were compared. Screening performance was compared by areas under the receiver operating characteristic curves. RESULTS: Of 58,710 women, 209 (0.3%) had a diagnosis of a fetus with Down syndrome. Although the race-based formula increased sensitivity in each population, the increase was statistically significant only in the white population, whereas a decrease in specificity was statistically significant in all 4 populations, as denoted by nonoverlapping confidence intervals. The area under the receiver operating characteristic curve for the model using the race-specific definition of short femur length was 0.67 versus 0.65 compared with the standard definition, and for humerus length it was 0.70 versus 0.71. CONCLUSIONS: The use of race-based formulas for the determination of short femur and humerus lengths did not significantly improve the detection rates for Down syndrome. PMID: 20103793 [PubMed - in process]

Sonographic prediction of fetal macrosomia: the consequences of false diagnosis.

Sonographic prediction of fetal macrosomia: the consequences of false diagnosis. J Ultrasound Med. 2010 Feb;29(2):225-30 Authors: Melamed N, Yogev Y, Meizner I, Mashiach R, Ben-Haroush A OBJECTIVE: The purpose of this study was to determine the effect of false diagnosis of macrosomia (<4500 g) on maternal/perinatal outcomes. METHODS: We conducted a case-control study of women (n = 1938) in whom sonographically estimated fetal weight (EFW) was determined up to 3 days before delivery and actual birth weight (BW) was 3500 to 4499 g. Women with false-positive and -negative findings for macrosomia were compared, respectively, with women with true-negative and -positive findings for outcome variables. RESULTS: The cesarean delivery (CD) rate was 2 to 2.5 times higher when EFW was 4000 to 4499 g, regardless of actual BW. Failure to detect macrosomia was associated with higher rates of perineal trauma, 5-minute Apgar scores less than 7, and neonatal trauma, mostly related to the higher rate of surgical vaginal deliveries. The use of another sonographic model with a lower false-positive rate could theoretically reduce the CD rate by approximately 5%. CONCLUSIONS: False diagnosis of macrosomia substantially increases the CD rate and leads to maternal/neonatal complications. PMID: 20103792 [PubMed - in process]

Patterns of fetal growth in a rural Indian cohort and comparison with a Western European population: data from the pune maternal nutrition study.

Patterns of fetal growth in a rural Indian cohort and comparison with a Western European population: data from the pune maternal nutrition study. J Ultrasound Med. 2010 Feb;29(2):215-23 Authors: Kinare AS, Chinchwadkar MC, Natekar AS, Coyaji KJ, Wills AK, Joglekar CV, Yajnik CS, Fall CH OBJECTIVE: The purpose of this study was to describe fetal size on sonography in a rural Indian population and compare it with those in European and urban Indian populations. Methods. Participants were from the Pune Maternal Nutrition Study of India. Fetal growth curves were constructed from serial ultrasound scans at approximately 18, 30, and 36 weeks' gestation in 653 singleton pregnancies. Measurements included femur length (FL), abdominal circumference (AC), biparietal diameter (BPD), and occipitofrontal diameter, from which head circumference (HC) was estimated. Measurements were compared with data from a large population-based study in France and a study of urban mothers in Vellore, south India. RESULTS: Fetal AC and BPD were smaller than the French reference at 18 weeks' gestation (-1.38 and -1.30 SD, respectively), whereas FL and HC were more comparable (-0.77 and -0.59 SD). The deficit remained similar at 36 weeks for AC (-0.97 SD), FL (-0.43 SD), and HC (-0.52 SD) and increased for BPD (-2.3 SD). Sonography at 18 weeks underestimated gestational age compared with the last menstrual period date by a median of -1.4 (interquartile range, -4.6, 1.8) days. The Pune fetuses were smaller, even at the first scan, than the urban Vellore sample. CONCLUSIONS: Fetal size was smaller in a rural Indian population than in European and urban Indian populations, even in mid pregnancy. The deficit varied for different fetal measurements; it was greatest for AC and BPD and least for FL and HC. PMID: 20103791 [PubMed - in process]

Prenatal sonographic detection of birth defects in 18 hospitals from South america.

Prenatal sonographic detection of birth defects in 18 hospitals from South america. J Ultrasound Med. 2010 Feb;29(2):203-12 Authors: Campaña H, Ermini M, Aiello HA, Krupitzki H, Castilla EE, López-Camelo JS, OBJECTIVE: The purpose of this study was to assess the accuracy of prenatal sonographic diagnosis of birth defects and the gestational age at detection according to the health insurance schemes of mothers in 450 malformed neonates from 18 South American hospitals on the basis of prenatal sonographic records. METHODS: Between July 2000 and December 2003, 18 hospitals included in the Latin American Collaborative Study of Congenital Malformations (13 from Argentina [8 public and 5 nonpublic], 3 from Brazil [2 public and 1 nonpublic], 1 from Chile [nonpublic], and 1 from Venezuela [public]) voluntarily participated in this prospective observational study, recording fetuses with sonographically detected malformations. Prenatal sonographic descriptions of anomalies were compared with those recorded at birth. RESULTS: Of 812 anomalies detected at birth, 457 had been prenatally detected (detection rate, 56.3%; 95% confidence interval, 52.8%-59.8%). Before 24 gestational weeks, anencephaly had the highest detection rate. Cleft lip and clubfoot were more easily detected when associated with other anomalies. The detection rates for central nervous system and renourinary malformations were greater than 80%. Detection rates between both health insurance schemes (public and nonpublic) did not show significant differences, but anencephaly, spina bifida, renourinary defects, and cleft lip with or without cleft palate were detected earlier in patients from nonpublic rather than in public hospitals. CONCLUSIONS: For specific anomalies, South America shows similar levels of prenatal sonographic detection as developed countries. Detection rates during pregnancy were similar for public and nonpublic hospitals, whereas cases were diagnosed earlier in patients from nonpublic hospitals. PMID: 20103790 [PubMed - in process]

Use of multiplanar 3-dimensional ultrasonography for prenatal sex identification.

Use of multiplanar 3-dimensional ultrasonography for prenatal sex identification. J Ultrasound Med. 2010 Feb;29(2):195-202 Authors: Hackett LK, Tarsa M, Wolfson TJ, Kaplan G, Vaux KK, Pretorius DH OBJECTIVE: Determination of fetal sex is an important part of detailed second-trimester ultrasonography. This task can be hindered by the fetal position, a low amniotic fluid volume, and advanced gestational age. Identification of fetal sex is further important in multiple gestations and prior histories of indeterminate-sex pregnancies. The goal of the study was to compare the effectiveness of 2-dimensional ultrasonography (2DUS) versus 3-dimensional ultrasonography (3DUS) at sex identification and to determine how genitalia measurements taken with 3DUS technology compare with measurements taken with 2DUS. METHODS: A total of 111 patients at or beyond 16 weeks' gestation were recruited. Assignments of fetal sex using 2DUS and 3DUS were compared by the test of proportions. The actual neonatal sex was obtained after delivery. Given such small number of misdiagnoses by either 2DUS or 3DUS, the accuracies of the two modalities were not found to be statistically distinguishable from one another (P = .5585). The penile length, scrotal width, and bilabial diameter according to gestational age were measured and compared with previously published 2DUS data by t tests. RESULTS: Sexes were assigned and interpreted in 65 cases. Ranges of genitalia measurements were plotted against gestational age and were found to be comparable with published data. There was a dramatic difference between the bilabial diameter and scrotal width with advancing gestational age that made sex determination much easier in the third trimester. CONCLUSIONS: Although 3DUS did not have better prediction of fetal sex when compared with 2DUS, it may be a useful tool in conjunction with traditional imaging techniques in assigning fetal sex. PMID: 20103789 [PubMed - in process]

High-resolution sonographic findings of ovarian granulosa cell tumors: correlation with pathologic findings.

High-resolution sonographic findings of ovarian granulosa cell tumors: correlation with pathologic findings. J Ultrasound Med. 2010 Feb;29(2):187-93 Authors: Kim JA, Chun YK, Moon MH, Lee YH, Cho HC, Lee MS, Song MJ OBJECTIVE: This study was performed to determine the high-resolution sonographic findings of ovarian granulosa cell tumors (GCTs) and to correlate the sonographic findings with the pathologic findings. METHODS: A retrospective review of sonographic findings was conducted on 16 patients with surgically proven ovarian GCTs. Patients' ages ranged from 10 to 64 years (mean, 37.7 years). We evaluated the sizes and morphologic appearances of the ovarian tumors. The blood flow patterns of the tumors were assessed with Doppler sonography (n = 6). Sonographic findings were compared with pathologic findings. RESULTS: The maximal diameters of the masses were 2.0 to 15.4 cm (mean, 8.2 cm). The morphologic appearances of the masses were classified into 3 patterns; solid and cystic (n = 10), solid with a sponge form appearance (n = 4), and entirely solid (n = 2). The measured resistive index and pulsatility index of the solid portions were 0.23 to 0.5 and 0.26 to 0.62, respectively. Pathologic diagnoses of 13 adult ovarian GCTs and 3 juvenile GCTs were obtained. The solid and cystic masses had GCTs with macrofollicular and microfollicular patterns pathologically. The solid masses with a sponge form appearance had prominent hemorrhagic necrosis and diffuse proliferation of granulosa cells with trabecular and microfollicular patterns. The entirely solid masses had diffuse cellular proliferation with a trabecular pattern without cystic changes or hemorrhagic foci. CONCLUSIONS: Sonographic findings of ovarian GCTs included solid and cystic masses, solid masses with a sponge form appearance, and entirely solid masses, and the sonographic findings correlated well with the histopathologic findings. PMID: 20103788 [PubMed - in process]

Detection of tumor-associated neoangiogenesis by Doppler ultrasonography during early-stage ovarian cancer in laying hens: a preclinical model of human spontaneous ovarian cancer.

Detection of tumor-associated neoangiogenesis by Doppler ultrasonography during early-stage ovarian cancer in laying hens: a preclinical model of human spontaneous ovarian cancer. J Ultrasound Med. 2010 Feb;29(2):173-82 Authors: Barua A, Bitterman P, Bahr JM, Bradaric MJ, Hales DB, Luborsky JL, Abramowicz JS OBJECTIVE: Tumor-associated neoangiogenesis (TAN) is one of the earliest events in ovarian tumor growth and represents a potential target for early detection of ovarian cancer (OVCA). Because it is difficult to identify patients with early-stage OVCA, the goal of this study was to explore a spontaneous animal model of in vivo ovarian TAN associated with early-stage OVCA detectable by Doppler ultrasonography (DUS). METHODS: White Leghorn laying hens were scanned transvaginally at 15-week intervals up to 45 weeks. Gray scale ovarian morphologic characteristics and Doppler indices were recorded. Hens were euthanized at diagnosis for ultrasonographic morphologic/vascular abnormalities or at the end of the study (those that remained normal). Ovarian morphologic and histologic characteristics were evaluated. Vascular endothelial growth factor (VEGF) and alpha(v)beta(3)-integrin expression was assessed by immunohistochemical analysis. Doppler ultrasonographic observations were compared with histologic and immunohisto-chemical findings to determine the ability of DUS to detect ovarian TAN. RESULTS: Significant changes in ovarian blood flow parameters were observed during transformation from normal to tumor development in the ovary (P < .05). Tumor-related changes in ovarian vascularity were identified by DUS before the tumor became detectable by gray scale imaging. Increased expression of VEGF and alpha(v)beta(3)-integrins was associated with tumor development. Ovarian TAN preceded tumor progression in hens. CONCLUSIONS: The results suggest that ovarian TAN may be an effective target for the detection of early-stage OVCA. The laying hen may also be useful for studying the detection and inhibition of ovarian TAN using various means, including the efficacy of contrast agents, targeted molecular imaging, and antiangiogenic therapies. PMID: 20103787 [PubMed - in process]

Reliability study of the sonographic measurement of the acromiohumeral distance in symptomatic patients

The purpose of this study was to evaluate the inter- and intra-observer reliability and accuracy of sonographic (US) acromiohumeral distance (AHD) measurement for both experienced and novice operators in US in patients suffering from subacromial impingement syndrome.A total of 43 patients (50 shoulders) diagnosed with subacromial impingement syndrome were recruited from an orthopedic outpatient clinic. The US measurement of AHD was obtained consecutively in a neutral position and in a 60° abduction position. A total of 300 blinded measurements were taken.In the neutral abduction group the intra- observer interclass correlation coefficient (ICC) was 0.94 for the experienced operator and 0.92 for the novice operator. The inter-observer ICC was 0.70 and the accuracy was 1.1 mm. In the 60° abduction group, the intra-observer ICC was 0.90 for the experienced operator and 0.87 for the novice operator. The inter-observer ICC was 0.64 and the accuracy was 1.4 mm. All ICCs were significant at a level of p < 0.0001.The inaccuracy of the method was 1 mm regardless of the experience of the observer. US AHD measurement in patients with shoulder complaints is not as accurate as reported in healthy subjects. This may have important implications for the clinical use of this parameter. © 2010 Wiley Periodicals, Inc. J Clin Ultrasound, 2010

Further observations on the empty "amnion sign"

To assess the positive predictive value of the empty "amnion sign" (visualization of an amnion without concomitant visualization of an embryo) for the diagnosis of early pregnancy failure.Retrospective study of 882 1st trimester sonographic examinations with abnormal findings among women who were threatening to abort. Eight hundred six met the inclusion criteria.In the study cohort 286 (35.5%) had no identifiable embryo and 71 of those without an identifiable embryo had a visible amnion (24.8%). The breakdown of the mean sac diameter of the study cohort was as follows: those measuring less than 16 mm (n = 16); those measuring 16-20 mm (n = 20); those measuring 21 mm or more (n = 35). Sixty-eight of the 71 patients had adequate follow-up. Pregnancy failure was confirmed in all 68 patients (positive predictive value = 100%).The data from this study indicate that visualization of an amnion without concomitant visualization of an embryo (the empty "amnion sign") confirms pregnancy failure regardless of the mean sac diameter and with a sufficiently high positive predictive value to make a definitive diagnosis. © 2010 Wiley Periodicals, Inc. J Clin Ultrasound, 2010

Color Doppler sonographic evaluation of flow volume of the internal carotid and vertebral arteries after carotid endarterectomy

To measure by Doppler sonography the blood flow volume (BFV) of the ipsilateral and contralateral extracranial internal carotid arteries (ICAs) and both vertebral arteries (VAs) before and after a carotid endarterectomy (CEA) of the ICA. We correlated the result with the degree of stenosis of the ICA.One hundred seven patients who had a CEA were divided into 2 groups. Group I consisted of subjects with stenosis of ipsilateral ICA of [ge]70% to near occlusion and Group II included subjects with near occlusion. The Doppler sonographic examinations were performed 1 day before the CEA, 7 days after the CEA, and 1 month after the CEA. The peak systolic velocity, end-diastolic velocity, time-averaged maximum blood flow velocity, resistance index of the ipsilateral ICA, and the BFV of both ICAs and both VAs were calculated.There was a significant increase in the peak systolic velocity, maximum blood flow velocity, and the BFV of the ipsilateral ICA after the CEA. The BFV of the contralateral ICA and both VAs were not significantly altered after the CEA in both groups.The main CEA hemodynamic effect was an increase in the BFV of the ipsilateral ICA regardless of the degree of stenosis. © 2010 Wiley Periodicals, Inc. J Clin Ultrasound, 2010

Role of sonography in the emergency room to diagnose sternal fractures

The diagnosis of a sternal fracture is often difficult when the fracture site shows only minimal displacement on conventional radiography. Recently, sonography (US) has been used widely in the emergency room (ER). We investigated the diagnostic performance of US in the ER for the diagnosis of sternal fractures.Thirty-six consecutive patients examined for pain and tenderness in the sternum after blunt chest trauma were enrolled in the study. Antero-posterior and lateral radiographs and sonograms of the sternum were obtained within 24 hours after admission. The 2 imaging modalities were interpreted in a blinded manner and their diagnostic sensitivity and specificity were calculated. The final diagnosis was based on results from the clinical examination, radiographs, and sonograms.Twenty-four of the 36 patients were diagnosed with sternal fractures. The sensitivity and specificity of the plain radiographs were 70.8% (95% CI = 56.0-85.6%) and 75.0% (95% CI = 60.9-89.1%), respectively. In contrast, sonography had a 100% sensitivity and specificity (95% CI = 90.3-100%).US has a higher sensitivity and specificity in diagnosing sternal fractures than conventional radiographs. US should be considered in patients with symptoms suggesting sternal fractures whose radiographs remain indeterminate. © 2010 Wiley Periodicals, Inc. J Clin Ultrasound, 2010

Re: Sonographic measurement of cross-sectional area of the median nerve in the diagnosis of carpal tunnel syndrome: Correlation with nerve conduction studies

No abstract.

Is neonatal risk from vasa previa preventable? The 20-year experience from a single medical center

Vasa previa is a rare condition associated with neonatal morbidity and mortality that may be diagnosed prenatally using transvaginal sonography. The aim of this study was to assess the prenatal detection of vasa previa and its subsequent impact on neonatal outcomes in two 10-year periods (1988-1997 versus 1998-2007).Retrospective review of all cases of vasa previa. Data on obstetrical history, modes of conception, sonographic scans, delivery mode, and neonatal outcome were retrieved and recorded.There were 19 pregnancies (21 neonates) with confirmed vasa previa (overall incidence of 1.7/10,000 deliveries). Vasa previa were diagnosed prenatally in 10 (52.6%) cases. In cases without prenatal diagnosis, there was a higher proportion of neonates with 1[prime] Apgar score [le]5 and cord blood pH 0.05), whereas perinatal mortality and 1[prime] Apgar scores [le]5 decreased from 25 to 0% and from 50 to 33.3% (p > 0.05).Prenatal sonographic screening using targeted scans for vasa previa in women at risk or as part of routine mid-gestation scanning may significantly impact its obstetric manifestations. © 2010 Wiley Periodicals, Inc. J Clin Ultrasound, 2010.

Sonographic findings in a patient with neurofibromatosis type 1 and a gastrointestinal stromal tumor

Gastrointestinal stromal tumors (GIST) have been suggested to be the most common neurofibromatosis 1-associated gastrointestinal tumors. This case report describes and compares US and CT findings of both abdominal neurofibromas and a gastrointestinal stromal tumor. On US, the GIST appeared as a well-defined inhomogeneous lesion with a target-like pattern similar to CT. The neurofibromas appeared as well-demarcated round nodules with a relatively homogeneous hypoechoic internal structure and were accompanied by subtle posterior acoustic enhancement. US and CT were able to differentiate between neurofibromatomas and GIST in this neurofibromatosis 1 patient; however, a biopsy of the suspicious mass was performed to clarify the diagnosis. © 2010 Wiley Periodicals, Inc. J Clin Ultrasound 2010

Sonographically measured perirenal fat thickness: An early predictor of atherosclerosis in HIV-1-infected patients receiving highly active antiretroviral therapy?

The aim of our study was to evaluate whether perirenal fat thickness (PRFT), a parameter of central obesity, is related to carotid intima-media thickness (IMT), an index of atherosclerosis in human immunodeficiency virus (HIV)-1-infected patients.We enrolled 70 consecutive HIV-1-infected patients receiving highly active antiretroviral therapy for more than 12 months, in a prospective cohort study. Sonographically measured PRFT and carotid IMT, as well as serum metabolic parameters, were evaluated. PRFT and IMT were measured using 3.75-MHz convex and 7.5-MHz linear probes, respectively.The mean PRFT and IMT in HIV-1-infected patients with visceral obesity was significantly greater than those in patients without it (p < 0.0001 and p < 0.01, respectively). Using the average IMT as the dependent variable in regression analysis, PRFT was an independent factor associated with carotid IMT (p < 0.05). A PRFT of 6.4 mm was the most discriminatory value for predicting an IMT [ge] 0.9 mm (sensitivity 83.3%, specificity 83.9%). Subjects with visceral obesity had a progressively increasing carotid IMT on the 12-month measurement (p < 0.05).Our data demonstrated that PRFT measurement could be used as an early predictor of IMT increase in HIV-1-infected patients receiving highly active antiretroviral therapy. © 2010 Wiley Periodicals, Inc. J Clin Ultrasound 2010

McKusick-Kaufman syndrome: The difficulty of establishing a prenatal diagnosis of an uncommon disorder

Prenatal evaluation of abdominal cystic masses can be complex and challenging. We report the case of a fetus with a large cystic abdominal mass and discuss how the differential diagnosis was narrowed to include McKusick-Kaufman syndrome (MKS). MKS is characterized by the triad of postaxial polydactyly, congenital heart disease, hydrometrocolpos, and genital malformations in males. Rare conditions such as MKS are difficult to diagnose prenatally and require postnatal phenotyping and molecular studies before a definitive diagnosis can be established. © 2010 Wiley Periodicals, Inc. J Clin Ultrasound 2010

Diagnostic accuracy of real-time 3D sonography in the diagnosis of congenital Mullerian anomalies in high-risk patients with respect to the phase of the menstrual cycle

To compare the diagnostic accuracy of 2-dimensional sonography (2DUS) and real-time 3-dimensional sonography (3DUS) in the diagnosis of congenital mullerian defects (CMD) with respect to the phase of the menstrual endometrium.The accuracy of sonography was examined on 108 women by 2 gynecologists during the 1st 5 days after cessation of menstrual flow and then re-examined at the cycle days 20-24. Entrance criteria for the patients enrolled in the study were as follows: women who were referred to our center with a suspected Mullerian anomaly at hysterosalpingography, and women who were suspected to have a uterine anomaly at our hospital during infertility, dysmenorrhea, and recurrent abortion workup. First, 1 of the gynecologists performed the 2DUS, and afterwards the 2nd gynecologist performed the real-time 3DUS. Results from both examiners were compared and correlated with the definitive diagnosis obtained by MRI, laparoscopy, or hysteroscopy. The sensitivity and specificity values of 2DUS and real-time 3DUS for the diagnosis of CMD were calculated at follicular and luteal phases.Among the 108 cases suspected to have CMD, the sensitivity and specificity values of real-time 3DUS were significantly higher in the follicular sensitivity, 94.7%, specificity, 75.0%, and luteal phases (sensitivity, 100%, specificity, 93.7%) when compared with 2DUS values (sensitivity of 30.2% and specificity of 78.1% in the follicular phase and sensitivity of 42.1% and specificity of 81.2% in the luteal phase).Real-time 3DUS is an accurate method that can be used for the diagnosis of congenital mullerian defects. © 2010 Wiley Periodicals, Inc. J Clin Ultrasound 2010

Giant cell tumor of a tendon sheath mimicking an axillary lymph node

A giant cell tumor of the tendon sheath (GCTTS) is 1 of the most common soft-tissue tumors of the hand and wrist, while the 2nd most frequent site is the ankle-foot complex. Although various solid tumors can develop in the axilla, GCTTS has not yet been reported. We describe the sonographic appearance of GCTTS in the axilla. © 2010 Wiley Periodicals, Inc. J Clin Ultrasound 2010

Sonographic diagnosis of postpartum pseudoaneurysms of the uterine artery: A report of 2 cases

Two cases of post-partum uterine artery pseudoaneurysm are described, 1 after normal vaginal delivery and the other after Caesarean section. Both cases were complicated by heavy bleeding and treated with catheter embolization. A turbulent arterial-type velocity waveform with high peak velocity and forward end-diastolic flow was registered in the feeding vessel. The peak blood flow velocity was high in both cases. The resistance index in the uterine artery was lower in the affected side of the uterus. Three-dimensional angiosonography was used to calculate the volume of the lesion, demonstrate its shape, and identify the feeding vessel. © 2009 Wiley Periodicals, Inc. J Clin Ultrasound, 2010

Sonographic diagnosis of penile Mondor's disease associated with absence of a dorsal penile artery

Penile Mondor's disease is an unusual condition, which is characterized by thrombosis in superficial dorsal penile vein. Here, we report the sonographic findings of this disease in a 35-year-old male along with the absence of right dorsal penile artery. © 2009 Wiley Periodicals, Inc. J Clin Ultrasound 2010

Contrast-enhanced sonography with abdominal virtual sonography in monitoring radiofrequency ablation of hepatocellular carcinoma

Background.Contrast-enhanced CT is regarded as the gold standard for monitoring radiofrequency ablation (RFA) of hepatocellular carcinoma (HCC). Recently, 3-dimensional volume data from CT have been used to create cross-sectional multiplanar reconstruction images. Using this technique, we can reconstruct 2-dimensional CT images identical in orientation to ultrasound (US) images, which we call virtual sonographic (VUS) images. The present prospective randomized control trial compared the number of CT scans needed to assess the efficacy of RFA of HCC using VUS-contrast-enhanced ultrasonography (CEUS) versus CT.Method.Subjects comprised 50 patients (50 HCCs) treated with US-guided RFA between May 2005 and August 2006, randomized to undergo assessment by CT (Group 1; 25 HCC nodules) or VUS-CEUS (Group 2; 25 HCC nodules). All patients were followed for 1 year. Primary endpoint was whether the number of CT scans could be reduced using VUS-CEUS.Result.Mean number of CT scans required was 1.64 ± 0.7 in Group 1 and 1.1 ± 0.2 in Group 2 (p < 0.001).Conclusion.VUS-CEUS can be used to assess the efficacy of HCC of RFA, with the potential to reduce the number of CT scans required for that purpose. © 2009 Wiley Periodicals, Inc. J Clin Ultrasound, 2010

Two- and three-dimensional prenatal sonographic diagnosis of prune-belly syndrome

We report the prenatal diagnosis of 6 cases of Prune-belly syndrome in the 2nd trimester. The sonographic diagnosis was based on the findings of oligohydramnios, renal anomalies, and a lower abdominal cystic mass representing the abnormal dilatation of the bladder on conventional 2-dimensional sonographic examination. We discuss the role of Doppler imaging and 3-dimensional sonography as complementary methods to conventional sonography. Four of our 6 cases were confirmed with associated defects. © 2009 Wiley Periodicals, Inc. J Clin Ultrasound, 2010

New ultrasound-based imaging technologies are claimed to avoid unnecessary breast biopsies, but what is an "unnecessary" image-guided needle biopsy of the breast?

No abstract.

Prenatal ultrasound and magnetic resonance imaging depiction of a small sublingual ranula

Prenatal diagnosis of a congenital ranula has rarely been reported. We describe the case of a small ranula depicted on prenatal sonogram and magnetic resonance imaging, in which we could confirm the intact airway. Although the size of the ranula noted in our fetus was the smallest among the cases reported in the English literature, both of these imaging modalities clearly presented typical diagnostic features present on both ultrasound and magnetic resonance imaging. © 2009 Wiley Periodicals, Inc. J Clin Ultrasound 2010

Contrast-enhanced sonography in the diagnosis of acute mesenteric ischemia: Case report

Acute mesenteric ischemia is a serious condition associated with high mortality. Multislice CT and magnetic resonance angiography have proved accurate in diagnosing this pathology, which requires a prompt diagnosis to start appropriate therapy. We report the case of an 87-year-old woman with acute mesenteric ischemia, in whom contrast-enhanced sonography visualized the occluded superior mesenteric artery and the infarcted portion of the intestine. © 2009 Wiley Periodicals, Inc. J Clin Ultrasound, 2010

Ultrasound diagnosis of dicephalic conjoined twins at 24 weeks of gestation

We report the case of dicephalic conjoined twins discovered incidentally on a routine ultrasound at 24 weeks of gestation. There were 2 heads and a neck that fused with 1 thorax, but the spines continued all the way to the coccyx. The spines were connected medially by a fused rib, and laterally, there were ribs that went around the thorax in a more normal fashion. Antenatal ultrasound images are supplemented by postnatal photographs and x-rays. © 2009 Wiley Periodicals, Inc. J Clin Ultrasound, 2010

Treatment of an extracapsular post-renal biopsy pseudoaneurysm with ultrasound-guided thrombin injection

Percutaneous renal biopsy is a convenient method to obtain allograft tissue for histologic evaluation. Vascular complications, such as arteriovenous (AV) fistula and pseudoaneurysm, following renal biopsy are well known, and they usually resolve without further intervention. When symptomatic, they should be treated. We present a patient on chronic anticoagulation who developed a pseudoaneurysm after percutaneous renal biopsy. Applying techniques learned in the management of femoral artery pseudoaneurysm, we treated our patient with ultrasound-guided thrombin injection. © 2009 Wiley Periodicals, Inc. J Clin Ultrasound, 2010

Conservative management of an extensive renal graft subcapsular hematoma arising during living donor nephrectomy. Role of Doppler sonographic posttransplant follow-up

We report a case of subcapsular hematoma (SH) of a kidney graft arising during minimal-incision living-donor nephrectomy. SH covered at least two-thirds of the cortical surface. Capsulotomy was not done because it was deemed too risky. In the immediate postoperative period, a rapid deterioration of graft function was observed associated with Doppler sonographic evidence of graft compression. However, in the following days, spontaneous resolution of SH and progressive improvement of Doppler findings was observed, which preceded full recovery of graft function. Conservative management seemed a valid approach of this complication in this case where Doppler sonography proved essential for the follow-up. © 2009 Wiley Periodicals, Inc. J Clin Ultrasound, 2010

Echocardiographic identification of ventricular septal rupture caused by acute stent thrombosis

Coronary stenting is an increasingly common procedure. Complications are rare. However, when they do occur, they often require urgent invasive treatment. Investigations that are critical for establishing a diagnosis as well as such guide treatment as a detailed assessment of myocardial morphology and function using transthoracic echocardiography may be overlooked in the haste to treat the patient. We present a case report of subacute drug-eluting stent thrombosis in which a meticulous echocardiographic examination allowed the identification of a ventricular septal rupture, which ultimately modified treatment. © 2009 Wiley Periodicals, Inc. J Clin Ultrasound, 2010

Continuous-type splenogonadal fusion associated with an ipsilateral testicular atrophy: Sonographic findings

Splenogonadal fusion is a rare congenital anomaly in which the spleen is abnormally connected to the gonad. Two types of splenogonadal fusion have been described: continuous and discontinuous. Splenogonadal fusion is frequently associated with cryptorchidism and/or congenital orofacial/limb anomalies. We describe the ultrasound findings in a case of continuous-type splenogonadal fusion associated with ipsilateral testicular atrophy with correlation with MRI. © 2009 Wiley Periodicals, Inc. J Clin Ultrasound 2009

The utility of thoracic ultrasound before local anesthetic video-assisted thoracoscopy in patients with suspected pleural malignancy

Video-assisted thoracoscopy under local anesthesia (VAT-LA) is a key investigation in the diagnosis and management of suspected malignant pleural effusion. Two problems encountered at VAT-LA are accessing the pleural space and fibrinous intrapleural septa. Thoracic sonography (TUS) is known to facilitate thoracocentesis after dry tap but has not been studied in detail before VAT-LA. We report a case of lateral decubitus pre-VAT TUS that helped locate the optimal access to the pleural space and demonstrated fibrinous intrapleural septation, thereby affecting the decision to avoid thoracoscopic pleurodesis. © 2009 Wiley Periodicals, Inc. J Clin Ultrasound, 2009