bluuebunny/crossref_metadata_2025 huggingface dataset:
Ultrasonography in the detection of cervical incompetency
Authors: Podobnik Mario , Bulié Milan , Smiljanicé Nikola , Bistrički Josip
Published: February 2007

In 80 pregnancies with clinical and ultrasonic signs of cervical incompetency, the length of the cervix and the thickness of the anterior wall of a lower uterine segment have been evaluated ultrasonically. We have also measured the width of the endocervical canal and studied the prolapse of fetal membranes (with fetal parts) into the endocervical canal. We evaluated these same parameters in 80 healthy pregnancies. The length of the cervix, the thickness of the anterior wall of a lower uterine segment, and the width of the endocervical canal were followed longitudinally in the patients from the 10th to the 36th gestation week. No statistically significant differences between age groups were found. In four age groups at risk for cervical incompetency, cervical lengths and wall thickness were significantly different (p < 0.001) from those in comparable controls. Forty‐five percent of the patients in the atrisk group, with cervical cerclage, delivered at 37.3 (range: 32 to 41) weeks and 6.25% of pregnancies ended in abortion when the amniotic membrane herniated into the cervical canal, with or without some part of the fetus.
Detection of open spina bifida by the lemon sign: Pathologic correlation
Authors: Gabbe Steven G , Mintz Marshall C , Mennuti Michael T , McDonnell Rn Ann E
Published: February 2007

This study was undertaken to evaluate the association of medial displacement of the frontal bones of the fetal calvarium, the lemon sign, with open spina bifida (OSB) and to assess other pathologic findings associated with this change. During the past 8 years, 8 cases of OSB were seen in our institution. The lemon sign was retrospectively identified in 6/6 cases of OSB scanned before 22 weeks gestation, while it was not seen in 3/3 cases examined after 26 weeks. One case was evaluated with serial studies before and after 22 weeks. Scalloping of the frontal bones was associated with a wide variety of pathological findings. This sign may prove to be an important marker for OSB.
The utility of image‐directed Doppler ultrasound in the evaluation of the “parallel channel” sign
Authors: Levy Howard M , Dobkin Gary R , Doubilet Peter M
Published: February 2007

Ultrasound has been shown to be an excellent modality in the evaluation of the jaundiced patient, proving extremely valuable in differentiating surgical (obstructive) from medical jaundice based on the presence or absence of ductal dilatation.1 The sonographic finding of intrahepatic dilatation has been termed the “double barrel,”2 “shotgun,”3, or “parallel channel”4 sign. This refers to visualization of dilated intrahepatic bile ducts with the normally visualized portal venous radicles. Subsequent to its initial description, this sign has also been observed in patients with increased hepatic arterial flow.5,6 In these patients, one of the components of the parallel channel sign represents the prominent intrahepatic artery. In the following case report, we demonstrate the use of pulsed Doppler to help make this distinction.
Ultrasound diagnosis of neonatal spinal epidural hemorrhage
Authors: Leadman M , Seigel S , Hollenberg R , Caco C
Published: February 2007

With the advent of the 5–7‐mHz transducer, ultrasound has been found to be very useful in evaluating abnormalities in the newborn spine, including tethered cord, meningomyelocele, spinal lipoma, and other forms of dysraphism.1 This is because of the ability of the ultrasound beam to penetrate mostly cartilaginous spine and its contents until six months of age. To our knowledge, ultrasound used to assess spinal cord trauma following birth has been mentioned as one case in a series2 and cited as useful in another.3 We present a case in which ultrasound was instrumental in evaluating spinal pathology and determining appropriate surgery.
Cerebral blood flow velocity waveforms in hydrocephalic fetuses
Authors: Kirkinen P. , Muller R. , Baumann H. , Briner J. , Lang W. , Huch R. , Huch A.
Published: February 2007

Pulsed Doppler recordings of intracranial arterial velocity waveforms were made in 9 hydrocephalic fetuses during the second or third trimesters of pregnancy. Normal, increased, and decreased velocity waveform indices could be measured in these cases, and 1 fetus presented retrograde diastolic flow. Cerebral blood flow patterns of hydrocephalic fetuses seem to differ individually from case to case, presenting no uniform waveform type in late pregnancy. There was no obvious correlation between ventricular dilatation and the type of the velocity waveform.
Congenital cerebrospinal fluid‐containing intracranial abnormalities: A sonographic classification
Authors: McGahan John P , Ellis William , Lindfors Karen K , Lee Benjamin C. P , Arnold Jerry P
Published: February 2007

Ultrasound is useful as a primary modality for diagnosis of complex nonhydrocephalic intracranial malformations. We present 10 cases of intracranial cerebrospinal fluid containing abnormalities that may be diagnosed by ultrasound. Congenital abnormalities presented include holoprosencephaly, hydranencephaly, agenesis of the corpus callosum with interhemispheric cyst, porencephaly, schizencephaly, and arachnoid cyst. Ultrasound may be used in the fetus or neonate in detecting and separating these abnormalities from hydrocephalus.
Studies on frequency‐dependent attenuation in the normal liver and spleen and in liver diseases, using the spectral‐shift zero‐crossing method
Authors: Itoh Kouichi , Yasuda Yoshikazu , Suzuki Osamu , Itoh Hiromi , Itoh Takashi , Jing‐Wen Tsao , Konishi Tatuo , Koyano Akira
Published: February 2007

This report presents results of studies using the spectral‐shift zero‐crossing method to measure frequency‐dependent attenuation (FDA) in normal liver and spleen and in diseased liver. We developed a new system for attenuation analysis that calculated FDA in dB/cm/MHz according to the following equation:

Data are collected from the region of interest on the scan image. Graphite‐gel phantoms of known attenuation value are used to create a high degree of accuracy in this new system. Mean attenuation of normal livers was 0.55 ± 0.05 dB/cm/MHz, while that of normal spleen was 0.37 ± 0.06 dB/cm/MHz. No correlation between FDA and age could be seen. FDA was 0.81 ± 0.17 dB/cm/MHz in fatty liver, 0.63 ± 0.13 dB/cm/MHz in liver cirrhosis, and 0.64 ± 0.12 dB/cm/MHz in chronic hepatitis. These values are higher than those obtained from normal liver, while tumor masses in the liver (hepatocellular carcinoma, hepatoblastoma, hemangioma) and diffuse infiltration by malignant lymphoma produced lower than normal values, averaging 0.38 ± 0.08 dB/cm/MHz.
Fetal weight estimates in diabetic gravid women
Authors: Miller Joseph M , Brown Haywood L , Khawli Oscar F , Korndorffer Frederick A , Gabert Harvey A
Published: February 2007

Fetal weight in utero was estimated sonographically within one week of delivery in 70 live‐born fetuses of diabetic gravidas. The best estimates of weight were obtained with formulas dependent on biparietal diameter, abdominal circumference, and femur diaphysis length, and with formulas using the two variables of femur diaphysis length and abdominal circumference. Use of a special formula for the fetus of a diabetic mother was not of additional benefit. Acceptable weight estimates for the macrosomic diabetic fetus were not obtained.
Observer error in the characterization of hepatic lesions in patients with neoplastic liver disease
Authors: Iscoe Neill A , McKee John D , Arenson Anna Marie , Szalai John P
Published: February 2007

Sixteen patients with known neoplastic liver disease underwent 20 ultrasound examinations by two separate teams to determine the level of agreement in the measurement of lesion size and sonographic characteristics. The intraclass correlation coefficient for the observations on lesion size was r = 0.97 (95% lower confidence limit r = 0.96). We conclude that sonographic estimation of the size of neoplastic liver lesions in highly reproducible and that the measurements obtained may be safely incorporated into the criteria of response for cancer clinical trials.
Ultrasonic examination of the wall of the fluid‐filled stomach
Authors: Worlicek Hans , Dunz Dorothee , Engelhard Karl
Published: February 2007

The ultrasonographic examination of the fluid‐filled stomach in five standardized positions permits the transabdominal visualization of the gastric wall in all sections of the organ. In a prospective study, 107 patients were examined—68 with a pathological change in the wall of the stomach and 39 with no gastric disease. In 56 patients (82.4%) the lesion was correctly identified. In addition to wall‐infiltrating processes and stenoses, circumscribed space‐occupying lesions were also detected; for example, localized carcinomas, leiomyosarcomas, lymphomas, leiomyomas, polyps, giant folds, and impressions of the gastric wall. Thirty‐seven patients (94.9%) with no gastric disease were considered normal at the ultrasonographic examination. The procedure suggests itself not only as a supplement to endoscopy and diagnostic X‐rays, but also as a diagnostic alternative in selected patients who cannot be stressed by these methods. The exclusion of gastric disease by this technique is not possible.
Human skin histology using high‐resolution echography
Authors: Murakami Shinji , Miki Yoshiharu
Published: February 2007

Normal and abnormal human skin echograms were made using new 25‐MHz and 40‐MHz ultrasonic sector scanners, and were compared with histologic sections. The malpighian layer of the epidermis was demonstrated as an echolucent zone under a strongly echogenic, linear corneo‐malpighian junction in normal palms and soles. Cross sections and longitudinal sections of hair follicles and hypertrophic sebaceous glands were also demonstrated as echolucent structures.
Development of individual growth standards for estimated fetal weight: II. Weight prediction during the third trimester and at birth
Authors: Deter Russell L. , Rossavik Ivar K. , Carpenter Robert J.
Published: February 2007

Using a weight estimation procedure based of the Rossavik growth model, we have evaluated the possibility of establishing individual growth curve standards for fetal weight estimates and of predicting birth weights in the second trimester. In 20 normal fetuses delivered at term, 95% of the weight estimates obtained after 26 weeks' menstrual age (MA) were within ± 22% of the predicted weight estimates. In these same fetuses the mean difference between birth weight estimates based on growth patterns before 26 weeks, MA, and actual birth weights was 1.2%, with 95% of the percent deviations being between 13.3% and −8.8%. In a similar prospective study, the mean percent difference was −1.7%, with a range of 9.6% to −13.6%. Direct comparison of weight estimates obtained during the last week before delivery with birth weight projections indicated that birth weight estimates obtained 14 weeks before delivery had smaller systematic and random errors than those obtained within a week of delivery. These results indicate that individual growth curve standards for fetal weight estimates and the growth potential of individual fetuses can be determined from growth patterns in the second trimester.
Predicting the birth characteristics of normal fetuses 14 weeks before delivery
Authors: Deter Russell L. , Hill Reba M. , Tennyson Linda M.
Published: February 2007

This investigation has evaluated the ability of Rossavik growth models (derived from data obtained before 26 weeks) to predict birth characteristics in normal fetuses (assuming no growth after 38 weeks). Both weight and head circumference were predicted without systematic errors and the ranges of the random errors were approximately ±10% and ±5%, respectively. A range of approximately ±10% for the random error was also found for the abdominal and thigh circumferences, but both parameters were systematically overestimated (17.3% and 6.4%, respectively). No evidence of a relationship between the percent deviation and age at delivery (up to 41 weeks) was found for any of the parameters studied.

As indicators of pregnancy outcome, Growth Potential Realization Index (GPRI) values were calculated for each parameter (predicted values corrected for systematic errors were used for the abdominal and thigh circumferences). Mean GPRI values were not signficantly different from 100% and the ranges were approximately 90% to 110% except for the head circumference (range: 95% to 105%). These results indicate that GPRI values can be used to characterize the outcome of prenatal growth processes on an individual basis, with each fetus acting as its own control.
Ultrasonographic evaluation of cervical lymph node metastases in esophageal cancer with special reference to the relationship between the short to long axis ratio (S/L) and the cancer content
Authors: Tohnosu Noriyuki , Onoda Shoichi , Isono Kaichi
Published: February 2007

Cervical lymph node metastasis was evaluated sonographically in 58 esophageal cancer patients. The short to long axis ratio (S/L) is a useful way to detect lymph node metastasis as opposed to the long axis alone. In other words, the lymph node exceeding 10 mm in long axis and with S/L over 0.5 showed a much higher incidence of metastasis than S/L under 0.5 in the analysis of the 126 detected lymph nodes. The cancer content was calculated with a microcomputer in each of the total 77 metastatic lymph nodes by enlarging the microscopic specimen 8 or 16 times using a magnifying apparatus. The average cancer content in the metastatic lymph nodes with S/L under 0.5 and over 0.5 was 26.0% and 59.1%, respectively, revealing a statistically significant difference (p < 0.01). Thus, cancer proliferation in the metastatic lymph nodes of esophageal cancer is closely related to the increase in S/L.
Ultrasound assessment of local complications of percutaneous renal stone removal
Authors: Ivory C. M. , Dubbins P. A. , Wells I. P. , Hammonds J. C.
Published: February 2007

Ultrasound evaluation of 20 consecutive patients undergoing percutaneous renal stone removal demonstrated fluid collections around the kidney to be common, occurring in 12 (60%). One was intraperitoneal, 7 were perirenal, and 4 were in the track through the posterior abdominal wall. In only 1 were related clinical complications evident.

At long‐term follow‐up, local capsular thickening related to a surface dimple was seen at the puncture site in 66%, and fine cortical scars were visible in 33%. Apart from one slightly larger local cortical scar related to a segmental infarction, no other change related to the procedure was demonstrated.
Sonography of anencephaly: Pitfalls in early diagnosis
Authors: Goldstein Ruth B. , Filly Roy A. , Calien Peter W.
Published: February 2007

A case in which the diagnosis of anencephaly was missed on a standard obstetrical sonogram performed at 12.5 menstrual weeks is described. Prompted by this case, we retrospectively reviewed the appearance of the cephalic pole of normal fetuses in 47 pregnancies ranging in menstrual age from 11 weeks to 16 weeks. Results indicate that the abnormal cephalic pole in the index case was similar to the appearance of many normal fetuses of similar menstrual age. We conclude that while anencephaly may be diagnosed as early as 11 menstrual weeks to 12 menstrual weeks, this defect may be difficult to diagnose on sonograms using standard sonographic techniques prior to 14 menstrual weeks.
Ultrasonography of the thyroid during pregnancy
Authors: Brander A. , Kivisaari L.
Published: February 2007

To discover whether pregnancy causes ultrasonically detectable changes in the thyroid, an ultrasound examination of the thyroid was performed repeatedly in 21 pregnant women with no history of thyroid disease.

Seven patients were examined three times and 14 twice during the course of pregnancy. The size of the thyroid was estimated and the echogenicity assessed with respect to homogenicity and degree by comparison with the echogenicity of adjacent muscles. The results were compared with the results of a control group of healthy female volunteers. The mean volume of the thyroid increased slightly during the course of pregnancy. No changes in the echogenicity or echostructure were noted.
Real‐time ultrasound evaluation of tuberculous pleural effusions
Authors: Martínez O. Carazo , Serrano B. Vargas , Rodr Romero R. Íguez
Published: February 2007

An evaluation of 21 patients with tuberculous pleurisy was carried out to assess the role of ultrasonography in the diagnosis of tuberculous pleural effusion. Ultrasonography revealed winding structures of different lengths and thicknesses (winding bands) in 8 patients, and filiform structures of a higher echogenicity and a shorter length (linear echoes) in 13. These findings were associated with exudates having a high content of fibrin and protein, respectively, suggesting that winding bands might be formed by fibrin and linear echoes by protein macroaggregates. Based upon these observations, ultrasonography seems to be a useful method for identifying tuberculous pleural effusion.
Hepatic parenchymal calcifications—differentiation from intrahepatic stones
Authors: Lin Hsien‐Hong , Changchien Chi‐Sin , Lin Deng‐Yn
Published: February 2007

Intrahepatic hyperechoic lesions with acoustic shadows could be stones or nonspecific calcifications. To verity this, 9 patients with hepatic parenchymal calcifications were compared with 40 patients with intrahepatic stones. A set of criteria are proposed for the diagnosis of intrahepatic stones: (A) dilated intrahepatic duct; (B) pneumobilia; or (C) 2 or more of the following: (1) common hepatic duct more than 6 mm in diameter, (2) multiple lesions in one lobe, (3) left lobe involvement, and (4) elevated serum alkaline phosphatase. The sensitivity, specificity, and overall accuracy were 97.5%, 88.9%, and 95.9, respectively. The criteria help in the selection of patients for evaluation of intrahepatic stones.
Sonographic relationship between gallbladder wall thickness and the etiology of ascites
Authors: Marti‐Bonmati Luis , Andres Juan C. , Aguado Cristina
Published: February 2007

Gallbladder wall thickness (GBWT) and serum albumin were determined in 54 patients with ascites. The statistical analysis of the results reveals a significant difference in GBWT between benign and malignant conditions (p < 0.01). GBWT was significantly thicker in patients with cirrhosis than in those with malignant ascites (p < 0.01) and other benign conditions. However, no significant differences were found between either cirrhotic cases with and without overlying hepatocarcinoma, or between noncirrhotic patients, malignant or otherwise. On comparing GBWT and simple routine sonography in establishing the etiology of ascites, the diagnostic reliability indices decreased with GBWT. This shows that GBWT determination lacks diagnostic importance in routine practice.

No correlation was found between serum albumin and GBWT, which suggests that the increase in GBWT observed in cirrhotic patients is mainly the result of accompanying portal hypertension.
Sonography and computed tomography of macroscopic tuberculosis of the liver
Authors: Brauner M. , Buffard M. D. , Jeantils V. , Legrand I. , Gotheil C.
Published: February 2007

Four patients with macronodular tuberculosis of the liver were examined with ultrasonography. The findings included 1 case with multiple hypoechoic areas and 3 cases with a solitary lesion, one hypoechoic mass without calcifications, and two partially calcified masses. Some ultrasound features are suggestive: a mass with irregular calcifications, ascites, spleen enlargement with defects, enlarged nodes, and complete resolution of the lesions in a few months with effective antituberculous therapy.

The first case was also examinated with computed tomography.
Sono‐enterocolonography by oral water administration
Authors: Hirooka Noboru , Ohno Takanori , Misonoo Masaki , Kobayashi Chizuko , Musha Hirotaka , Mori Hiroshi , Ohto Masao
Published: February 2007

A new ultrasound technique for intestinal examination, named “sonoenterocolonography by oral water administration,” was devised. The diagnostic usefulness and limitations of this procedure were studied in 56 subjects including 42 normal patients, 10 patients with 13 colonic polyps and 4 patients with colon carcinomas.

Except for the rectum, almost all the intestines were clearly visualized by ultrasonography as tubular structures filled with water. In every case, ileocecal valve movement was clearly observed dynamically. Eight of the 9 elevated polypoid lesions of the bowel, ranging in size from 10 mm to 20 mm, were detected by this method without any special pretreatment.

Although this method may not be indicated for the screening of minute lesions, it may possibly be useful as a supportive diagnostic modality for intestinal disorders, especially in the ileocecal region.
Ultrasound of the normal nongravid uterus: Correlation with gross and histopathology
Authors: Platt Joel F. , Bree Robert L. , Davidson Darrell
Published: February 2007

Accurate assessment of uterine size and significance of uterine enlargement are common clinical problems. We examined 156 patients by sonography prior to scheduled hysterectomy. Uterine volumes from normal‐sized uteri were calculated from the sonograms using the equation of a prolate ellipsoid formula, and these calculated volumes were highly correlated with actual measured uterine volumes. Mean values and normal ranges of uterine weight were determined. These values are of particular value in postmenopausal patients in whom subjective evaluation of uterine enlargement is often difficult. When a sonographically enlarged, but otherwise normal uterus is discovered, it may contain a leiomyoma or other pathology not morphologically detectable by ultrasound.
Sonography of subacute thyroiditis: Changes in the findings during the course of the disease
Authors: Tokuda Yasutaka , Kasagi Kanji , Iida Yasuhiro , Yamamoto Kazutaka , Hatabu Hiroto , Hidaka Akinari , Konishi Junji , Ishii Yasushi
Published: February 2007

Fifteen patients with subacute thyroiditis were studied with thyroid sonography. There were local hypoechoic areas in all patients during the active phase of the disease. Among 6 patients who underwent follow‐up studies during the course of treatment, 3 had recurrence or aggravation of clinical symptoms such as painful swelling of the thyroid region, which was associated with, and sometimes preceded by, spread or reappearance of the sonographic abnormality. All 6 patients showed complete disappearance of the hypoechoic area when they were in remission. The thyroid sonography is useful not only for the initial diagnosis but also for the follow‐up of these patients during the course of the disease.
Sonographic anatomy of the caudate lobe veins
Authors: Fanney Daryl R. , Castillo Mauricio , Casillas Javier , Montalvo Berta
Published: February 2007

Because of their small size, the caudate lobe veins (CLV) are not routinely imaged with ultrasonography. We recently examined 4 patients with elevated central venous pressure in whom the CLV were easily identifiable. To our knowledge this is the first report of sonographic visualization of these veins. We suggest that visualization of the CLV may not be as rare as previously presumed, and based on our experience, we will propose a nomenclature system for these veins.
Endometrial hyperplasia: Value of endometrial thickness in ultrasonographic diagnosis and clinical significance
Authors: Malpani Ajay , Singer Jonas , Wolverson Michael K. , Merenda Gloria
Published: February 2007

The records of 90 patients with histologically proven endometrial hyperplasia (EH) were reviewed retrospectively. Eleven of these patients had pelvic ultrasound examinations available. These were compared to the pelvic ultrasound examinations of 19 patients with a histologically normal endometrium, available in 126 consecutive patients seen over the same period of time. Patients with EH had a mean endometrial thickness of 18.8 mm (range 8 mm to 45 mm) vs 5.4 mm (range 2 mm to 10 mm) in the control group. This difference in thickness was statistically significant (p ≪ .01). The specificity and sensitivity of endometrial thickness in the diagnosis of EH were 100% and 81%, respectively, when 10 mm was taken as the upper limit of normal. Ultrasonographically demonstrable endometrial characteristics can differentiate EH from normal endometrium in a great majority of cases. The clinicopathological significance of EH is discussed.
Transvaginal imaging: Applied physical principles and terms
Authors: Thaler Israel , Manor Dorit
Published: February 2007

In this article the properties of ultrasound in tissues and the factors governing image quality are discussed. Particular emphasis is placed on the vaginal probe. The virtues of transvaginal scanning both in gynecology and obstetrics are well described in subsequent articles in this symposium. Only by understanding the properties of ultrasound can the capabilities and limitations of this technique be appreciated. A comprehensive knowledge of the basic physical principles is mandatory for the clinician as well the investigator to attain the highest quality results. The technical aspects of operating ultrasound instruments, e.g., machine controls, electronic image formation, scan converters and techniques for preprocessing and postprocessing, are not discussed.
Transvaginal ultrasonically guided follicular aspiration: A comparative study with laparoscopically guided follicular aspiration
Authors: Gonen Yael , Blanker Joseph , Casper Robert F.
Published: February 2007

This study, comparing transvaginal ultrasound‐guided follicle aspiration with laparoscopic‐guided follicle aspiration for in vitro fertilization confirms that the use of laparoscopy appears to have no advantage for oocyte recovery over the ultrasonically directed technique. The latter offers potential benefits of less trauma, less risk, less morbidity, avoidance of general anesthesia, decreased operating room and personnel time, decreased expense, and in general, greater acceptance.
The discriminatory zone of βhyphen;hCG for vaginal probes
Authors: Peisner David B. , Timor‐Tritsch Ilan E.
Published: February 2007

Recent developments in both laboratory measurements and ultrasound technology have revolutionized the management of early pregnancy. The discriminatory zone concept is a direct result of these developments. By correlating the serum βhyphen;hCG values to the size of an intrauterine gestational sac, a value can be chosen that corresponds to the threshold of visualization of the sac. If the βhyphen;hCG is above this value, a sac must be seen, and if it is not, aggressive steps should be taken to determine whether the pregnancy is abnormal or ectopic. The discriminatory zone may vary among institutions due to different equipment and assays. Thus, its value should be calculated individually at each institution. A proper discriminatory zone and a management protocol such as the one above can eliminate much of the uncertainty in the management of suspected ectopic and early pregnancies.
Transvaginal sonographic diagnosis of congenital anomalies between 9 weeks and 16 weeks, menstrual age
Authors: Rottem Shraga , Bronshtein Moshe
Published: February 2007

A 6.5‐MHz transvaginal probe was employed for the screening of congenital malformations in 1652 patients between 9 weeks and 16 weeks, menstrual age. Transvaginal sonography detected 61 malformations in 40 fetuses. The overall diagnostic frequency of the congenital anomalies in this series was 2.6%. As described in this study, several congenital malformations are now detectable before the 16th week, and transvaginal sonography appears to be the diagnostic method of choice for the first and early second trimester.
Transvaginal scanning of the endometrium
Authors: Fleischer Arthur C. , Gordon Alan N. , Entman Stephen S. , Kepple Donna M.
Published: February 2007

Transvaginal sonography (TVS) can accurately depict the anteroposterior, width, and long axis of the endometrium. This article describes and illustrates normal and abnormal endometria as depicted by TVS.
Hemodynamic evaluation of the female pelvic vessels using a high‐frequency transvaginal image‐directed Doppler system
Authors: Thaler Israel , Manor Dorit , Rottem Shraga , Timor‐Tritsch Ilan E. , Brandes Joseph M. , Itskovitz Joseph
Published: February 2007

Perfusion characteristics of the female pelvic vessels were studied by a high‐frequency transvaginal image‐directed Doppler system. A 5‐MHz Doppler transducer was coupled to a 6.5‐MHz probe especially designed for intravaginal use. Distinct patterns of flow velocity waveforms were obtained from the ascending branch of the uterine artery, before and during pregnancy. A gradual increase in diastolic flow throughout gestation was observed, consistent with a decrease in vessel resistance. Flow velocity profiles in the ovarian artery were sampled from the infundibulo‐pelvic ligament. Only limited diastolic flow could be detected in either ovary during the follicular phase of the cycle. In the luteal phase there was a marked increase in this flow but only in the ovary containing the corpus luteum. In early pregnancy the high diastolic flow was maintained or even increased, consistent with a low arterial resistance. High image resolution and a higher frequency Doppler transducer increase the usefulness of this technique in the hemodynamic evaluation of the female pelvic vessels.
Focal hepatic fatty infiltration as a cause of pseudotumors: Ultrasonographic patterns and clinical differentiation
Authors: Wang Sun‐Sang , Chiang Jen‐Huey , Tsai Yang‐Te , Lee Shou‐Dong , Lin Han‐Chieh , Chou Yi‐Hong , Lee Fa‐Yauh , Wang Jyh‐Seng , Lo Kwang‐Juei
Published: February 2007

Focal hepatic fatty infiltration may be mistaken for hepatic neoplasm on ultrasonography. A sonographic feature mimicking “space occupying lesions” was identified in 41 cases with focal fatty liver, which led to the recognition of four sonographic patterns: (1) Ten patients in whom the livers were characterized by irregular configurations of hyperechoic and hypoechoic areas. Although confusing to inexperienced sonographers, all of them were properly interpreted by experienced sonographers. (2) One patient in whom the hepatic sonography revealed a hyperechoic nodule, but which was correctly diagnosed by computed tomography (CT) scan. (3) Six patients in whom the livers were characterized by multiple confluent hyperechoic lesions, which were all misinterpreted by sonographers and misinterpreted following CT scans in 4 cases and angiography in 3 cases. (4) Twenty‐four patients in whom the livers revealed focal spared areas, which was misdiagnosed by sonographers in 14 cases, but correctly diagnosed by CT scan in all 24 cases.
Ultrasound diagnosis of gastroesophageal reflux and hiatal hernia in infants and young children
Authors: Westra Sjirk J. , Wolf Bart H. M. , Staalman Chris R.
Published: February 2007

In 30 young children suspected of gastroesophageal reflux (GER), the G–E junction was examined with ultrasonography directly after a feeding while these children were on overnight extended esophageal pH monitoring (EEpHM) (32 simultaneous ultrasound/EEpHM studies). The two tests showed 81% to 84% agreement in the detection of the presence or absence of GER, depending on whether the whole period of EEpHM or only the part of it covering the ultrasound observation period were used as the standard. The discrepancies between the two tests were explained by the much longer monitoring period of EEpHM compared to ultrasonography and the inability of EEpHM to show reflux of neutralized gastric contents directly after milk feedings. The two studies probably measure different aspects of clinically significant reflux and must be correlated with the clinical symptoms. Morphological findings associated with significant reflux were (1) a short intra‐abdominal part of the esophagus, (2) a rounded gastroesophageal angle, and (3) a “beak” at the gastroesophageal junction. Barium meal findings confirmed these sonographic signs, indicating a sliding hiatal hernia of the distal esophagus, either fixed or intermittent. Ultrasonography can be recommended as a useful and physiological screening test to demonstrate clinically significant GER and a predisposing hiatal hernia of the esophagus in symptomatic children.
Doppler ultrasonographic evaluation of abnormal pregnancies in the first trimester
Authors: Stabile Isabel , Grudzinskas Jurgis , Campbell Stuart
Published: February 2007

Doppler examination of uteroplacental vessels was performed in the first trimester of pregnancy in 111 women with a normal pregnancy outcome and in 10 women with pregnancies that had or subsequently failed due to anembryonic pregnancy (N = 41, missed abortion (N = 11, subsequent spontaneous abortion of live fetus (N = 21, and ectopic pregnancy (N = 3).

Flow velocity waveforms (FVWs) were obtained three times by the same observer from subplacental vessels just within the myometrium. The Resistance Index (RI) of the FVWs was compared with the values obtained from 73 uncomplicated pregnancies and 38 women with threatened miscarriage and normal outcome. There was no apparent difference in the values for RI in the 10 patients whose pregnancies had failed, although the 3 live ectopic pregnancies studied had higher values.

Although these studies may improve our understanding of the pathophysiology of early placentation, they are unlikely to be of value in the diagnosis of early pregnancy failure.
The length of pregnancy: An echographic reappraisal
Authors: Todros Tullia , Ronco Guglielmo , Lombardo Daniela , Gagliardi Leone
Published: February 2007

A study of 998 pregnant women was conducted to estimate the random errors in dating pregnancy by menstrual history and by ultrasound measurements of the fetus (crown–rump length or biparietal diameter before 20 weeks, menstrual age) as well as the biological variability of pregnancy length. The latter was found to be 7.74 days. The random errors made when dating pregnancy by menstrual history and by ultrasound measurements were 7.16 days and 4.26 days, respectively. (All variabilities are expressed as standard deviations).

The differences between the two methods were mainly attributable to some large errors occurring when dating pregnancy on the basis of menstrual history. Differences between methods of more than 10 days were observed in about 10% of our population. When the two methods were used on the same patients to define a pregnancy as preterm, at term, or postterm, discrepancies were found in about 7% of cases.
Sonographic assessment and grading of spleen size
Authors: Ishibashi Hiromi , Higuchi Noriaki , Shimamura Ryuji , Hirata Yasuhiko , Kudo Jiro , Niho Yoshiyuki
Published: February 2007

Ultrasonography was used to evaluate spleen size in patients with various clinical conditions including those of the liver, blood, collagen, or autoimmune disease. To express spleen size, a spleen index (SI), the product of the transverse diameter and its perpendicular diameter measured on the maximum cross‐sectional image of the spleen, was used. SI correlated well with the volumes of resected spleens. Splenomegaly was present in high percentages of patients with liver, blood, collagen, and autoimmune disease, even though a majority of these spleens were not large enough to palpate. By grading the SI, characteristic distributions of SI were obtained for patients with different types of diseases. Obtaining and grading the SI by the use of ultrasound appears to be a significant supplemental aid for evaluating spleen size, especially in patients whose spleens are not palpable.
Image‐directed Doppler ultrasound: A screening technique for patients at high risk to develop deep vein thrombosis
Authors: Cronan John J. , Froehlich John A. , Dorfman Gary S.
Published: February 2007

Hip fracture patients typify a population at high risk to develop deep vein thrombosis (DVT). Recently ultrasound has been used successfully to diagnose DVT when clinical suspicion exists. In this prospective study, 88 hip fracture patients asymptomatic for DVT were screened serially with compression ultrasound to assess the development of thrombus within the femoral or popliteal systems. Contrast venography was employed as a control. Twelve of the 76 patients (16%) completing the study were noted by ultrasound to have a clot. Venography confirmed a clot in each case and detected no additional femoral or popliteal clot. The possibility of utilizing ultrasound to screen additional high risk groups for DVT should be investigated based on the encouraging results of this series.
Sonographic appearances of superficial soft tissue lipomas
Authors: Fornage Bruno D. , Tassin Gerard B.
Published: February 2007

High‐resolution real‐time sonography was used to evaluate 35 superficial soft tissue lipomas. Thirty were located in subcutaneous tissues and 5 in superficial muscles. The lipomas were assessed for location, shape and size, boundaries, echotexture, homogeneity, and sound through transmission. All were elongated, with their greatest diameter parallel to the skin. Twenty‐three lipomas (66%) showed a homogenous echotexture. Twenty‐one (60%) were well defined, and the remainder showed ill‐defined margins blending into the surrounding tissues. Twenty‐nine percent of the lipomas were hypoechoic, 22% were isoechoic, 29% were hyperechoic, and 20% showed a mixed pattern. An elongated isoechoic or echogenic mass in the subcutaneous tissues should suggest the diagnosis of lipoma.
Umbilical artery velocity waveforms in early pregnancy: A transvaginal color Doppler study
Authors: Arduini Domenico , Rizzo Giuseppe
Published: February 2007

In a cross‐sectional study, umbilical artery velocity waveforms were recorded in 214 low‐risk pregnancies at 7 weeks to 16 weeks, menstrual age, by means of transvaginal color and pulsed Doppler ultrasonography. In all the cases studied, end diastolic velocities were absent until the 10th week. From this age onward end diastolic velocities were present in a percentage of pregnancies, progressively increasing with gestation and reaching 100% at 15 weeks. Similarly, the percentage of cardiac cycles in which end diastolic velocities were absent progressively decreased with advancing menstrual age. The normal range for the pulsatility index was constructed and a quadratic function was found to optimally fit its fall during gestation. No differences in pulsatility index values were found at these menstrual ages in 12 pregnancies that later developed intrauterine growth retardation and/or pregnancy‐induced hypertension, suggesting that placental alterations causing abnormalities in umbilical velocity waveforms occur later in gestation.
Hair as a sonographic marker of ovarian teratomas: Improved identification using transvaginal sonography and simulation model
Authors: Bronshtein M. , Yoffe N. , Brandes J. M. , Blumenfeld Z.
Published: February 2007

An in vitro sonographic model was developed to simulate the transvaginal sonographic appearance of hair‐containing cystic teratomas of the ovary. Two groups of patients with ovarian teratomas were compared: group A—consisting of 32 patients scanned before the simulation model was used, and group B—consisting of 25 patients in whom the diagnosis of hair‐containing ovarian teratomas was made after the simulation model experience. The positive predictive value of transvaginal sonography in correctly diagnosing this type of tumor was 27/32 (84%) in group A and 25/25 (100%) in group B. By using this simple in vitro simulation model, the preoperative diagnosis of ovarian cystic teratomas by transvaginal sonography was made very accurate, enabling prospective planning of the type of operation and its timing.
Thickening of the gallbladder wall in ascites
Authors: Colli Agostino , Cocciolo Massimo , Buccino Guglielmo , Parravicini Roberto , Martinez Edoardo , Rinaldi Giovanni , Scaltrini Giancarlo
Published: February 2007

The thickening of the gallbladder wall in patients with ascites is commonly related to hypoalbuminemia and/or portal hypertension. To evaluate the pathogenetic role of these two factors, we correlated gallbladder wall thickness (GBWT) with the albuminemia and the serum–ascites albumin gradient (SAAG), an index of portal hypertension, in 47 patients with ascites caused by cirrhosis of the liver or abdominal malignancy. We found a thickened gallbladder wall in 30/47 patients. The correlation between GBWT and SAAG was 0.64 (n = 47 p < 0.001). No correlation was found between GBWT and albuminemia (r = 0.04). We suggest that the sonographic finding of ascites and gallbladder wall thickening should be considered a valuable sign of transudative ascites and of portal hypertension whatever its cause.
Effects of volume loading on left atrial systolic time intervals
Authors: Okamoto Mitsunori , Tsubokura Tokuo , Morishita Kazuhiko , Nakagawa Hiroshi , Yamagata Togo , Kawagoe Takuji , Hondo Tatsuya , Tsuchioka Yukiko , Matsuura Hideo , Kajiyama Goro
Published: February 2007

The effects of volume loading on the left atrial preejection period (LAPEP) and left atrial ejection time (LAET) were examined in 24 patients with various heart diseases using pulsed Doppler echocardiography. In response to volume loading, the left atrial dimension before atrial contraction significantly increased from 30.6 mm ± 5.8 mm to 32.4 mm ± 5.4 mm and the change in the left atrial dimension during atrial contraction tended to increase. The peak velocity in the atrial contraction phase significantly increased from 58 cm/s ± 14 cm/s to 63 cm/s ± 13 cm/s, and the integral of the atrial contraction phase tended to increase. LAPEP significantly decreased from 114 ms ± 16 ms to 104 ms ± 14 ms and LAET significantly decreased from 128 ms ± 15 ms to 124 ± 12 ms. The relation between LAET and left ventricular end‐diastolic pressure, and that between LAPEP and mean pulmonary capillary wedge pressure, shifted downward to the right after volume loading. Thus, left atrial ejection is augmented by volume loading according to the Frank–Starling mechanism, while LAPEP decreases due to an increase in preload and LAET decreases due to an increase in afterload.
Recurrent hepatocellular carcinoma: Usefulness of ultrasonography compared with computed tomography and AFP assay
Authors: Shibata Toshiya , Kubo Souichi , Itoh Kyo , Sagoh Tadashi , Nishimura Kazumasa , Nakano Yoshihisa , Yamaoka Yoshio , Ozawa Kazue , Konishi Junji
Published: February 2007

Follow‐up studies using monitoring with alpha1‐feto protein (AFP), ultrasonography (US), and computed tomography (CT) were carried out in 75 patients who had prior partial hepatectomy for hepatocellular carcinoma (HCC). Recurrence in the remaining liver was confirmed in 31 patients (41.3%) during the 4 month to 3 years 7 month period. Ultrasonography detected recurrence in 29 cases (sensitivity: 93.5%), CT in 26 (83.9%), and AFP assay in 12 (38.7%). In 4 patients, ultrasonography detected four recurrent nodules that CT missed. In 1 patient, two subphrenic nodules were detected with CT but not with ultrasonography. The specificity of US, CT, and AFP assay was 90.9%, 95.5%, and 93.2% respectively. Frequent follow‐up study with ultrasonography in combination with CT and AFP assay should be recommended for the early detection of recurrent HCC. Ultrasonography is mandatory for the follow‐up of patients with a prior hepatectomy for HCC.
Assessment of abdominal involvement of adult T‐cell leukemia/lymphoma by ultrasonography: Comparison among four clinical types
Authors: Shimamura Ryuji , Ishibashi Hiromi , Morioka Eiji , Teshima Takanori , Kudo Jiro , Hirata Yasuhiko , Shibuya Tsunefumi , Niho Yoshiyuki
Published: February 2007

Adult T‐cell leukemia/lymphoma (ATLL) is an HTLV‐I associated lymphoid malignancy frequently seen in Japan. Abdominal involvement in 40 patients with ATLL were assessed by ultrasonography and the findings seen in four clinical types, acute, chronic, lymphoma and smoldering, were compared. Splenomegaly was frequently found in the cases of acute and lymphoma types, and the sizes of the spleens measured by ultrasonography correlated well with the disease activity. Hepatomegaly was also found more frequently in acute and lymphoma types, and hepato‐splenomegaly was proved to be due to the infiltration by ATL cells. Nodular lesions in spleen and liver and abdominal lymph node swelling were also found frequently in the lymphoma type but rarely in the other types. Ascites, pleural effusion, and pericardial effusion were found in the active stage of acute and lymphoma types. Ultrasonography also could detect findings associated with therapies. Thus, ultrasonography studies were found to be very useful for assessing the clinical classification, examining various pathological conditions associated with ATLL, and monitoring the disease activity.
Reduction of soft tissue deposition in normal triplets
Authors: Hata Toshiyuki , Deter Russell L. , Hill Reba M.
Published: February 2007

In a previous study, birth weight projections obtained with Rossavik growth models were systematically greater than actual birth weights in triplets but not in singletons. To investigate the cause of this overestimation, average mean percent deviations for head circumference (HC), abdominal circumference (AC), thigh circumference (ThC), and weight (WT) at different times in the third trimester were studied in 13 normal triplet and 20 normal singleton fetuses using individual growth curve standards. Average mean percent deviation values for HC in both singletons and triplets were close to zero throughout the third trimester. Average mean percent deviation values for AC in both singletons and triplets were similar, and remained relatively constant. Average mean percent deviation values for ThC in triplets decreased toward the end of the third trimester, but those for singletons increased. Average mean percent deviation values for estimated weight did not change during the third trimester in singletons whereas those in triplets decreased. The difference in average mean percent deviation values for estimated weight between singletons and triplets in the 32‐ to 36‐week interval was statistically significant. There were no significant differences between actual and predicted measurements for HC in both singletons and triplets at birth. However, actual birth measurements were systematically less than predicted birth measurements for AC and ThC in singletons, and for AC, ThC, and WT for triplets. These systematic differences were significantly larger in triplets for ThC and WT. Nutrition Score values, direct measures of subcutaneous tissue, were significantly lower in triplets compared to singletons. These results suggest that the deposition of soft tissue seen in normal singletons during the third trimester occurs to a much lesser extent in normal triplets.
Intrahepatic venous and portal venous aneurysms examined by color Doppler flow imaging
Authors: Tanaka Sachiko , Kitamura Tsugio , Fujita Makoto , Iishi Hiroyasu , Kasugai Hiroshi , Nakanishi Katsumi , Okuda Shigeru
Published: February 2007

Thirteen cases with liver cystic lesions, which were suspected to communicate with intrahepatic vessels on the basis of ordinary sonography, were examined by color Doppler flow imaging. By this method, blood flow within the cystic lesion was detected in 5 of these cases, and the communication to the intrahepatic vessel confirmed. Information about the hemodynamics of aneurysms was obtained. Two of these lesions were diagnosed as an aneurysmal porta‐hepatic venous fistula, another 2 as a portal venous aneurysm, and the remaining 1 as a hepatic venous aneurysm.