bluuebunny/crossref_metadata_2025 huggingface dataset:
Carotid artery involvement in Takayasu's arteritis: evaluation of the activity by ultrasonography.
Authors: Park S H , Chung J W , Lee J W , Han M H , Park J H
Published: January 2017

The purpose of this study was to investigate the ultrasonographic criteria for determining the activity of carotid lesions in Takayasu's arteritis. In 10 consecutive patients, common carotid arteries with active lesions (n = 8) and inactive lesions (n = 9) were included in the study. The activity of the carotid lesions was determined on the basis of clinical and laboratory findings and computed tomographic scans. Special focus was placed on thickness and echogenicity of the involved arterial wall and outer diameter of the involved arterial segment. All 17 common carotid arteries evaluated showed segmental or diffuse circumferential thickening of the involved wall. The wall thickness was 2.5 to 5.0 mm (mean +/‐ SD, 3.3 +/‐ 0.8 mm) in active lesions and 1.1 to 2.0 mm (mean, 1.6 +/‐ 0.4 mm) in inactive lesions. The outer diameter of the involved segment was 7.0 to 15.0 mm (mean, 10.0 +/‐ 2.4 mm) in active lesions and 4.9 to 9.5 mm (mean, 6.8 +/‐ 1.4 mm) in inactive lesions. Active lesions showed hyperechogenicity in the full thickness of the involved wall (n = 6) or concentric triple layers with a hyperechoic middle layer (n = 2). Inactive lesions showed hyperechogenicity (n = 7) or isoechogenicity (n = 2) of the involved wall. One active lesion showed intramural arteries. Although precise measurement to tenths of a millimeter is impossible with the transducer used, prominent wall thickening with a maintained outer diameter in the common carotid artery suggests an active lesion, whereas mild wall thickening with a decreased outer diameter suggests an inactive lesion. Triple layers of a thickened wall with intramural arteries can be an ultrasonographic finding of an active lesion.
Combined use of genetic sonography and maternal serum triple‐marker screening: an effective method for increasing the detection of trisomy 21 in women younger than 35 years.
Authors: DeVore G R , Romero R
Published: January 2017

The current standard of practice is to screen women younger than 35 years for trisomy 21 with maternal triple‐marker screening, followed by amniocentesis in high‐risk (1:10‐1:190) patients. Non‐high‐risk patients are not offered further diagnostic testing. This study was conducted to determine whether genetic sonography of fetuses considered to be at moderate risk (1:190‐1:1000) after maternal triple‐marker screening increases the detection for trisomy 21, is cost‐effective, and reduces the number of amniocenteses required to detect a single fetus with trisomy 21.

After triple‐marker screening, mathematical modeling was used to classify 500,000 theoretical fetuses as high, moderate, or low risk (>1:1001‐1:10,000) for trisomy 21. The sensitivity for genetic sonography varied between 60% and 90%, and false‐positive rates varied between 5% and 25%. Two programs (I and II) were compared with the control program. The control program included patients with high‐risk fetuses (1:10‐1:190) who had amniocentesis. Program I consisted of patients in the moderate‐risk group (1:191‐1:1000) who had genetic sonography followed by amniocentesis only when an abnormal sonographic finding was present. Program II used an approach in which genetic sonography was done for both high‐ and moderate‐risk fetuses, and amniocentesis was performed only when an abnormal sonographic finding was present.

When added to the control program, genetic sonography significantly increased the detection rate of Down syndrome (range, 68.1%‐77.8% versus 49%), reduced the cost of detection, and resulted in a ratio of fetuses with Down syndrome detected to normal fetuses lost because of amniocentesis of greater than 1 (range, 2.1‐4.2). Compared with the control program, program II significantly increased the detection of fetuses with trisomy 21 (range, 56%‐72%) when the sensitivity of genetic sonography was >70%, reduced the cost of detection, and had ratios of trisomy 21 detection to normal fetuses lost because of amniocentesis of between 2.38 and 17.88.

Women younger than 35 years and classified as having moderate risk after triple‐marker screening could undergo genetic sonography under 1 of 2 approaches, either of which would result in an increased detection rate of trisomy 21 and be cost‐effective without increasing the loss rate of normal fetuses after genetic amniocentesis.
Deferoxamine‐induced dysplasia of the knee: sonographic features and diagnostic performance compared with magnetic resonance imaging.
Authors: Chan Y L , Chu C W , Chik K W , Pang L M , Shing M K , Li C K
Published: January 2017

To evaluate the features and diagnostic performance of sonography in the assessment of deferoxamine‐induced dysplasia of the knee.

The left knees of 32 patients with thalassemia who were receiving regular blood transfusions and chelation therapy were studied with sonography for signs of deferoxamine‐induced bone dysplasia. Abnormal physeal and metaphyseal changes detected on sonography included notching at the metaphyseal corner, a blurred or irregular peripheral juxtaphyseal metaphyseal contour, and widening of the peripheral juxtaphyseal metaphyseal echogenic interface. The accuracy of sonography in diagnosing dysplasia was evaluated by using magnetic resonance imaging as the standard of reference.

There were 14 true‐positive findings, 10 true‐negative findings, 7 false‐negative findings, and 1 false‐positive sonographic diagnosis of dysplasia, giving 67% sensitivity, 91% specificity, a 93% positive predictive value, and a 59% negative predictive value.

Sonography was specific but only moderately sensitive in the diagnosis of deferoxamine‐induced dysplasia at the knee when compared with magnetic resonance imaging.
Assessment of a new logistic model in the preoperative evaluation of adnexal masses.
Authors: Alcázar J L , Errasti T , Laparte C , Jurado M , López-García G
Published: January 2017

To assess a new logistic regression model developed to predict malignancy in adnexal masses.

In the first part of this study, we developed a logistic model by applying logistic regression analysis in a series of 268 adnexal masses (203 benign and 65 malignant lesions) in 248 patients (mean age, 43.6 years; SD, 14.2 years) evaluated and treated at our institution. Eleven parameters were entered in the logistic regression analysis in a forward stepwise way. In the second part of the study, we evaluated the model's diagnostic performance in a further set of 135 adnexal masses (103 benign and 32 malignant tumors) in 129 patients (mean age, 44.4 years; SD, 14.6 years). This diagnostic performance was compared with that of age, tumor volume, Sassone's and Ferrazzi's B‐mode ultrasonographic morphologic scoring systems, serum cancer antigen 125 level, and the tumor's lowest resistive index. Comparison was done by calculating the area under the receiver operating characteristic curve.

In logistic analysis, only menopausal status, the presence of papillary projections, the logarithm of the cancer antigen 125 value, tumor blood flow location, and the lowest resistive index were retained in the model. The model had the best area under the curve (0.97), significantly higher than patient age (area under the curve, 0.78; P = .001), tumor volume (area under the curve, 0.68; P < .0001), cancer antigen 125 (area under the curve, 0.88; P = .008), lowest resistive index (area under the curve, 0.85; P = .011), Ferrazzi's scoring system (area under the curve, 0.89; P = .01), and maximal peak systolic velocity (area under the curve, 0.71; P< .0001). Comparison with Sassone's scoring system (area under the curve, 0.91) did not reach statistical significance, but a clear trend was found (P = .116).

The model had the best diagnostic performance for discriminating between benign and malignant adnexal masses. A clinical prospective evaluation is needed to confirm its actual value.
Translabial sonography of vaginal fibroids: report of 2 cases and review of the literature.
Authors: Torreggiani W , Zwirewich C , Lyburn I , Harris A , Davis J E , Wilkie D , Fenster H , Marchinkow L
Published: January 2017

To determine the role of translabial sonography in the diagnosis of vaginal fibroids.

Two women with vaginal masses of undetermined origin were examined by various imaging procedures, including translabial sonography.

Initial examinations, which included transabdominal sonography, cystoscopy, and cystourethrography, yielded inconclusive findings. Translabial sonography, however, suggested isolated vaginal leiomyomas in both patients, and in both the diagnosis was confirmed histologically after surgery.

Translabial sonography should be considered as an adjunct to transabdominal and transvaginal sonography for patients with suspected vaginal fibroids.
Sonographic features of ovarian cystadenofibromas: spectrum of findings.
Authors: Alcázar J L , Errasti T , Mínguez J A , Galán M J , García-Manero M , Ceamanos C
Published: January 2017

To describe the sonographic characteristics of ovarian cystadenofibromas.

We conducted a retrospective study of 23 ovarian tumors histopathologically confirmed as ovarian cystadenofibromas that were preoperatively evaluated by transvaginal color Doppler sonography.

In all cases the mass was predominantly cystic. Septations appeared in 30.4% of the tumors. Papillary projections or solid nodules appeared in 56.5% of the cases. The most frequent appearance was a unilocular complex cystic mass. In 47.8% of the tumors, vascularization was detected, having a typical pattern of peripheral vascularization with scattered vessels of high blood flow impedance.

We have described the sonographic spectrum of findings of ovarian cystadenofibromas. The most frequent appearance was a unilocular cystic mass with gross papillary projections or solid nodules. In almost half of the tumors, vascularization could be detected.
Nutcracker Syndrome in Children With Orthostatic Proteinuria
Authors: Park Seong Jin , Lim Joo Won , Cho Byung-Soo , Yoon Tai Young , Oh Joo Hyeong
Published: January 2017

Objective. To evaluate the Doppler sonographic findings of the left renal vein in children with orthostatic proteinuria in comparison with healthy children and to propose more reliable sonographic criteria for diagnosing nutcracker syndrome in children. Methods. Doppler sonographic findings in 47 children with orthostatic proteinuria and in 27 healthy control subjects were compared. The diagnosis of orthostatic proteinuria was made on the basis of clinical and laboratory findings. The peak velocity and anteroposterior diameter were measured at the hilar and aortomesenteric portions of the left renal vein. The means ± 2 SD of the anteroposterior diameter ratio and peak velocity ratio between the 2 portions were calculated for control subjects and used as the cutoff levels for nutcracker syndrome. Results. The peak velocity ratios between aortomesenteric and hilar portions were 5.21 ± 2.55 in the patient group and 2.57 ± 0.70 in the control group. The anteroposterior diameter ratios between the 2 portions were 5.31 ± 2.65 in the patient group and 2.77 ± 0.69 in the control group. We set the cutoff level of anteroposterior diameter and peak velocity ratios for the diagnosis of nutcracker syndrome at mean ± 2 SD of the value for the control group (3.98 for the peak velocity ratio and 4.16 for the anteroposterior diameter ratio). When these cutoff levels were applied, the patients with orthostatic proteinuria had abnormal levels of anteroposterior diameter in 27 (57.4 %) of 47, peak velocity in 30 (63.8%) of 47, and both in 23 (48.9%) of 47. Conclusions. Nutcracker syndrome may be an important cause of orthostatic proteinuria in children. Doppler sonography of the left renal vein may be a useful screening tool in patients with suspected orthostatic proteinuria to evaluate whether the cause is nutcracker syndrome.
Sonographic Findings of Acute Urinary Retention Secondary to an Impacted Pelvic Mass
Authors: Yang Jenn-Ming , Huang Wen-Chen
Published: January 2017

Objective. To describe the sonographic findings in a series of cases of acute urinary retention due to an impacted pelvic mass. Methods. The anatomic changes of the lower urinary tract in 6 patients with impacted pelvic masses and acute urinary retention (3 cases of an impacted uterine leiomyoma and 3 cases of a retroverted gravid uterus) were evaluated with transabdominal and transvaginal sonography. Results. When patients were in the supine position, the impacted pelvic masses displaced the cervix superiorly and anteriorly, compressing the lower bladder, leading to obstruction of the internal urethral orifice. During straining, there was no limitation of urethral mobility, but the increased abdominal pressure further compressed the lower bladder. When the subjects stood, the lower bladder filled with urine. There was descent of the bladder neck, and obstruction was relieved. Conclusions. Acute urinary retention in cases of an impacted pelvic mass is caused by a displaced cervix compressing the lower bladder, obstructing the internal urethral orifice. The urethra itself is not compressed or distorted.
Assessment of Therapeutic Response in Hepatocellular Carcinoma Treated With Percutaneous Radio Frequency Ablation
Authors: Choi Dongil , Lim Hyo K. , Kim Seung Hoon , Lee Won Jae , Jang Hyun-Jung , Kim Hana , Lee Soon Jin , Lim Jae Hoon
Published: January 2017

Objectives

To compare the results of multiphase helical computed tomography and power Doppler ultrasonography with a microbubble contrast agent in the assessment of the therapeutic response to radio frequency ablation in hepatocellular carcinoma.

Methods

In 66 patients with 73 nodular hepatocellular carcinomas ranging from 1.0 to 4.0 cm (mean, 2.6 cm) in diameter, contrast‐enhanced power Doppler ultrasonography was performed after intravenous bolus injection of a galactose‐based microbubble contrast agent before and after radio frequency ablation. The results of the studies were compared with the findings of follow‐up 3‐phase helical computed tomography. All patients were regularly followed up with computed tomography for more than 1 year (range, 13–19 months).

Results

In 8 (11%) of 73 hepatocellular carcinomas, immediate follow‐up computed tomography obtained within 2 hours after radio frequency ablation showed focal enhancing portions within the treated lesions, suggesting residual non‐necrotic tumors. All 8 of these tumors had intratumoral flow signals on contrast‐enhanced power Doppler ultrasonography. The diagnostic agreement between computed tomography and contrast‐enhanced power Doppler ultrasonography was achieved in 100%. Among the remaining 65 hepatocellular carcinomas with the absence of residual tumors at both immediate follow‐up computed tomography and contrast‐enhanced power Doppler ultrasonography, subsequent follow‐up computed tomography showed local regrowth at the margins of 10 lesions (15%).

Conclusions

The results of contrast‐enhanced power Doppler ultrasonography closely correlated with those of immediate follow‐up computed tomography for detecting residual tumors in hepatocellular carcinomas treated with radio frequency ablation. Both techniques, however, showed a limitation in detecting small or microscopic residual tumors and in predicting local regrowth in the treated lesions.
Sonography in Renovascular Hypertension
Authors: Lee Hsin-Yi , Grant Edward G.
Published: January 2017

Objectives

To familiarize practitioners with different sonographic manifestations of renal artery compromise and the sonographic techniques for renal artery imaging.

Methods

Approximately 1500 examinations evaluating for renal artery disease are performed in our vascular laboratory every year. Most of the patients have the symptoms of hypertension (possibly related to renovascular etiology) and renal insufficiency. From our cumulative experience, the optimal scanning techniques are defined for each renal artery, for extrarenal versus intrarenal vascular evaluation, and for patients with different body habitus. We have also tabulated our technical success rate. Cases with sonographic evidence of renal artery compromise are identified. The validity, sensitivity, and specificity of different parameters are examined.

Results

We achieve an approximately 75% to 80% success rate in obtaining technically adequate studies. We have not found the tardus‐parvus waveform evaluation to be as valuable as direct interrogation of the renal artery.

Conclusions

Duplex/color Doppler sonography serves a vital role in the diagnosis of renal artery stenosis and occlusion; it has an excellent correlation with contrast‐enhanced angiography. It is also used for intraoperative or postrevascularization surveillance to show evidence of recurring stenosis, thrombosis, and other complications.
Sonography for Detection of Spinal Dermal Sinus Tracts
Authors: Lin Kuang-Lin , Wang Huei-Shyong , Chou Ming-Liang , Lui Tai-Ngar
Published: January 2017

Objective. It is well known that spinal dysraphism may be complicated by meningitis as a result of infection traveling from the skin along a patent dermal sinus tract. The only clue is the lower back cutaneous lesions. Our aim was to investigate the correlation between cutaneous lesions, patent dermal sinus tracts, and spinal dysraphism and their complications. Methods. Five patients (3 female and 2 male) with spinal patent dermal sinus tracts were studied. We used a 7‐MHz linear transducer with a two‐dimensional real‐time sonographic system to insonate and obtain transverse and longitudinal views of the spinal cord and subcutaneous area, extending from the cervical cord to the sacral areas. Subsequently, we performed spinal magnetic resonance imaging in every patient to confirm the diagnosis and to evaluate the intraspinal conditions. Results. The associated central nervous system anomalies and complications were tethered cords (n = 5), dermoid cysts (n = 3), lipoma (n = 2), central nervous system infections (n = 2), and syringomyelia (n = 1). The outcomes were better in those who received surgical intervention before they were infected. Conclusions. Early detection of spinal patent dermal sinus tracts and related anomalies was accomplished with spinal sonography and allowed for prophylactic treatment (e.g., early surgical intervention) before the onset of neurologic deficits.
The Early Sonographic Appearance of Placenta Accreta
Authors: Comstock Christine H. , Lee Wesley , Vettraino Ivana M. , Bronsteen Richard A.
Published: January 2017

Objective. To determine whether any sonographic findings in the first trimester predict placenta accreta. Methods. Patients who had a diagnosis of placenta accreta, increta, or percreta by clinical course or pathologic examination of the uterus and who had had a sonographic examination at 10 weeks or earlier were included in this study. Results. Seven patients met the study criteria. In 6 of these, who had had at least 1 previous cesarean delivery, the gestational sac was located in the lower uterine segment at the time of the early scan. Two of these pregnancies failed shortly after the early scan, and the patients underwent dilation and curettage, at which time severe bleeding necessitated a hysterectomy. The other 4 continued to term but had sonographic findings typical of placenta accreta during subsequent scans. In the seventh patient (who had had no previous cesarean deliveries), the gestational sac was located in the uterine fundus. Conclusions. In a patient with a previous cesarean delivery, a sac lying in the lower uterine segment on a scan at 10 weeks or earlier suggests the possibility of placenta accreta.
Sonohysterography Compared With Endometrial Biopsy for Evaluation of the Endometrium in Tamoxifen‐Treated Women
Authors: Hann Lucy E. , Kim Cathleen M. , Gonen Mithat , Barakat Richard , Choi Patricia H. , Bach Ariadne M.
Published: January 2017

Objective. This study was performed to compare endometrial biopsy and sonohysterography for evaluation of the endometrium in tamoxifen‐treated women. Methods. Medical records were retrospectively reviewed to identify 51 consecutive tamoxifen‐treated women who had sonohysterography and correlative endometrial biopsy for evaluation of postmenopausal bleeding or thickened endometrium of greater than 8 mm. Endometrial biopsy and sonohysterographic results were compared in all women, and for 27 (53%) women who had hysteroscopy with dilation and curettage, endometrial biopsy and sonohysterographic findings also were compared with surgical pathologic findings. Results. Thirty‐two (63%) of 51 sonohysterograms revealed endometrial polyps; 4 (8%) showed endometrium of greater than 5 mm; 14 (27%) showed endometrium of less than 5 mm; and 1 (2%) was inadequate. Endometrial biopsy findings were benign endometrium in 42 (82%), polyps in 4 (8%), and insufficient samples in 5 (10%). Among the adequate sonohysterograms, 64% (32 of 50) resulted in a diagnosis of polyps (95% confidence interval, 49%–77%) whereas the corresponding proportion for endometrial biopsy was 9% (4 of 46; 95% confidence interval, 2%–21%). For the group with hysteroscopy, 24 (92%) of 26 polyps were confirmed histopathologically; 1 polyp had complex hyperplasia. Polyps were present in 23 (89%) of 26 women with benign endometrium or insufficient samples by endometrial biopsy, and only 1 confirmed polyp was identified by endometrial biopsy. The sensitivity of sonohysterography for diagnosis of endometrial polyps (100%) was significantly higher than for endometrial biopsy (4%; P < .01). Conclusions. In tamoxifen‐treated women, sonohysterography provides a significant improvement in sensitivity for diagnosis of endometrial polyps compared with endometrial biopsy.
Echogenic Intracardiac Focus
Authors: Winn Virginia D. , Sonson Joy , Filly Roy A.
Published: January 2017

Objective. To assess the potential rate of specular reflectors within the fetal heart producing reflections of sufficient amplitude to be mistaken for echogenic intracardiac foci. Methods. Between July 1999 and December 2000, 200 patients were randomly selected from the University of California, San Francisco, perinatal database who met the following criteria: (1) had singleton pregnancy, (2) delivered at University of California, San Francisco, and (3) had obstetric sonography at University of California, San Francisco, between 18 and 22 weeks' gestation. Bright focal reflections within the heart were judged to be either “true” or “false” echogenic intracardiac foci. Results. In this population of patients who underwent routine obstetric sonography at a tertiary care hospital, the rate of true echogenic intracardiac focus cases was 11 per 200 (5.5%). The rate of false echogenic intracardiac focus cases was 34 per 200 (17%). The most common locations for identification of a spurious echogenic intracardiac focus were the endocardial cushion, the moderator band, and the tricuspid valve annulus. Conclusions. A specular reflection from the moderator band was judged the false echogenic intracardiac focus most likely to fool examiners. The rate of specular reflection from the moderator band was 11 per 200 (5.5%). Because it is possible to generate a specular reflection from an interface in the fetal heart in virtually any patient, it is important to exercise caution before diagnosing an echogenic intracardiac focus.
The Cesarean Delivery Scar Pouch
Authors: Fabres Cecilia , Aviles Guillermo , De La Jara Carlos , Escalona Juan , Muñoz Jorge Felipe , Mackenna Antonio , Fernández Carlos , Zegers-Hochschild Fernando , Fernández Emilio
Published: January 2017

Objective. We sought (1) to describe an anatomic defect of the uterine cavity in the anterior isthmus diagnosed by transvaginal sonography in a group of premenopausal women with previous cesarean deliveries, (2) to establish whether there is an association between the presence of the pouch and a bleeding disturbance, and (3) to compare the diagnostic efficacy of transvaginal sonography versus hysteroscopy for the detection of this defect. Methods. We performed a retrospective study of 92 premenopausal women with histories of at least 1 cesarean delivery. Age, number of previous cesarean deliveries, time elapsed between last cesarean delivery and first consultation, and total area of the pouch were recorded in groups of women with and without abnormal bleeding. Hysteroscopy was also performed in 43.8% of the patients who had abnormal bleeding. Results. In all women, transvaginal sonography revealed the presence of a pouch on the anterior uterine segment at the site of the expected previous cesarean delivery scar. Hysteroscopy showed 100% correlation with transvaginal sonography in detection of this pouch. Conclusions. The high correlation between bleeding disturbances and the presence of a pouch, in the absence of other pathologic entities, suggests this anatomic defect as the possible cause, especially in view of the fact that women who had heavier and longer bleeding episodes tended to have a larger pouch. Transvaginal sonography is a very simple, noninvasive, low‐cost examination that should be considered as the first choice for screening, because it highly correlates (100%) with hysteroscopy in the diagnosis of this defect and may help rule out other causes.
Color Doppler Sonographically Guided Transthoracic Needle Aspiration of Lung and Mediastinal Masses
Authors: Gorguner Metin , Misirlioglu Filiz , Polat Pinar , Kaynar Hasan , Saglam Leyla , Mirici Arzu , Suma Selami
Published: January 2017

Objective. This study investigated the diagnostic value of color Doppler sonographically guided transthoracic needle aspiration in lung and mediastinal masses. Methods. B‐mode and color Doppler sonographic images were obtained in 48 patients with mediastinal or peripheral pulmonary tumors. Color Doppler sonography was used to show the vascular structures before the transthoracic needle aspiration procedure. It was also used to locate the needle tip during the procedure by showing the twinkling sign. This maneuver was performed with motion of the inner stylet. Pathologic and microbiological examination of the aspirates was made. Results. Vascular structures were detected in 37 cases on color Doppler images and in 10 cases on B‐mode images. Similarly, the needle tip was observed in 39 cases on color Doppler images but in only 9 cases on B‐mode images. No complications were observed except partial pneumothorax in 2 cases. The method had sensitivity of 90.0%, specificity of 87.5%, a positive predictive value of 97.2%, a negative predictive value of 63.6%, and diagnostic accuracy of 89.6%. Conclusions. Color Doppler sonographically guided transthoracic needle aspiration is a safe diagnostic method in malignant lung tumors, especially peripheral tumors, because of its ability to differentiate vascular structures within a tumor before the transthoracic needle aspiration procedure. It provides additional information about the location of the needle tip.
Minimally Invasive Management of 14.5‐Week Abdominal Pregnancy Without Laparotomy
Authors: Mitra Avick G. , LeQuire Mark H.
Published: January 2017

Objective. To evaluate the possible role of a novel, minimally invasive approach to the management of abdominal pregnancy. Methods. We hypothesized that sonographically guided feticide without subsequent laparotomy for removal of the fetus and placenta could minimize potential blood loss and would be a reasonable approach in the care of a patient who had a viable 14.5‐week abdominal pregnancy with placental implantation directly over the bifurcation of the left common iliac artery. An extensive MEDLINE literature review revealed 1 case of sonographically guided feticide followed 10 days later by uneventful laparotomy for removal of the fetus and placenta. Thus, we used sonographically guided feticide without subsequent laparotomy for removal of the products of conception. Results. The sonographically guided feticide was uneventful, and the patient had no major postprocedure morbidity; a mild ileus was treated conservatively without the need for nasogastric suctioning. No major postprocedure bleeding was encountered. Human chorionic gonadotropin levels dropped precipitously. During the 1.5 years of postprocedure follow‐up, the patient reported no major complications. The gestational sac involuted very slowly; amniotic fluid volume appeared normal at 6 months after the procedure but was diminished at the 9‐month postprocedure examination. Conclusions. In cases of previable intra‐abdominal pregnancy, sonographically guided feticide may lessen the risk of extensive hemorrhage that can be associated with exploratory laparotomy. Sonographically guided feticide without subsequent exploratory laparotomy can result in a gradual resorption of the products of conception and an uncomplicated recovery. This treatment option should be considered in the management of this potentially life‐threatening condition.
Bladder Wall Thickness on Ultrasonographic Cystourethrography
Authors: Yang Jenn-Ming , Huang Wen-Chen
Published: January 2017

Objective. To explore factors affecting bladder wall thickness on ultrasonographic cystourethrography in female patients with lower urinary tract symptoms. Methods. The records of 492 female patients with lower urinary tract symptoms who had undergone a urodynamic study and ultrasonography of the lower urinary tract and who had normal urinalysis findings, negative urine culture results, or both were identified from our urogynecologic database. These included 248 patients with urodynamic stress incontinence, 38 with detrusor overactivity, 39 with mixed incontinence, 35 with a hypersensitive bladder, 42 with voiding difficulty, and 90 with normal urodynamic findings. Results. Age, resting bladder neck angle, urethral mobility, and maximum urethral closure pressure were significantly associated with bladder wall thickness at the trigone and dome. Bladder wall thickness at the trigone was correlated with that at the dome (P < .0001). Bladder wall thickness at the trigone was positively correlated with pressure transmission ratios in the first and second quarters of the urethra (P < .0001; P = .002, respectively), whereas that at the dome was positively correlated with intravesical pressure at maximum flow and with detrusor opening pressure (P = .027; P = .046, respectively). Age and intravesical pressure at maximum flow were independently associated with bladder wall thickness at the trigone and dome (P = .007; P = .028), respectively. A thickened bladder wall was a common finding in female lower urinary tract symptoms, except in the patients with a hypersensitive bladder. Conclusions. Demographic, anatomic, and urodynamic factors may affect the bladder wall thickness at the trigone, dome, or both.
Childhood Cardiac Function After Prenatal Diagnosis of Intracardiac Echogenic Foci
Authors: Wax Joseph R. , Donnelly Jon , Carpenter Molly , Chard Renée , Pinette Michael G. , Blackstone Jacquelyn , Cartin Angelina
Published: January 2017

Objective. To determine whether prenatally diagnosed intracardiac echogenic foci are associated with childhood cardiac dysfunction and persistence. Methods. Children in whom intracardiac echogenic foci were shown on prenatal sonography at 1 perinatal center underwent echocardiography at ages 2 to 7 years. A single pediatric cardiologist, blinded to the prenatal sonographic intracardiac echogenic focus locations, assessed cardiac function by measuring the left ventricular shortening fraction and myocardial performance index. The presence of tricuspid and mitral valve regurgitation was also sought. The secondary outcome was intracardiac echogenic focus persistence. Results. Twenty‐five children, 14 (56%) male and 11 (44%) female, were examined at a mean age ± SD of 3.0 ± 1.0 years. Prenatally, 18 children (72%) had left ventricular intracardiac echogenic foci, and 7 (28%) had right ventricular intracardiac echogenic foci. The left ventricular shortening fraction was normal in all children. The overall mean left ventricular myocardial performance index (reference value, 0.36 ± 0.06), was normal for both children with left ventricular intracardiac echogenic foci (0.36 ± 0.06) and those with right ventricular intracardiac echogenic foci (0.36 ± 0.04). Two children with left ventricular intracardiac echogenic foci had an isolated left ventricular myocardial performance index of greater than 2.5 SD above the mean. Trace tricuspid valve regurgitation and mitral valve regurgitation were noted in 13 (52%) and 2 (8%) of the children, respectively, similar to the general population. Left ventricular intracardiac echogenic foci persisted in 16 children (89%), whereas right ventricular intracardiac echogenic foci persisted in 2 (29%) (P = .007). Conclusions. Prenatally diagnosed intracardiac echogenic foci are often persistent but not associated with childhood myocardial dysfunction.
Effect of Aging on the Adult Extrahepatic Bile Duct
Authors: Bachar Gil N. , Cohen Maya , Belenky Alexander , Atar Eli , Gideon Shafir
Published: January 2017

Objective. To determine whether the size of the extrahepatic bile duct increases with age in adults. Methods. We prospectively collected data on 251 patients aged 20 years or older who underwent abdominal sonography. None of the patients had a history of liver, gallbladder, biliary, or pancreatic disease or surgery. The extrahepatic bile duct was measured at 3 locations: in the porta hepatis, in the most distal aspect of the head of the pancreas, and midway between these points. Least squares linear regression was used to correlate patient age and the size of the extrahepatic bile duct. Results. There were 126 men and 125 women aged 20 to 94 years (mean ± SD, 52.5 ± 17.63 years). Twelve percent of the study population were younger than 30 years, and 12% were older than 80 years. The mean diameters of the common bile duct in the 3 locations were as follows: proximal, 3.39 ± 1.14 mm; middle, 3.72 ± 1.28 mm; and distal, 4.28 ± 1.18 mm. The overall mean for all measures was 3.66 ± 1.15 mm. The width of the common bile duct ranged from 1.0 to 8.6 mm. There was a significant correlation between common bile duct size and age (r = 0.535; P < .001). Mean common bile duct sizes were 3.128 ± 0.862 mm in the patients younger than 50 years and 4.19 ± 1.15 mm in the patients older than 50 years (P < .001 by independent t test for equality of means). We have found that the duct gradually dilated 0.04 mm/y. Conclusions. This study revealed an age‐dependent change in the diameter of the extrahepatic bile duct. We suggest that the upper normal limit of the duct in elderly persons be set at 8.5 mm.
Detection and Characterization of Perianal Inflammatory Disease
Authors: Mallouhi Ammar , Bonatti Hugo , Peer Siegfried , Lugger Petra , Conrad Friedrich , Bodner Gerd
Published: January 2017

Objective. To evaluate the accuracy of transperineal gray scale and color Doppler sonography for the detection and characterization of perianal inflammatory disease with surgical correlation. Methods. Eighty‐seven patients with suspected perianal inflammatory disorders underwent transperineal gray scale and color Doppler sonography with a linear 4‐ to 7‐MHz transducer that was used to scan the entire perianal region for the detection of suspected inflammatory disorders. Each detected inflammatory disorder was evaluated to determine its morphologic characteristics and extent. Color Doppler sonography was applied to assess the presence of increased vascularity in the perianal region. In comparison with surgical findings, the diagnostic performance of transperineal sonography was assessed by means of receiver operating characteristic analysis for lesion detection and the Spearman ρ test for lesion characterization. Logistic regression analysis was used to assess whether increased perineal vascularity was a predictive factor of perianal inflammatory disease. Results. Seventy‐seven perianal inflammatory disorders were confirmed in 62 patients. Gray scale sonography achieved a significantly good performance in the detection (area under the curve = 0.86; P < .001) and characterization (r = 0.65; P < .001) of perianal inflammatory disease. For the detection of perianal fistulas and abscesses, sensitivity was 100% for both, and specificity was 100% and 94%, respectively. With the use of color Doppler sonography, the diagnostic confidence increased slightly (area under the curve = 0.89) but significantly (P = .002). Logistic regression analysis identified hypervascularity at the periphery of a perianal lesion as a significant independent predictor of an inflammatory disease. Conclusions. Combined gray scale and color Doppler sonography enables a high detectability rate and comprehensive characterization of perianal abscesses and fistulas.
Sonographic Markers of Hemoglobin Bart Disease at Midpregnancy
Authors: Tongsong Theera , Wanapirak Chanane , Sirichotiyakul Supatra , Chanprapaph Pharuhas
Published: January 2017

Objective. To evaluate the efficacy of various sonographic markers at midpregnancy in predicting fetal hemoglobin Bart disease. Methods. Four hundred eighty‐eight pregnancies at risk of having fetuses with hemoglobin Bart disease were recruited for prenatal diagnosis with cordocentesis at 18 to 21 gestational weeks. Before cordocentesis, the sonographic markers, including cardiothoracic ratio, placental thickness, pericardial effusion, pleural effusion, ascites, subcutaneous edema, cord edema, dilated umbilical vein, and amniotic fluid index, were assessed and recorded. The definite fetal diagnosis was based on blood analysis. The efficacy of each sonographic marker in predicting hemoglobin Bart disease was evaluated by sensitivity and specificity. Results. Among 488 pregnancies undergoing prenatal diagnosis, 100 fetuses were proved to be affected by hemoglobin Bart disease. The cardiothoracic ratio gave the highest sensitivity, 95.0%, with specificity of 96.1%, followed by placental thickness. Signs of hydrops fetalis were observed in 33.0% of cases; they did not increase the sensitivity of the cardiothoracic ratio but strongly reinforced the diagnosis when they appeared. Conclusions. At midpregnancy, sonographic markers can effectively differentiate normal pregnancies from those with fetal hemoglobin Bart disease. Among couples at risk with no sonographic markers, the risk of having an affected child is nearly eliminated. The most sensitive marker was the cardiothoracic ratio, followed by placental thickness.
Posterior Acoustic Shadowing in Benign Breast Lesions
Authors: Weinstein Susan P. , Conant Emily F. , Mies Carolyn , Acs Geza , Lee Steven , Sehgal Chandra
Published: January 2017

Objective. To show a variety of benign breast lesions that exhibit posterior acoustic shadowing on sonography. Methods. The cases illustrate a variety of pathologic breast conditions that were collected at a referral breast center at a tertiary medical center. Results. A variety of pathologic conditions are discussed, with pathologic‐imaging correlation. Conclusions. Although posterior acoustic shadowing is a sonographic feature that is most commonly associated with mammary malignancies, this sonographic finding may also be seen with benign breast lesions.
Sonographic Features of an Intraductal Polypoid Mass
Authors: Kim Na Ra , Kim Se Hyung , Lee Jeong Min , Lee Kyoung Ho , Kim Young Jun , An Su Kyung , Jung Ah Young , Han Joon Koo , Choi Byung Ihn
Published: January 2017

Objective. To identify laboratory and sonographic features capable of differentiating hepatocellular carcinoma (HCC) invading the bile duct from intraductal cholangiocarcinoma (IDCCC). Methods. Nine patients with HCC invading the bile duct and 8 patients with IDCCC were found in our radiologic and pathologic database. Laboratory (α‐fetoprotein, cancer antigen 19‐9, total bilirubin, and alkaline phosphatase) and sonographic findings were retrospectively reviewed by 2 reviewers by consensus. Sonographic findings included the presence and echo texture of parenchymal masses, the margin and echo texture of intraductal masses, continuity between parenchymal and intraductal masses, cystic ductal dilatation or wall thickening of the bile duct, and the presence of associated chronic liver disease. Results. Significant differences were found in the levels of total bilirubin (14 versus 3.5 mg/dL), α‐fetoprotein (2984 versus 5 ng/mL), and cancer antigen 19‐9 (8574 versus 1861 U/mL) in HCC and IDCCC (P < .05). Echogenicity of the intraductal masses was iso or low in 8 (88.9%) of 9 HCCs and 3 (37.5%) of 8 IDCCCs (P < .05). In all 7 patients with HCC but in no patient with IDCCC, the parenchymal masses were contiguous with the intraductal masses (P < .05). Cystic ductal dilatation of bile duct was seen in 8 (88.9%) of 9 HCCs and 3 (37.5%) of 8 IDCCCs (P < .05). All 9 (100%) of 9 HCCs and 3 (37.5%) of 8 IDCCCs were associated with chronic liver disease (P < .05). Parenchymal masses occurred in 7 patients with HCC (77.8%) and in 3 patients with IDCCC (37.5%), but the difference was not statistically significant (P = .153). The margins of the intraductal masses were smooth in all 9 (100%) of 9 HCCs and lobulated in 3 (37.5%) of 8 IDCCCs (P = .082). Conclusions. Combined interpretation of laboratory and sonographic features may help in the differentiation of HCC with bile duct invasion and IDCCC.
The Use of the Minimum Projection Mode in 4‐Dimensional Examination of the Fetal Heart With Spatiotemporal Image Correlation
Authors: Espinoza Jimmy , Gonçalves Luís F. , Lee Wesley , Chaiworapongsa Tinnakorn , Treadwell Marjorie C. , Stites Susan , Schoen Mary Lou , Mazor Moshe , Romero Roberto
Published: January 2017

Objective. The minimum projection mode (MPM) is a rendering algorithm available in some 3‐ and 4‐dimensional ultrasonography systems that, in 1 image, allows the visualization of vessels and cystic anatomic structures located in different scanning planes. The objective of this study was to compare the information displayed in images obtained with the MPM with their corresponding 2‐dimensional ultrasonographic images from fetuses with and without structural heart defects. Methods. Thirty‐two volume data sets acquired with the spatiotemporal image correlation technique from fetuses with (n = 15) and without (n = 17) structural heart defects were analyzed. Rendered images of the upper abdomen, 4‐chamber view, and 3‐vessel view were compared with the corresponding 2‐dimensional images. Two independent observers with experience in fetal echocardiography reviewed these volume data sets using the MPM. The visualization rate of specific anatomic structures seen from a transverse sweep of the heart was recorded for each observer, and the interobserver agreement was assessed by statistical indices of agreement (κ statistic). Results. Images obtained by the MPM displayed more vascular structures than those of corresponding 2‐dimensional images at the level of the 3‐vessel view. For conotruncal anomalies, the minimum mode projected the aorta and pulmonary arteries in 1 single plane, facilitating the understanding of their spatial relationships. The interobserver agreement score was moderate to “almost perfect” for assessment of most anatomic structures in the upper abdomen, 4‐chamber view, and 3‐vessel view sections. However, interobserver agreement ranged from fair to poor for visualization of the left outflow tract, atrial septum, and flap of the foramen ovale. Conclusions. The MPM is an alternative rendering modality that facilitates visualization of normal and abnormal vascular connections to the fetal heart at the level of the 3‐vessel view. This technique may be useful in prenatal diagnosis of conotruncal anomalies and in assessment of the spatial relationships of abnormal vascular connections in the upper mediastinum.
The Clinical Value of 3‐Dimensional Saline Infusion Sonography in Addition to 2‐Dimensional Saline Infusion Sonography in Women With Abnormal Uterine Bleeding
Authors: de Kroon Cornelis D. , Louwé Leonie A. , Trimbos J. Baptist , Jansen Frank Willem
Published: January 2017

Objective. To evaluate the clinical relevance of 3‐dimensional saline infusion sonography (3D‐SIS) in addition to conventional SIS in women with abnormal uterine bleeding suspected of having intrauterine abnormalities. Methods. All women suspected of having intrauterine abnormalities were eligible. Before 3D‐SIS, conventional SIS was performed. The results of these techniques were compared with the “combined method reference standard” (hysteroscopy, endometrial sampling, and clinical follow‐up in cases with normal SIS findings). Diagnostic characteristics (with 95% confidence intervals [CIs]) of 3D‐SIS and SIS were calculated as well as their respective accuracy in evaluating the histologic nature, the intrauterine extension, and the location of intrauterine abnormalities. Moreover, the reliability (κ value) and clinical relevance of 3D‐SIS were assessed. Results. A total of 49 women were included, and 4 women were excluded. The positive predictive values of 3D‐SIS and SIS were, respectively, 1.00 and 0.86 (95% CI, 0.72–0.99; P = .15), and the diagnostic accuracy values were 0.98 (95% CI, 0.94–1.0) and 0.91 (95% CI, 0.83–0.99; P = .08). Saline infusion sonography and 3D‐SIS were equally accurate in evaluating the histologic nature, intrauterine extent, and location of intrauterine abnormalities (respective κ values: 0.85 versus 0.93; P = .88; 0.83 versus 0.83; and 0.77 versus 0.80; P = .81). The reliability of 3D‐SIS was good: intraobserver and interobserver agreement (κ) were 0.78 and 0.72. Three women (6.7%) had the benefit of additional 3D‐SIS: in these women, SIS wrongly led to a diagnosis of intrauterine abnormalities (P = .08). Conclusions. Three‐dimensional saline infusion sonography is valid and reliable in women suspected of having intrauterine abnormalities and may indeed have relevant clinical value in addition to conventional SIS.
Risk for Malignancy of Thyroid Nodules as Assessed by Sonographic Criteria
Authors: Iannuccilli Jason D. , Cronan John J. , Monchik Jack M.
Published: January 2017

Objective. To correlate sonographic and color Doppler characteristics of thyroid nodules with the results of sonographically guided fine‐needle aspiration biopsy to establish the relative importance of these features in predicting risk for malignancy. Methods. We retrospectively analyzed the sonographic features of 34 malignant and 36 benign thyroid nodules with respect to size, echogenicity, echo structure, shape, border, calcification, and internal vascularity. Individual features and combinations of features were analyzed for their correlation with benign or malignant disease. A comparative analysis of several authors' previously proposed methods for distinguishing between benign and malignant nodules using sonographic criteria was also performed to determine their sensitivity and specificity in predicting nodule disease within our study data. Results. Nodule size ranged from 0.8 to 4.6 cm in greatest dimension (mean, 1.96 cm; SD, 0.877 cm). The prevalence of malignancy in our study population was estimated to be nearly 5.33%. Intragroup comparison of sonographic features among benign and malignant nodules resulted in identification of intrinsic calcification as the only statistically significant predictor of malignancy (35.3% sensitive and 94.4% specific; P < .005). Presence of a “snowstorm” pattern of calcification was 100% specific for malignancy. Echogenicity, echo structure, shape, border classification, and grade of internal vascularity did not show any significant difference between benign and malignant nodules in this study. Various combinations of features previously suggested to be significant predictors of malignancy were also analyzed and shown to have very little sensitivity or specificity in predicting benign or malignant disease among nodules in our study population. Conclusions. This study indicates that the presence of intrinsic microcalcification is the only statistically reliable criterion on which to base increased suspicion for malignancy in thyroid nodules. Our results indicate the need for biopsy in determining further workup. All nodules that show the presence of intrinsic microcalcification should undergo biopsy, particularly if calcifications have a snowstorm appearance on sonography.