bluuebunny/crossref_metadata_2025 huggingface dataset:
The fishing and natural mortality of large, piscivorous Bull Trout and Rainbow Trout in Kootenay Lake, British Columbia (2008–2013)
Authors: Thorley Joseph L. , Andrusak Greg F.
Published: January 2017

Background

Estimates of fishing and natural mortality are important for understanding, and ultimately managing, commercial and recreational fisheries. High reward tags with fixed station acoustic telemetry provides a promising approach to monitoring mortality rates in large lake recreational fisheries. Kootenay Lake is a large lake which supports an important recreational fishery for large Bull Trout and Rainbow Trout.

Methods

Between 2008 and 2013, 88 large (≥500 mm) Bull Trout and 149 large (≥500 mm) Rainbow Trout were marked with an acoustic transmitter and/or high reward ($100) anchor tags in Kootenay Lake. The subsequent detections and angler recaptures were analysed using a Bayesian individual state-space Cormack–Jolly–Seber (CJS) survival model with indicator variable selection.

Results

The final CJS survival model estimated that the annual interval probability of being recaptured by an angler was 0.17 (95% CRI [0.11–0.23]) for Bull Trout and 0.14 (95% CRI [0.09–0.19]) for Rainbow Trout. The annual interval survival probability for Bull Trout was estimated to have declined from 0.91 (95% CRI [0.76–0.97]) in 2009 to just 0.46 (95% CRI [0.24–0.76]) in 2013. Rainbow Trout survival was most strongly affected by spawning. The annual interval survival probability was 0.77 (95% CRI [0.68–0.85]) for a non-spawning Rainbow Trout compared to 0.41 (95% CRI [0.30–0.53]) for a spawner. The probability of spawning increased with the fork length for both species and decreased over the course of the study for Rainbow Trout.

Discussion

Fishing mortality was relatively low and constant while natural mortality was relatively high and variable. The results indicate that angler effort is not the primary driver of short-term population fluctations in the Rainbow Trout abundance. Variation in the probability of Rainbow Trout spawning suggests that the spring escapement at the outflow of Trout Lake may be a less reliable index of abundance than previously assumed. Multi-species stock assessment models need to account for the fact that large Bull Trout are more abundant than large Rainbow Trout in Kootenay Lake.
Are maternal and sonographic factors associated with the detection of a fetal echogenic cardiac focus?
Authors: Ehrenberg H M , Fischer R L , Hediger M L , Hansen C , Stine D
Published: January 2017

To evaluate the influence of maternal weight and the orientation of the fetal 4‐chamber heart view on the detection of a fetal echogenic cardiac focus.

In this nested case‐control study, 103 women undergoing anatomic surveys at 15 to 22 weeks between January 1, 1997, and June 15, 1999, were identified as having an echogenic cardiac focus via our computerized database. A control group was selected from among the same group of patients. Data were collected from the sonography reports, prenatal records, and sonographic images of 4‐chamber heart views; maternal characteristics and sonographic details were recorded, including the orientation of the 4‐chamber view (apical, basilar, and right and left lateral).

Gravidas in the echogenic cardiac focus group were more likely to be of lower weight (68.0 +/‐ 14.4 versus 72.9 +/‐ 18.3 kg; P = .04), of lower body mass index (25.5 +/‐ 5.3 versus 27.3 +/‐ 6.2 kg/m2; P = .03), of younger age (24.4 +/‐ 6.5 versus 26.9 +/‐ 6.9 years; P = .01), and African American or Asian (37.9% versus 27.2% and 9.7% versus 2%; P = .01). Cases were scanned at earlier gestational ages (18.9 +/‐ 1.6 versus 19.5 +/‐ 1.7 weeks; P = .01). The focus group was more likely to have had an apical view of the fetal heart taken (80.8% versus 51.4%; P = .0001). Controls were more likely to have had a right lateral view taken (44.6% versus 20.8%; P = .002). No significant difference was found between groups in terms of any other maternal or sonographic variable studied.

The echogenic cardiac focus group was more likely to have a lower body mass index and to be scanned with the apical fetal heart view. The orientation of the fetal 4‐chamber heart view exerted the most statistically significant influence on detection rates for the echogenic cardiac focus, implying that the more technically facile the sonographic study, the more likely an echogenic cardiac focus will be found.
Outcome of pregnancy after prenatal diagnosis of umbilical vein varix.
Authors: Rahemtullah A , Lieberman E , Benson C , Norton M E
Published: January 2017

Previous studies of umbilical vein varix diagnosed prenatally have been small, and the results have been contradictory. We wanted to determine whether prenatally diagnosed umbilical vein varix is associated with an increased risk of fetal anomalies or poor perinatal outcomes. We identified all cases of fetal intra‐abdominal umbilical vein varix diagnosed on the basis of prenatal ultrasonography at Brigham and Women's Hospital between 1988 and 1998. Cases were reviewed to determine the presence of other sonographic findings as well as pregnancy and neonatal outcomes. We identified 25 cases and included those 23 for which follow‐up was available. In 11 cases (48%), pregnancies and neonatal outcomes were normal, with full‐term delivery, appropriate birth weight, and no evidence of anomalies. Three cases (13%) had preterm deliveries, and 1 had Kell isoimmunization requiring postnatal transfusion. In the remaining 8 cases (35%), structural anomalies were present. One fetus had a chromosomal abnormality (69,XXX). Prenatal diagnosis of fetal umbilical vein varix appears to be associated with a high rate of fetal anomalies. Detection of an umbilical vein varix should prompt a thorough examination of the fetus, including a fetal survey and echocardiogram. Isoimmunization should be ruled out, and consideration of karyotyping should be discussed if other anomalies are present.
Usefulness of echocystography in the study of vesicoureteral reflux.
Authors: Escape I , Martínez J , Bastart F , Solduga C , Sala P
Published: January 2017

The aim of our study was to assess the usefulness of contrast‐enhanced sonography in detecting and staging vesicoureteral reflux in pediatric patients. Forty‐nine children between birth and 5 years of age were studied for vesicoureteral reflux. Echocystography with the use of an endovesical signal enhancer was performed first, followed immediately by conventional voiding cystourethrography. The findings obtained by echocystography and voiding cystourethrography were consistent in 89 (90.8%) of 98 ureterorenal units (a ureterorenal unit is 1 kidney with its own ureter). Reflux was demonstrated by voiding cystourethrography in 13 cases; in 9 of these cases diagnosis had also been made by echocystography. Five cases of reflux detected by echocystography were not identified by voiding cystourethrography. With voiding cystourethrography as the standard of reference, sensitivity was 69%; specificity, 94%; positive predictive value, 64%; and negative predictive value, 95%. In conclusion, echocystography is a useful tool for the diagnosis of vesicoureteral reflux. Its ability to detect reflux is similar to that of cystography in cases of high‐grade reflux, and it may be an appropriate complementary technique to voiding cystourethrography, because it avoids exposure to radiation.
Contrast‐enhanced, wide‐band harmonic gray scale imaging of hepatocellular carcinoma: correlation with helical computed tomographic findings.
Authors: Numata K , Tanaka K , Kiba T , Saito S , Ikeda M , Hara K , Tanaka N , Morimoto M , Iwase S , Sekihara H
Published: January 2017

We evaluated the usefulness of contrast‐enhanced, wide‐band harmonic gray scale imaging for the diagnosis of hepatocellular carcinoma and compared it with helical computed tomography. Forty‐eight patients with 61 hepatocellular carcinoma lesions were scanned by contrast‐enhanced, wide‐band harmonic gray scale imaging after an intravenous bolus injection of the contrast agent Levovist. Fifty‐seven of the 61 hepatocellular carcinoma lesions showed hypervascular enhancement, and intratumoral vessels could be observed in 40 of the 57 lesions. Helical computed tomography revealed a high‐attenuation area in 54 of the 61 lesions, whereas the other lesions showed an equivocal‐attenuation area. Contrast‐enhanced, wide‐band harmonic gray scale imaging is a useful method for diagnosing the vascularity of hepatocellular carcinoma.
Detection of hepatocellular carcinomas and dysplastic nodules in cirrhotic liver: accuracy of ultrasonography in transplant patients.
Authors: Kim C K , Lim J H , Lee W J
Published: January 2017

The purpose of this study was to assess the usefulness of ultrasonography in the detection of hepatocellular carcinomas and dysplastic nodules in patients with liver cirrhosis. Pretransplantation sonograms in 52 patients with liver cirrhosis who underwent orthotopic liver transplantation were evaluated retrospectively. The numbers of hepatocellular carcinomas and dysplastic nodules were assessed in the explanted liver specimens and compared with pretransplantation ultrasonographic results. Eighteen hepatocellular carcinomas in 16 patients and 20 dysplastic nodules in 11 patients were present in the explanted livers. The size of hepatocellular carcinomas ranged from 0.6 to 5.0 cm (mean, 2.1 cm) in diameter, and that of dysplastic nodules ranged from 0.5 to 1.7 cm (mean, 1.0 cm) in diameter. Pretransplantation ultrasonography enabled detection of 6 of 18 hepatocellular carcinoma and 0 of 20 dysplastic nodule lesions; lesion detection sensitivity for hepatocellular carcinomas and dysplastic nodules was 33% and 0%, respectively. Patient sensitivity and specificity for hepatocellular carcinomas were 38% (6 of 16) and 92% (33 of 36), and those for dysplastic nodules were 0% and 95% (39 of 41), respectively. On the basis of our results, ultrasonography is insensitive for detection of hepatocellular carcinomas and dysplastic nodules in patients with advanced liver cirrhosis.
Low‐intensity pulsed ultrasound initiates bone healing in rat nonunion fracture model.
Authors: Takikawa S , Matsui N , Kokubu T , Tsunoda M , Fujioka H , Mizuno K , Azuma Y
Published: January 2017

Low‐intensity pulsed ultrasound exposure has been shown clinically to shorten the fracture repair process and to induce healing of nonunions in humans, but its mechanism of action remains unclear. In this study we investigated the effect and mechanism of low‐intensity pulsed ultrasound on nonunion fracture healing in rat tibias. A consistently reproducible nonunion was produced in rat tibias by muscle interposition without osteotomy. This model was produced by creating a closed tibial fracture with only the distal end of the tibialis anterior muscle interposed into the fracture site. One limb was noninvasively exposed to low‐intensity pulsed ultrasound (a 200‐millisecond burst of sine waves of 1.5 MHz, repeating at 1.0 kHz) for 20 minutes daily. The incident intensity was approximately 30 mW/cm2. Rats were killed at intervals between 2 and 6 weeks. The events were assessed by radiographs, microfocus X‐ray computed tomograms, and histologic examination. After 6 weeks of exposure, 7 of 14 nonunion fractures showed healing on radiologic assessment. The results of three‐dimensional microfocus X‐ray computed tomographic reconstruction and histologic examination also supported this finding. On the other hand, all control tibias remained in a state of nonunion during the same period. These results indicate that low‐intensity pulsed ultrasound promotes healing in the rat nonunion fracture model.
Low‐resistance endometrial arterial flow in the exclusion of ectopic pregnancy revisited.
Authors: Wherry K L , Dubinsky T J , Waitches G M , Richardson M L , Reed S
Published: January 2017

The objective of this study was to evaluate the efficacy of endometrial arterial flow in the exclusion of ectopic pregnancy. From October 1997 to June 1999, 66 women with elevated beta‐human chorionic gonadotropin titers and clinical indications of ectopic pregnancy were evaluated by endovaginal sonography. Women with a gestational sac containing an embryo, a yolk sac, or both were excluded from the study. Doppler ultrasonography was performed in the remaining cases when a definite intrauterine pregnancy could not be visualized. In all cases the thermal index was kept to less than 1.0, consistent with as‐low‐as‐reasonably‐achievable principles. Trophoblastic flow was defined as a resistive index of less than 0.6 within the endometrium. Statistical analysis was performed using a 2‐tailed t test. Twenty women had ectopic pregnancies; 33 had spontaneous pregnancy losses; and 13 had normal intrauterine pregnancies. A total of 29 women had endometrial trophoblastic flow: 11 of 13 with intrauterine pregnancies, 1 of 20 with ectopic pregnancies, and 17 of 33 with spontaneous pregnancy losses. The negative predictive value for the presence of endometrial low‐resistance flow for excluding ectopic pregnancy was 97%. The presence of low‐resistance arterial endometrial flow can be a useful sign in diagnosing an early intrauterine pregnancy and decreasing the probability that an ectopic pregnancy is present, particularly in patients with otherwise normal ultrasonographic findings.
Hydatid liver cyst: an 11‐year experience of treatment with percutaneous aspiration and ethanol injection.
Authors: Giorgio A , Tarantino L , de Stefano G , Francica G , Mariniello N , Farella N , Perrotta A , Aloisio V , Esposito F
Published: January 2017

To report an 11‐year experience of treatment of hydatid liver cysts with double percutaneous aspiration and injection of alcohol.

Of the 129 patients with 174 hydatid liver cysts admitted to our department between January 1988 and January 1999, 79 patients with 119 vital hydatid liver cysts were selected for double percutaneous aspiration and injection of alcohol. Under ultrasonographic guidance, cystic cavities were first drained through fine needles, and then 95% sterile ethanol was injected and left in situ. The same procedure was repeated 3 days later without reaspiration of the injected alcohol. General anesthesia without endotracheal intubation was performed in 21 selected cases.

Double percutaneous aspiration and injection of alcohol was completed in 78 patients with 118 hydatid liver cysts. In 1 case the procedure could not be accomplished because of an intracystic hemorrhage. A total of 254 punctures were performed, and the ethanol injected per session ranged between 12 and 250 mL. The mean hospital stay was 2.9 days (range, 2‐7 days). The overall median follow‐up was 48 months (range, 6‐122 months). At the last ultrasonographic examination, 45.8% of the treated hydatid liver cysts had a solid pattern, 47.4% were no longer appreciable, and 6.8% had a minimal liquid component. Intracystic relapse occurred in 5% of the patients. In no case were any new cysts observed either in different hepatic segments or in any extrahepatic location. The morbidity rate was 9%, and 1 death occurred (mortality rate, 1.3%).

Over a long period, double percutaneous aspiration and injection of alcohol proved to be a substantially safe, effective, and low‐cost procedure for hydatid liver cyst treatment.
Significance of the solid component in predicting malignancy in ovarian cystic teratomas: diagnostic considerations.
Authors: Mlikotic A , McPhaul L , Hansen G C , Sinow R M
Published: January 2017

To determine whether gray scale characteristics of the solid components of cystic ovarian teratomas exist that could differentiate more common benign forms from malignant variants.

We retrospectively reviewed the sonographic images of 188 ovarian teratomas that contain at least a 25% cystic component and correlated the images with the final diagnosis. Features of the solid component assessed included its echo texture, overall appearance, shape, size, and internal homogeneity.

One‐hundred seventy‐seven teratomas were benign, and 11 were malignant; among the malignant masses, 7 were high grade. Of the benign forms, 155 solid components (88%) were hyperechoic, 168 (95%) were focal in appearance, 105 (59%) were nodular in shape, and 123 (69%) were uniformly solid. Of the malignant types, 9 solid components (82%) were isoechoic, 6 (55%) had branching, 6 (55%) were irregular in shape, and 8 (73%) were uniformly solid. Five malignant teratomas (45% overall and 71% of high‐grade subtypes) had branching isoechoic components. Only 2 benign teratomas (1%) had isoechoic components that branched.

The presence of a branching isoechoic component in a cystic ovarian teratoma may suggest malignancy.
Fourteen‐gauge ultrasonographically guided large‐core needle biopsy of breast masses.
Authors: Schoonjans J M , Brem R F
Published: January 2017

Large‐core needle biopsy of the breast can be performed with stereotactic or ultrasonographic guidance. However, ultrasonographically guided large‐core needle biopsy has notable advantages, including the absence of ionizing radiation, increased patient comfort, and greater cost‐effectiveness. The purpose of this study was to evaluate the accuracy of ultrasonographically guided large‐core needle biopsy for the diagnosis of breast cancer in palpable and nonpalpable breast masses.

The study was a retrospective review of consecutive ultrasonographically guided large‐core needle biopsies for indeterminate breast masses. A total 424 ultrasonographically guided core biopsies were performed in 367 patients with 1 or more breast masses. Ultrasonographically guided core biopsy was performed with a 14‐gauge spring‐loaded needle and a freehand technique. Correlation of ultrasonographically guided core biopsy pathologic findings with subsequent surgical pathologic findings or long‐term imaging follow‐up was performed.

Of 424 indeterminate breast lesions for which histopathologic findings were obtained by ultrasonographically guided core biopsy, 234 cancers were diagnosed. Twenty‐eight additional lesions had either questionable but not definitively malignant pathologic features (n = 11) or radiologic‐pathologic discordance (n = 17) and were surgically excised. Of these, 8 additional cancers were diagnosed. Patients or surgeons chose excision of 41 additional lesions that were benign on ultrasonographically guided core biopsy No cancer was found in these surgical specimens. One additional cancer was diagnosed at a 6‐month imaging follow‐up because of interval growth. On the basis of surgical and long‐term imaging follow‐up, the sensitivity of ultrasonographically guided core biopsy for the diagnosis of breast carcinoma was 99.2% (95% confidence interval, 95.6%‐99.9%) in 173 palpable breast masses and 93.2% (95% confidence interval, 87.1%‐97%) in 251 nonpalpable masses. In cancers diagnosed on the basis of immediate surgical excision as a result of ultrasonographically guided core biopsy that showed either questionable pathologic features or radiologic‐pathologic discordance, the sensitivity of ultrasonographically guided core biopsy for the diagnosis of breast cancer was 99.2%.

Ultrasonographically guided large‐core needle biopsy is a sensitive percutaneous biopsy method for the diagnosis of breast cancer in palpable and nonpalpable breast masses.
Assessment of Blood Flow Velocity Waveforms of the Pulmonary Circulation by Multigate Spectral Doppler Scanning and Traditional Pulsed Doppler Ultrasonography
Authors: Liang Ren-Ing , Prapas Nikos , Detti Laura , Cosmi Erich , Copel Joshua A. , Mari Giancarlo
Published: January 2017

Objective. To assess (1) pulmonary artery and peripheral pulmonary blood flow by using a multigate spectral Doppler system and standard pulsed color Doppler ultrasonography and (2) the reproducibility of peripheral pulmonary artery blood flow velocity waveforms. Methods. Thirty‐three women were enrolled in the study. Fetal pulmonary artery flow velocity waveforms were investigated by multigate spectral Doppler scanning and traditional pulsed Doppler ultrasonography plus color flow mapping. To establish the relationship between these 2 methods, we calculated the correlation coefficient, coefficient of variation, and limits of agreement. Results. The 2 methods were not significantly correlated. The range of measurement agreement for these 2 methods suggests that there is a significant difference between the main and peripheral pulmonary artery blood flow, and the difference should be taken into account in the interpretation of Doppler flow velocity studies of the pulmonary artery. Conclusions. Multigate spectral Doppler scanning with power Doppler imaging may be a better way to assess the average flow impedance in a highly vascularized organ. This technique supplies a large number of Doppler signals in the region of interest and offers a quantified range of Doppler measurements, improving our understanding of fetal hemodynamics.
Transvaginal and Transabdominal Extended Field‐of‐View (EFOV) and Power Doppler EFOV Sonography in Gynecology
Authors: Henrich Wolfgang , Fuchs Ilka , Schmider Annette , Bühling Kai J. , Dudenhausen Joachim W.
Published: January 2017

Objective. To evaluate the possible advantages, applications, and usefulness of real‐time transabdominal and transvaginal extended field‐of‐view sonography combined with power Doppler sonography in gynecology. Methods. A series of 63 gynecologic patients, referred for preoperative sonographic examination and for whom the examiner thought that extended field‐of‐view sonography might be helpful in imaging pathologic findings, were selected. Patients were examined with conventional vaginal and abdominal B‐mode sonography, extended field‐of‐view sonography, and power Doppler extended field‐of‐view sonography. A sonographic system with 3.5‐ to 7‐MHz transducers was used to study and document pathologic findings. Results. Extended field‐of‐view sonography provided a superior overview of pathologic findings and topography by creating a single image showing the relationship to reference structures. The combination of power Doppler extended field‐of‐view sonography provided additional information on the perfusion pattern in huge masses. In comparison with conventional sonographic images, the extended field‐of‐view sonographic images were easier to interpret by the referring or nonexamining physician. A list of proposed gynecologic applications for the use of extended field‐of‐view sonography was compiled. Conclusions. The extended field‐of‐view and power Doppler extended field‐of‐view sonographic technique provides documentation of surroundings, topographic orientation, and perfusion patterns in large pelvic masses and findings that exceed the limitations of the conventional sonographic sector. The clinical applications and advantages of extended field‐of‐view and power Doppler extended field‐of‐view imaging in gynecologic sonography are illustrated.
Renal Sonography in the Intensive Care Unit
Authors: Keyserling Harold F. , Fielding Julia R. , Mittelstaedt Carol A.
Published: January 2017

Objective. To evaluate the efficacy of renal sonography performed in intensive care units on patients with the diagnosis of acute or acute‐on‐chronic renal failure. Methods. We reviewed all renal sonograms performed in our institution during 1 year on critically ill patients for evaluation of renal failure. Renal failure was defined as a serum creatinine level greater than 1.5 mg/dL or an increase of greater than 20% from the baseline creatinine level. Exclusion criteria included patient age younger than 18 years and signs or symptoms of obstructive uropathy. Using the electronic medical record, we recorded patient age, sex, blood urea nitrogen level, serum creatinine level, blood urea nitrogen–creatinine ratio, and clinical indication for intensive care unit admission. Sonographic reports were reviewed for the presence or absence of hydronephrosis. The total cost of these examinations was estimated with the use of Medicare reimbursement rates for 2000. Results. One hundred five renal sonographic examinations were performed on 104 patients meeting all inclusion criteria. Only 1 study had positive results for hydronephrosis, which was graded as mild. Incidental findings not immediately affecting patient care and including ascites and simple renal cysts were identified in 91 patients. The estimated total cost of the examinations was $13,350.75. Conclusions. In critically ill patients with acute renal failure and no physical findings suggesting obstructive uropathy, renal sonography to evaluate for hydronephrosis is probably not indicated. This holds true regardless of patient age, sex, medical or surgical disposition, and blood urea nitrogen–creatinine ratio.
Ultrasonographic Nomograms of the Fetal Fourth Ventricle
Authors: Goldstein Israel , Makhoul Imad R. , Tamir Ada , Rajamim Bat-Sheva , Nisman Daniel
Published: January 2017

Objective. To characterize normal growth of the fetal fourth ventricle on ultrasonography throughout pregnancy. Methods. Consecutive biometric measurements and fetal organ scans were obtained from 299 patients undergoing fetal anatomic surveys between 13 and 40 weeks' gestation. Using 7‐ and 3.5‐MHz transducers for early (13‐ to 17‐week) and late (>17‐week) examinations, respectively, we scanned the fetal head in the axial plane with special focus on the posterior fossa of the brain. The fourth ventricle was identified, and its anteroposterior diameter and width were measured. A “triangle” formula was used for calculating its circumference and area. Results. The fourth ventricle was shown as a hypoechoic triangle below the level of the cerebellum. A linear regression line of the fourth ventricle was observed across gestational age, and a first‐degree correlation was found between gestational age and anteroposterior diameter of the fourth ventricle (r = 0.894; P < .0001; y = –0.84 + 0.23 × gestational age), its width (r = 0.657; P < .0001; y = 3.82 + 0.14 × gestational age), its circumference (r = 0.843; P < .0001; y = 5.11 + 0.58 × gestational age), and its area (r = 0.844; P < .0001; y = –10.11 + 1.17 × gestational age). Twelve enlarged fourth ventricles were found between 14 and 16 weeks, but results of follow‐up scans at 20 weeks were normal. Conclusions. An isolated enlarged fourth ventricle in the early second trimester might represent a normal variant; it should be followed, but decisions about the fate of the pregnancy should not be based solely on this finding.
Sonography of the Acute Abdomen in the Pediatric Patient
Authors: Babcock Diane S.
Published: January 2017

Objective. To review the causes and sonographic appearance of pathologic processes that result in abdominal pain in the pediatric patient and to understand the use and limitations of abdominal sonography in the acute pediatric abdomen. Methods. A pictorial review of cases is presented. Results. Sonography in conjunction with color and pulsed Doppler imaging is a valuable tool in the evaluation of the acute abdomen in the pediatric patient. This article reviews the use of sonography in the evaluation of the acute abdomen in the pediatric patient. Conclusions. The causes of the acute abdomen in children vary depending on the ages of the children. Sonography is a noninvasive modality and is useful for assessing these patients.
Intracervical Sonographic‐Pathologic Correlation
Authors: Dubinsky Theodore J. , Reed Susan D. , Grieco Verena , Richardson Michael L.
Published: January 2017

Objective. To determine whether current‐generation endoluminal ultrasonic transducer technology could visualize dysplastic and malignant cervical lesions. Methods. Inclusion criteria for patients enlisted in the study were abnormal Papanicolaou test results, an abnormality seen at colposcopy, and consent for a cone biopsy. In addition, we included 4 women who were undergoing hysterectomy but had no evidence of cervical abnormalities at the time of surgery, for a total of 28 women. We used a 20‐MHz annular array intravascular transducer. We correlated all sonographic and pathologic results with regard to being normal or abnormal using the Pearson product moment correlation coefficient, and we evaluated interobserver variation by having 5 blinded sonologists interpret each examination and calculating κ statistics. Results. We performed intracervical sonography on 24 women with abnormal Papanicolaou test results and on 4 women without abnormalities. Nineteen of the 24 women with proven disease had abnormal sonographic images. Five women with pathologically proven cervical intraepithelial neoplasia I had normal sonographic images. Lesions ranged in size from 0.3 to 7 mm. Two carcinomas (5 and 7 mm diameter), multiple nabothian cysts, cervicitis, and 2 giant cell foreign body reactions were visible on sonography. The correlation coefficient for abnormal sonographic and pathologic findings was 0.87 (P < .005). We obtained a κ value of 0.75 for interobserver variation. Conclusions. Intracervical sonography was able to visualize dysplastic lesions and carcinomas as hypoechoic defects with surrounding echogenic areas of glandular cervical mucosa. Lesions were shown with sufficient resolution and interobserver variation to suggest that the technique may be clinically applicable, particularly for planning surgical therapy. However, design of a transducer that can be easily sterilized between examinations, similar to current endovaginal probes, would be necessary to make intracervical sonography a clinically feasible examination.
Second‐Trimester Sonographic Findings in Trisomy 22
Authors: Sepulveda Waldo , Be Cecilia , Schnapp Carlos , Roy Mita , Wimalasundera Ruwan
Published: January 2017

Objective. To describe cases of trisomy 22 detected prenatally on second‐trimester sonography and to review the literature on similar cases, with special emphasis on the prenatal findings and pregnancy outcome. Methods. We performed follow‐up second‐trimester sonography and fetal karyotyping on 3 pregnant women who were referred because of abnormal findings on initial second‐trimester scans. We also conducted a literature search for other reports of sonographic findings in trisomy 22. Results. Fetal abnormalities shown on sonography included nuchal thickening, mild generalized skin edema, an atrioventricular septal defect, an interventricular septal defect, edema of the scalp, face, and neck, severe left pleural effusion with a marked mediastinal shift, ascites, agenesis of the diaphragm, ambiguous genitalia, a single umbilical artery, bradycardia, a multicystic left kidney, and an absent right kidney. All 3 fetuses had karyotypes indicating trisomy 22. One pregnancy was terminated at the parents' request, and 2 ended in fetal death at 23 and 26 weeks. Our literature search revealed only 1 previous report of second‐trimester sonographic diagnosis of trisomy 22. We found 3 other reports describing prenatal diagnosis in the third trimester, but only limited information on the sonographic findings was available. Conclusions. Second‐trimester sonography provides valuable clues for the prenatal diagnosis of several chromosomal disorders, including trisomy 22. Prenatal karyotyping is warranted if fetal growth restriction is detected in the second trimester, especially if associated with congenital defects.
Extra‐Low Acoustic Power Harmonic Images of the Liver With Perflutren
Authors: Maruyama Hitoshi , Matsutani Shoichi , Saisho Hiromitsu , Mine Yoshitaka , Yuki Hidenobu , Miyata Keiji
Published: January 2017

Objective. The features of images below the extra‐low mechanical index level were studied to elucidate a suitable mechanical index level for observing real‐time and continuous harmonic images of rabbit livers with VX‐2 tumors with the use of perflutren. Methods. Eight New Zealand White rabbits, 2 with healthy livers and 6 with VX‐2 tumors, were examined by harmonic imaging (1.85 and 3.7 MHz) at a frame rate of 17 Hz under various mechanical index levels. Results. Real‐time enhanced images of the liver were observed continuously in all rabbits. Vascular images were more clearly visualized at the low mechanical index level (mechanical index, 0.18) than at any other level. However, predominant enhanced images of the whole liver were observed only at the extra‐low mechanical index level (mechanical index, 0.06). In VX‐2 tumors, tumor vessels were shown more clearly at a low acoustic power level than at an extra‐low level. The histologically proved area of viable tumor was enhanced as a stain in the tumor nodule at an extra‐low mechanical index level. Conclusions. Harmonic imaging under extra‐low mechanical index levels with perflutren could provide real‐time and continuous enhanced images of the liver, which would contribute to improvement of the diagnostic ability of contrast‐enhanced sonography in liver diseases.
Carotid Pseudostring Sign From Vasa Vasorum Collaterals
Authors: Kriegshauser J. Scott , Patel Maitray D. , Nelson Kent D.
Published: January 2017

Objective. To describe the spectral and color Doppler imaging findings in 2 cases of internal carotid artery occlusion with vasa vasorum collateral flow, which we term the “pseudostring sign.” Methods. Spectral and color Doppler imaging findings in both cases were reviewed. Magnetic resonance angiography in 2 cases and conventional angiography in 1 case were also reviewed. Results. Both patients had color Doppler images showing that the internal carotid artery was a narrow, stringlike vessel with arterial flow that had normal spectral Doppler features (velocity <125 cm/s with a normal waveform). Magnetic resonance angiography in 1 patient showed total occlusion of the proximal internal carotid artery with patent vasa vasorum collaterals reconstituting the lumen distally. In the second patient, magnetic resonance angiography showed total occlusion of the proximal internal carotid artery, and conventional angiography showed proximal occlusion with collateral flow through the vasa vasorum. Conclusions. Proximal internal carotid artery occlusion with vasa vasorum collateral flow should be considered when color Doppler imaging shows a seemingly narrow internal carotid artery with tortuosity and normal spectral Doppler features. Patients with these features should not undergo carotid endarterectomy directly on the basis of only the Doppler findings.
Diagnosis of Intracranial Dural Arteriovenous Fistulas by Carotid Duplex Sonography
Authors: Tsai Li-Kai , Jeng Jiann-Shing , Wang Hung-Jung , Yip Ping-Keung , Liu Hon-Man
Published: January 2017

Objective. To validate carotid duplex sonography (CDS) in diagnosis of intracranial dural arteriovenous fistulas (AVFs) against the standard of cerebral catheter angiography. Methods. We investigated 35 patients with dural AVFs and 64 patients without dural AVFs confirmed by the catheter angiographic studies. Twenty CDS parameters in 4 categories, including resistive index (RI), flow volume, peak systolic velocity, and end‐diastolic velocity, were evaluated. Abnormal CDS findings were defined as the data above 95th percentile or below 5th percentile values from 180 control subjects. We determined the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy in each CDS parameter. Results. The parameter of RI of the external carotid artery (ECA; cutoff points: right, 0.72; left, 0.71) yielded the highest sensitivity (74%), specificity (89%), positive predictive value (79%), negative predictive value (86%), and accuracy (84%) for predicting dural AVFs. All other ECA‐related parameters yielded sensitivity lower than 70%, and those related to the internal carotid artery were lower than 30%. The sensitivity values for the parameter of RI of the ECA in different locations of dural AVFs were 54% (7 of 13 patients) in cavernous sinus dural AVFs and 86% (19 of 22 patients) in non–cavernous sinus dural AVFs (P = .05). Conclusions. The RI of the ECA is the best CDS parameter for predicting intracranial dural AVFs. Carotid duplex sonography can be used as the initial screening tool for diagnosis in patients having symptoms related to dural AVFs.
Prenatal Diagnosis of Isolated Tricuspid Valve Atresia
Authors: Tongsong Theera , Sittiwangkul Rekwan , Wanapirak Cnanane , Chanprapaph Pharuhas
Published: January 2017

Objective. To describe the prenatal features of fetal tricuspid atresia. Methods. Four cases of fetal tricuspid atresia were prenatally diagnosed, sonographically described, and followed. Results. On the basis of this small series, the key findings for diagnosis included the demonstration of no patent tricuspid valve on the 4‐chamber view, no flow across the tricuspid valve on pulsed or color Doppler flow mapping, small right ventricles, and associated interventricular septal defects. Increased nuchal translucency thickness may give the first clue leading to follow‐up scans, resulting in a definite diagnosis. Conclusions. Tricuspid atresia can be readily diagnosed prenatally. The key findings and differential diagnoses are provided.
Power Doppler Endoscopic Ultrasonography for the Differential Diagnosis Between Pancreatic Cancer and Pseudotumoral Chronic Pancreatitis
Authors: Săftoiu Adrian , Popescu Carmen , Cazacu Sergiu , Dumitrescu Daniela , Georgescu Claudia Valentina , Popescu Mihai , Ciurea Tudorel , Gorunescu Florin
Published: January 2017

Objective. The accuracy of endoscopic ultrasonography (EUS) and EUS‐guided fine‐needle aspiration for the differential diagnosis of pancreatic masses is variable in the literature, being as low as 75% in some studies. The aim of the study was to assess the accuracy of power Doppler EUS for the differential diagnosis between pancreatic cancer and pseudotumoral chronic pancreatitis. Methods. We included 42 consecutive patients with pancreatic tumor masses (27 men and 15 women) examined by EUS between January 2002 and August 2004. Endoscopic ultrasonographic procedures included power Doppler EUS as well as EUS‐guided fine‐needle aspiration in all patients. Final diagnosis of pancreatic cancer was confirmed in 29 patients on the basis of a combination of information provided by imaging tests, follow‐up of at least 6 months, and laparotomy in 18 patients for diagnostic or palliative reasons. Results. Sensitivity and specificity of the absence of power Doppler signals inside the suggestive pancreatic mass were 93% and 77%, respectively, with accuracy of 88%. Moreover, the addition of the information provided by the presence of peripancreatic collaterals improved the sensitivity and specificity to 97% and 92%, with accuracy of 95%. Conclusions. Power Doppler EUS provides useful information for the differential diagnosis of pancreatic masses. The results were in concordance with previous studies that showed a hypovascular pattern of pancreatic carcinoma, as well as the formation of collaterals in advanced cases due to the invasion of the splenic or portal veins. Further studies of dynamic EUS with contrast agents are necessary to better characterize pancreatic masses.
Ultrasonography of Anterosuperior Calcaneal Process Fracture
Authors: Boutry Nathalie , Vanderhofstadt Antoine , Peetrons Philippe
Published: January 2017

Objective. The purpose of this series is to describe the ultrasonographic findings of anterosuperior calcaneal process (ASCP) fracture. Methods. Two patients with ASCP fractures were examined with ultrasonography. Both of them had pain over the lateral aspect of the ankle 10 to 13 months after an injury. Initial radiographs had shown no evidence of bone fracture or bone avulsion. Results. In both cases, ultrasonography revealed the presence of a bone fragment adjacent to the ASCP suggestive of a misdiagnosed fracture. The latter was confirmed by radiographs. In 1 case, a hypoechoic thickening of the calcaneocuboid component of the bifurcate ligament was also identified on ultrasonographic scans. Conclusions. Ultrasonography is potentially valuable in detecting clinically or radiographically occult ASCP fractures.
Identification of the Fetal Hippocampus and Fornix and Role of 3‐Dimensional Sonography
Authors: Gindes Liat , Weissmann-Brenner Alina , Weisz Boaz , Zajicek Michal , Geffen Keren Tzadikevitch , Achiron Reuven
Published: January 2017

Objectives

The purposes of this study were to identify the fetal hippocampus and fornix using 3‐dimensional sonography, to measure their curved length during pregnancy, and to describe a systematic method for volume data set analysis of the fetal hippocampus and fornix.

Methods

Three‐dimensional volumes of the fetal brain were acquired prospectively in 34 patients between 14 and 37 weeks' gestation. Volumes were acquired with trans‐abdominal and transvaginal transducers. All volumes were analyzed offline by 2 examiners separately. The feasibility of identifying the fetal hippocampus and fornix was analyzed. The curved length of the hippocampus‐fornix structure was measured on the right and left hemispheres.

Results

The fetal hippocampus and fornix were identified bilaterally in 32 of 34 fetuses (94%) at gestational ages of 14 weeks 5 days to 37 weeks 1 day (mean, 23 weeks 3 days). In 1 fetus (3%), only one side was shown, and in another fetus (3%), both sides were obscured by acoustic shadows. A systematic approach for identification of the fetal hippocampus is described. Linear growth of the fetal hippocampus and fornix was shown during pregnancy and was correlated with both the gestational week and the head circumference (R = 0.71 and 0.74, respectively; P = .01). The length of the hippocampus and fornix did not differ between the left and the right hemispheres (P = .598).

Conclusions

The fetal hippocampus and fornix can be identified by a systematic analysis of 3‐dimensional data set volumes. The normal hippocampus and fornix show linear growth throughout pregnancy.
First‐Trimester Visualization of the Fourth Ventricle in Fetuses With and Without Spina Bifida
Authors: Solt Ido , Acuna Joann G. , Adeniji Beni A. , Mirocha James , Kim Matthew J. , Rotmensch Siegfried
Published: January 2017

Objectives

The purpose of this study was to examine the efficacy of nonvisualization of the fourth ventricle for first‐trimester detection of spina bifida.

Methods

A total of 250 digitally stored sonographic examinations at gestational ages of 11 weeks to 13 weeks 6 days (245 normal and 5 randomly interspersed spina bifida cases) were retrospectively analyzed by 4 blinded reviewers for the presence or absence of the fourth ventricle followed by an anteroposterior ventricular dimension measurement. The ventricle size was related to the crown‐rump length and gestational age by linear regression analysis and Pearson correlation.

Results

The fourth ventricle was identified in 971 of 1000 image readings (97.1%). False‐negative and false‐positive readings occurred in 11 of 20 (55.0%) and 20 of 980 (2.0%) cases, respectively (sensitivity, 0.45; specificity, 0.98.). False‐negative and false‐positive readings were evenly distributed throughout the gestational age range. When the ventricular size was measurable, its mean dimensions increased linearly with gestational age and were below the fifth percentile in 10 of 245 (4.0%) normal and 0 of 4 spina bifida cases, respectively. Intraclass correlation coefficient estimates were calculated based on the 2‐way analysis of variance model and found to be 0.30 for a single rater and 0.64 for the mean of 4 raters.

Conclusions

Nonvisualization of the first‐trimester fourth ventricle is a less robust screening parameter for spina bifida than previously published.
Color‐Coded Duplex Sonography Compared to Multidetector Computed Tomography for the Diagnosis of Crohn Disease Relapse and Complications
Authors: Gaitini Diana , Kreitenberg Adam J. , Fischer Doron , Maza Itay , Chowers Yehuda
Published: January 2017

Objectives

The purpose of this study was to evaluate the accuracy of color‐coded duplex sonography for the diagnosis of Crohn disease relapse and complications compared to multidetector computed tomography (CT).

Methods

The Institutional Ethics Committee approved the protocol research, and written consent forms were obtained. Patients with a diagnosis of Crohn disease presenting with symptoms of relapse or complications (54 patients; 27 female; ages 9–80 years; mean, 34.6 years) were enrolled. Patients underwent color‐coded duplex sonography and multidetector CT examinations within 2 weeks of each other. Multidetector CT was the reference standard. The location and extent of diseased bowel, wall thickness, stenosis, hyperemia, mesenteric fat thickening, lymphadenopathy, abscesses, fistulas, peritoneal fluid, and signs of hepatobiliary disease were searched for.

Results

About of 80% of the patients had terminal ileal involvement, and 55% had disease confined to the ileum. A significant correlation between the two modalities was found regarding wall thickness, abscesses, and fistulas (P < .05). Color‐coded duplex sonography had sensitivity and specificity of 88% and 53%, respectively, for diagnosis of luminal stenosis. Hyperemia was more commonly diagnosed on color‐coded duplex sonography. Color‐coded duplex sonography had sensitivity and specificity of 84% and 83% for diagnosis of mesenteric fat thickening and lymphadenopathy and 66% and 86% for peritoneal fluid. Fatty liver was found in 18% and gallstone disease in 6%.

Conclusions

Color‐coded duplex sonography was accurate in diagnosing the disease location, wall thickness, and extraintestinal inflammatory findings associated with Crohn disease, potentially placing it as the first‐line imaging modality for the diagnosis of Crohn disease relapse and complications.
Varicocele and Epididymitis in Behçet Disease
Authors: Yilmaz Omer , Yilmaz Sedat , Kisacik Bunyamin , Aydogdu Mehmet , Bozkurt Yalcin , Erdem Hakan , Pay Salih , Saglam Mutlu , Dinc Ayhan
Published: January 2017

Objective—

Behçet disease is a systemic disease with protean manifestations. Vasculitis is a hallmark of the disease and may involve arteries, veins, and capillaries. Varicocele is dilatation of the pampiniform plexus veins. We aimed to investigate the incidence of varicocele in patients with Behçet disease.

Methods

The study included 47 male patients with Behçet disease and 31 healthy control participants. All underwent a clinical evaluation including a medical history and systemic and scrotal examinations. Subsequently, 2 investigators blinded to the clinical data performed sonographic examinations and measured pampiniform plexus vein diameters.

Results

The mean age of the patients ± SD was 23.4 ± 3.2 years; disease durations ranged from 3 to 120 months (46 ± 31 months). Scrotal pain or a palpable mass was detected by clinical examination in 24 patients with Behçet disease (51.1%) and 5 healthy participants (16.1%; P = .002). By color Doppler examination, left varicocele was diagnosed in 26 patients with Behçet disease (55.3%) and 9 healthy participants (29%; P = .02). All patients with right varicocele also had left varicocele; that condition was detected in 10.6% (5 patients) of the Behçet disease group and 6.4% (2 patients) of the control group (P > .05). Eight patients with Behçet disease (17%) had epididymitis, whereas none of the healthy participants did (P = .019, Fisher exact test). Genital ulcers and erythema nodosum lesions were more common among patients with varicocele (P = .034 and .058, respectively). There were no differences in smoking, epididymitis, arthritis, uveitis, or other clinical parameters for distinguishing varicocele in patients with Behçet disease.

Conclusions

The incidence of varicocele was increased in Behçet disease. Whether varicocele confers fertility problems in patients with Behçet disease and the underlying mechanism for a possible association are yet to be determined.