bluuebunny/crossref_metadata_2025 huggingface dataset:
The Effectiveness and Reliability of Disclosing Solution in Adhesive Remnant Index: A Pilot Study
Authors: MF Usoff , M Dasor , FH Al-Bayaty
Published: January 2017

Introduction: In clinical investigation, scoring the adhesive remnant index (ARI) from tooth surface was difficult due to a lack of a contrasting color in the orthodontic adhesive. Adhesive remnant on the tooth surface is more visible if disclosing solution is applied after debonding. To date, no studies have assessed ARI using a disclosing solution.

Objectives: To compare the effectiveness of visual inspection and digital photography in ARI assessment using disclosing solution and to investigate the reliability of two examiners in scoring ARI on the tooth surface.

Material and Method: Brackets of MBT prescription were bonded to the 10 extracted teeth using self-etching primer and light cure adhesive. All brackets from the samples were mechanically debonded using selected pliers. After debonding, disclosing solution was applied on the adhesive remnant and ARI score were visually recorded. The ARI were also scored from photographs of the samples which were taken with the macro lens of DSLR Camera. Comparison of ARI score between visual and photographic inspection were analyzed using Fisher Exact test. Intra-operator and Inter-operator reliability of ARI score were calibrated using Kappa test.

Result: The Fisher Exact test revealed no statistically significance difference of ARI assessment between visual and photographic inspection (p > 0.95). ARI score of 3 were found 70% in both techniques. These findings indicated that the bond failure frequently occur between bracket and adhesive. Calibration was carried out and the result showed photographic inspection had a better agreement (K > 0.62) than visual inspection (K > 0.57) for both calibrations Conclusion: Disclosing solution application is a viable new approach for further clinical study of adhesive remnant on the tooth surface either by visual inspection or photography.
Dental Caries and Related Factors in Vietnamese Dental Patients
Authors: Kieu Thoai Quoc , Ngo Lan Thi Quynh , Pham Thuy A Anh Vu
Published: January 2017

Objective: To assess the association of dental caries with self-reported dental caries, dental knowledge and habit; and with obesity in Vietnamese dental patients

Methods: A cross sectional study was conducted on 367 adults (148 males, 219 females, mean age: 34.9 years old) who first visited at the Faculty of Odonto-Stomatology, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam. Self-reported dental caries, dental knowledge and habits, and anthropometric index were investigated by the self-administered questionnaire. Dental status including DT, MT, FT were examined. The multiple logistic regression analysis was performed to explore factors that were associated with dental caries.

Results: Prevalence of dental caries in the study sample was 53.1%. The factors significantly related to dental caries were subjects having dental scaling during last year (OR=2.1; CI=1.1-4.0), self-checked teeth/gum frequency (OR=1.7; CI=1.0-3.0), self-reported dental caries (OR=2.4; CI=1.1-5.1), having knowledge on dental caries caused by bacteria (OR=2.1; CI=1.1-4.0), having knowledge on regular dental checkups (OR=3.9; CI=1.8-8.7) and overweight/obesity (OR=3.1; CI=1.5-6.2).

Conclusion: Dental caries was associated with behavioral factors, dental knowledge and nutritional status in Vietnamese dental patients. Providing the dental knowledge with emphasis on oral self-checked oral disease behaviors and normal weight maintenance are necessary to prevent dental caries.
Tissue Response of TM-Joint to Arthritis Induction Methods in Rat
Authors: Wang Ding Han , Yang Mu Chen , Hsu Wun Eng , Hsu Ming Lun
Published: January 2017

Objective: Pathogenesis of rheumatoid arthritis (RA) related temporomandibular joint disorder remains unclear. Some studies investigated the change of condyle after Complete Freund's Adjuvant (CFA) injection which is similar to osteoarthritis. However, there were few studies to demonstrate effect of TMJ in CIA which mimics RA. The aim of this study was to investigate the TM-joint response of CFA and CIA group in rat model.

Methods: 24 Rats were divided into 4 groups. (1) Control group. (2) 50μl type I collagen injection group. (3) 50μl CFA injection group. (4) 25μl type I collagen + 25μl CFA injection group. Drug injection was performed on day 0 and day 14 and sacrificed on day 7, and day 35. After sacrificed, TMJ tissue was collected to do the H&E stain and investigated the inflammatory (IL-1β and MMP3) gene expression.

Results: TMJ tissue of CFA group demonstrated adaptive bone growth. On the other hand, the subchondral bone of CIA group appeared degenerative process. The trend of IL-1β and MMP3 gene increased in CFA and CIA group compared to control group in synovial tissue and disc (p<0.05).

Conclusion: Within limitation of this study, it’s concluded that the CIA method can be used in RA related TMD mechanism research.
Characterisation of the opposing effects of G6PD deficiency on cerebral malaria and severe malarial anaemia
Authors: Clarke Geraldine M , Rockett Kirk , Kivinen Katja , Hubbart Christina , Jeffreys Anna E , Rowlands Kate , Jallow Muminatou , Conway David J , Bojang Kalifa A , Pinder Margaret , Usen Stanley , Sisay-Joof Fatoumatta , Sirugo Giorgio , Toure Ousmane , Thera Mahamadou A , Konate Salimata , Sissoko Sibiry , Niangaly Amadou , Poudiougou Belco , Mangano Valentina D , Bougouma Edith C , Sirima Sodiomon B , Modiano David , Amenga-Etego Lucas N , Ghansah Anita , Koram Kwadwo A , Wilson Michael D , Enimil Anthony , Evans Jennifer , Amodu Olukemi K , Olaniyan Subulade , Apinjoh Tobias , Mugri Regina , Ndi Andre , Ndila Carolyne M , Uyoga Sophie , Macharia Alexander , Peshu Norbert , Williams Thomas N , Manjurano Alphaxard , Sepúlveda Nuno , Clark Taane G , Riley Eleanor , Drakeley Chris , Reyburn Hugh , Nyirongo Vysaul , Kachala David , Molyneux Malcolm , Dunstan Sarah J , Phu Nguyen Hoan , Quyen Nguyen Ngoc , Thai Cao Quang , Hien Tran Tinh , Manning Laurens , Laman Moses , Siba Peter , Karunajeewa Harin , Allen Steve , Allen Angela , Davis Timothy ME , Michon Pascal , Mueller Ivo , Molloy Síle F , Campino Susana , Kerasidou Angeliki , Cornelius Victoria J , Hart Lee , Shah Shivang S , Band Gavin , Spencer Chris CA , Agbenyega Tsiri , Achidi Eric , Doumbo Ogobara K , Farrar Jeremy , Marsh Kevin , Taylor Terrie , Kwiatkowski Dominic P ,   MalariaGEN Consortium
Published: January 2017

Glucose-6-phosphate dehydrogenase (G6PD) deficiency is believed to confer protection against Plasmodium falciparum malaria, but the precise nature of the protective effect has proved difficult to define as G6PD deficiency has multiple allelic variants with different effects in males and females, and it has heterogeneous effects on the clinical outcome of P. falciparum infection. Here we report an analysis of multiple allelic forms of G6PD deficiency in a large multi-centre case-control study of severe malaria, using the WHO classification of G6PD mutations to estimate each individual’s level of enzyme activity from their genotype. Aggregated across all genotypes, we find that increasing levels of G6PD deficiency are associated with decreasing risk of cerebral malaria, but with increased risk of severe malarial anaemia. Models of balancing selection based on these findings indicate that an evolutionary trade-off between different clinical outcomes of P. falciparum infection could have been a major cause of the high levels of G6PD polymorphism seen in human populations.
Electromagnetic and material contributions to stress, energy, and momentum in metamaterials
Authors: Kemp B. A. , Sheppard C. J.
Published: January 2017

We demonstrate modeling of the field-kinetic and material response subsystem for various media and extend the models to dispersive negative index metamaterials.  It is shown that neither the Minkowski or Abraham models are universally correct, as demonstrated to describe metamaterials under both the field-kinetic and wave SEM models for various applications such as negative refraction, perfect lensing, and invisibility cloaking.
Laparoscopic ultrasonographic appearance of the common bile duct mucosa: a predictor of choledocholithiasis.
Authors: Berber E , Garland A M , Foroutani A , String A , Siperstein A E
Published: January 2017

Previously we reported on the use of laparoscopic ultrasonography in detecting common bile duct stones during laparoscopic cholecystectomy. The aim of this study is to describe the laparoscopic ultrasonographic appearance of the common bile duct mucosa in patients with choledocholithiasis. Medical records of 44 patients with an increased risk for common bile duct stones undergoing laparoscopic cholecystectomy between 1993 and 1998 were reviewed. In the operating room, the laparoscopic ultrasonographic appearance of the common bile duct mucosa was scored in real time as normal, mild changes (hyperechoic mucosa), or severe changes (hyperechoic with mucosal thickening). Of the 31 patients (70%) with stones or sludge in the biliary tree, 29 (94%) had either severe (58%) or mild (36%) hyperechoic and 2 (6%) had normal‐appearing common bile duct mucosa on laparoscopic ultrasonography. Of the 13 patients (30%) with no documented stones or sludge, 11 (85%) had normal and 2 (15%) had mild hyperechoic common bile duct mucosa on laparoscopic ultrasonography. Both of these patients had laboratory values indicating recent passage of common bile duct stones. The association between common bile duct stones and the presence of hyperechoic common bile duct mucosa was statistically significant (P < .0001, Fisher's exact test). This is the first report of hyperechoic common bile duct mucosa demonstrated by laparoscopic ultrasonography as a predictor of common bile duct stones. This finding is evident in the majority of patients with common bile duct stones and also may be associated with recent passage of a stone into the duodenum.
Evaluation of the woman with postmenopausal bleeding: Society of Radiologists in Ultrasound‐Sponsored Consensus Conference statement.
Authors: Goldstein R B , Bree R L , Benson C B , Benacerraf B R , Bloss J D , Carlos R , Fleischer A C , Goldstein S R , Hunt R B , Kurman R J , Kurtz A B , Laing F C , Parsons A K , Smith-Bindman R , Walker J
Published: January 2017

A panel of 14 physicians practicing medicine in the United States with expertise in radiology, obstetrics and gynecology, gynecologic oncology, hysteroscopy, epidemiology, and pathology was convened by the Society of Radiologists in Ultrasound to discuss the role of sonography in women with postmenopausal bleeding. Broad objectives of this conference were (1) to advance understanding of the utility of different diagnostic techniques for evaluating the endometrium in women with postmenopausal bleeding; (2) to formulate useful and practical guidelines for evaluation of women with postmenopausal bleeding, specifically as it relates to the use of sonography; and (3) to offer suggestions for future research projects.

October 24 and 25, 2000, Washington, DC, preceding the annual Society of Radiologists in Ultrasound Advances in Sonography conference.

Specific questions to the panel included the following: (1) What are the relative effectiveness and cost‐effectiveness of using transvaginal sonography versus office (nondirected) endometrial biopsy as the initial examination for a woman with postmenopausal bleeding? (2) What are the sonographic standards for evaluating a woman with postmenopausal bleeding? (3) What are the abnormal sonographic findings in a woman with postmenopausal bleeding? (4) When should saline infusion sonohysterography or hysteroscopy be used in the evaluation of postmenopausal bleeding? (5) Should the diagnostic approach be modified for patients taking hormone replacement medications, tamoxifen, or other selective estrogen receptor modulators?

Consensus recommendations were used to create an algorithm for evaluating women with postmenopausal bleeding. All panelists agreed that because postmenopausal bleeding is the most common presenting symptom of endometrial cancer, when postmenopausal bleeding occurs, clinical evaluation is indicated. The panelists also agreed that either transvaginal sonography or endometrial biopsy could be used safely and effectively as the first diagnostic step. Whether sonography or endometrial biopsy is used initially depends on the physician's assessment of patient risk, the nature of the physician's practice, the availability of high‐quality sonography, and patient preference. Similar sensitivities for detecting endometrial carcinoma are reported for transvaginal sonography when an endometrial thickness of greater than 5 mm is considered abnormal and for endometrial biopsy when "sufficient" tissue is obtained. Currently, with respect to mortality, morbidity, and quality‐of‐life end points, there are insufficient data to comment as to which approach is more effective. The conference concluded by identifying several important unanswered questions and suggestions that could be addressed by future research projects.
Early second‐trimester low umbilical coiling index predicts small‐for‐gestational‐age fetuses.
Authors: Degani S , Leibovich Z , Shapiro I , Gonen R , Ohel G
Published: January 2017

To evaluate the role of the early second‐trimester Doppler velocimetric studies of the umbilical coiling index and umbilical cord cross‐sectional area as tests for the prediction of small‐for‐gestational age infants.

Doppler blood flow studies in 147 singleton pregnancies at risk for delivery of a small‐for‐gestational‐age neonate were performed at 15 +/‐ 1 (SD) weeks' gestation from the uterine artery, umbilical artery, middle cerebral artery, inferior vena cava, and ductus venosus. Pulsatility index values were calculated for the arteries, and preload index values and systolic‐atrial contraction ratios were calculated for the veins. The sonographic cross‐sectional area of the umbilical cord was measured in a plane adjacent to the insertion into the fetal abdomen. The umbilical coiling index was calculated by using sonographic longitudinal views of cord vessels from several segments antenatally and by dividing the total number of helices by cord length (centimeters) postnatally. Small‐for‐gestational‐age neonates were identified when the birth weight was below the 10th percentile for gestational age.

Among 147 pregnancies studied, 124 fulfilled the study criteria. Thirty‐nine of the neonates were small for gestational age at birth (31.5%). The mean +/‐ SD gestational age at delivery of the appropriate‐for‐gestational‐age neonates was 39.7 +/‐ 1.28 weeks, and that of the small‐for‐gestational‐age neonates was 36.4 +/‐ 2.9 weeks (range, 28‐40 weeks). The best single predictor of a small‐for‐gestational‐age infant was the coiling index, with sensitivity of 79%, specificity of 86%, a positive predictive value of 72%, and a negative predictive value of 90%.

The umbilical coiling index measured in the second trimester is useful in predicting the birth of a small‐for‐gestational‐age infant and may serve as a marker for subsequent growth restriction.
Abdominal three‐dimensional power Doppler imaging.
Authors: von Herbay A , Häussinger D
Published: January 2017

Three‐dimensional ultrasonic angiography is a new power Doppler ultrasonographic imaging mode that appears to improve the visualization of vascular anatomy in abdominal sonography. This study illustrates the utility of three‐dimensional ultrasonic angiography in the abdomen, especially with respect to liver and portal vein anatomy, vascularization of the kidney, and vessels localized in the retroperitoneum.
Ultrasonographic appearance of Ascaris lumbricoides in the small bowel.
Authors: Mahmood T , Mansoor N , Quraishy S , Ilyas M , Hussain S
Published: January 2017

Roundworm infestation, one of the most common helminthic diseases worldwide, is caused by Ascaris lumbricoides, one of the largest parasites that infests the human bowel. A lumbricoides is virtually universal at some stage of childhood in semitropical and tropical regions. This study describes our experience with the ultrasonographic appearance of intestinal ascariasis in 84 patients, 2.5 to 42 years of age, examined over 2 years beginning October 1997. The patients' conditions ranged from acute intestinal obstruction to no clinical features pertaining to obstruction. Ultrasonographic examination was performed with an Echocee power Doppler real‐time unit with a variable‐frequency 3.7‐MHz convex, 7.5‐MHz linear probe. In longitudinal section the Ascaris worm presented as a linear intraluminal mass with 3 or 4 linear echogenic interfaces; in the cross section, it was round, sometimes appearing as a "target" sign. Some worms also showed serpentine movements. Sonographic examination of the patients in the left lateral decubitus position after ingestion of water improved detection and visualization of the worms in some cases. It is concluded that A lumbricoides in the small bowel has a sonographic appearance that can be recognized by the wary observer.
Three‐dimensional quantitative echocardiographic assessment of ventricular volume in healthy human fetuses and in fetuses with congenital heart disease.
Authors: Meyer-Wittkopf M , Cole A , Cooper S G , Schmidt S , Sholler G F
Published: January 2017

The purpose of this study was to evaluate the feasibility of three‐dimensional freehand echocardiographic assessment of ventricular volumetry in healthy fetuses and in fetuses with congenital heart disease. The study was approved by the hospital institutional review board. After echocardiographic examination by conventional ultrasonographic equipment interfaced with a magnetic tracking system, three‐dimensional cardiac data were collected prospectively in 57 fetuses. Ventricular volumes were determined from three‐dimensional data sets, and 22 fetuses with congenital heart disease were compared with 29 healthy fetuses. A multiple regression analysis of covariance was performed to assess between‐group differences. Gated three‐dimensional volume data sets enabled assessment of ventricular volumes in 51 of the 57 fetuses. Both fetuses with and without congenital heart disease had exponential increases in cardiac volumes during gestation. In fetuses with congenital heart disease and a marked inequality of ventricular size but no heart failure, the combined end‐diastolic and stroke volumes of both ventricles were found to be significantly reduced compared with controls with no disease and fetuses with other types of congenital heart disease. Three‐dimensional imaging can provide estimates of ventricular volume changes in fetal hearts with abnormal ventricular morphology that cannot easily be performed by two‐dimensional echocardiography, and it may provide insight into evolving congenital heart disease.
Discrimination of sonographically detected breast masses using frequency shift color Doppler imaging in combination with age and gray scale criteria.
Authors: Bhatti P T , LeCarpentier G L , Roubidoux M A , Fowlkes J B , Helvie M A , Carson P L
Published: January 2017

Frequency shift color Doppler imaging was assessed in conjunction with patient age and gray scale (GS) features for discriminating benign from malignant breast masses. Thirty‐eight women with sonographically detected masses scheduled for biopsy were evaluated using a 6‐ to 13‐MHz scan head, and the masses were delineated in ultrasonographic image volumes. Vascularity in and around each mass was quantified using speed‐weighted pixel density (SWD). Gray scale features were ranked visually on a linear scale. Combinations of indices were compared with histologic findings (18 benign and 20 malignant). Receiver operating characteristic analysis ranked performance in decreasing order from the SWD‐Age‐GS index, to SWD‐GS, SWD‐Age, Age‐GS, GS criteria, SWD, and Age. At 100% sensitivity, SWD‐Age‐GS, SWD‐GS, and SWD‐Age discriminated benign from malignant masses with specificities of 94%, 89%, and 72%, respectively. These results indicate significant improvement in ultrasonographic discrimination of sonographically detected breast masses by combining the vascularity measure SWD with age and GS criteria.
Compression repair of ruptured pseudoaneurysms guided by color Doppler ultrasonography: report of two cases.
Authors: Beer M , Beissert M , Sandstede J , Wittenberg G , Tschammler A , Hahn D
Published: January 2017

Noninvasive treatment of ruptured postcatheterization pseudoaneurysms is rare. We report the use of ultrasonographically guided compression repair for the treatment of ruptured pseudoaneurysms in 2 cases. To ensure the immediate stop of bleeding, more compression was applied than for nonruptured pseudoaneurysms, regardless of flow in the femoral artery or vein, thus maximizing the effectiveness of this therapy. With this method, complete thrombosis of the pseudoaneurysm could be achieved in less than 30 minutes. In both cases, ultrasonographically guided compression repair was faster than the time needed to prepare an operating room for surgical treatment. In follow‐up examinations, no recurrences or further complications were detected. Ultrasonographically guided compression repair can be used for noninvasive treatment of ruptured pseudoaneurysms in some cases, provided that more compression than indicated for nonruptured pseudoaneurysms is applied. Further clinical experience with more patients will be necessary to determine the exact benefits and possible limitations.
Ovarian sclerosing stromal tumors: gray scale and color Doppler sonographic findings.
Authors: Lee M S , Cho H C , Lee Y H , Hong S R
Published: January 2017

Sclerosing stromal tumors are rare benign ovarian stromal tumors, which have distinctive clinical and pathologic features. The tumors occur predominantly in the second and third decades and are histologically characterized by the pseudolobular pattern of the cellular and hypocellular areas, marked vascularity, and heterogeneity of the cellular area. We analyzed 7 cases of sclerosing stromal tumors, which showed a typical sonographic appearance. On sonograms, sclerosing stromal tumors were solid and cystic and contained multiple round or cleftlike cysts. Ascites was rare. On transvaginal color Doppler sonograms, sclerosing stromal tumors were very hypervascular in the peripheral solid area and internal intercystic space and showed low‐impedance flow. We conclude that sclerosing stromal tumors should be considered in young women with menstrual irregularity who have hypervascular solid and cystic adnexal masses.
Flash echo gray scale imaging with subtraction in assessment of small hepatocellular carcinoma treated with percutaneous ethanol injection: preliminary report.
Authors: Wang J H , Lu S N , Changchien C S , Lee C M , Tung H D , Chen T M
Published: January 2017

To assess the therapeutic effect of percutaneous ethanol injection on small hepatocellular carcinoma by using a flash echo imaging system, a newly developed technique for detecting echoes from microbubble contrast agents more efficiently.

Six patients with 7 small nodular hepatocellular carcinomas, proved by fine‐needle aspiration cytologic or pathologic examination, were included. Percutaneous ethanol injection was performed until there was no intratumoral color signal on conventional color and power Doppler ultrasonography. A bubble contrast agent was then injected, and flash echo imaging in the subtraction mode was performed for assessment of the therapeutic effect. Dynamic computed tomography, magnetic resonance imaging, and hepatic angiography were also used for evaluation of the therapeutic effect.

Five tumors had perfusion defects that were equal in size to or larger than the tumors. No tumor stain was shown on hepatic angiography. Two tumors had partial perfusion defects. Viable tumors were confirmed by tumor resection in 1 case and cytologic examination in the other.

Our preliminary results show that flash echo imaging with subtraction has potential value in evaluation of the therapeutic effect of percutaneous ethanol injection on small hepatocellular carcinoma.
Ultrasonography of the fetal thyroid: nomograms based on biparietal diameter and gestational age.
Authors: Ranzini A C , Ananth C V , Smulian J C , Kung M , Limbachia A , Vintzileos A M
Published: January 2017

To describe gestational age‐dependent and ‐independent nomograms for fetal thyroid size.

Two hundred fetuses were evaluated between 16 and 37 weeks' gestation in this cross‐sectional study.

Nomograms of fetal thyroid size were created by using the 5th, 10th, 50th, 90th, and 95th percentiles based on biparietal diameter and gestational age. A second‐order polynomial fit for biparietal diameter and a linear fit for gestational age best described thyroid circumference measurements. Variations in thyroid circumference measurements increased with both larger biparietal diameter and advancing gestational age. There was no intraobserver or interobserver variability in thyroid circumference measurements (P > .20).

Both biparietal diameter and gestational age serve as good predictors of fetal thyroid circumference. When the biparietal diameter is difficult to measure, gestational age can be used to assess thyroid size.
A reappraisal of amniotic fluid alpha‐fetoprotein measurement at the time of genetic amniocentesis and midtrimester ultrasonography.
Authors: Silver R K , Leeth E A , Check I J
Published: January 2017

To evaluate the contemporary utility of amniotic fluid alpha‐fetoprotein measurement as a complementary test for fetal abnormalities at the time of invasive genetic testing.

A review of amniotic fluid alpha‐fetoprotein test results was conducted to determine the frequency with which elevated alpha‐fetoprotein values added independent diagnostic information and altered clinical management. Amniotic fluid specimens processed for alpha‐fetoprotein between 1995 and 1998 were included. Elevated alpha‐fetoprotein cases were classified as either incidental to the fetal abnormality diagnosed or central to the identification of a fetal anomaly on the basis of whether an ultrasonographic examination had already identified the anomaly before amniocentesis. The costs associated with alpha‐fetoprotein testing were used to estimate the expenditure per pregnancy in which elevated alpha‐fetoprotein values would add discriminatory diagnostic value. A hypothetical national cost model was constructed to explore the utility of selective rather than routine amniotic fluid alpha‐fetoprotein measurement.

Eighty‐two (3%) of 2769 amniotic fluid alpha‐fetoprotein values were elevated. In only 1 instance was the elevated result found to be partially discriminatory (e.g., an established diagnosis of microcephaly with an associated small encephalocele identified after the elevated amniotic fluid alpha‐fetoprotein value prompted repeated ultrasonographic assessment). Sixty‐one other neural tube defects were detected by ultrasonography alone (myelomeningocele, n = 28; anencephaly, n = 24; and encephalocele, n = 9). Thus, an elevated alpha‐fetoprotein result added diagnostic precision in only 1 (0.036%) of 2769 cases. Cost estimates suggested that routine amniotic fluid alpha‐fetoprotein assessment resulted in a $219,000 expenditure per informative case.

Routine measurement of amniotic fluid alpha‐fetoprotein during amniocentesis may not be warranted in centers with expertise in targeted ultrasonographic imaging.
Comparison of axial reconstructed ultrasonographic images from three‐dimensional data volumes and computed tomographic scans in the documentation and detection of liver lesions.
Authors: Beissert M , Jenett M , Kessler C , Keberle M , Jahns R , Hahn D
Published: January 2017

To compare axial reconstructed ultrasonographic images from three‐dimensional data volumes and conventional computed tomographic scans in documentation and detection of liver lesions.

The livers of 23 patients were examined by a multifrequency curved array transducer to acquire three‐dimensional data volumes and by conventional computed tomography The ultrasonographic device was equipped with three‐dimensional ultrasonographic technology allowing for real‐time parallel movement in every plane within an acquired data volume. Axial ultrasonographic images reconstructed from three‐dimensional data volumes were compared with conventional computed tomographic scans.

When both methods were taken together, a total of 51 different liver lesions could be detected. Reconstructed ultrasonographic images depicted 44 (86%) of 51 lesions, and computed tomographic scans showed 46 (90%) of 51 lesions. Compared with computed tomography, ultrasonography depicted 5 additional lesions in 3 of the patients (4 hemagiomas and 1 unspecified lesion), whereas 7 lesions were missed in another 4 patients (4 metastases, 2 calcifications, and 1 cyst). The Pearson correlation coefficient between ultrasonography and computed tomography was r = 0.84 (P < .001).

Our study shows that ultrasonographic images can be effectively reconstructed from three‐dimensional data volumes. With respect to documentation and detection of liver lesions, the results obtained by three‐dimensional ultrasonography appear comparable with those obtained by conventional computed tomography. However, several technical and procedural limitations have to be respected.
Bronchoscopic Ultrasonography in the Diagnosis of Tracheobronchial Invasion of Esophageal Cancer
Authors: Nishimura Yoshihiko , Osugi Harushi , Inoue Kiyotoshi , Takada Nobuyasu , Takamura Masashi , Kinosita Hiroaki
Published: January 2017

Objective. To study the usefulness of bronchoscopic ultrasonography in diagnosing tracheobronchial invasion of esophageal cancer and to compare it with endoscopic ultrasonography, bronchoscopy, and computed tomography. Methods. We prospectively investigated 59 patients with newly diagnosed esophageal cancer located at or above the level of the tracheal bifurcation. A 20‐MHz ultrasonic probe covered by a sheath with a balloon inflated with water was used for bronchoscopic ultrasonography. The presence of tracheobronchial invasion was diagnosed on the basis of an interruption in the most external hyperechoic layer of the tracheal bronchus. Results. Bronchoscopic ultrasonography was completed without complications in all patients, but endoscopic ultrasonography was performed completely in only 44% of them. The overall accuracy rates for diagnosis of tracheobronchial invasion on the basis of bronchoscopy, bronchoscopic ultrasonography, endoscopic ultrasonography, and computed tomography were 78%, 91%, 85%, and 58%, respectively. Statistical examination showed that the accuracy of bronchoscopic ultrasonography and bronchoscopy was significantly greater than that of computed tomography, and the accuracy of bronchoscopic ultrasonography was greater than that of bronchoscopy. Conclusions. Bronchoscopic ultrasonography is useful for evaluating cancer invasion into the tracheal bronchus. It is more accurate than the other methods and could be used to visualize the layered structure of the tracheal bronchus in all patients.
Genetic Sonography
Authors: DeVore Greggory R. , Romero Roberto
Published: January 2017

Objective. To determine whether offering genetic sonography to patients who decline invasive testing can increase the detection rate of trisomy 21 and is cost‐effective. Methods. The detection rate of trisomy 21, the number of pregnancy losses after amniocentesis, and the cost of detecting a single fetus with trisomy 21 were determined in women 35 years and older managed according to the following 3 policies: (1) universal amniocentesis, (2) genetic counseling for maternal age–associated risks for trisomy 21 followed by amniocentesis in patients who elected it, and (3) genetic counseling followed by genetic sonography in patients who originally declined genetic amniocentesis. Results. From a population of 40,143 women 35 years and older, the expected number of trisomy 21 fetuses was 349. After genetic counseling, 32% of patients declined invasive testing, resulting in detection of 70% of fetuses with trisomy 21. For universal amniocentesis, the cost to detect 1 fetus with trisomy 21 was $138,036. For the 32% who declined invasive testing after genetic counseling and underwent genetic sonography, the cost to detect a single fetus with trisomy 21 was a function of sensitivity and the screen‐positive rate. For screen‐positive rates between 5% and 25%, genetic sonography resulted in a cost savings between 14.3% and 18.8% when compared with universal invasive testing and resulted in a considerable increase in detection of fetuses with trisomy 21 (77% to 97%). Conclusions. A policy of offering genetic sonography followed by amniocentesis to patients 35 years and older who originally decline invasive testing for the diagnosis of trisomy 21 is cost‐effective and results in a higher overall detection rate for trisomy 21 without an increased risk of pregnancy loss.
The Evolving Appearance of a Congenital Diaphragmatic Hernia
Authors: Vettraino Ivana M. , Lee Wesley , Comstock Christine H.
Published: January 2017

Objective. The prenatal differentiation of a fetal congenital diaphragmatic hernia from other echogenic chest masses can be difficult. The implications of the leading diagnosis can greatly affect the neonatal prognosis. The cases presented illustrate how the primary diagnosis of a fetal chest mass can change during the course of gestation as the appearance of the chest mass evolves. Methods. A descriptive analysis of 2 cases reviewed the importance of considering multiple causes of an echogenic chest mass. Results. The sonographic features of a congenital diaphragmatic hernia that have been described in the literature were not always present at the time of initial evaluation. Conclusions. A congenital diaphragmatic hernia should be part of the differential diagnosis considered during consultation with parents whose fetus has an echogenic chest mass.
The Genetic Sonogram
Authors: Bromley Bryann , Lieberman Ellice , Shipp Thomas D. , Benacerraf Beryl R.
Published: January 2017

Objective. To determine the risk of Down syndrome in fetuses with sonographic markers using the Bayes theorem and likelihood ratios. Methods. We prospectively evaluated the midtrimester sonographic features of fetuses with Down syndrome and compared them with euploid fetuses. Patients were referred for an increased risk of aneuploidy and evaluated for the presence of structural defects, a nuchal fold, short long bones, pyelectasis, an echogenic intracardiac focus, and hyperechoic bowel. All fetuses underwent amniocentesis at the time of sonographic assessment. The sensitivity, specificity, and likelihood ratios for markers were calculated both as nonisolated and isolated findings. Results. There were 164 fetuses with Down syndrome and 656 euploid fetuses. The presence of any marker resulted in sensitivity for the detection of Down syndrome of 80.5% with a false‐positive rate of 12.4%. The absence of any markers conferred a likelihood ratio of 0.2, decreasing the risk of Down syndrome by 80%. As an isolated marker, the nuchal fold had an “infinite” likelihood ratio for Down syndrome; a short humerus had a likelihood ratio of 5.8, whereas structural anomalies had a likelihood ratio of 3.3. Other isolated markers had low likelihood ratios because of the higher prevalence in the unaffected population. The likelihood ratios for the presence of 1, 2, and 3 of any of the markers were 1.9, 6.2, and 80, respectively. Conclusions. Although an isolated marker with a low likelihood ratio may not increase a patient's risk of Down syndrome, the presence of such a marker precludes reducing the risk of aneuploidy. Clusters of markers appear to confer a higher risk.
AIUM Standard for the Performance of an Ultrasound Examination of the Abdomen or Retroperitoneum
Authors: Grant Edward G. , Barr Lori L. , Borgstede James , Gooding Gretchen A.W. , Hamper Ulrike M. , Hertzberg Barbara S. , Horrow Mindy , Kane Robert A. , Kremkau Frederick , Meilstrup Jon W. , Needleman Laurence , Piccoli Catherine W. , Townsend Ronald R. , Merritt Christopher R.B. , Perlmutter Gordon S.
Published: January 2017

The American Institute of Ultrasound in Medicine (AIUM) is an educational, scientific, and professional society concerned with the advancement of the art and science of ultrasound in medicine and research. To promote this mission, the AIUM is pleased to publish, in conjunction with the American College of Radiology (ACR), the updated Standard for Performance of an Ultrasound Examination of the Abdomen or Retroperitoneum. We are indebted to the many volunteers who contributed their time, knowledge, and energy to bringing this document to completion.

The AIUM represents the entire range of clinical and basic science interests in medical diagnostic ultrasound and with hundreds of volunteers, the AIUM has promoted the safe and effective use of ultrasound in clinical medicine for 50 years. This document, and others like it, will continue to advance this mission.

Clinical Standards of the AIUM are intended to provide the medical ultrasound community with guidelines for the performance and recording of high quality ultrasound examinations. The standards reflect what the AIUM considers the minimum criteria for a complete examination in each area, but are not intended to establish a legal standard of care. AIUM accredited practices are expected to generally follow the standards with the recognition that deviations from the standards will be needed in some cases depending on patient needs and available equipment. Practices are encouraged to go beyond the standards to provide additional service and information as needed by their referring physicians and patients.
Ultrasonography of the Scrotum
Authors: Ragheb Dina , Higgins Joseph L.
Published: January 2017

Objective. To review the ultrasonographic technique, anatomy, and pathologic entities found in the scrotum during evaluation of scrotal masses, acute scrotal pain, and male infertility. Method. A pictorial review of cases with diagrams of pertinent anatomic features and findings is presented. Results. Ultrasonography in conjunction with color and pulsed Doppler imaging has supplanted other imaging modalities in the evaluation of scrotal diseases and disorders. Ultrasonography is valuable in the evaluation of the acutely painful scrotum in addition to scrotal masses and male infertility. Advances in ultrasonographic spatial and low‐contrast resolution have improved our ability to more clearly define diagnoses for the referring urologist and have led to new observations that are currently being investigated and have yet to be fully understood. Microlithiasis and the mottled appearance of seminiferous tubule sclerosis and atrophy are 2 such entities. This article reviews the pertinent normal scrotal anatomy and the use of ultrasonography in the evaluation and classification of acute scrotal pain, scrotal masses, male infertility, and trauma. This review article also discusses pitfalls of color Doppler imaging in assessment of the scrotum and how to avoid them. Conclusion. The use of ultrasonography in the evaluation of the scrotum benefits from an understanding of scrotal anatomy and familiarity with potential pitfalls of color Doppler and pulsed Doppler evaluation.
Three‐dimensional Sonographic Measurement of Liver Volume in the Small‐for‐Gestational‐Age Fetus
Authors: Kuno Atsushi , Hayashi Yoshinobu , Akiyama Masashi , Yamashiro Chizu , Tanaka Hirokazu , Yanagihara Toshihiro , Hata Toshiyuki
Published: January 2017

Objectives

To assess the growth of the fetal liver in normal pregnancies and to evaluate the ability of fetal liver volume measurement for prediction of small‐for‐gestational‐age fetuses.

Methods

Three‐dimensional sonographic examinations were performed on 14 appropriate‐for‐gestational‐age and 10 small‐for‐gestational‐age fetuses. Liver volume and liver length were measured every 2 weeks after 20 weeks" menstrual age until delivery.

Results

A curvilinear relationship was found between the menstrual age and liver volume (R2 = 88.4%; P < .0001), and a normal range of liver volume measurement for estimating the growth of the fetal liver during normal pregnancy was generated. Liver length was normal in 7 of 10 small‐for‐gestational‐age fetuses, whereas liver volume values in all small‐forgestational‐age fetuses were below normal ranges in the mid to late third trimester.

Conclusions

Our findings suggest that liver volume may be a useful measurement for diagnosing small‐for‐gestational‐age fetuses in the mid to late third trimester but that liver length may not be predictive. Further studies involving a larger sample size would be needed to confirm this suggestion.
Diagnosis of Posterior Enterocele
Authors: Vierhout Mark E. , van der Plas-de Koning Yvonne W. C. M.
Published: January 2017

Objectives

To describe a new ultrasonographic technique and to compare it with intraoperative findings in women with a suspected enterocele.

Methods

An observational study was conducted in the Department of Gynecology of a medium‐sized teaching hospital. Twenty‐nine patients with clinical and ultrasonographic diagnoses of an enterocele were reviewed. All patients had vaginal repair surgery, including a posterior repair in which the existence of an enterocele was confirmed or denied.

Results

In 27 of the 29 patients, the enterocele was diagnosed as such during surgery and handled accordingly. The 2 enteroceles that were not confirmed were smaller types.

Conclusions

Rectal ultrasonographic findings were in good accordance with intraoperative anatomic characteristics. Rectal ultrasonography has the capability of diagnosing small, occult enteroceles. This can have important clinical implications in the prophylactic use of additional enterocele repair during hysterectomy or prolapse surgery.
Sonographic Findings of the Hepatobiliary‐Pancreatic System in Adult Patients With Cystic Fibrosis
Authors: Dietrich Christoph F. , Chichakli Maruan , Hirche Tim O. , Bargon Joachim , Leitzmann Peter , Wagner Thomas O. , Lembcke Bernhard
Published: January 2017

Objectives

Sonography of the liver, biliary system, and pancreas in adult patients with cystic fibrosis is by far less systematically documented than in pediatric patients with cystic fibrosis. In this prospective study, duplex sonographic findings of the liver, biliary system, and pancreas in adult patients with cystic fibrosis were compared with those of healthy control subjects.

Methods

Seventy‐two consecutive patients with cystic fibrosis and 60 healthy control subjects were examined by high‐resolution sonography. The incidence of perihepatic lymphadenopathy, the hepatic echo pattern, the detection rate of liver tumors, the flow patterns in the hepatic and portal veins, and pathologic gallbladder and pancreas findings were recorded. Additionally, cholestasis‐indicating enzyme levels (γ‐glutamyl transpeptidase and alkaline phosphatase), liver function test results (alanine aminotransferase and aspartate aminotransferase levels), and amylase and lipase levels were recorded as well.

Results

Patients with cystic fibrosis, when compared with healthy subjects on sonographic examination, had a higher incidence of microgallbladder (25% versus 0%) and cystic lesions of the pancreas (18% versus 0%). The number of abnormal echo patterns of the liver was increased (46% versus 15%), with a higher incidence of a nontriphasic flow pattern in the right hepatic vein. The differences proved to be statistically significant (P < .05).

Conclusions

Typical sonographic findings in adult patients with cystic fibrosis are a microgallbladder and small cystic lesions of the pancreas. Pathologic findings of the liver can be shown by B‐mode and duplex sonography, but the resulting patterns are less characteristic.
Doppler Sonographic Findings in Children With Idiopathic Portal Vein Cavernous Deformity and Variceal Hemorrhage
Authors: Barakat Maha
Published: January 2017

Objective. To describe the flow patterns in the portal vascular territory in children with portal vein cavernous deformity. Methods. The study included 12 children (age 4–10 years) with hematemesis, melena, or both in whom B‐mode gray scale sonography revealed small anechoic spaces replacing the site of the portal vein. The portal vein cavernous deformity was present either alone (in 8 patients) or with congenital hepatic fibrosis (in 4). Doppler sonography (color and spectral) was performed to assess the flow in the portal vascular territory, splenic vein, intrasplenic veins, and abdominal collaterals. Results. Doppler sonography confirmed the venous flow waveform in the cavernous portal vein in all children with normal flow direction in the few intrahepatic portal vein branches and also in the intrahepatic veins. Splenomegaly was present in all. The intrasplenic veins were dilated in all but had normal flow direction except in 2 with spontaneous trans‐splenic shunts. Gallbladder varices were shown in 4 patients, and perisplenic collaterals were shown in 3. Conclusions. Doppler sonography is a valuable noninvasive imaging technique for assessment of the portal hemodynamic profile in patients with portal vein cavernous deformity, which can affect subsequent treatment decision making. Trans‐splenic shunts are uncommon, but this Doppler sonographic report documents such shunts in children with portal hypertension.
A Long‐term Transdermal Nitric Oxide Donor Improves Uteroplacental Circulation in Women With Preeclampsia
Authors: Nakatsuka Mikiya , Takata Masayo , Tada Katsuhiko , Asagiri Kazuo , Habara Toshihiro , Noguchi Soichi , Kudo Takafumi
Published: January 2017

Objective. To determine the effects of long‐term transdermal administration (range, 4–30 days; mean ± SD, 11.1 ± 7.2 days) of isosorbide dinitrate, a nitric oxide donor, in preeclamptic women. Methods. We studied uterine and fetoplacental circulation of 12 preeclamptic women with oligohydramnios and an elevated pulsatility index in the uterine arteries. Results. Transdermal isosorbide dinitrate significantly suppressed the blood pressure of patients. Pulsed Doppler ultrasonography revealed that the average pulsatility index in the uterine arteries was significantly reduced by treatment with isosorbide dinitrate (P < .003). The average pulsatility index in the umbilical artery was also significantly reduced (P < .004). Furthermore, the size of the amniotic fluid pocket increased approximately 4‐fold by treatment with isosorbide dinitrate. Conclusions. Long‐term transdermal administration of isosorbide dinitrate improves fetoplacental circulation and may be effective therapy for avoiding maternal hypertension and oligohydramnios in some preeclamptic women.
Umbilical Artery Doppler Waveform Notching
Authors: Abuhamad Alfred , Sclater Annette J. , Carlson Eric J. , Moriarity Richard P. , Aguiar Maria A.
Published: January 2017

Objective. To evaluate in a prospective, controlled fashion the prevalence of umbilical artery Doppler waveform notching and its association with cord and placental abnormalities. Methods. During a 6‐month period, umbilical artery velocity waveforms were prospectively obtained on 1857 pregnancies at greater than 27 weeks' gestation. All pregnant patients with the presence of a persistent fetal umbilical artery waveform notch formed the study population (cases). Control patients, matched for gestational age, with normal umbilical artery waveforms, were selected for comparison (2 controls per case). After delivery, detailed pathologic examination was performed on all umbilical cords and placentas. Results. The presence of an umbilical artery waveform notch was noted in 29 (1.6%) of 1857 pregnancies. Postnatal placental evaluation showed the presence of an accessory placental lobe in 5 (17%) of 29 cases compared with 1 (1.8%) of 54 controls (P = .018). Overall, the presence of an umbilical artery waveform notch was associated with umbilical cord abnormalities in 21 (72%) of 29 cases compared with 8 (14%) of 54 controls (odds ratio, 15; 95% confidence interval, 4.4–54.4). Conclusions. Umbilical artery waveform notching appears to be a strong predictor of cord and placental abnormalities. This finding may have important clinical implications.