bluuebunny/crossref_metadata_2025 huggingface dataset:
Color/power Doppler sonographic differential diagnosis of superficial lymphadenopathy: metastasis, malignant lymphoma, and benign process.
Authors: Shirakawa T , Miyamoto Y , Yamagishi J , Fukuda K , Tada S
Published: January 2017

Differentiation of lymph nodes as metastasis, malignant lymphoma, and benign lesions by gray scale and color/power Doppler ultrasonography has been reported. In this study we sought to determine patterns of abnormal vascularity, the relationship between diagnostic criteria and node size, and which vessel in the node was best suited for Doppler spectral analysis. Extrahilar vessels, defined as vessels entering through the lymphatic surface and not through the hilus, were also investigated.

One hundred twenty‐nine nodes were examined by color/power Doppler ultrasonography.

Extrahilar vessels were seen in 85.4% of metastatic, 40.5% of lymphomatous, and 7.7% of benign nodes regardless of node size. The mean pulsatility index and resistive index values of metastatic nodes were higher than those of benign nodes regardless of their size. Those of lymphoma were intermediate compared with the others.

A pulsatility index greater then 1.3 and a resistive index greater than 0.72 suggested malignancy as measured from any vessel.
Frequency of a monochorionic pair in multiple gestations: relationship to mode of conception.
Authors: Chow J S , Benson C B , Racowsky C , Doubilet P M , Ginsburg E
Published: January 2017

To determine whether the mode of conception affects the frequency of monochorionicity in multiple gestations.

Our study population consisted of all women with multiple gestations who had a first‐trimester sonogram at our institution between May 1998 and April 2000. The frequency of monochorionicity in pregnancies conceived naturally was compared with the frequency in pregnancies achieved via any form of assisted reproductive technology and among the different types of assisted reproductive technology.

Our study consisted of 464 multiple gestations comprising 332 twin, 113 triplet, 16 quadruplet, and 3 quintuplet pregnancies. The higher the fetal number, the more likely the pregnancy resulted from assisted reproductive technology (72.6% of twins, 84.1% of triplets, 92.8% of quadruplets, and 100% of quintuplets; P < .05, Fisher exact test). Monochorionic pairs were found more commonly in naturally conceived pregnancies than in those resulting from assisted reproductive technology (28.2% versus 5.4%; P < .000001, chi2 test). The frequency of monochorionic pairs after in vitro fertilization with blastocyst transfer on day 5 (10.5%) was double the frequency from in vitro fertilization with cleavage stage transfer on day 3 (4.9%), but the difference was not statistically significant (P = .24, Fisher exact test).

Monochorionic pairs are relatively common in naturally conceived twins and in higher‐order multiple gestations with more than 3 fetuses arising from assisted reproductive technology, but they are uncommon in twins and triplets arising from assisted reproductive technology There is a trend toward a higher frequency of monochorionic pairs after day 5 blastocyst transfer than day 3 transfer, but a larger study population is needed to confirm this finding.
Color Doppler and duplex sonography in 5 patients with thoracic outlet syndrome.
Authors: Wadhwani R , Chaubal N , Sukthankar R , Shroff M , Agarwala S
Published: January 2017

To evaluate the use of color Doppler sonography in the diagnosis of thoracic outlet syndrome.

We studied color Doppler sonographic findings in 5 clinically suspected cases of thoracic outlet syndrome. The subclavian artery and vein were studied in varying degrees of abduction to assess the severity of the syndrome.

Significant changes, i.e., stages of increased velocities, preocclusion, and occlusion in the subclavian artery in varying degrees of abduction, were noted in 4 of 5 cases. Blunted flow in the axillary artery (4 patients) and a rebound increase in velocities on release of abduction were noted in 3 patients. These changes suggested that significant narrowing was causing symptoms.

Color Doppler sonography is a noninvasive, effective method compared with digital subtraction angiography in the diagnosis of thoracic outlet syndrome.
Subtorsion of the ovary: sonographic features and clinical management.
Authors: Shalev J , Mashiach R , Bar-Hava I , Girtler O , Bar J , Dicker D , Meizner I
Published: January 2017

To define the sonographic imaging criteria of ovarian subtorsion.

Fourteen women 16 to 35 years of age with suspected unilateral twisted ovaries were sonographically evaluated in a tertiary care center before laparoscopy. Transvaginal sonography was performed to determine the longest ovarian dimension, diameter of the periovarian vessels, and degree of intraovarian blood flow and to evaluate ovarian morphology. Laparoscopy was performed to verify the sonographic findings and to perform detorsion.

All ovaries with subtorsion were of normal size, although still significantly longer than the contralateral, normal ovaries (47.5 and 29.6 mm, respectively; P = .001). The mean diameter of the periovarian vessels was significantly greater for the ovaries with subtorsion than the normal ovaries (29.9 and 19.2 mm, respectively; P= .0001). At laparoscopy, the ovary was twisted less than 180 degrees in 9 patients and 180 degrees to 360 degrees in 5. The degree of twisting correlated significantly with the size of the ovary (P = .016) and diameter of the periovarian vessels (P = .046). The 3‐month sonographic follow‐up after detorsion revealed bilateral normal ovarian dimensions with proper follicular growth.

Congestion of the periovarian vessels with normal ovarian morphology and persistent blood flow on sonography, combined with the presence of appropriate clinical signs, may be indicative of ovarian subtorsion.
Fetal stimulation by pulsed diagnostic ultrasound.
Authors: Fatemi M , Ogburn P L , Greenleaf J F
Published: January 2017

To show that pulsed ultrasound from a clinical ultrasonic imaging system can stimulate the fetus. Stimulation is defined mainly as increased fetal gross body movements in response to excitation.

Fetuses of a group of 9 volunteer women (mean gestational age, 33.37 weeks; range, 25‐40 weeks) were evaluated for body movement under 3 different conditions: (1) control, with no ultrasound exposure; (2) ultrasound in continuous wave Doppler mode; and (3) pulsed ultrasound in pulsed Doppler and B modes. A conventional external fetal monitor, with negligible ultrasonic output, was used to monitor fetal gross body motions. After an initial rest period of 3 minutes with 1 or no fetal motion, fetuses were monitored for an additional 3 minutes under the exposure criterion defined for each condition. Resulting fetal motions under the 3 conditions were compared using the Wilcoxon signed rank test.

The test showed that fetuses moved significantly more frequently under condition 3 (mean +/‐ SD, 3.43 +/‐ 1.93 movements per minute) than under condition 1 (0.40 +/‐ 7.33 movements per minute) or condition 2 (0.63 +/‐ 7.67 movements per minute); P = .004 and .016, respectively. Fetal movements under conditions 1 and 2 did not differ significantly.

Diagnostic ultrasound may stimulate fetal body motion.
Lymph node hilus: gray scale and power Doppler sonography of cervical nodes.
Authors: Ahuja A , Ying M , King A , Yuen H Y
Published: January 2017

To investigate the difference in the nodal hilus evaluated by gray scale and power Doppler sonography.

One hundred ninety‐two patients with proven cervical lymphadenopathy were included in the study (metastases, n = 118; tuberculosis, n = 56; and lymphoma, n = 18). Lymph nodes were evaluated by gray scale sonography for the echogenic hilus and power Doppler sonography for hilar vascularity.

Hilar vascularity was found even though the lymph node did not show an echogenic hilus on gray scale sonography (metastases, 59%; tuberculosis, 66%; and lymphoma, 91%).

Sonologists should be aware that gray scale and Doppler sonography show different aspects of the hilus, and the absence of the hilus on gray scale sonography does not necessarily imply an associated absence of hilar vascularity.
Sonography and color Doppler sonography for monitoring conservatively treated infantile hypertrophic pyloric stenosis.
Authors: Riccabona M , Weitzer C , Lindbichler F , Mayr J
Published: January 2017

To evaluate the role of sonography in infants with hypertrophic pyloric stenosis undergoing conservative medical treatment.

Twenty‐two infants (17 male and 5 female; age range, 1‐12 weeks) were clinically and sonographically considered suitable for conservative treatment and underwent follow‐up during the course of the disease. Sonography was performed under a standardized protocol and included color Doppler sonography.

Fifteen infants (mean age, 9 weeks) needed surgery. They initially had a mean pyloric length of 18 mm, a diameter of 10.5 mm, and a wall thickness of 4 mm, with visible passage of food into the duodenum. These values deteriorated during follow‐up (mean preoperative values: length, 20 mm; diameter, 12 mm; and wall thickness, 4.5 mm); furthermore, passage of food through the pyloric canal ceased. Seven infants (mean age, 3 weeks) were successfully treated conservatively Their initial mean pyloric measurements were slightly smaller (length, 15 mm; diameter, 10 mm; and wall thickness, 3.8 mm) and did not deteriorate during follow‐up. In all of them, sonography showed improvement of passage through the pyloric canal within several days, as shown and documented by color Doppler sonography; morphologic changes persisted longer despite clinical improvement.

Sonography, including color Doppler sonography, is a valuable tool for monitoring infants with hypertrophic pyloric stenosis undergoing conservative treatment; however, initial sonograms cannot predict the further course of the disease.
Small Hepatocellular Carcinoma
Authors: Shirato Kazuhito , Morimoto Manabu , Tomita Naohiko , Kokawa Atsushi , Sugimori Kazuya , Saito Takafumi , Numata Kazushi , Sekihara Hisahiko , Tanaka Katsuaki
Published: January 2017

Objective. To evaluate the therapeutic effectiveness of percutaneous radio frequency ablation of small (≤3‐cm) hepatocellular carcinoma with a LeVeen needle electrode. Methods. Thirty patients (mean age, 65.7 years) with 32 hepatocellular carcinomas (range, 1.2–3.0 cm; mean, 2.3 ± 0.5 cm) underwent percutaneous radio frequency ablation to the center of the hepatocellular carcinoma after expansion of the inner needles. The manufacturer's recommended radio frequency ablation protocol was used. Posttreatment contrast‐enhanced color Doppler sonography, contrast‐enhanced computed tomography, and fine‐needle biopsy were performed to assess the radio frequency ablation–induced coagulated necrosis. Results. Severe intratreatment pain made us abort radio frequency ablation in 2 patients. Complete tumor necrosis was achieved in 1 treatment session with 1 needle electrode insertion in 28 (93.4 %) of 30 nodules (28 patients). We found no residual focus on both color Doppler sonography and computed tomography after any of the sessions. In follow‐ups ranging from 3 to 15 months (mean, 8.4 months), no local recurrence was found in cases with complete tumor ablation. Conclusions. Radio frequency ablation with the LeVeen needle electrode was effective, obtaining complete coagulated necrosis with a safety margin when used for the treatment of small hepatocellular carcinomas.
Contrast‐Enhanced Two‐ and Three‐dimensional Sonography for Evaluation of Intra‐abdominal Hemorrhage
Authors: Liu Ji‐Bin , Merton Daniel A. , Goldberg Barry V. , Rawool Nandkumar M. , Shi William T. , Forsberg Flemming
Published: January 2017

Objective. To determine whether a contrast agent enhances sonographic detection of bleeding sites in the abdomen and whether contrast‐enhanced three‐dimensional sonography provides additional information compared with contrast‐enhanced two‐dimensional sonography. Methods.Bleeding sites were created within the livers (n = 3), spleens (n = 5), and kidneys (n = 3) of 3 dogs. A sonographic contrast agent with vascular and parenchymal enhancement capabilities was administered intravenously at a dose of 0.02 mL/kg. Before and after each contrast agent injection, the bleeding sites were imaged with two‐ and three‐dimensional sonography in gray scale harmonic imaging and color flow modes. Sonographic findings were compared with gross pathologic findings. Results.Non– contrast‐enhanced sonography was not able to show the specific location of the active bleeding in any of the organs evaluated. The contrast agent enhanced the sonographic detection of blood flow in normal vessels and extravasated blood from damaged vessels or organs in all cases. Intrasplenic and intrahepatic hematomas were better identified on delayed imaging sequences because there was marked enhancement of the normal parenchyma, whereas the hematomas remained unenhanced. Reconstructed three‐dimensional sonography showed spatial relationships of the bleeding sites and surrounding structures. Gross pathologic findings were consistent with the contrast‐enhanced sonographic results. Conclusions.Contrast‐enhanced sonography improves the detection and evaluation of abdominal bleeding sites. Contrast‐enhanced three‐dimensional sonography appears to provide additional information when compared with two‐dimensional sonography.
Effects of Oophorectomy and Hormone Replacement Therapy on the Pulsatility Indices of Hepatic and Renal Arteries
Authors: Mihmanli Ismail , Mihmanli Veli , Kantarci Fatih , Albayram Mehmet Sait , Atakir Kadir , Cantasdemir Murat , Akman Canan
Published: January 2017

Objectives

To investigate the flow velocity waveform changes of the hepatic and renal arteries in women with surgical menopause who received hormone replacement therapy versus those who did not.

Methods

Eighty women who had undergone surgical menopause were divided into 2 groups. The first group (n = 38) consisted of patients who did not receive estrogen treatments after surgery; patients in the second group (n = 42) did receive treatments. The hepatic and renal arteries of patients in both groups were examined by duplex Doppler ultrasonography before the commencement of hormone replacement therapy and after 2 years of treatment, and the pulsatility indices were calculated.

Results

No significant differences were detected in the renal and hepatic artery pulsatility indices of patients in the estrogen treatment group (group 2) before and after total abdominal hysterectomy and bilateral salpingo‐oophorectomy (P > .05). No significant differences in preoperative and postoperative hepatic arterial pulsatility indices were detected among patients in group 1 (P > .05). Renal artery pulsatility indices measured before and after total abdominal hysterectomy and bilateral salpingo‐oophorectomy did show a statistically significant difference in group 1 (P < .001). In addition, a statistically significant difference was detected before and after surgery in both groups when pulsatility indices were measured at the second‐year control dose.

Conclusions

Hepatic arterial pulsatility indices are not affected in postmenopausal women, but renal artery pulsatility indices rise to some extent in women not receiving hormone replacement therapy.
Clinical Utility of Sonography in the Diagnosis and Treatment of Placental Abruption
Authors: Glantz Chris , Purnell Leslie
Published: January 2017

Objective.
To determine the sensitivity and specificity of sonography for detection of placental abruption and whether sonographic results correlate with management or outcome.
Methods.
We identified 149 consecutive patients who underwent sonography at 24 weeks' gestational age or later for ruling out abruption or vaginal bleeding. Obstetric and neonatal data were obtained from the hospital perinatal database. Sonographic results, pathologic reports, and hospital charts were reviewed. Sonographic sensitivity, specificity, and positive and negative predictive values were calculated, and regression was used to determine independence of associations.
Results.
Of the 149 patients, 17 (11%) had sonographic evidence of abruption, and 32 (21%) had evidence of abruption at delivery. As the scan‐to‐delivery interval decreased, the positive predictive value increased and the negative predictive value decreased. Of 55 patients who gave birth within 14 days of sonography, 8 (15%) had scans consistent with abruption, and 29 (53%) had abruption at delivery; the sensitivity, specificity, and positive and negative predictive values of sonography were 24%, 96%, 88%, and 53%, respectively. Positive sonographic findings were univariately associated with 2‐ to 3‐fold greater subsequent tocolysis, betamethasone use, duration of hospitalization, follow‐up sonograms, preterm delivery, low birth weight, and neonatal intensive care unit admission. All but low birth weight and neonatal intensive care unit admission remained independently significant after adjustment for gestational age (P < .05).
Conclusions.
Sonography is not sensitive for detection of placental abruption, but a positive finding is associated with more aggressive management and worse neonatal outcome.
Application of Lung Volume Measurement by Three‐dimensional Ultrasonography for Clinical Assessment of Fetal Lung Development
Authors: Osada Hisao , Iitsuka Yoshinori , Masuda Kentaro , Sakamoto Rie , Kaku Kenshi , Seki Katsuyoshi , Sekiya Souei
Published: January 2017

Objective.
To prepare nomograms for normal fetal lung volume using three‐dimensional ultrasonography and to evaluate the possibility of clinical applications of this procedure.
Methods.
One hundred twenty‐five healthy neonates with birth weights within ±1.5 SD (group A), 9 neonates with intrauterine growth restriction (birth weight less than –1.5 SD) but no severe respiratory disturbance at birth (group B), and 10 neonates with severe respiratory disturbance but no intrauterine growth restriction (group C) were studied. With the use of a three‐dimensional ultrasonographic device, continuous B‐mode images centering on the fetal thorax were acquired as volume data. Analytical software was used to repeatedly trace the contours of bilateral fetal lungs on transverse slices to calculate the lung volume.
Results.
In group A, the total volume of normal fetal lungs can be expressed by the second‐degree regression equation: 0.08 × (gestational week – 30.1)2 + 3.28 × gestational week – 67.2 (R = 0.909; P < .001). The lung volumes of groups B and C were below the 25th and 2.5th percentiles, respectively, of this regression curve. For the same case, the lung volume increased with gestational week in group B but remained unchanged or even decreased in group C. The total volume of normal fetal lungs can also be expressed by the linear regression equation: 0.02 × estimated fetal weight + 0.29 (R = 0.902). The lung volumes of groups B and C were distributed below and above, respectively, the 2.5th percentile of the regression line.
Conclusions.
This analytical method may be applied to evaluate lung development.
Sirenomelia Sequence
Authors: Monteagudo Ana , Mayberry Patricia , Rebarber Andrei , Paidas Michael , Timor-Tritsch Ilan E.
Published: January 2017

Objective. To describe the sonographic findings of sirenomelia during the first trimester on both two‐dimensional sonography with color Doppler imaging and three‐dimensional sonography. Methods. Two cases of sirenomelia in primiparous patients with histories of infertility are described. The diagnosis was made on the basis of two‐dimensional sonography, and three‐dimensional sonography was used to further characterize the findings. Results. Both fetuses had size‐date discrepancies, increased nuchal translucency, large intra‐abdominal vessels, and 2‐vessel umbilical cords. Both pregnancies were terminated by dilation and curettage after the patients viewed the three‐dimensional pictures of the fetuses. Conclusions. During the first trimester of pregnancy, rare and lethal anomalies can be diagnosed with a high degree of confidence if a thorough, age‐dependant anatomic survey of the fetus is performed.
Early Transvaginal Fetal Orbital Measurements
Authors: Rosati Paolo , Guariglia Lorenzo
Published: January 2017

Objective. To assess whether simple biometric parameters such as orbital diameters measured in early pregnancy by transvaginal sonography can be used as screening tools for aneuploid fetuses. Methods. The study group consisted of 2771 fetuses of pregnant women referred to our center for genetic amniocentesis and examined by transvaginal sonography between 11 and 16 weeks' gestation. Karyotypes were normal in 2717 fetuses, and 54 fetuses were aneuploid. Individual values for the aneuploid fetuses were compared with normative data obtained previously for single orbital measurements (interocular and binocular distance) versus gestational age and head measurements. Results. The orbital diameters were within the normal range in the cases with trisomy 21, gonosomal aberrations, trisomy 18, and unbalanced anomalies. Three of the 4 fetuses with trisomy 13 had hypotelorism, confirmed later at autopsy in 2 cases and after delivery in 1 case. Conclusions. With regard to the small number of cases, our data suggest that ocular biometric parameters may be useful sonographic markers for trisomy 13, even if further evaluation is needed.
Sonography of Fetal Choroid Plexus Cysts
Authors: Turner Shannon R. , Samei Ehsan , Hertzberg Barbara S. , DeLong David M. , Vargas-Voracek Rene , Singer Amy , Maynor Carolyn H. , Kliewer Mark A.
Published: January 2017

Objective. To establish diagnostic criteria for the diagnosis of fetal choroid plexus cysts across gestation. Methods. Prenatal sonographic images of 166 fetuses without choroid plexus cysts were prospectively collected from 13 weeks to term. Texture characteristics of the choroid plexus regions were analyzed to quantify changes as a function of gestational age. A set of 20 fetal sonographic images with choroid plexus cysts were used to create cyst prototypes (1.5–2.5 mm), which were randomly embedded into normal choroid plexus images from varying gestational ages. A test set of 544 images was created, which included 408 images with choroid plexus cysts and 136 images without choroid plexus cysts. Four observers following a blinded study design evaluated the presence of choroid plexus cysts in the images. The influence of cyst size and gestational age on the detection of cysts was measured with receiver operating characteristic analysis and analysis of variance. Observer agreement was characterized by agreement κ statistics. Results. Texture analysis indicated greater echo texture heterogeneity at earlier gestational ages. The receiver operating characteristic analysis showed a corresponding decrease in diagnostic accuracy for cyst detection at earlier gestational ages. The cyst detection threshold (area under the receiver operating characteristic curve, 0.8) was 2.4 mm (SE, 0.2 mm) for 13 to 21 weeks' gestation and decreased to 1.9 mm (SE, 0.17 mm) for 22 to 38 weeks' gestation. Average interobserver and intraobserver κ statistics were 0.37 and 0.53, respectively. Conclusions. Because of the changing echo texture of the choroid plexus through gestation, choroid plexus cysts must be at least 2.5 mm in diameter for confident diagnosis before 22 weeks' gestation and at least 2 mm after 22 weeks.
Usefulness of Three‐dimensional Sonography in Procedures of Ablation for Liver Cancers
Authors: Xu Hui-Xiong , Yin Xiao-Yu , Lu Ming-De , Xie Xiao-Yan , Xu Zuo-Feng , Liu Guang-Jian
Published: January 2017

Objective. To investigate the usefulness of three‐dimensional sonography in procedures of ablation for liver cancers. Methods. Two‐ and three‐dimensional sonography were used in guiding 18 chemical ablation procedures (7 with boiling carboplatin ablation and 11 with ethanol ablation) and 21 radio frequency ablation procedures for treatment of liver cancers. The applicator conspicuity depicted by the 2 imaging modalities, the confidence level of the operator in determining the position relationship between the applicator and the tumor using the 2 imaging modalities, and the alteration of ablation procedures were evaluated. Results. Three‐dimensional sonography was better than two‐dimensional sonography in delineation of multitined, expandable electrode tips in radio frequency ablation procedures, whereas the 2 modalities were equal in depicting percutaneous transhepatic cholangiography needle tips in chemical ablation procedures. Three‐dimensional sonography significantly enhanced the confidence level in defining the spatial relationship between applicator and tumor in comparison with two‐dimensional sonography (P < .01). Suboptimal applicator placement was detected in 6 (15%) of 39 ablation procedures on three‐dimensional sonography: 3 chemical ablation procedures and 3 radio frequency ablation procedures. Applicator adjustment was required in 3 chemical ablation procedures. In 15 (38%) of 39 procedures, three‐dimensional sonography allowed better visualization of the position relationship between the applicator and adjacent critical structures. Conclusions. Three‐dimensional sonography was useful in delineation of expandable radio frequency electrodes, improvement of operator confidence level, determination of applicator placement, and visualization of the position relationship between the applicator and adjacent critical structures during procedures of liver cancer ablation under image guidance.
The Neonatal Diaphragmatic Crura Are Hypertrophied
Authors: Moes Maria J. , Filly Roy A.
Published: January 2017

Objective. To sonographically show that the neonatal crura are markedly hypertrophied. Methods. Fifty patients in each of 2 groups, ages 0 to 2 months and 18 to 40 years, were randomly chosen from patients who recently underwent abdominal sonography. A single longitudinal plane of a section was used to measure both the anteroposterior diameter of the aorta and the diaphragmatic crus. The ratios of these were compared in the 2 groups. Results. A significant difference was shown between the sizes of the diaphragmatic crura of the neonate and the adult when the aorta was used as an internal standard of size variability. The mean ratio of the aorta to the right crus in neonates was 2.95, and in young adults it was 1.04 (P < .0001). Conclusions. The neonatal crura are hypertrophied at birth, likely to allow the markedly atelectatic and fluid‐filled lungs to fully expand in relatively few breaths.
Sonographic Evaluation of Bladder Volume in Diabetic Children and Adolescents Compared With Nondiabetic Subjects
Authors: Castro Juni Carvalho , Camargos Aroldo Fernando , Goulart Eugênio Andrade , Junqueira Heloisa Santos
Published: January 2017

Objectives. An increase in volume and evidence of postvoiding residuals are both encountered in the bladder of diabetic patients and can lead to urinary tract infections and impair renal function. Our objective was to compare the bladder volume of diabetic children and adolescents with that of nondiabetic subjects. Methods. We investigated 247 diabetic patients and 228 control subjects between the ages 3 and 21 years. The sonographic examination was performed with a full bladder, after spontaneous voiding, and after forced voiding. Three dimensions were determined: longitudinal, transverse, and anteroposterior transverse. The data were analyzed by the χ2 test, analysis of variance, the Kruskal‐Wallis test, and multivariate regression. Results. The 2 groups were equivalent for age (P = .56) and sex (P = .82). The median full bladder volume was larger in the diabetic group (268 mL) than in the control group (220 mL; P = .0004). Postvoiding residual volume after spontaneous and forced voiding was significantly higher in the diabetic group (P < .0001). Multivariate analysis showed that being diabetic (P = .021), older than 9 years (P = .000), and female (P = .036) all influenced full bladder volume. Conclusions. Sonographic evaluation showed incipient bladder dysfunction in diabetic patients. The multivariate analysis showed that the increase in bladder volume had a association with age (>9 years), female sex, and mean glycosylated hemoglobin value. Thus, bladder volume evaluation by sonography should be incorporated in the routine assessment of patients with type 1 diabetes.
Sonographic Evaluation of the Lower Uterine Segment in Patients With Previous Cesarean Delivery
Authors: Cheung Vincent Y. T. , Constantinescu Oana C. , Ahluwalia Birinder S.
Published: January 2017

Objective. To evaluate the appearance of the lower uterine segment (LUS) in pregnant women with previous cesarean delivery and to compare the LUS thickness with that in women with unscarred uteri. Methods. In a prospective study, sonographic examination was performed on 53 pregnant women with previous cesarean delivery (cesarean group), 40 nulliparas (nullip‐control), and 40 women who had 1 or more childbirths with unscarred uteri (multip‐control) between 36 and 38 weeks' gestation to assess the appearance and compare the thickness of the LUS. In the cesarean group, the sonographic findings were correlated with the delivery outcome and the intraoperative LUS appearance. Results. In the cesarean group, 44 patients (83.0%) had a normal‐appearing LUS indistinguishable from that of control groups; 2 patients (3.8%) had an LUS defect suggestive of dehiscence; and 7 patients (13.2%) had thickened areas of increased echogenicity with or without myometrial thinning. Although the cesarean group had a thinner LUS (1.9 ± 1.4 mm) when compared with both the nullip‐control group (2.3 ± 1.1 mm; P > .05) and the multip‐control group (3.4 ± 2.2 mm; P < .001), only the latter difference achieved statistical significance. One of the 2 patients who had a sonographically suspected LUS defect had confirmed uterine dehiscence during surgery. An intraoperatively diagnosed paper‐thin LUS, when compared with an LUS of normal thickness, had significantly smaller sonographic LUS measurements (1.1 ± 0.6 versus 2.0 ± 0.8 mm, respectively; P = .004). Conclusions. Prior cesarean delivery is associated with a sonographically thinner LUS when compared with those with prior vaginal delivery. Prenatal sonographic examination is potentially capable of diagnosing a uterine defect and determining the degree of LUS thinning in patients with previous cesarean delivery.
Display of 3‐Dimensional Ultrasonographic Images for Interventional Procedures
Authors: Rose Steven C. , Nelson Thomas R. , Deutsch Reena
Published: January 2017

Objective. The goal of this project was to assess the display of 3‐dimensional ultrasonographic images as used for interventional procedures, particularly the conspicuity of various targets and interventional devices, comparing volume‐rendered (VR) versus multiplanar reformatted (MPR) display approaches. Methods. A series of ultrasonographic phantoms were made from a petroleum gel with cornstarch used to vary the echo texture. Three‐dimensional ultrasonographic target and device conspicuity were judged with a 5‐point visual rating scale. The MPR image was considered the reference standard. Volume‐rendered image conspicuity was judged for combinations of 7 different postprocessing display parameters and compared with MPR images. Results. Definite visualization of the embedded objects occurred in 92% of MPR and 13% of VR test situations (P < .0001). Volume‐rendered display was associated with a mean conspicuity degradation of 2.6 on a scale of 0 through 4 (P < .0001) compared with MPR methods. The proportion of satisfactory VR images was greatest in test situations with a large degree of difference of echogenicity between the background medium and the embedded object. The transparent‐type postprocessing rendering modes were superior to the surface‐type rendering modes (P < .0001). Conclusions. Current 3‐dimensional ultrasonographic MPR imaging display in a solid organ environment provides better visualization performance of target and needle conspicuity than VR image display when there are not large differences in the signal levels of targeted structures and devices compared with surrounding tissues. The difficulty in viewing both target and device with VR imaging may restrict its ability to guide interventional procedures in some clinical situations.
Syndromes With Focal Femoral Deficiency
Authors: Filly Anthony L. , Robnett-Filly Barbara , Filly Roy A.
Published: January 2017

Objective. To further characterize the prenatal diagnosis of proximal focal femoral deficiency and to contrast this entity with a variety of other “syndromes” in which the femur may be deficient. Methods. We report 2 cases of proximal focal femoral deficiency and a case of femoral‐facial syndrome. Results. A series of 3 women whose fetuses had deficiency of 1 or both femurs were carefully analyzed for severity and for similarities and differences with other syndromes in which the femur may be deficient, as well as syndromes showing global skeletal abnormalities. Conclusions. Prenatal sonography is a valuable tool both for detecting cases of proximal focal femoral deficiency, separating them from syndromes showing global skeletal abnormalities, and for stratifying them according to severity.
Value of Transducer Positions in the Measurement of Finger Flexor Tendon Thickness by Sonography
Authors: Klauser Andrea , Stadlbauer Karl-Heinz , Frauscher Ferdinand , Herold Manfred , Klima Guenther , Schirmer Michael , zur Nedden Dieter
Published: January 2017

Objective. To assess the value of 2 transducer positions for measurement of finger flexor tendon thickness by sonography. Methods. Flexor tendon thickness of the third finger was measured sonographically by 2 independent investigators in 20 healthy volunteers (n = 40 fingers) and in 4 cadaveric specimens (n = 4 fingers). Flexor tendon thickness was measured at histologic examination in the cadaveric specimens. We defined the area of the A1 annular pulley as position I and the area of the A2 annular pulley as position II. Sonographic measurements were performed in transverse (dorsovolar and radioulnar) and longitudinal planes. Interobserver and intraobserver variabilities were evaluated by each investigator performing 3 measurements at each position. Results. In position I, volunteers had flexor tendon thickness of 2.7 to 4.0 mm (mean ± SD, 3.28 ± 0.26 mm) longitudinally; transversally the thickness was 2.5 to 4.0 mm (mean, 3.34 ± 0.29 mm) dorsovolar and 5.5 to 8.9 mm (mean, 7.34 ± 0.71) radioulnar in position I. Position II revealed thickness of 3.2 to 4.2 mm (mean, 3.6 ± 0.23 mm) longitudinally; transversally the thickness was 2.7 to 4.1 mm (mean, 3.4 ± 0.27) dorsovolar and 4.3 to 6.8 mm (mean, 5.27 ± 0.65) radioulnar. Interobserver and intraobserver variability for position I was better than for position II (P < .01 versus P < .05). Sonographic findings correlated excellently with histologic findings (r2 = 0.94). Conclusions. Standardized transducer positions for sonographic measurements of finger flexor tendon thickness showed good interobserver and intraobserver variability. Position I was found to be more reliable than position II.
Are Intracardiac Echogenic Foci Markers of Congenital Heart Disease in the Fetus With Chromosomal Abnormalities?
Authors: Wax Joseph R. , Cartin Angelina , Pinette Michael G. , Blackstone Jacquelyn
Published: January 2017

Objective. To determine whether intracardiac echogenic foci (ICEF) are markers of congenital heart disease (CHD) in fetuses with chromosomal abnormalities. Methods. We identified all fetuses with chromosomal abnormalities undergoing targeted sonography at 17 weeks' to 21 weeks 6 days' gestation in a single perinatal center from January 1, 1994, to June 30, 2003. Offspring with and without CHD were compared for the presence or absence of ICEF. Results. Two (8%) of 25 fetuses with ICEF had CHD versus 38 (33.3%) of 114 fetuses without ICEF (P = .006). Similarly, 1 (5.5%) of 18 fetuses with trisomy 21 and ICEF had CHD compared with 16 (37.2%) of 43 fetuses with trisomy 21 without ICEF (P = .009). Conclusions. Intracardiac echogenic foci in fetuses with chromosomal abnormalities, including those with trisomy 21, are not useful markers for CHD.
In Vitro Sonographic Evaluation of Sentinel Lymph Nodes for Detecting Metastasis in Breast Cancer
Authors: Shin Jung Hee , Choi Hye-Young , Moon Byung-In , Sung Sun Hee
Published: January 2017

Objective. To assess the accuracy and the effectiveness of in vitro sonography of sentinel lymph nodes (LNs) for differentiating benignity from metastasis during breast cancer operations. Methods. Two hundred twenty‐two fresh sentinel LNs obtained during surgery were examined by in vitro sonography to detect metastasis in 47 patients with breast cancer. Sonographic criteria of malignant LNs were defined as uneven cortical thickness of greater than 3 mm in depth, round hypoechoic nodes, and the absence of an echogenic hilum. Histopathologic results were correlated with those obtained by the sonographic study. Statistical analysis was performed with a κ value to evaluate the accuracy of in vitro sonography of sentinel LNs. Results. On sonographic examination, 190 (85.6%) of the 222 sentinel LNs were benign. Among the 190 benign LNs, in only 8 (4.2%) was the presence of metastasis pathologically proved, which indicated focal micrometastasis in the cortex. Thirty‐two sentinel LNs were sonographically positive. In 19 (59.4%) of the 32 sentinel LNs, metastasis was pathologically confirmed. The remaining 13 sonographically positive LNs (40.6%) did not reveal any histologically malignant cells. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 70.4%, 93.3%, 59.4%, 95.7%, and 90.5%, respectively. Conclusions. The in vitro sonographic evaluation of the sentinel LNs during breast cancer operations may be a reliable method of predicting nodal metastasis and may be helpful in deciding the extent of LN dissection.
Sonographic and Color Doppler Findings in Aortoarteritis (Takayasu Arteritis)
Authors: Chaubal Nitin , Dighe Manjiri , Shah Mohit
Published: January 2017

Objective. To review the sonographic appearance of aortoarteritis. 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 aortoarteritis. We can accurately diagnose, grade, and follow the progress of the disease. The response to treatment can also be assessed. This presentation reviews the sonographic findings in aortoarteritis. Conclusions. Color‐coded Doppler sonography can facilitate an accurate diagnosis of Takayasu arteritis by the characteristic appearance. Associated organ involvement can also be assessed.
Evaluation of Differences Between Observers and Automatic‐Manual Measurements in Calculation of Doppler Parameters
Authors: Unal Birsen , Bagcier Sebnem , Simsir Ilknur , Bilgili Yasemin , Kara Simay
Published: January 2017

Objective. We aimed to search for differences between observers and automatic and manual measurements in calculations of Doppler parameters. Methods. The middle cerebral artery (MCA), central retinal artery, ophthalmic artery (OA), common carotid artery (CCA), vertebral artery (VA), popliteal artery (PA), interlobar renal artery (IRA), and arcuate renal artery (ARA) were evaluated in 20 healthy subjects bilaterally. Peak systolic velocity (PSV), end‐diastolic velocity (EDV), time‐averaged maximum velocity (TAMAX), resistive index (RI), and pulsatility index (PI) were measured from the same spectrum manually by 3 observers and automatically. Results of 4 measurements were compared by analysis of variance and Pearson tests. Results. The comparison of the 4 measurements revealed significant differences for most parameters except TAMAX of the OA, VA, and ARA and PSV, EDV, and PI of the PA. An automatic calculator yielded lower PSV, RI, and PI values (except the MCA and PA) and higher EDV values compared with manual measurements. The magnitudes of difference were in the range of 1% to 16% for velocities and 4% to 14% for RI and PI. The means of difference were 3.185 cm/s for PSV of the CCA and 0.054 for RI of the IRA. Correlation was high for PSV, EDV, and TAMAX in all arteries (except TAMAX of PA) and relatively low for PI and RI in most of the arteries. Conclusions. Although our study was performed on healthy subjects, our results showed that, in most cases, readers and the automatic approach disagreed on evaluation of Doppler parameters. This may be important in preventing false diagnoses in cases with Doppler values close to upper limits and may necessitate establishment of new limits for each method.
Sonographic Differentiation of Benign and Malignant Cystic Lesions of the Breast
Authors: Chang Yun-Woo , Kwon Kwi Hyang , Goo Dong Erk , Choi Deuk Lin , Lee Hye Kyung , Yang Seung Boo
Published: January 2017

Objectives

The purpose of this study was to subdivide the types of sonographic findings of benign versus malignant cystic masses and to determine appropriate patient care according to the sonographic findings with pathologic correlation.

Methods

The sonographic findings of 175 symptomatic cystic breast lesions were pathologically proven and reviewed retrospectively. Cystic lesions were classified as 6 types: simple cysts (type I), clustered cysts (type II), cysts with thin septa (type III), complicated cysts (type IV), cystic masses with a thick wall/septa or nodules (type V), and complex solid and cystic masses (type VI). Sonographic findings were compared with the pathologic results and were evaluated according to the incidence of benign and malignant masses.

Results

All 23 type I, 15 type II, 22 type III, and 35 type IV cases were pathologically proven to be benign. Seven (25.9%) of the 27 type V cases and 33 (62.3%) of the 53 type VI cases were proven to be malignant. We analyzed the shapes and margins of 80 cases of cystic masses with a solid component (types V and VI); 16 (44%) of 36 sonographically circumscribed masses were malignant.

Conclusions

Because the sonographically detected simple cysts (type I), clustered cysts (type II), and cysts with thin septa (type III) were all benign, annual routine follow‐up appears reasonable. Symptomatic complicated cysts (type IV) should be aspirated and appropriately treated according to clinical symptoms. Cystic masses with a solid component (types V and VI) should be examined by biopsy with pathologic confirmation.
Sonographic Evaluation of the Endometrium in Patients With a History or an Appearance of Polycystic Ovarian Syndrome
Authors: Peri Nagamani , Levine Deborah
Published: January 2017

Objectives

The purpose of this study was to assess the incidence and significance of a thick, cystic‐appearing endometrium in association with a history or an ovarian appearance of polycystic ovarian syndrome.

Methods

An Institutional Review Board–approved, retrospective medical record review of sonographic studies from January 1, 1998, to December 31, 2005, found 245 patients with clinical features, a characteristic sonographic appearance of the ovaries, hormonal abnormalities, or a history of polycystic ovarian syndrome. The sonographic thickness and appearance of the endometrium (homogeneous or heterogeneous) and histologic findings on biopsy were obtained.

Results

Two hundred twenty‐seven patients had a homogeneous endometrium in the range of 1 to 17 mm (mean ± SD, 6.4 ± 3.1 mm); 18 patients had a heterogeneous endometrium in the range of 4 to 23 mm (mean, 13.2 ± 5.6 mm). Of the 18 patients with a heterogeneous endometrium, 9 also had a sonographic finding of tiny cystic foci within the endometrium. Of these, 5 had endometrial biopsy, resulting in 2 cases of a proliferative endometrium and 1 case each of simple hyperplasia, hyperplasia with atypia, and scant tissue. No cases of hyperplasia were present in the patients with a homogeneous endometrium.

Conclusions

A heterogeneous cystic endometrium is associated with the prolonged proliferative phase from chronic anovulation as well as endometrial hyperplasia.
The Cisterna Magna Septa
Authors: Robinson Ashley J. , Goldstein Ruth
Published: January 2017

Objectives

The purpose of this study was to show the normal sonographic embryologic anatomy of the cisterna magna septa, fourth ventricle, and cerebellar vallecula at various stages of development and our experience with their variable appearance in multiple planes and to discuss the probable relationship between the cisterna magna septa, Dandy‐Walker continuum, mega cisterna magna, and persistent Blake's pouch.

Methods

Retrospective and prospective selection of examples of cisterna magna septa was performed over approximately a 12‐month period. Standard and nonstandard imaging planes were adopted as necessary.

Results

The septa are typically seen inferoposterior to the cerebellar vermis, usually straight and parallel, arising at the cerebellovermian angle and coursing posteriorly to the occipital bone. The cisterna magna septa become contiguous with the roof of the fourth ventricle inferior to the cerebellar vermis. The cerebrospinal fluid space enclosed between the cisterna magna septa is in direct contiguity with the fourth ventricle via the vallecula and is always completely anechoic because it develops intra‐ and not extra‐axially.

Conclusions

We propose that the cisterna magna septa represent the walls of Blake's pouch, a phylogenetic vestigial structure observed during ontogeny. Additionally, our observations support current opinion that a persistent Blake's pouch and mega cisterna magna represent (less severe) abnormalities within the Dandy‐Walker continuum. The cisterna magna septa therefore are a marker of normal development of the roof of the rhombencephalon. Deviation from their normal appearances should prompt a closer assessment for associated abnormalities of the cerebellum, vermis, and brain stem by additional imaging in orthogonal planes with either sonography or magnetic resonance imaging.
High Fetal Splenic Artery Peak Velocity in Fetuses With Hemoglobin Bart Disease
Authors: Tongsong Theera , Tongprasert Fuanglada , Srisupundit Kasemsri , Luewan Suchaya
Published: January 2017

Objective. The purpose of this study was to evaluate the role of the splenic artery (SPA) peak systolic velocity (PSV) in identifying fetuses with hemoglobin (Hb) Bart disease among pregnancies at risk for the disease. Methods. Pregnancies at risk for fetal Hb Bart disease scheduled for cordocentesis at 18 to 25 weeks' gestation at Maharaj Nakorn Chiang Mai Hospital were recruited into the study. The SPA PSV was measured before cordocentesis, and the final fetal diagnosis of Hb Bart disease was based on fetal Hb typing using high‐performance liquid chromatography. Results. Seventy‐six singleton pregnancies at risk for fetal Hb Bart disease were sonographically evaluated for the SPA PSV and underwent cordocentesis for fetal blood analysis. Among the 76 recruited pregnancies, 17 fetuses with Hb Bart disease were finally diagnosed by fetal blood analysis with high‐performance liquid chromatography, and the remainder had no abnormalities or had the α‐thalassemia 1 trait and were defined as unaffected fetuses. The mean SPA PSVs ± SD for the unaffected and affected fetuses were significantly different: 21.17 ± 3.7 cm/s (range, 13.8–29.9 cm/s) and 26.12 ± 3.6 cm/s (range, 20.4–31.5 cm/s) respectively. The SPA PSV of the affected fetuses was higher than that of the unaffected ones (Wilcoxon signed rank test, P < .001). Conclusions. Splenic artery PSV assessment at mid pregnancy may have a potential role in identifying fetuses with Hb Bart disease. Further studies to evaluate the effectiveness of the SPA PSV in differentiating affected from unaffected fetuses among pregnancies at risk are desirable.