Normal Sonogram Research Articles

Sylvian fossa sonographic measurements in 18 to 23 weeks fetuses with and without cerebral malformations

Abnormal sulcation of the brain is frequently associated with severe malformations, but the prenatal diagnosis is challenging, especially in early pregnancy. Our study aimed to investigate the value of Sylvian fossa sonographic biometry in the diagnosis of cerebral malformation in the second trimester of gestation. We prospectively established the normal values of the Sylvian fossa depth in a cohort of nonconsecutive patients, with singleton pregnancies and normal fetuses between 18+0 and 23+0 weeks' gestation. For each patient, a coronal view of the fetal brain, with a clear visualization of the anterior complex and the Sylvian fissure, was acquired by 1 sonologist, who also measured the depth of the fossa. Reproducibility for each parameter was assessed by a second sonologist using stored images. We also retrospectively acquired the same measurements in second trimester fetuses with central nervous system anomalies. In 103 fetuses with a normal sonogram, the mean depth of the Sylvian fossa was 3.9±0.8 mm Interobserver reproducibility analysis demonstrated good results. Notably, 11 of 31 fetuses with cerebral malformations had a Sylvian fossa depth of <-2 z-scores, and these were found to have malformations of cortical development, lissencephaly in particular, or microcephaly. Sonographic measurement of the Sylvian fossa during second trimester is feasible and reproducible. A shallow Sylvian fossa is associated with malformations of cortical development, microcephaly, or both.

New Diagnosis of Endometriosis is Less Common in Women over Age Forty Presenting with Pelvic Pain

To investigate the incidence of new diagnosis of endometriosis in women at or above the age of 40 who present with previously undiagnosed pelvic pain and no previous surgical or sonographic evidence of endometriosis to a tertiary care clinic specializing in pelvic pain and endometriosis. Retrospective cohort study (on the basis of the Strengthening the Reporting of Observational Studies in Epidemiology guidelines) of the incidence of laparoscopically proven endometriosis in women presenting with previously undiagnosed pelvic pain on the basis of age category (age <40 years or ≥40 years). Adjusted odds ratios and 95% confidence intervals were calculated using a multivariable logistic regression model. Pelvic pain focused gynecology clinic at a tertiary care hospital. Premenopausal women between 18 to 51 years who presented with pelvic pain and were booked for laparoscopy for the diagnosis and the possible treatment of endometriosis between the years 2012 to 2016. Patients who had had previous laparoscopy and those who had sonographic evidence of endometriosis were excluded from the study. Laparoscopic visual evaluation and treatment was carried out in all patients by specialized gynecologists focusing on endometriosis surgery. Presence or absence of visualized endometriosis at laparoscopy. We evaluated 174 women who met the inclusion criteria. Endometriosis was diagnosed in 35% (19/55) of patients aged 40 years and above and in 67% (80/119) of patients below the age of 40 years. Odds ratio adjusted for body mass index and parity was 2.38 (1.09-5.00; p = .03). When assessed as a continuous curvilinear variable without division to age categories, age was significant even in the more comprehensive model including more potential confounders. Secondary outcome analysis demonstrated that deep infiltrating endometriosis was diagnosed in 5% (3/55) of the women at or above 40 years and in 8% (10/119) of women below 40 years (p = .76). In addition, a curvilinear relationship was found with age, and there was also a lower incidence of endometriosis of 50% (19/38) in the youngest cohort of women aged 18 to 25 years. The likelihood of a new diagnosis of endometriosis in women with pelvic pain, no previous laparoscopy and a normal sonogram in our referral center was lower in women aged 40 and above. Careful counseling and consideration of the risks and yield of surgery is recommended before performing a laparoscopy for investigation of pelvic pain in this age group.

Abnormal sonographic appearance of posterior brain at 11-14 weeks and fetal outcome.

The aim of this retrospective study was to describe the sonographic appearance of the posterior brain anatomy in normal fetuses at 11 to 14 weeks of pregnancy and to determine the fetal outcome when one of the posterior brain anatomical space is not recognized. Two groups of patients were included in the study: a control group of consecutive 311 healthy fetuses with a normal sonogram and a study group of 21 fetuses with absence of one of the three posterior brain spaces. In each fetus, images of the mid-sagittal view of the fetal face and brain at 11 to 14 weeks of gestation were obtained. In all fetuses with absence of one of the three posterior brain spaces, a severe anomaly, including open spina bifida, cephalocele, Dandy-Walker complex, and chromosomal aberrations, was associated. Our study indicates that the sonographic finding characterized by the absence of one of the three posterior brain spaces seems to facilitate not only the detection of open spina bifida, as previously reported, but also of other neural tube defects, such as cephalocele, and is an important risk factor for cystic posterior brain anomalies, and/or chromosomal abnormalities. Thus it seems a poor prognostic finding for major fetal abnormalities.

Advanced secondary abdominal pregnancy: A complication of induced abortion

Introduction: Secondary abdominal pregnancies usually develop as a result of a tubal abortion, tubal rupture or uterine rupture with intraabdominal implantation. Case Report: We report a 40-year-old patient gravida IV, para III suffering from abdominal pain. She was in the 29th week of gestation according to a 14th-week normal sonogram. She had unsuccessfully attempted to induce abortion with the assistance of a home midwife in the 14th week. This caused severe abdominal pain, but she chose not to be hospitalized because of fear of prosecution. Ultrasound demonstrated that the fetus was out of the uterus and revealed a heterogeneous mass in the left lower quadrant. Laparotomy revealed an area of thin fibrotic scar behind the uterus with normal tubes and ovaries. The fetus in the amniotic sac was surrounded by intestinal loops. The placenta, implanted behind the left broad ligament at the edge of the scar area was removed with a brisk bleeding, which was controlled. No postoperative complications were observed. Conclusion: Presence of little free fluid and a uterine scar with normal fallopian tubes against a history of an unsuccessful induced abortion and severe illness are highly suggestive of a uterine rupture resulting in secondary implantation on the broad ligament. This is probably the first case that shows an abdominal pregnancy can result from unsuccessful induced abortion. In the countries where abortion is not permitted, patients with low socioeconomic status are prone to the dangerous consequences of illegal attempts to induce abortion. Close observation and special follow-up care are necessary in such cases.

Value of Sonography Combined With Clinical Assessment to Evaluate Muscle Injury Severity in Athletes

Predicting when an athlete can return to sport after muscle injury is a major concern. To determine whether combining objective clinical and ultrasound findings at presentation accurately predicted time to sport resumption in athletes with muscle injuries. Cohort study. Sports medicine clinic. A total of 93 consecutive patients, 87 male and 6 female, were seen over a 1-year period for sudden-onset muscle pain while engaging in a sporting activity within the last 5 days and inability to continue the training session or game. Standardized physical examination and sonogram. Statistical associations between clinical and sonographic features at presentation and time to sport resumption (<40 days or ≥ 40 days) were evaluated using multivariate models. Correlations between time to sport resumption predicted by a sports medicine specialist and actual time to sport resumption were evaluated using the Spearman rank correlation coefficient. The 93 patients had 95 injuries, caused by muscle contraction in 86 cases and impact in 9 cases. Only 7 injuries had normal sonogram findings. Late sport resumption was associated with 4 clinical criteria (bruising, tenderness to palpation, range-of-motion limitation compared with the other limb, and increased pain with isometric contraction during passive limb straightening) and 4 sonographic criteria (disorganized fibrous tissue, intramuscular hematoma, intermuscular hematoma, and power Doppler signal). The Spearman rank correlation coefficient between predicted and actual times was 0.669 (P < .0001) for mild exercise resumption and 0.804 (P < .0001) for full sport resumption. A combination of physical and sonographic data collected during the acute phase of sport-related muscle injury was effective in predicting time to sport resumption.

A clinico-etiological study of cervical lymphadenopathy in children with special reference to ultrasonography

Objectives: The aim of this study was to evaluate the etiological factors for cervical lymphadenopathy in children and the role of ultrasonography (USG) in diagnosis. Methods: A total of 200 children of significant cervical lymphadenopathy between 3 months to18 years were pro-spectively included in a tertiary referral hospital. All subjects were evaluated by history, examination, hemogram, chest X-ray, mantoux test, fine needle aspiration cytology (FNAC), acid-fast bacillus (AFB) staining, ultrasonography (USG) of lymph node. Open lymph node biopsy, bone marrow examination, serological tests were optional. Results: A total of 84 subjects (42%) identified as benign reactive, 80 (40%) as tuberculosis, 20 (10%) chronic lym-phadenitis, 12 (6%) non-Hodgkin and 4 (2%) Hodgkin’s lymphoma by USG. However, on USG among 84 subjects of benign reactive lymphadenopathy, 60 (71.4%) were having features of benign reactive lymph node, remaining 24 (28.6%) have normal sonogram; out of 80 subjects of tuberculosis lymphadenitis 66 (82.5%) have features of tuber-culosis and rest14 (17.5%) have nonspecific ultrasound changes; among 16 subjects of lymphoma, 10 (62.5%) have features of malignancy, rest 6 (37.5%) have nonspecific changes in USG examination. Male to Female ratio was1.68:1. Cervical lymphadenopathy was most prevalent in 6 to 10 years age group. Conclusion: Reactive lymphadenitis due to underlying acute bacterial or viral infection was the commonest cause of significant cervical lymphadenopathy in children and ultrasonography is a good noninvasive diagnostic modality, but requires other tests for definitive diagnosis.

Normal obstetric ultrasound reduces the risk of Down syndrome in fetuses of older mothers

The objective of this study is to determine whether a normal fetal morphology ultrasound scan in women older than 35 years reduces the risk of aneuploidy. We reviewed the results of amniocentesis and second trimester sonogram in all women older than 35 years from 1991 to 1995. None had prior screening. We excluded fetuses with structural anomalies. We determined the sensitivity and specificity of minor markers in detecting Down syndrome and also determined the reduction in risk of a normal sonogram. Among the 2060 women older than 35 years giving birth during the study period, 16 (0.78%) delivered an infant with Down syndrome. Of the 16 fetuses, two had no prenatal testing or ultrasound, two had invasive testing but no second trimester sonogram, five had a normal sonogram and seven had one or more sonographic markers of Down syndrome. At least 17% of women older than 35 years did not participate in prenatal testing or ultrasound. Ultrasound detected Down syndrome with a sensitivity of 59% (95% confidence interval: 45-72%), a false-positive rate of 10.6% (9.4-11.8%) and a positive predictor value of 1 in 9. The likelihood of having normal karyotype if the sonogram was normal was 0.46 (0.31-0.61). In women older than 35 years, a normal second trimester sonogram reduces the risk of Down syndrome by more than 50%. At least 17% of women older than 35 years do not participate in prenatal testing or ultrasound.

The Use of Ultrasound-Based ???Soft Markers??? for the Prediction of Pelvic Pathology in Women With Chronic Pelvic Pain???Can We Reduce the Need for Laparoscopy?

ABSTRACT An estimated one of every 10 gynecologic visits—and half of all diagnostic laparoscopies—are occasioned by chronic pelvic pain (CPP), a condition that often presents a difficult clinical problem. The most common disorders found at laparoscopy are pelvic endometriosis and adhesions, but no obvious cause of pain is identified in as many as 40% of women evaluated. Transvaginal sonography (TVS), in addition to disclosing ovarian cysts and hydrosalpinges, can provide more subtle information such as the degree of ovarian and uterine mobility and tenderness, findings characterized as “soft markers” of pelvic disease. This study sought soft markers in 120 consecutive premenopausal, nonpregnant women with CPP who were to have diagnostic or operative laparoscopy. They had experienced lower abdominal pain for at least 6 months, which was rated for intensity by visual analog scores. Pain was not associated exclusively with menses or intercourse. A single gynecologist experienced in TVS performed all the studies. Longitudinal and transverse views of the uterus and adnexa were obtained. All of the women subsequently had laparoscopy under general anesthesia. The patients, whose mean age was 31 years, had pain for 46 months on average. Seventy of the 120 participants (58%) had pelvic pathology: 51 of them, endometriosis alone; 7, endometriosis plus pelvic adhesions; 6, pelvic adhesions only; 5, hydrosalpinx plus adhesions; and one, hydrosalpinx with endometriosis. Hard markers were absent on TVS in 96 women. The most common such marker was a cyst consistent with endometrioma. Of 94 women lacking hard markers, 51 (53%) had soft markers. Laparoscopy confirmed abnormalities in 37 women having soft markers on TVS. Thirty of them had endometriosis; 6, adhesions; and one, endometriosis and adhesions. Nine women, most of them with low-grade endometriosis, had falsely negative TVS diagnoses. The likelihood ratio was infinity for hard markers (100% specificity); 1.9 (95% confidence interval [CI], 1.2–3.1) for soft markers; and 0.18 (95% CI, 0.09–0.34) for a “normal” sonogram. The pretest probability of pelvic disease was 58% overall, 100% when hard markers were present, and 73% with soft markers. With a normal sonogram, the figure fell to 20%. Seeking site-specific tenderness and ovarian mobility on TVS makes it easier to detect and exclude pelvic pathology in women with CPP. The investigators believe that taking both hard and soft markers into account may significantly lower the number of diagnostic laparoscopies required.

Utility of follow-up renal sonography in children with vesicoureteral reflux and normal initial sonogram.

The purpose of this study was to determine the value of follow-up renal sonography in children who presented with urinary tract infection and were found to have a voiding cystogram diagnosis of vesicoureteral reflux while having a normal initial renal sonogram. We retrospectively reviewed the medical records of 64 consecutive children who presented for follow-up renal sonography with a voiding cystogram diagnosis of vesicoureteral reflux and a normal initial sonogram conducted as part of the routine evaluation after urinary tract infection. Data recorded included gender, age, initial grade of reflux, time to follow-up sonogram, and abnormalities on follow-up sonogram. Children with conditions that may predispose to vesicoureteral reflux were excluded. Children who were studied (7 boys, 57 girls) ranged in age from 1 month to 10 years, 10 months (mean: 35.6 months; median: 24 months). Ninety-four (73.4%) of 128 renal units demonstrated vesicoureteral reflux on voiding cystogram; 89 (94.7%) of 94 of them were grade 1 to 3. The mean time to follow-up was 22 months (range: 4 months to 5 years, 2 months; median: 18 months). All 128 (95% confidence interval: 0%-2.8%) renal units were normal on follow-up sonography. Routine performance of repeat sonography seems unnecessary among children, particularly girls, with low- to medium-grade vesicoureteral reflux, who have had a previous normal sonogram and no conditions that predispose to vesicoureteral reflux.

A likelihood ratio approach to meta-analysis of diagnostic studies.

To develop a clinically and methodologically sound approach to diagnostic meta-analysis. Two-step model was used involving four fictitious sets of 10 studies each with varying sensitivity and specificity; this was followed by the application of the method to data from a published systematic review of emergency ultrasound. Multidimensional test characteristics (relating to the detection or exclusion of the condition of interest) were described by likelihood ratio scatterplots and pooled likelihood ratios. Likelihood ratios summarise the ability of a test to revise the prior probability of disease. They can be summarised by established fixed-effects and random-effects methods. Likelihood ratios precisely describe both directions of test performance. By plotting positive against negative likelihood ratios, together with their 95% confidence intervals, a multidimensional forest plot is obtained that can be interpreted in analogy to therapeutic meta-analyses. There are accepted threshold values of positive and negative likelihood ratios (i.e. 10.0 and 0.1) to recommend a test for clinical use. In the matrix space, distinct test characteristics can even be assessed by eyeballing. With regard to data from the real meta-analysis, the suggested high discriminatory power of ultrasound was only partially qualified by likelihood ratios. The positive value confirms the reliability of a positive scan, whereas the negative value questions a normal sonogram. A full characterisation of test performance requires multidimensional effect measures. Likelihood ratios are recommended descriptors of the two dimensions of diagnostic research evidence and provide a convenient means to visualise and to communicate results as weighted summary estimates of a diagnostic meta-analysis.

The clinical diagnosis of chronic acalculous cholecystitis

Background. Chronic acalculous cholecystitis (CAC), a diagnosis of exclusion, appears to be more common than was previously thought. We correlated the pathology with test results and response to treatment in a prospective study to obtain data for evidence-based management. Methods. The study subjects were patients with chronic biliary symptoms but had normal sonogram results. They were further investigated with esophagogastroduodenoscopy, multidiscipline evaluations, and cholecystokinin-stimulated scintigraphy (CCK-HIDA). They were offered laparoscopic cholecystectomy (LC) when the symptoms were intransigent, and the main abnormality was a low ejection fraction (EF) as determined by CCK-HIDA. We analyzed the histologic findings of the gallbladder, CCK-HIDA EF, and clinical outcomes during the control period with a concurrent series of LC for calculus from the same surgeons. Results. Of 176 cholecystectomies for biliary pain without stones, 152 had pathologically verified CAC. EF by CCK-HIDA was low in patients with CAC (18%) and low in normal gallbladders (26%). In the same period, 497 patients had cholecystectomies for cholelithiasis. Lasting symptom relief for CAC after LC was not different from that for calculous disease (85% vs 90%). Conclusions. The syndrome consisting of chronic biliary symptoms, stone-free sonograms, low EF in CCK-HIDA, and absence of other pain sources is highly predictive for CAC, which is well treated with LC, with results similar to those for calculous disease. (Surgery 2001;130:578-83.)

Complete Hydatidiform Mole and a Coexistent Viable Fetus: Report of Two Cases and Review of the Literature

Objective. The aim of this study was to report the clinical features, management, and outcome of two cases of complete hydatidiform mole with a coexisting viable fetus and to review the literature.Patients. In this article, we report on the well-documented follow-up of 2 cases of twin pregnancies with complete hydatidiform mole and a viable fetus, both of which ended with the delivery of a normal infant at 41 and 26 weeks of gestation. It is of interest that both pregnancies were achieved following induction of ovulation with hMG/hCG. Since 1977, the year in which complete and partial moles were characterized as distinct pathologic entities, 15 cases (including our 2) have been reported.Results. Persistent GTT developed in eight patients (53.3%) and four patients (27.7%) developed metastatic disease. Seventy-five percent patients with persistent GTT were treated with single-agent chemotherapy. The median gestational age of the patients with subsequent persistent GTT was 34.5 weeks compared to 38 weeks in the patients without persistent GTT.Conclusion. Complete hydatidiform mole and coexistent fetus is a rare occurrence and is associated with an increased risk of persistent gestational trophoblastic tumor. Based on currently available information, it seems that in the presence of a stable pregnancy, normal karyotype, and a normal sonogram it is reasonable to allow the pregnancy to continue.

Power Doppler imaging of acute renal transplant rejection

Purpose We evaluated the usefulness of power Doppler imaging (PDI) in diagnosing acute renal-transplant rejection. Methods Twenty-eight patients underwent 33 renal-transplant biopsies for suspected acute rejection. Patterns of renal parenchymal vascularity revealed by PDI in patients with abnormal biopsy results were compared with patterns in a group who had normal biopsy results. PDI examinations were reviewed retrospectively by 2 independent radiologists who had no knowledge of the biopsy results. A PDI diagnosis of acute rejection required marked vascular pruning in both the cortex and medulla. PDI results then were compared with transplant-biopsy results. Results The sensitivity and specificity of PDI for diagnosing acute renal-transplant rejection were 40% and 100%, respectively. None of the patients with negative biopsy results had PDI abnormalities. The negative predictive value of PDI was 33%, and the positive predictive value was 100%. Conclusions In our study, an abnormal sonogram was highly predictive of acute transplant rejection. However, a normal sonogram did not exclude the possibility of rejection. © 1999 John Wiley & Sons, Inc. J Clin Ultrasound 27:171–175, 1999.

Vesicoureteral Reflux in Older Children: Concordance of US and Voiding Cystourethrographic Findings

PURPOSE: To determine if a negative renal sonogram is reliably predictive of the absence of vesicoureteral reflux at voiding cystourethrography (VCUG) in children aged 5 years or older. MATERIALS AND METHODS: Imaging studies in 70 children aged 5 years or older who underwent renal ultrasound (US) and VCUG on the same day were reviewed. These children had initially undergone evaluation because of a urinary tract infection. RESULTS: Five of 70 children had abnormal sonograms; two (40%) of the five had reflux at VCUG. One had mild pelvicalyceal dilatation, and one had a small kidney. The other three (without reflux) had a pelvic kidney, a calyceal diverticulum, or a renal stone. Of 65 children with a negative sonogram, 19 (29%) had reflux at VCUG; 46 (71%) did not. Altogether, of the 70 children, 21 had reflux, 19 (90%) of whom had no sonographic abnormality. CONCLUSION: Children with abnormal screening renal sonograms often have vesicoureteral reflux, but a normal sonogram does not reliably exclude the cond...

Vesicoureteral reflux in older children: concordance of US and voiding cystourethrographic findings.

To determine if a negative renal sonogram is reliably predictive of the absence of vesicoureteral reflux at voiding cystourethrography (VCUG) in children aged 5 years or older. Imaging studies in 70 children aged 5 years or older who underwent renal ultrasound (US) and VCUG on the same day were reviewed. These children had initially undergone evaluation because of a urinary tract infection. Five of 70 children had abnormal sonograms; two (40%) of the five had reflux at VCUG. One had mild pelvicalyceal dilatation, and one had a small kidney. The other three (without reflux) had a pelvic kidney, a calyceal diverticulum, or a renal stone. Of 65 children with a negative sonogram, 19 (29%) had reflux at VCUG; 46 (71%) did not. Altogether, of the 70 children, 21 had reflux, 19 (90%) of whom had no sonographic abnormality. Children with abnormal screening renal sonograms often have vesicoureteral reflux, but a normal sonogram does not reliably exclude the condition even in children aged 5 years or older. Therefore, VCUG must be performed even in older children, regardless of US findings, if clinical decisions are influenced by documentation of the presence of VUR.

Pregnancy outcomes following false-positive multiple marker screening tests.

Pregnancy outcomes in women with a false-positive midtrimester multiple marker screening test (MMST) were reviewed. A genetic database was used to identify all women > or = age 30 who had a MMST at 15-20 weeks of gestation, a targeted ultrasound, and amniocentesis, and complete pregnancy outcome data. All patients with an abnormal fetal ultrasound (US) or karyotype were excluded. The incidence of adverse outcomes (defined as fetal death, preterm delivery, or a birth weight less than the 10th percentile for gestational age), in those women with a positive MMST (risk of Down's syndrome > or = 1:190) was compared to the incidence of adverse outcomes in control women with negative MMST. Chi-square analysis and Fisher's exact tests were used for comparisons as appropriate. Complete data was available from 1135 women. Seventy-seven percent were over age 35. Two hundred and forty-six women (22%) had a positive multiple marker test. No significant differences in outcomes were discovered after comparisons to controls: fetal death 1 of 246 (0.4%) versus 12 of 889 (1.3%), p = 0.32; preterm delivery 32 of 246 (13.0%) versus 147 of 889 (16.5%), p = 0.17; birth weight less than the 10th percentile, 9 of 246 (3.7%) versus 30 of 889 (3.4%), p = 0.83. Our data suggest that women > or = age 30 with a false-positive MMST and a normal midtrimester obstetrical sonogram are not at an increased risk for adverse pregnancy outcomes in later gestation.

Do morphometric markers increase identification of downs syndrome fetuses in an otherwise normal sonogram?

Do morphometric markers increase identification of downs syndrome fetuses in an otherwise normal sonogram?

Faint and positive amniotic fluid acetylcholinesterase with a normal sonogram

OBJECTIVE: Both faint and positive amniotic fluid acetylcholinesterase determinations have been associated with fetal abnormalities. We evaluated the effect of a normal sonogram and positive or faint acetylcholinesterase level on the risk for anomalies. STUDY DESIGN: Between Jan. 1, 1989, and Feb. 1, 1995, 4859 amniocenteses were performed. Twenty-three cases of abnormal acetylcholinesterase determinations combined with normal sonograms were identified, and pregnancy outcomes were determined. RESULTS: One abnormal karyotype was identified (45,X/47,XXX mosaic). No neural tube defects were seen in infants with an abnormal acetylcholinesterase determination and normal sonogram. One fetus of a twin pregnancy had a ventral wall defect that was not detected on ultrasonography. Seventy-three percent of infants were normal at birth, but 27% of the pregnancies had abnormal outcomes. CONCLUSIONS: Advances in ultrasonography have led to improved detection of fetal abnormalities. With a normal karyotype, repeat invasive testing may not be necessary. (Am J Obstet Gynecol 1996;175:1000-3.)

Can the Presumed Risk of Autosomal Trisomy Be Decreased in Fetuses of Older Women Following a Normal Sonogram?

Previous studies showed that a sonographic scoring system can be used to identify women under age 35 who are at an increased risk for a fetal autosomal trisomy. We propose to use the same scoring system to select women over age 35 who are at a decreased risk of a fetal autosomal trisomy because the ultrasonogram is normal. We reviewed the sonographic scores of 97 trisomic and 694 normal control fetuses from two previously published consecutive series designed to identify women at increased risk for an affected fetus. Using the same scoring index in this study, we calculated the sensitivity and specificity of a score=0 zero for identifying fetuses with autosomal trisomy. We then applied Bayes' theorem to determine the probability of an autosomal trisomy at various maternal ages, given a sonographic score of 0. Of the 97 fetuses with an autosomal trisomy, 83 had a score of ≥1, for a sensitivity of 86% (95% CI 77-92%). Of the 694 control fetuses with normal karyotype, 606 had a score of 0, for a specificity of 87% (95% CI 83-89%). A 42 year old woman's probability of an autosomal trisomy if the sonographic score is 0 becomes equivalent to the age-specific probability for a 35 year old woman. Using the lower limit of the CIs for sensitivity and specificity, we calculated that the probability of having a fetus with an autosomal trisomy falls from 18.8 in 1000 to 5.3 in 1000 for a 40 year old woman with a sonographic score of 0. Our data show that ultrasonography and maternal age provide a more accurate estimation of risk of fetal autosomal trisomy than maternal age alone. The approach described in this report may further define the candidates for karyotyping such that fewer amniocenteses would be necessary for close to the same number of chromosomally abnormal fetuses identified. This approach would result in a decrease in cost as well as morbidity and mortality for normal fetuses being tested

Ultrasonographic evaluation of multicystic dysplastic kidney.

Eleven cases of multicystic dysplastic kidney (MCDK) in children were diagnosed over an 11 year period. All underwent postnatal ultrasound (US) studies. Four different patterns of MCDK were recognized: (1) Six cases presented with the classic sonogram of multicystic components. (2) Three cases had hydronephrotic form; correct diagnosis between hydronephrotic form of MCDK and hydronephrosis was difficult as there was a medially-located, large, lobulated cyst and there was connection between the large cyst and neighboring small cysts. (3) One case initially presented with normal renal sonogram but a small cyst appeared on follow up sonogram and there was also decreased renal size and increased echogenecity. (4) One case had only two moderate-sized cysts but no identifiable renal parenchyma. Two cases had follow-up US examination and one dysplastic kidney decreased in renal size on follow-up sonogram. Intravenous urography and radionuclide study revealed both these dysplastic kidneys to be nonfunctioning. Nine children had surgical resection of the diseased kidneys. Contralateral renal anomalies were detected in five children, which included ureteropelvic junction stenosis, ureterovesical junction stenosis, distal ureteral stenosis and polycystic kidney disease. Two of three hydronephrotic forms of MCDK had contralateral ureteral stenosis. Two of six classic forms of MCDK had contralateral ureteral stenosis. The proportion of contralateral ureteral stenosis was higher in the group of hydronephrotic forms of MCDK. Ultrasonography is beneficial for conclusive diagnosis of MCDK; however, a differential diagnosis of simple hydronephrosis needs to be considered.