Routine Ultrasonography Research Articles

Machine learning-based prediction model integrating ultrasound scores and clinical features for the progression to rheumatoid arthritis in patients with undifferentiated arthritis.

Predicting rheumatoid arthritis (RA) progression in undifferentiated arthritis (UA) patients remains a challenge. Traditional approaches combining clinical assessments and ultrasonography (US) often lack accuracy due to the complex interaction of clinical variables, and routine extensive US is impractical. Machine learning (ML) models, particularly those integrating the 18-joint ultrasound scoring system (US18), have shown potential to address these issues but remain underexplored. This study aims to evaluate ML models integrating US18 with clinical data to improve early identification of high-risk patients and support personalized treatment strategies. In this prospective cohort, 432 UA patients were followed for 1year to track progression to RA. Four ML algorithms and one deep learning model were developed using baseline clinical and US18 data. Comparative experiments on a testing cohort identified the optimal model. SHAP (SHapley Additive exPlanations) analysis highlighted key variables, validated through an ablation experiment. Of the 432 patients, 152 (35.2%) progressed to the RA group, while 280 (64.8%) remained in the non-RA group. The Random Forest (RnFr) model demonstrated the highest accuracy and sensitivity. SHAP analysis identified joint counts at US18 Grade 2, total US18 score, and swollen joint count as the most influential variables. The ablation experiment confirmed the importance of US18 in enhancing early RA detection. Integrating the US18 assessment with clinical data in an RnFr model significantly improves early detection of RA progression in UA patients, offering potential for earlier and more personalized treatments. Key Points •A machine learning model integrating clinical and ultrasound features effectively predicts rheumatoid arthritis progression in undifferentiated arthritis patients. •The 18-joint ultrasound scoring system (US18) enhances predictive accuracy, particularly when incorporated with clinical variables in a Random Forest model. •SHAP analysis underscores that joint severity levels in US18 contribute significantly to early identification of high-risk patients. •This study offers a feasible and efficient approach for clinical implementation, supporting more personalized and timely RA treatment strategies.

Predicting preterm birth using electronic medical records from multiple prenatal visits

This study aimed to predict preterm birth in nulliparous women using machine learning and easily accessible variables from prenatal visits. Elastic net regularized logistic regression models were developed and evaluated using 5-fold cross-validation on data from 8,830 women in the Nulliparous Pregnancy Outcomes Study: New Mothers-to-Be (nuMoM2b) dataset at three prenatal visits: 60 - 136, 160 - 216, and 220 - 296 weeks of gestational age (GA). The models’ performance, assessed using Area Under the Curve (AUC), sensitivity, specificity, and accuracy, consistently improved with the incorporation of data from later prenatal visits. AUC scores increased from 0.6161 in the first visit to 0.7087 in the third visit, while sensitivity and specificity also showed notable improvements. The addition of ultrasound measurements, such as cervical length and Pulsatility Index, substantially enhanced the models’ predictive ability. Notably, the model achieved a sensitivity of 0.8254 and 0.9295 for predicting very preterm and extreme preterm births, respectively, at the third prenatal visit. These findings highlight the importance of ultrasound measurements and suggest that incorporating machine learning-based risk assessment and routine late-pregnancy ultrasounds into prenatal care could improve maternal and neonatal outcomes by enabling timely interventions for high-risk women.

Best Practices: Ultrasound Versus MRI in the Assessment of Pelvic Endometriosis.

Endometriosis is a common yet morbid disease. Imaging plays an important role in diagnosis and treatment planning. Both ultrasound (US) and MRI are used to detect disease. We performed a literature review to assess whether one is superior. A total of 33 studies from the 4482 identified in the initial search were found to assess the efficacy of US and/or MRI in detecting pelvic endometriosis. Most studies were performed at centers with extensive experience with endometriosis, using dedicated US and MRI protocols. A wide range of sensitivities and specificities were reported, but overall weighted means of diagnostic statistics for US and MRI were similar. The choice of dedicated US versus dedicated MRI in the evaluation of endometriosis should therefore be based on the expertise in the region. The data also showed US had better accuracy than MRI for identifying the depth of wall invasion in bowel-wall disease, whereas MRI better depicted pelvic-wall and extraperitoneal disease than US. Routine US and MRI protocols performed worse than dedicated US and MRI protocols, which may account for delays in diagnoses. Clinical and research efforts directed at improving the sensitivity of routine imaging for diagnosing deep endometriosis could improve patient access to appropriate care.

Knots of the Umbilical Cord: Incidence, Diagnosis, and Management

(Int J Gynecol Obstet. 2024;00:1–8. doi: 10.1002/ijgo.15373) The umbilical cord is surrounded by Wharton jelly and is frequently referred to as the “lifeline” because of its essential function in transporting nutrients and expelling fetal waste. Factors such as the length and coiling of the cord impact its health and functionality. An essential aspect of umbilical cord function is an arterial anastomosis, known as “Hyrtl anastomosis,” which helps regulate and distribute blood flow to the placenta. This structure, typically located 3 cm before the cord enters the placenta, is vital for fetal well-being, and abnormalities can increase fetal stress or, in severe cases, lead to fetal demise. Umbilical cord knots (UCK) are among the observed abnormalities, often detected accidentally during routine sonography. True knots range from 0.3% to 2.1%, and while usually solitary, multiple knots can occur. Such knots have also been observed in monkey fetuses. The clinical significance of a knot depends on whether it is tight or loose; a tight knot, especially in a hyper-coiled cord, is less flexible and more prone to complications during birth.

Factors Predicting Fetal Growth Restriction and Fetal Cardiac Remodeling.

This study aimed to investigate factors influencing fetal growth restriction (FGR) occurrence and assess the clinical significance of fetal cardiac parameters in FGR prediction. Pregnant women with clinically suspected FGR (n=179) and uncomplicated pregnancies (n=53) were included. All had undergone routine obstetric ultrasonography and fetal echocardiography. Umbilical artery flow (UAF) and fetal cardiac parameters (left atrial transverse diameter (LAd), right atrial transverse diameter (RAd), left ventricular transverse diameter (LVd), right ventricular transverse diameter (RVd), foramen ovale width, atrial septum diameter, interventricular septal thickness, left ventricular posterior wall thickness, right ventricular free wall thickness, aortic diameter, pulmonary artery diameter, mitral E velocity, mitral A velocity, tricuspid E velocity, tricuspid A velocity, aortic valve peak flow velocity, and pulmonary valve peak flow velocity) were detected. Follow up was conducted until birth, various fetal clinical parameters were collected: maternal body mass index (BMI), hypertensive disorders complicating pregnancy (HDCP), abnormal umbilical artery flow, placental or umbilical cord anomalies, low amniotic fluid volume, preterm birth, emergency cesarean delivery, maternal height, maternal age, gestational diabetes mellitus (GDM), hypothyroidism, assisted reproductive technology (ART), parity, and neonatal gender. Participants were categorized into confirmed FGR (n=119) and control (n=113) groups based on neonatal birth weight. Significant differences were observed between groups in maternal BMI, HDCP, abnormal UAF, placental or umbilical cord anomalies, low amniotic fluid volume, preterm birth, and emergency cesarean delivery. FGR was positively related to abnormal UAF, placental or umbilical cord anomalies, preterm birth and emergency cesarean delivery and negatively to maternal BMI (r=-0.276). Compared to the control group, the FGR group exhibited significantly larger RAd, RVd, RA/LA, and RV/LV. Fetal growth-restricted fetuses have enlarged right heart structures. Fetal cardiac examinations are valuable for early FGR diagnosis, potentially improving neonatal body weight and reducing adverse pregnancy outcomes.

Routine Transvaginal Ultrasound at the Time of the Anatomy Scan: To Do or Not To Do?

There are no universal guidelines for transvaginal ultrasound (TVUS) at the time of the anatomy scan. TVUS can provide information on placental location and cervical length (CL) but may lead to more interventions. As a quality assurance initiative, a universal TVUS (UTVUS) protocol at the time of the anatomy scan was started at our institution. This study was conducted to assess whether there was a decrease in preterm birth (PTB), postpartum hemorrhage (PPH), and neonatal intensive care unit (NICU) admission once UTVUS was implemented. This was a retrospective cohort study performed on singleton gestations from February 2021 to January 2022. In the first 6 months of the study period, patients only had TVUS based on risk factors (pre group). In the second half of the study period, UTVUS was implemented at the time of the anatomy scan (post group). A total of 2,118 patients were included in the study. There were 1,037 patients in the pre group, of which 161 underwent TVUS based on high-risk factors (history of the cervical procedure, history of prior PTB, and placenta appearing low lying or cervix appearing short on abdominal ultrasound). The post group/UTVUS included 1,081 patients. Patients in the pre group had statistically significantly earlier gestational age at first TVUS (p < 0.0001), were less likely to have had a prior PTB <36 weeks (p = 0.03), and were more likely to have a history of cervical procedure (p = 0.0006) than patients in the post group. There was an increased use of vaginal progesterone in the UTVUS with 33 patients (as opposed to 10 patients in the pre group; p = 0.0007). The proportion of patients with PTB, PPH, or NICU admission did not significantly differ between the two groups even after adjusting for cofounders (p > 0.05). Our data show that UTVUS did not decrease the adverse pregnancy outcomes. In addition, the implementation of UTVUS adds more discomfort for a patient, more time to the patient's scan, and is an additional cost. Therefore, surveillance by abdominal ultrasound and adding TVUS based on risk factors may be a reasonable alternative. · UTVUS showed no difference between CLs.. · There is not sufficient evidence to conclude a difference between PTB or PPH in the two groups.. · There was significantly more placenta previa diagnosed in the post group, yet most resolved..

7812 Community Practice Setting Experience in Evaluation of Incidental Thyroid Nodules

Abstract Disclosure: N. Abate: None. H. Rhodes: None. M. Horlavadi: None. B. Adams-Huet: None. M. Chandalia: Advisory Board Member; Self; Boehringer Ingelheim. Speaker; Self; Boehringer Ingelheim, Eli Lilly &amp; Company, Novo Nordisk. Background: There is a significant increase in detection of incidental thyroid nodules due to increase in routine screening ultrasounds at church, workplace, and health fairs, increase in routine ultrasound in primary care clinics and incidental finding of thyroid nodule during carotid artery ultrasound. These patients are then referred for thyroid nodule fine needle aspiration biopsy. Aim of this study was to evaluate real world data in frequency of thyroid cancer in patients referred for incidental thyroid nodule to a nonacademic Endocrinology clinic utilizing centralized collection of cytology and molecular analysis. Method: Medical records were reviewed for consecutive FNA of incidental thyroid nodule in an Endocrinology clinic in greater Houston from 2021 to 2023. FNA was performed in patients selected based on ACR TI-RADS classification. Patients with Bethesda score of 3 or more had molecular testing with Thyroseq performed. Patients with intermediate or high probability of cancer on Thyroseq as well as Patients with Bethesda 4 and 5 on cytopathology were referred for surgery. Surgical pathology was obtained in patients who underwent surgery. Data was tabulated and analyzed using SAS. Results: A total of 304 subjects, 267 Female and 37 males, age 57 ± 13, nodule size 2.69 ± 1.4 (mean ± SD), had thyroid nodule FNA between 2021 and 2023. Of these FNA, 23 (7.5%) sample collections were insufficient, 233 (77.3%) were benign (Bethesda 2), 46 (15%) were Atypia of undetermined significance or Suspicious for malignancy. Of those subjects with Bethesda 3 or higher, 36 patients had molecular testing by Thyroseq Method. Fifteen patients had intermediate and high risk finding on Thyroseq. Thirty-four subjects had surgery and 8 patients had malignancy on surgical pathology. One patient was identified as Medullary Thyroid cancer on Thyroseq, confirmed by surgery. Frequency of malignancy in incidentally detected thyroid nodule in the whole group was 2.6%, those with Bethesda 3 and more was 17.4% and those with Thyroseq intermediate or high risk was 27%. Conclusion: Availability of centralized cytopathology and reflex molecular testing to Community practice settings helps reducing unnecessary thyroid surgeries in patients with incidental thyroid nodules. Presentation: 6/1/2024

Routine third-trimester ultrasonography and child neurodevelopmental outcomes: a follow-up of a pragmatic cluster-randomised controlled trial

ABSTRACT Aims/Background Routine third-trimester ultrasonography is increasingly conducted to screen for foetal growth restriction (FGR) and reduce adverse perinatal and child neurodevelopmental outcomes using timely obstetric management. While it did not reduce adverse perinatal outcomes in previous trials, evidence regarding its association with child neurodevelopmental outcome is absent. We examined whether routine third-trimester ultrasonography is positively associated with child developmental and behavioural/emotional outcomes compared to usual care. Design/Methods Dutch mothers with a low-risk pregnancy participating in a subsample (n = 1070) of a nationwide cluster-randomised trial reported infant (age 6 months) and toddler (age 28 months) developmental milestones (Ages and Stages Questionnaire) and toddlers’ internalising and externalising problems (Child Behavior Checklist). Usual care (n = 380) comprised selective ultrasonography. The intervention strategy (n = 690) included two routine third-trimester ultrasounds next to usual care. Both strategies applied the same interdisciplinary protocol for FGR detection and management. Results Adjusted linear mixed-level regressions revealed that routine third-trimester ultrasonography was positively but modestly related to z-standardised infant developmental milestones at 6-month follow-up, B = 0.20, 95%CI [0.07; 0.32], p = 0.003, compared to usual care. At 28-month follow-up, these strategies did not differ in child developmental outcome and internalising and externalising problems. Conclusion Routine third-trimester ultrasonography was positively but modestly associated with infant development. In toddlerhood, routine ultrasonography was not related to child developmental and behavioural/emotional outcomes. Overall, these findings do not support the implementation of routine third-trimester ultrasonography for low-risk pregnant women for reasons concerning children’s early neurodevelopmental outcomes.

Prenatal ultrasound detection of fetal amniotic band ingestion in monochorionic diamniotic twin pregnancy: a rare case report

BackgroundAmniotic Band Syndrome (ABS) is a rare congenital condition characterized by the formation of fibrous bands within the amniotic sac that can entangle and restrict fetal development, leading to various deformities. In this report, we present an unprecedented case of fetal amniotic band ingestion in a monochorionic diamniotic (MCDA) twin pregnancy. Reporting this case is essential for expanding the understanding of the diverse presentations of amniotic bands, considering this rare entity in the differential diagnosis of prenatal ultrasound findings, and emphasizing the importance of vigilant prenatal monitoring and individualized management strategies.Case PresentationA 35-year-old gravida 2, para 1 woman with an MCDA twin pregnancy experienced an uneventful pregnancy until the 33rd week, when routine ultrasonography revealed mild intrauterine growth restriction in both twins. At 35 weeks and 5 days gestation, the patient presented with mild abdominal pain. An emergency ultrasound revealed that Twin A ingested an amniotic band. Despite the absence of overt fetal distress, a comprehensive risk assessment was conducted, taking into account potential complications, such as airway obstruction and gastrointestinal issues due to prolonged amniotic band ingestion. Considering the risks versus the benefits of continued gestation and the near-term status, an emergency cesarean section was performed. The procedure resulted in the successful delivery of both twins with satisfactory Apgar scores. A 9-cm fibrous strand was promptly extracted from Twin A’s oral cavity after delivery, confirming prenatal diagnosis. Both neonates underwent thorough examinations, revealing no additional anomalies, and demonstrated normal development during the nine-month follow-up.ConclusionThis case highlights the inherent challenges in diagnosing and managing the rare presentations of amniotic band-related complications, particularly in MCDA twin pregnancies. The instance of fetal amniotic band ingestion underscores the vital role of comprehensive prenatal imaging in ensuring accurate diagnosis and tailoring individualized risk assessments throughout the pregnancy in such rare and complex situations.

Efficacy of ultrasonographic diaphragmatic parameters in distinguishing diaphragmatic dysfunction in cats.

Diaphragmatic dysfunction (DD) is often underdiagnosed in veterinary medicine. Various ultrasonographic diaphragmatic parameters, including diaphragmatic excursion (DE), diaphragmatic thickness (Tdi) and diaphragmatic thickening fraction (DTF), can be used to identify DD. We aimed to establish normal reference intervals in healthy cats, examine the effects of intrinsic factors on diaphragmatic parameters and evaluate the efficacy of these parameters in identifying DD in healthy and diseased cats. This prospective observational study was conducted on 22 healthy cats and 12 diseased cats using ultrasonographic techniques to evaluate DE, Tdi and DTF. The correlation between diaphragmatic parameters and intrinsic factors, including sex, age, body weight and body condition score, was analysed using Pearson correlation analysis. Cut-off values for healthy and diseased cats were established using receiver operating characteristic curve analysis. The mean DEs of the left and right hemidiaphragms were 0.66 ± 0.16 and 0.64 ± 0.18 cm, respectively. The mean Tdis in the end-inspiration phase were 0.13 ± 0.03 and 0.12 ± 0.03 cm for the left and right hemidiaphragms, respectively, whereas in the end-expiration phase the mean Tdi was 0.07 ± 0.03 cm for both hemidiaphragms. The DTF ranges for the left and right hemidiaphragms were 23.90-122.1% and 38.80-107%, respectively. Intrinsic factors had no significant impact on DE, Tdi and DTF. The DE measurements for the left hemidiaphragm were more accurate for evaluating diaphragmatic function. To distinguish between healthy and diseased cats, the cut-off value, sensitivity and specificity were 0.458 cm (area under the curve [AUC] 0.846), 75.00% and 86.36%, respectively, for the left hemidiaphragm and 0.423 cm (AUC 0.704), 41.67% and 100%, respectively, for the right hemidiaphragm. Normal reference values for DE, Tdi and DTF were established for healthy cats. DE, particularly in the left hemidiaphragm, obtained using routine ultrasonography, improves the efficacy of identifying DD and assists clinicians in the diagnosis and treatment of cats with cardiorespiratory disease.

Ultrasound in GCA: Halo Sign Quantification and Visual Symptoms, Systemic Inflammation and Relapse Risk.

A sonographic scoring system, termed Halo count and Halo score, of temporal and axillary arteries (TAXA) in suspected giant cell arteritis (GCA) has been proposed for outcome prognostication. We conducted a retrospective review into the relationship of Halo count and Halo score and clinical-laboratory parameters amongst patients diagnosed with GCA via our rapid-access pathway to determine whether these measures should form part of our local routine clinical practice. This review of TAXA ultrasound (US) images in patients with diagnosed GCA did not identify any correlation between Halo count/score and ocular symptoms, jaw claudication, 6-month relapse risk or inflammatory markers. This suggests that further prospective evaluation of Halo count and -score is required before adopting these measures into routine US scanning of TAXA for suspected GCA.

Prevalence Of Congenital Abnormalities On Routine Antenatal Ultrasonography During Second And Third Trimester Of Pregnancy: A Study In A District Hospital Of North East India

Background Prevalence of congenital anomalies varies greatly from country to country. It is reported about 2.5% in India. In India, congenital anomalies are responsible for 15% of perinatal mortality and for 10% to 15% of neonatal deaths. The main aim of the study is to evaluate the prevalence of the congenital anomalies and malformation patterns in our hospital population. Material &amp; Method This is a cross-sectional study carried out in the ‘Radiology unit’ of ‘District Hospital, Gomati’, Tripura. The study population includes about 910 antenatal mothers in the second and third trimester, who were referred to ‘Radiology unit’ from the outpatient and inpatient departments of ‘Obstetrics and Gynaecology’ of the same hospital between September 2017 to February 2018 were included in the study. Data of Antenatal ultrasounds was statistically analyzed on structured data collection form to determine the prevalence of congenital anomaly in 2nd &amp; 3rd trimester. Results: Total 910 numbers of 2nd and 3rd trimester prenatal ultrasonography (USG) were done. Out of these 18 numbers of congenital anomalies were detected. The antenatal prevalence of congenital anomalies was 1.97%. The mean maternal age and mean gestational age at diagnosis was 22.9 years and 27.7 weeks respectively. Genitourinary system defect was the commonest (27.77%), of which maximum number had pyelactasis i.e. 3 (16.66%) cases. Conclusion: Ultrasonography is a cost-effective, non-invasive and sensitive tool in detecting the congenital anomalies antenatally in the hands of an experienced radiologist. Besides the first-trimester USG, the second trimester scan is mandatory in detecting anomaly in the growing foetus, as the majority of congenital anomalies are detected between 20 and 22 weeks of pregnancy

Unique Variants of Megacalycosis on Magnetic Resonance Urography

To present a unique set of patients diagnosed with megacalycosis by magnetic resonance urography (MRU) to re-evaluate the definition of megacalycosis and provide a new perspective on diagnosis and treatment. A retrospective chart review of patients with megacalycosis as diagnosed by MRU was conducted. MRU was performed to determine the presence of obstruction, further visualize renal anatomy, and clarify the presence of megacalycosis. Patients who were asymptomatic and demonstrated no evidence of obstruction were managed with long-term observation through renal bladder ultrasonography, and symptomatic patients who showed evidence of obstruction (crossing vessels, abnormal renal transit time, or disparity in differential renal function of <40%) were treated surgically with a dismembered Anderson-Hynes pyeloplasty. Thirteen cases of megacalycosis were identified as diagnosed by MRU at our institution between 2007 and 2020. In 7 patients (54%), MRU revealed the simultaneous occurrence of obstruction and megacalycosis. In patients with obstruction (N=7), surgical intervention was required to correct the obstruction via robotic pyeloplasty. In patients without obstruction (N=6), conservative management was performed to monitor megacalycosis through long-term follow-up via routine ultrasounds. While megacalycosis has historically referred to the non-obstructive dilatation of the renal calyces, our study presents 7 cases of obstruction occurring simultaneously with megacalycosis as diagnosed by MRU. By expanding the designation of megacalycosis to include patients with obstruction, surgical treatment can be explored to prevent future renal colic and/or renal deterioration in those patients.

Downgrading Breast Imaging Reporting and Data System categories in ultrasound using strain elastography and computer-aided diagnosis system: a multicenter, prospective study.

To determine whether adding elastography strain ratio (SR) and a deep learning based computer-aided diagnosis (CAD) system to breast ultrasound (US) can help reclassify Breast Imaging Reporting and Data System (BI-RADS) 3 and 4a-c categories and avoid unnecessary biopsies. This prospective, multicentre study included 1049 masses (691 benign, 358 malignant) with assigned BI-RADS 3 and 4a-c between 2020 and 2022. CAD results was dichotomized possibly malignant vs. benign. All patients underwent SR and CAD examinations and histopathological findings were the standard of reference. Reduction of unnecessary biopsies (biopsies in benign lesions) and missed malignancies after reclassified (new BI-RADS 3) with SR and CAD were the outcome measures. Following the routine conventional breast US assessment, 48.6% (336 of 691 masses) underwent unnecessary biopsies. After reclassifying BI-RADS 4a masses (SR cut-off <2.90, CAD dichotomized possibly benign), 25.62% (177 of 691 masses) underwent an unnecessary biopsies corresponding to a 50.14% (177 vs. 355) reduction of unnecessary biopsies. After reclassification, only 1.72% (9 of 523 masses) malignancies were missed in the new BI-RADS 3 group. Adding SR and CAD to clinical practice may show an optimal performance in reclassifying BI-RADS 4a to 3 categories, and 50.14% masses would be benefit by keeping the rate of undetected malignancies with an acceptable value of 1.72%. Leveraging the potential of SR in conjunction with CAD holds immense promise in substantially reducing the biopsy frequency associated with BI-RADS 3 and 4A lesions, thereby conferring substantial advantages upon patients encompassed within this cohort.

Fetal size monitoring in women with gestational diabetes and normal glucose tolerance.

To monitor fetal size and identify predictors for birthweight in women with gestational diabetes (GDM) and normal glucose tolerance (NGT). Cohort study of 1843 women universally screened for GDM, with routine ultrasounds each trimester. Women with GDM and NGT were categorized in subgroups by birthweight centile. Of the total cohort, 231 (12.5%) women were diagnosed with GDM. Fetal size, incidence of large-for-gestational age (LGA: 12.3% of GDM vs. 12.9% of NGT, p = 0.822) and small-for-gestational age (SGA) neonates (4.8% of GDM vs. 5.1% of NGT, p = 0.886) were similar between GDM and NGT. GDM women with LGA neonates were more insulin resistant at baseline and had more often estimated fetal weight (EFW) ≥ P90 on the 28-33 weeks ultrasound (p = 0.033) than those with AGA (appropriate-for-gestational age) neonates. Compared to NGT women with AGA neonates, those with LGA neonates were more often obese and multiparous, had higher fasting glycemia, a worse lipid profile, and higher insulin resistance between 24 -28 weeks, with more often excessive gestational weight gain. On the 28-33 weeks ultrasound, abdominal circumference ≥ P95 had a high positive predictive value for LGA neonates in GDM (100%), whereas, in both GDM and NGT, EFW ≥ P90 and ≤ P10 had a high negative predictive value for LGA and SGA neonates (> 88%), respectively. There were no differences in fetal size throughout pregnancy nor in LGA incidence between GDM and NGT women. EFW centile at 28-33 weeks correlated well with birthweight. This indicates that GDM treatment is effective and targeted ultrasound follow-up is useful. TRIAL REGISTRATION CLINICALTRIALS.GOV: NCT02036619. Registration date: January 15, 2014. https://clinicaltrials.gov/ct2/show/NCT02036619 .

The Causes of Thyrotoxicosis, Clinical Features, and Treatment Strategies in a Former Iodine Deficient Area

Thyrotoxicosis is a hypermetabolic condition caused by excess thyroid hormones in the circulation with/without increased production from the thyroid gland. In this prospective study, we aimed to investigate the causes of thyrotoxicosis, clinical features, and treatment strategies in a former iodine-deficient area. Thyroid function tests, antithyroid and antithyroid receptor antibodies, and routine thyroid ultrasonography was obtained, and a thyroid scintigraphy/radioactive iodine uptake test was performed on need. A statistically significant difference was found between toxic multinodular goiter (TMNG) and Graves’ disease (GD) groups when mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), alanine aminotransferase (ALT), and aspartate aminotransferase (AST) values were analyzed. TSH levels were significantly lower in GD patients compared to those in TMNG and TNG patients, but free triiodothyronine (FT3) and free thyroxine (FT4) values were higher. A high level of TSH receptor antibody (TRAb) was observed in patients with normal antithyroid peroxidase (Anti-TPO). TRAb levels were found to be high. Anti-TPO and anti-thyroglobulin (Anti-Tg) levels were observed to be positively correlated with sT3 and sT4 levels. TMNG is the leading cause of thyrotoxicosis; despite sufficient iodide intake in our former iodine-deficient region, TMNG is characteristically seen in older patients with much lower thyroid hormone levels than GD. According to the study results, the diagnosis of patients with thyrotoxicosis, their clinical presentation, the treatment they will receive, early detection of postoperative complications were predicted

Effects of COVID-19 Infection on Fetal Growth in Pregnancy

Background: Infections are known to affect fetal development and growth. Studies have shown that there is a higher frequency of maternal vascular malperfusion in the placental bed in pregnant women infected with COVID-19. It is further suggested that the abovementioned changes seen in the placentas of women infected with COVID-19 is associated with significant clinical sequelae, such as, preterm birth, fetal growth restriction (FGR), and fetal demise. Although there are growing studies that have evaluated the impact of COVID-19 infection on fetal growth, data remains limited. As a result, there is little consensus on perinatal recommendations and counseling that should be given to women infected patients COVID-19 during pregnancy. During the COVID-19 pandemic, our Maternal Fetal Medicine Clinics opted to perform serial growth ultrasounds and additional antenatal testing in the third trimester in women infected with the disease. Whether performance of these ultrasounds identified cases of fetal growth restriction and impacted fetal outcomes remains unknown. The purpose of this study is to perform a retrospective review of all ultrasounds performed in women identified to have COVID-19 during June 2020-December 2022, and to evaluate the impact on fetal growth. We hypothesize that COVID-19 will increase the risk of fetal growth restriction compared to pregnant women without COVID-19. Study Design: This is a retrospective cohort study within the Obstetrix Maternal-Fetal Medicine Specialist of Houston Clinics. The study included all patients aged 16-55 years old with a singleton pregnancy who received an ultrasound at Obstetrix Maternal-Fetal Medicine Specialist of Houston between June 2020-December 2022. COVID-19 infection during pregnancy was defined as a self-reported positive SARS-Co-2 RT-PCR or Rapid Test. FGR was defined as estimated fetal weight less than the 10% or abdominal circumference less than the 10% for gestational age. Maternal and fetal characteristics, including FGR, were collected and compared between the two groups. Results: Among the 21,917 women with a singleton pregnancy who received an ultrasound at Obstetrix Maternal-Fetal Medicine Specialist of Houston between June 2020-December 2022, 484 (2%) had COVID-19 infection during pregnancy and 21,433 (98%) did not. Of those who had COVID-19 infection during pregnancy there were 45 (9%) cases of FGR, and when compared to pregnant individuals reporting negative for COVID-19 there were 2,928 (14%) cases of FGR, p=005. When the 484 women who had COVID-19 were stratified by the timing of their COVID-19 infection by first, second and third trimester, there was no significant difference in the proportion who had an offspring with FGR (p=0.33 Cochran-Armitage test for trend). Conclusion: COVID-19 infection in pregnancy, when compared to those who do not have COVID-19 infection in pregnancy does not appear to be more associated with FGR. The performance of routine serial fetal growth ultrasounds may not be indicated in pregnant women solely for the purpose of having a history of a COVID-19 infection during pregnancy.

Pivotal Role of Duplex Ultrasonography on Arteriovenous Fistula for Hemodialysis Access

The global incidence of end-stage renal disease (ESRD) is rising, amounting to more than 800 million individuals are suffered, in line with the rise of the number of patients undergoing hemodialysis as treatment modalities. Hemodialysis requires vascular access, and the arteriovenous fistula (AVF) access is considered the most ideal vascular access option due to its long-term patency and low complication rate compared to other access options. However, up to one-third of hospital admissions for ESRD patients are caused by AVF dysfunction, which is also one of the main causes of morbidity and mortality in ESRD patients. AVF creation requires careful pre- and post-operative evaluation to ensure the vascular access maturation and patency. While the latest guidelines have not explicitly emphasized the role of vascular mapping and surveillance, routine duplex ultrasonography before and after AVF creation procedures holds great potential advantages to ensure the success of AV access for hemodialysis.

Integration of a Comprehensive Ultrasound Assessment in the Prognostic Modeling of benign and Malignant Ovarian Tumors

Ovarian tumors can be challenging to diagnose and treat, especially in areas with limited access to advanced medical care. During routine prenatal ultrasounds, abnormal growths in the ovaries can be unexpectedly discovered. In clinical practice, it is essential to accurately differentiate between benign and malignant ovarian tumors in order to develop appropriate treatment plans. Ultrasound imaging has become the preferred diagnostic tool. The aim of this article is to examine the ultrasound characteristics of ovarian and adnexal growths and to explore how these characteristics, along with other clinical factors, can aid in predicting the likelihood of ovarian cancer.

Research protocol - Evaluating data quality in the Netherlands Perinatal Registry (Perined): A data comparison study using hospital records from the IUGR Risk Selection (IRIS) study

Background The quality of registry based studies depends largely on the data accuracy of the registries. The Dutch Perinatal Registry (Perined) is a nationwide database comprising perinatal data digitally provided by different healthcare providers. Perined data are used for comparing outcomes across regions and healthcare institutions as well as for quality analyses and research purposes. However, little is known about the data quality of the Perined database. Therefore, the aim of this study is to assess the quality of Perined data compared to hospital records and case report forms (CRFs) that were part of the IUGR Risk Selection (IRIS) study. Methods In this comparison study data from Perined and the IRIS Study will be used. The IRIS study was a large cluster-randomized trial investigating the effectiveness of routine third trimester ultrasonography in reducing severe adverse perinatal outcomes among Dutch low-risk pregnant women. A subsample of the IRIS study of neonates being at risk of severe adverse perinatal outcomes and their mothers will be used. Baseline demographic data were collected by midwives from participating women at inclusion (around 22 weeks’ gestation) using CRFs, and in-depth neonatal and maternal clinical data were retrieved from hospital records by trained research assistants. These latter IRIS study data were linked and compared to Perined data. Completeness of Perined data will be calculated for every variable. The reliability will be assessed as the percent of agreement between Perined and hospital record data or the CRF-based data. Additionally, intra-class correlation coefficients will be calculated for continuous variables, and Kappa and ‘Prevalence-and-Bias-Adjusted Kappa’ will be calculated for categorical variables. Discussion The results of the proposed comparison study will provide users of Perined data insight in its data quality. This will serve as an example of the accuracy of registry based data used in maternal and neonatal care research.