Sonographic Criteria Research Articles

Sonography of iatrogenic pneumothorax in pediatric patients.

Pneumothorax is defined as the presence of air in the pleural cavity. The incidence of iatrogenic pneumothorax in the pediatric population is 0.3–0.48 in 1000 patients. A conventional chest X-ray, in some cases supplemented with chest computed tomography, is a typical imaging examination used to confirm the diagnosis of pneumothorax. Within the last years, the relevance of transthoracic lung ultrasound in the diagnostic process of this disease entity has greatly increased. This is confirmed by the opinion of a group of experts in ultrasound lung imaging in patients in a life-threatening condition, who strongly recommend a transthoracic ultrasound examination for the diagnosis of pneumothorax in such patients. These data constituted the basis for initiating the prospective studies on the application of this method in pneumothorax diagnosis in patients of pediatric hematology and oncology wards.AimThe aim of the study was to present the possibility of using the transthoracic lung ultrasound in the diagnostic process of pneumothorax in pediatric patients, with particular attention paid to its iatrogenic form. The article discusses sonographic criteria for pneumothorax diagnosis in pediatric patients, including the sensitivity and specificity of the method, in relation to conventional chest X-ray.Material and methodsThe prospective studies included a group of patients treated in the Clinic of Pediatrics, Pediatric Hematology, Oncology and Endocrinology of the Academic Clinical Centre (Medical University of Gdańsk, Poland) in whom a central venous catheter was placed in the subclavian veins. The studies lasted for one year – from 1 July 2011 to 30 June 2012. The examined group comprised 63 patients – 25 girls (39.7%) and 38 boys (60.3%) aged from 1 to 17. The analysis included the results of 115 ultrasound examinations conducted in this group.ResultsIn t he examined group with suspected or diagnosed neoplasm, iatrogenic pneumothorax was identified in 4 out of 63 patients (6.3%). In all cases, it was a consequence of procedures connected with the introduction of a central catheter. In the examined material, the sensitivity, specificity and predictive values (positive and negative) of the transthoracic lung ultrasound equaled 100%.ConclusionsThe transthoracic ultrasound examination is a highly effective method in diagnosing iatrogenic pneumothorax in pediatric patients. However, to confirm this conclusion, multicenter studies, among considerably larger populations, are necessary.

Correlation Between Sonography and Antibody Activity in Patients With Hashimoto Thyroiditis

Patients with Hashimoto thyroiditis show structural changes of the thyroid that can be identified by a variety of sonographic criteria. We conducted this study to investigate whether there is a correlation between sonography and antibody activity and to assess the role of sonography in the diagnosis and follow-up of Hashimoto thyroiditis. In addition, we present a new classification system (termed the VESINC system [volume, echogenicity, sonographic texture, pseudonodular hypoechoic infiltration, nodules, and cysts]), which helps improve the clarity of sonographic findings. The study included 223 consecutive patients with previously diagnosed Hashimoto autoimmune thyroiditis who attended the thyroid clinic of the German Armed Forces Central Hospital in Koblenz for follow-up examinations between 2006 and 2008. Laboratory tests were performed to measure the levels of free triiodothyronine, free thyroxine, thyrotropin, anti-thyroglobulin antibodies (TgAbs), and antithyroid peroxidase antibodies (TPOAbs). Sonography was performed according to a strict protocol. We then assessed whether a correlation existed between antibody activity and the 6 sonographic variables of the VESINC system. Hypoechogenicity, heterogeneity, and pseudonodular hypoechoic infiltration were associated with significantly higher TPOAb activity (P < .001). There were no significant correlations between the other sonographic variables examined (cysts, nodules, and volume) or the biometric data with the TPOAb and TgAb levels. In addition, an assessment of TgAb levels did not show significant differences in correlations with any of the sonographic variables. Sonography is a noninvasive diagnostic imaging modality that provides information about the level of inflammatory activity. Markedly decreased echogenicity, heterogeneity, and multifocal pseudoinodular hypoechoic infiltration are indicative of a high level of inflammatory activity. The sonographic classification system presented here (VESINC system) can be a useful tool for comparing sonographic findings in a rapid and objective manner during follow-up of Hashimoto thyroiditis.

Miscarriage in contemporary maternal-fetal medicine: targeting clinical dilemmas

Miscarriage in contemporary maternal-fetal medicine: targeting clinical dilemmas

Acute Appendicitis: Investigating an Optimal Outer Appendiceal Diameter Cut-Point in a Pediatric Population

BackgroundAcute appendicitis is the most common cause of abdominal pain in children requiring operative intervention. Among a number of sonographic criteria to aid in the diagnosis of appendicitis, an outer diameter >6 mm is the most objective and widely accepted. However, there is a lack of evidence-based standards governing this consensus. Study ObjectivesThe aim of this study was to determine the outer appendiceal diameter that maximizes sensitivity and specificity in a pediatric population. MethodsA retrospective review of all urgent diagnostic ultrasounds (US) was performed over 2 years in children aged <18 years. The diagnostic accuracy of various cut-points was assessed by calculating the sensitivity and specificity and plotting a receiver operating characteristic (ROC) curve. ResultsThe study sample consisted of 398 patients in whom the appendix was visualized on US. The median outer appendiceal diameter was significantly higher in the surgical group compared to the nonsurgical group (9.4 mm; range = 8.1–12.0 vs. 5.5 mm; range = 4.4–6.5, p < 0.01). The optimal cut-point with the greatest area under the ROC curve was determined to be an outer appendiceal diameter of 7.0 mm. ConclusionsIn our patients, adopting a 7-mm rather than a 6-mm appendiceal diameter threshold would balance a greater number of missed cases of acute appendicitis for a reduction in the number of unnecessary surgeries.

Fetal kidneys: additional sonographic criteria of normal development

The aim of this study was to establish objective criteria for the evaluation of cortical echogenicity (CE), cortical thickness (CT), and medullary thickness (MT), as well as the corticomedullary ratio (CMR), throughout gestation. In this prospective single-center study, CE, MT, CT, and CMR were evaluated in a group of singleton pregnancies examined by ultrasound during the second and third trimesters. The CE evolved from a hyperechoic pattern compared with the liver or spleen during early second trimester to a hypoechogenic pattern in the third trimester, with no fetus displaying cortical hyperechogenicity after 32 weeks. CT increased from 1.8 to 2.5 mm (p < 0.05) from 21 to 25 to 34 to 37 weeks; MT from 2.7 to 5.1 mm (p < 0.0001), and the CMR decreased from 0.7 to 0.5 (p < 0.001). The CE, CT, and MT evolve with gestation. Cortical hyperechogenicity compared with the liver or spleen after 32 weeks or a CMR above 0.7 in the third trimester should raise the suspicion of a fetal nephropathy.

Role of Dynamic Contrast‐Enhanced Sonography for Characterization and Monitoring of Extramedullary Myeloma

To measure blood perfusion in extramedullary myeloma by contrast-enhanced sonography, correlate it with specific hematologic parameters, and determine their utility for local and systemic response monitoring. Twenty-five consecutive patients (14 male and 11 female; median age, 68 years) with extramedullary myeloma were included. After intravenous administration of 2.4 mL of sulfur hexafluoride, extramedullary myeloma masses were examined for 60 seconds. All patients underwent contrast-enhanced sonography at baseline, and 15 were monitored additionally (3 weeks during therapy). Average peak perfusion, regional blood flow (RBF), and regional blood volume (RBV) were calculated. Baseline perfusion parameters were compared with short-term follow-up sonographic data and serologic biomarkers (M gradient). For validation of extramedullary myeloma and systemic myeloma, patients underwent midterm (<3 months) imaging and serologic diagnosis. Patients with baseline β2-microglobulin (B2M) greater than 3.5 mg/L (n = 17) showed higher perfusion parameters compared with baseline B2M less than 3.5 mg/L (n = 8). At short-term follow-up, patients were classified by serologic criteria as responders (n = 9) and nonresponders (n = 6) and by sonographic criteria as responders (n = 10) and nonresponders (n = 5). In sonographic responders, mean peak, RBV, and RBF dropped from 59.13, 1446.09, and 71.52 (artificial units) at baseline to 29.30, 364.19, and 34.64 at follow-up (P < .05), whereas in nonresponders, perfusion parameters increased from 33.18, 789.82, and 36.92 at baseline to 51.14, 1491.06, and 65.34 at follow-up (P > .05). Prediction of a midterm course of systemic myeloma using serologic data yielded sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 0.66, 0.77, 0.66, and 0.77, whereas sonographic results (judged by RBV) yielded values of 0.66, 0.55, 0.5, and 0.71. Separate prediction of a local (extramedullary myeloma) response by sonography yielded sensitivity, specificity, PPV, and NPV of 0.8, 1.0, 1.0, and 0.71. Contrast-enhanced sonography is a valuable tool for short-term monitoring of the treatment response in extramedullary myeloma.

Clinical, ultrasonographical and histopathological aspects in Hashimoto’s thyroiditis associated with malignant and benign thyroid nodules

The reported prevalence of chronic autoimmune thyroiditis associated with differentiated thyroid cancer (DTC) is heterogeneous.The aim of this study was to evaluate some epidemiological, clinical, sonographical and histological features of operated thyroidnodules with background diffuse autoimmune thyroiditis. The study included 411 cases with Hashimoto's thyroiditis (HT), of which 118 presented thyroid nodular disease(TND). Thyroidectomy was performed in 76 cases. Of these patients, 24 presented histologically confirmed DTC and 52 benign lesions.DTC types were as follows: papillary thyroid cancer (PTC) (n = 6), follicular variant of PTC (FVPTC) (n = 6), papillary microcarcinomas(n = 8), follicular thyroid carcinoma (n = 1) and the mixed form (classic PTC and FVPTC) (n = 3). The benign nodules were dominatedby: follicular adenoma (48%), and colloid goitre (40.3%). The sonographic features with predictive risk for malignancy in cases with HT associated with TND were represented by: solidcomposition, hypoechogenicity and microcalcifications. The characters of margins, the nodular shape and the type of vascularity do notseem to be as useful for identification of malignant nodules in HT. Fine needle-aspiration biopsy (FNAB) showed in DTC cases differentcytological smears: malignant (ten), indeterminate (eight), benign (two), and non-diagnostic (four). In the group of benign nodules, theindeterminate smears represented also a significant percentage (n = 12). The incidence of TND associated with HT was 28.7%. Among 76 operated cases, 31.5% presented DTC. The accuracyof FNAB in the preoperative diagnosis showed higher sensitivity (90.0%) and specificity (61.5%) compared to sonographic criteria.

Sonographic measurement criteria for the diagnosis of internal jugular phlebectasia in children

To establish sonographic (US) criteria for the diagnosis of internal jugular phlebectasia (IJP) in children and to determine reliable cutoff values of US measurements with high specificity and sensitivity. We used B-mode US for the measurement of internal jugular vein transverse (T) and anteroposterior (AP) diameter, and cross-sectional area (CSA) at rest and during the Valsalva maneuver (VM) in 21 patients, aged 15 months to 16 years, diagnosed with IJP, and compared the results with those of 88 healthy children. Receiver operating characteristics curves were used to determine the optimal cutoff values. Patients with IJP had higher T, AP diameters, and CSA at rest and during VM than controls on the same side (p < 0.001). Receiver operating characteristics curves showed that CSA during the VM on both sides yielded the best results (cutoff value 220 mm(2) with 92.3% sensitivity, 92% specificity on the right side; 188 mm(2) with 90% sensitivity, 87.5% specificity on the left side). AP diameter offered better specificity and sensitivity (≥85%) than T diameter during VM on both sides. We suggest using an AP diameter >15 mm as a cutoff point for both sides for the diagnosis of IJP in daily practice. US measurement of the jugular vein diameter might help increasing clinicians' awareness of clinically unrecognized cases of IJP and identifying borderline cases that require follow-up.

The usefulness of gestational sac and placental sonographic morphology in differentiating between second‐trimester tubal and abdominal pregnancy: Case report and a review of literature

Second-trimester tubal pregnancy is rarely encountered and published cases are limited. There are no established sonographic criteria to differentiate it from abdominal pregnancy; however, differences in their medical management make this distinction important. We report a case of a 14-week 5-day tubal pregnancy that presented near rupture. Sonography demonstrated many overlapping features with abdominal pregnancy. In addition, the extrauterine gestational sac was rounded and well defined and the placenta was crescent-shaped. We propose that these sonographic features represent a second-trimester tubal pregnancy rather than an abdominal pregnancy.

Association between nonalcoholic fatty liver disease and the incidence of cardiovascular and renal events

BackgroundRecent data suggest that the presence of non-alcoholic fatty liver disease (NAFLD) may be linked to increased cardiovascular and chronic kidney diseases. Here we assess whether NAFLD, as diagnosed by ultrasound, predicts the risk of incident cardiovascular and renal impairment events. MethodsA total of 1150 patients with normal or near normal liver and kidney functions, and without protienuria or histories of cardiovascular accident were included in this multicenter prospective observational cohort study. All patients were subjected to full clinical evaluation, laboratory investigation including estimation of the GFR and immunonephelometric evaluation for protienuria, and abdominal ultrasonography for diagnosis of NAFLD. The metabolic syndrome was defined according to the modified National Cholesterol Education Program (NCEP)–ATP criteria. All patients followed up periodically over three years for the incidence of cardiovascular (including coronary heart disease, ischemic stroke and cerebral hemorrhage) and renal impairment events. ResultsOnly 747 (62.25%) patients completed the follow-up examination and were included in the final analysis. 35.8% of them fulfilled the sonographic criteria of NAFLD. The frequency of cardiovascular accident and renal impairment was significantly higher in them: 136 patients (50.7%) vs. 110 (23%); P<0.001 for cardiovascular events, 88 (32.8%) vs. 88 (18.4%), P<0.001 for microalbuminuria; and 24 (8.9%) vs. 14 (2.9%), P<0.001 for macroalbuminuria. Also, mean estimated glomerular filtration rate (eGFR) was significantly lower in patients with NAFLD (96±23.28 vs. 111±28.37; P<0.001). Logistic regression analysis revealed that NAFLD was the best predictor for cardiovascular and renal impairment. ConclusionNAFLD is a good predictor of cardiovascular and renal diseases.

ULTRASOUND CRITERIA AND GUIDED FINE‐NEEDLE ASPIRATION DIAGNOSTIC YIELDS IN SMALL ANIMAL PERITONEAL, MESENTERIC AND OMENTAL DISEASE

Peritoneal, mesenteric, and omental diseases are important causes of morbidity and mortality in humans and animals, although information in the veterinary literature is limited. The purposes of this retrospective study were to determine whether objectively applied ultrasound interpretive criteria are statistically useful in differentiating among cytologically defined normal, inflammatory, and neoplastic peritoneal conditions in dogs and cats. A second goal was to determine the cytologically interpretable yield on ultrasound-guided, fine-needle sampling of peritoneal, mesenteric, or omental structures. Sonographic criteria agreed upon by the authors were retrospectively and independently applied by two radiologists to the available ultrasound images without knowledge of the cytologic diagnosis and statistically compared to the ultrasound-guided, fine-needle aspiration cytologic interpretations. A total of 72 dogs and 49 cats with abdominal peritoneal, mesenteric, or omental (peritoneal) surface or effusive disease and 17 dogs and 3 cats with no cytologic evidence of inflammation or neoplasia were included. The optimized, ultrasound criteria-based statistical model created independently for each radiologist yielded an equation-based diagnostic category placement accuracy of 63.2-69.9% across the two involved radiologists. Regional organ-associated masses or nodules as well as aggregated bowel and peritoneal thickening were more associated with peritoneal neoplasia whereas localized, severely complex fluid collections were more associated with inflammatory peritoneal disease. The cytologically interpretable yield for ultrasound-guided fine-needle sampling was 72.3% with no difference between species, making this a worthwhile clinical procedure.

ACR Appropriateness Criteria® First Trimester Bleeding

Vaginal bleeding is not uncommon in the first trimester of pregnancy. Ultrasound is the foremost modality for evaluating normal development of the gestational sac and embryo and for discriminating the causes of bleeding. While correlation with quantitative βHCG and clinical presentation is essential, sonographic criteria permit diagnosis of failed pregnancies, ectopic pregnancy, gestational trophoblastic disease and spontaneous abortion. The American College of Radiology Appropriateness Criteria guidelines have been updated to incorporate recent data. A failed pregnancy may be diagnosed when there is absence of cardiac activity in an embryo exceeding 7 mm in crown rump length or absence of an embryo when the mean sac diameter exceeds 25 mm. In a stable patient with no intrauterine pregnancy and normal adnexae, close monitoring is advised. The diagnosis of ectopic pregnancy should be based on positive findings rather than on the absence of an intrauterine sac above a threshold level of βHCG. Following abortion, ultrasound can discriminate retained products of conception from clot and arteriovenous fistulae. The American College of Radiology Appropriateness Criteria® are evidence-based guidelines for specific clinical conditions that are reviewed every two years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.

SAT0530 The Useful of us in Diagnosis of Carpal Tunnel Syndrome in Diabetics: a Proposal for New Reference Values.

BackgroundCarpal Tunnel Syndrome (CTS) is a neural affection that in diabetic patients can be associated with polyneuropathy (DP). In rheumatologists’s practice, ultrasonography represents a useful tool in the study of...

Hypertrophic pyloric stenosis in premature infants: evaluation of sonographic criteria and short-term outcomes

To examine the sonographic measurements of pyloric muscle and pyloric thickness in premature infants with hypertrophic pyloric stenosis (HPS) and to correlate these measurements with patients variables. We aimed also to evaluate the clinical features and short-term outcome of HPS in premature compared to term infants. The medical notes and the pyloric ultrasounds of all premature infants (<37weeks) admitted to the Neonatal Surgical Unit with HPS over a 20-year period (1990-2010) were retrospectively reviewed. Sonographic measurements of the pyloric length, muscle thickness and the pyloric ratio (muscle thickness divided by pyloric diameter) were correlated to weight at presentation, duration of symptoms and corrected gestational age. Multiple regression and correlation analysis was carried out. Seventy-five preterm infants were identified (51M:24F). Median gestational age was 34weeks. Median weight at presentation was 2.74kg. Forty-two had an ultrasound (US) before surgery, 37 measurements were analysed. Pyloric length, muscle thickness and pyloric ratio were not affected by weight at presentation (p=0.67, p=0.122, p=0.849), corrected gestational age (CGA) (p=0.921, p=0.678, p=0.076), or duration of symptoms (p=0.827, p=0.268, p=0.281). Mean length of stay was 6days and overall complication rate was 27%, both higher than reported in term infants (p<0.001). Premature infants with HPS have a higher female preponderance than expected. Ultrasound measurements in premature infants with HPS are not affected by weight, corrected gestational age or duration of symptoms. In addition, they have a longer hospital stay and increased complication rate compared to term infants.

Obstetric Ultrasound: Errors and Pitfalls in Fetal Growth Restriction

IntroductionUltrasound is a method of tracking deviations fetal growth. In 75% of cases of fetal growth restriction (CIR), biological or constitutional factors are associated.Methods InvolvedThe cases were selected retrospectively from the personal archive of the authors, cases and situations experienced that can lead to misinterpretation by the sonographer on suspicion of CIR in order to discuss the sonographic diagnostic criteria.DiscussionThe triad: amniotic fluid, placenta and fetal movement activates normal are great indicators to rule out other etiologies involved in the genesis of the CIR. The normal fetal morphology is important to exclude malformations and chromosomal defects that cause the CIR also symmetrical. The fetuses with growth restriction of symmetrical (fetal weight below the 10th percentile for gestational age referred to) have different etiologies and may be maternal (congenital infections, chromosomal disorders, chromosomal abnormalities not like gastroschisis, irradiation, teratogenic drugs) or constitutional.Conclusion of the PresentationThe sonographic identification of fetal weight below the 10th percentile for gestational age that should trigger the search for possible etiologies involved in low fetal weight. However, it is important biological and constitutional rule, which accounts for most cases, so that there is no premature termination of pregnancy. IntroductionUltrasound is a method of tracking deviations fetal growth. In 75% of cases of fetal growth restriction (CIR), biological or constitutional factors are associated. Ultrasound is a method of tracking deviations fetal growth. In 75% of cases of fetal growth restriction (CIR), biological or constitutional factors are associated. Methods InvolvedThe cases were selected retrospectively from the personal archive of the authors, cases and situations experienced that can lead to misinterpretation by the sonographer on suspicion of CIR in order to discuss the sonographic diagnostic criteria. The cases were selected retrospectively from the personal archive of the authors, cases and situations experienced that can lead to misinterpretation by the sonographer on suspicion of CIR in order to discuss the sonographic diagnostic criteria. DiscussionThe triad: amniotic fluid, placenta and fetal movement activates normal are great indicators to rule out other etiologies involved in the genesis of the CIR. The normal fetal morphology is important to exclude malformations and chromosomal defects that cause the CIR also symmetrical. The fetuses with growth restriction of symmetrical (fetal weight below the 10th percentile for gestational age referred to) have different etiologies and may be maternal (congenital infections, chromosomal disorders, chromosomal abnormalities not like gastroschisis, irradiation, teratogenic drugs) or constitutional. The triad: amniotic fluid, placenta and fetal movement activates normal are great indicators to rule out other etiologies involved in the genesis of the CIR. The normal fetal morphology is important to exclude malformations and chromosomal defects that cause the CIR also symmetrical. The fetuses with growth restriction of symmetrical (fetal weight below the 10th percentile for gestational age referred to) have different etiologies and may be maternal (congenital infections, chromosomal disorders, chromosomal abnormalities not like gastroschisis, irradiation, teratogenic drugs) or constitutional. Conclusion of the PresentationThe sonographic identification of fetal weight below the 10th percentile for gestational age that should trigger the search for possible etiologies involved in low fetal weight. However, it is important biological and constitutional rule, which accounts for most cases, so that there is no premature termination of pregnancy. The sonographic identification of fetal weight below the 10th percentile for gestational age that should trigger the search for possible etiologies involved in low fetal weight. However, it is important biological and constitutional rule, which accounts for most cases, so that there is no premature termination of pregnancy.

Obstetric Ultrasound: Errors and Pitfalls in the Second Trimester of Pregnancy

The majority of fetal malformations has confirmed his diagnosis in routine obstetric ultrasound examination or during the morphological examination of the second trimester of pregnancy. The aim of this essay is demonstrate the possible errors and pitfalls in ultrasound diagnosis in the second trimester of pregnancy with emphasis on fetal malformations. The cases were selected retrospectively from the personal archive of the authors, cases and situations experienced that can lead to misinterpretation by the sonographer to illustrate and discuss the sonographic diagnostic criteria defined in the literature. Some variations of normal in the second trimester of pregnancy, birth and choroid plexus cysts, cystic adenomatoid malformation, cystic hygroma, pelvic dilatation, changes in amniotic fluid can be resolved and lead to misinterpretation. Knowledge of this variability is crucial for the correct diagnosis. Ultrasonography is the most appropriate method of screening for abnormalities in the second trimester of pregnancy with high specificity in diagnosing malformations. However, the lack of care and embryological landmarks and sonographic aspects usual for their gestational age may lead to misinterpretation.

Value of 3-Dimensional Sonography for Prenatal Diagnosis of Vertebral Formation Failure

The purposes of this study were to explore the value of 3-dimensional sonography for diagnosis of vertebral formation failure in the developing fetus and to formulate antenatal sonographic diagnostic criteria for suspected vertebral formation failure based on a comparison of sonographic characteristics of the disorder with normal sonographic findings and other imaging data. This study included sonographic data from 30 healthy fetuses and 13 fetuses suspected to have vertebral formation failure. Three-dimensional reconstruction of sagittal sections of the physiologic curves of the cervicothoracic and lumbosacral regions of the healthy fetuses was performed, and reconstruction was also performed on selected areas of interest when vertebral malformation was suspected. Stored data were analyzed, and a comparison with other image data was performed using various methods. Three-dimensional reconstruction was more suitable for fetal spinal sonography among the 30 healthy fetuses, and it was particularly superior in detecting the positions of spines with evident physiologic curvature. The images revealed suspected vertebral formation failure in 13 cases, and the confirmed findings included 7 cases of hemivertebrae, 2 cases of butterfly vertebrae, 2 cases of mixed malformations (butterfly vertebra and hemivertebra), and 1 case of a coronal cleft vertebra. One case was lost to follow-up. The sonographic characteristics were definite, and there were evident differences from the sonograms of spina bifida. Three-dimensional sonography is helpful for detection of vertebral formation failure in the developing fetus and might provide prognostic information with the potential to ameliorate the progressive spinal deformities that can result from embryonic vertebral formation failure.

Covered Transjugular Intrahepatic Portosystemic Shunts: Accuracy of Ultrasound in Detecting Shunt Malfunction

The purpose of this study was to determine the accuracy of ultrasound for detecting transjugular intrahepatic portosystemic shunt (TIPS) malfunction in covered stents in comparison with bare metal stents. During a 6-year period, 126 TIPS angiography examinations were performed in 78 patients who had undergone a recent TIPS ultrasound examination. Radiology reports and images were retrospectively reviewed, and the sensitivity and specificity of sonographic parameters for detecting TIPS dysfunction were calculated using TIPS angiography and portosystemic gradient as the reference standards. Of 126 paired studies, 43 were in bare metal TIPS and 83 were in covered TIPS. Peak shunt velocity of covered and bare metal TIPS measured by ultrasound showed comparable sensitivities for detection of shunt dysfunction, using both depressed (< 90 cm/s) and elevated (> 200 cm/s) peak shunt velocity criteria. However, a depressed velocity was more specific in covered TIPS (0.939 vs 0.550, p < 0.001) whereas elevated velocity was more specific in bare TIPS (0.485 vs 0.800, p = 0.041). An interval change in peak TIPS velocity greater than 25% was significantly more sensitive in detection of dysfunction in covered TIPS (0.815 vs 0.400, p = 0.015) whereas detection based on main portal vein velocities (≤ 30 cm/s) was not statistically different in the two groups. Our data suggest that the accuracy of ultrasound for detection of TIPS shunt malfunction is at least as high in covered stents as in bare metal stents. Diagnostic performance for several sonographic parameters varied significantly between bare and covered stents, suggesting the need for optimization of sonographic criteria for covered stents.

The role of colour Doppler sonography in the diagnosis of lower limb Klippel–Trénaunay syndrome

To investigate the accuracy of colour Doppler sonography as compared to phlebography in patients with Klippel-Trénaunay syndrome (KTS). From September 2004 to May 2012, 59 consecutive patients seen in Shandong medical imaging research institute with a clinical suggestion of KTS were included. Thirty-four were female and 25 were male, with a mean age of 28.4 years. Colour Doppler sonography was used to assess the lower limb veins. The main sonographic criteria for a positive diagnosis were visualization of the lateral vein or sciatic vein, capillary haemangioma, and abnormality of the deep veins. These data were compared with phlebography findings. The κ statistic was used to determine the level of agreement. The sensitivity, specificity, positive and negative predictive values, and accuracy of colour Doppler sonography as a diagnostic test were assessed. Colour Doppler sonography findings were positive in 21 of 59 patients with a clinical suggestion of KTS. The diagnosis was confirmed using phlebography in 22 patients. There were two false-positive results and one false-negative result by colour Doppler sonography. The κ-value was 0.892. Sensitivity, specificity, positive and negative predictive values, and accuracy for colour Doppler sonography were 95.4, 94.6, 91.3, 97.2, and 94.9%, respectively. Colour Doppler sonography is an accurate, reliable, and non-invasive investigation in the assessment of patients with suspected KTS.

Morbidly adherent placenta: evaluation of ultrasound diagnostic criteria and differentiation of placenta accreta from percreta

To evaluate the diagnostic accuracy of two-dimensional (2D) gray-scale and color Doppler and three-dimensional (3D) power Doppler sonographic criteria for morbidly adherent placenta (MAP), and to identify criteria to help distinguish placenta accreta from placenta percreta. We enrolled 187 patients with placenta previa and history of uterine surgery and performed transabdominal and transvaginal ultrasound examination for early detection of MAP. With 2D gray-scale transabdominal and transvaginal ultrasonography, we investigated loss/irregularity of the echolucent area between the uterus and the placenta ('clear space'), thinning or interruption of the hyperechoic interface between the uterine serosa and the bladder wall and the presence of turbulent placental lacunae with high-velocity flow (>15 cm/s). Using transabdominal 3D power Doppler, we evaluated the hypervascularity of the uterine serosa-bladder wall interface and irregular intraplacental vascularization. Ultrasound findings were reviewed against the final diagnosis made during Cesarean section (CS). MAP was detected on CS in 41 patients. All of them had an anterior placenta previa (34 major and seven minor) and had undergone at least one previous CS. The evaluated sonographic criteria showed good diagnostic performance; in MAP patients at least two out of five criteria were detected, with at most one of the criteria present in patients without MAP. Loss/irregularity of clear space used as a single criterion was responsible for the most false positives, demonstrating a low positive predictive value. Irregular intraplacental vascularization with tortuous confluent vessels affecting the entire width of the placenta, and hypervascularity of the entire uterine serosa-bladder wall interface, were only detected, on 3D power Doppler, in cases of placenta percreta. The reviewed ultrasound criteria may be useful for the prenatal diagnosis of MAP and to differentiate between placenta accreta and placenta percreta; 3D power Doppler techniques were an important aid in the diagnosis.