Sonographic Scoring System Research Articles

Determination of optimal cutoff value of ulcerative colitis intestinal ultrasound index to estimate endoscopic improvement in ulcerative colitis.

The ulcerative colitis intestinal ultrasound (UC-IUS) index (UII) has been reported as a sonographic scoring system correlating with the Mayo endoscopic subscore (MES). Endoscopic improvement (EI) of UC (MES ≤ 1) is a crucial therapeutic target in clinical practice. However, the cutoff value for estimating EI using the UII has not been established. We established test and validation cohorts comprising patients with UC undergoing IUS and endoscopy within a 15-day interval at our institution. IUS findings (bowel wall thickness, bowel blood flow, bowel wall structure, haustrations, and inflammatory fat) and endoscopic activity (MES) of each colon segment (ascending, transverse, descending, and sigmoid colon) were assessed. In the test cohort (74 segments), UII was correlated with MES (r = 0.645, p < 0.0001). The median UII was 1.0 and 6.0 among participants with MES ≤ 1 and MES ≥ 2, respectively. A UII of 2 was identified as the threshold for estimating MES ≤ 1 with receiver operating characteristic analysis. In the validation cohort (122 segments), UII was correlated with MES (r = 0.675, p < 0.0001) and the estimation ability of UII ≤ 2 for EI had a positive predictive value of 85.4% and negative predictive value of 79.0%. This estimation ability of UII for EI was numerically lower but not statistically different from the previously reported Milan Ultrasound Criteria and Kyorin Ultrasound Criterion for UC. UII ≤ 2 can be a simple, feasible criterion for estimating EI. Correlation with MES is an advantage of the UII compared with other criteria. Proper use of various sonographic criteria is important.

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.

Value of high-frequency ultrasound in the treatment of moderate and severe acne vulgaris.

Acne treatment may fail or cause undesirable side effects due to inaccurate evaluation. High-frequency ultrasound (HFUS) can monitor systemic treatment in patients with moderate-to-severe acne vulgaris. In this prospective study, consecutive patients with moderate-to-severe acne vulgaris were recruited. Patients were graded by a comprehensive clinical assessment before and after therapy. Simultaneous HFUS grading was independently evaluated according to the sonographic scoring system for acne (SSSA). Clinical and HFUS grades were compared through kappa analysis. A total of 70 patients were enrolled. At baseline, 36 (51.4%) and 34 (48.6%) patients were graded as moderate and severe, respectively, through clinical assessment. However, 27 patients (38.6%) scored SSSA-Grade II and 43 (61.4%) scored SSSA-Grade III in the HFUS grading. Sixty-one patients (87.1%) were in the consistent category as per clinical assessment and HFUS grades, with Kappa1 =0.745, whereas higher HFUS grades were observed in nine patients. By the end of the observation, 65 of all patients (92.9%) showed significant improvement and 5 (7.1%) showed no apparent improvement after the treatment. According to the clinical assessment, 14, 52, and 4 patients were graded as mild, moderate, and severe, respectively. On the other hand, 11, 51, and 8 patients had SSSA-Grade I, II, and III, respectively. Of all patients, 63 (90.0%) had consistent evaluation results, with Kappa2 =0.762, whereas the remaining seven patients had an HFUS grade higher than the clinical. HFUS is a useful tool for dermatologists to monitor the treatment of moderate and severe acne vulgaris.

Comparison between a prenatal sonographic scoring system and a clinical grading at delivery for Placenta Accreta Spectrum disorders

Objective Placenta Accreta Spectrum (PAS) disorders have become a major iatrogenic obstetric complication worldwide. Data on the accuracy of ultrasound examination diagnosis are limited by incomplete confirmation and variability in the description of the different grades of PAS at delivery. The aim of this study was to compare our prenatal routine sonographic screening and diagnostic scoring system with a standardized clinical grading system at birth in patient at risk of PAS Study design This is a retrospective cohort study of 607 pregnant patients with at least one prior cesarean delivery between December 2013 and December 2018. All patients were assessed for PAS using our institutional prenatal sonographic scoring system and the corresponding ultrasound findings were compared with those of a standardized clinical intra-operative macroscopic grading system of the degree of accreta placentation at vaginal birth or laparotomy. Results PAS was diagnosed clinically at birth in 50 (8.2%) cases, 17 of which were confirmed by histopathology. A low (score ≤ 5), medium (score 6-7), high (score ≥ 8) probability for PAS was reported in 502, 61 and 44 cases, respectively. The probability score increased significantly (p < .001) in women ≥2 prior cesarean deliveries, with an anterior low-lying/placenta previa, with absent clear space, increased in retroplacental vascularity and with the size and numbers of lacunae. The number of cases classified clinically as grade 1 (non-PAS) and 3 (adherent PAS) was significantly (p < .001) lower in women with a high probability score whereas the rates of the other grades was significantly (p < .001) higher. The widest discrepancy between ultrasound probability score and clinical grade was found for grade 2 which, describes a partial placental adherence and grades 4 and 5 which, refer to placental percreta which describes tissue having invade trough the uterine serosa and beyond. Conclusions Both ends of the spectrum of accreta placentation remain difficult to diagnose antenatal and clinically at birth, in particular when no histopathologic confirmation is available. There is a need to develop ultrasound accuracy score systems that can differentiate between the different grades of PAS and which are validated by standardized clinical and pathology protocols.

Diagnostic Performance of a Sonographic Volume and Solid Vascular Tissue Score (VSVTS) for Preoperative Risk Assessment of Pediatric and Adolescent Adnexal Masses.

To evaluate the diagnostic performance of a Volume and Solid Vascular Tissue Score (VSVTS) for preoperative risk assessment of pediatric and adolescent adnexal masses. A retrospective cohort study comprised of all female individuals who presented with an adnexal mass that was managed surgically between April 2011 and March2016. The Hospital for Sick Children (Toronto, Ontario, Canada). Female individuals 1-18years of age who presented to a large tertiary pediatric hospital with an adnexal mass that was managed surgically. Main outcome measures included diagnostic performance of the VSVTS for malignancy via sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (LR+), negative likelihood ratio (LR-), and receiver operating characteristic area-under-the-curve (AUC) analysis. A total of 179 masses in 169 subjects were included. The malignancy rate was 10.6%. The AUC for the VSTVS was 0.919. A VSTVS cut-off value of 4 achieved a sensitivity of 79% (95% CI 0.54-0.93), specificity of 88% (95% CI 0.82-0.93), PPV of 0.44 (95% CI 0.33-0.56), NPV of 0.97 (95% CI 0.94-0.99), LR+ of 6.77 (95% CI 4.18-10.97), and LR- of 0.24 (95% CI 0.10-0.57). A sonographic scoring system based on the volume and presence of solid vascular tissue improves PPV for preoperative risk stratification of adnexal masses in the pediatric and adolescent population compared to existing ultrasound-only approaches. Further prospective research is needed to determine how best to incorporate components of such scoring systems into clinical management algorithms.

Development and Validation of a Sonographic Enthesitis Instrument in Psoriatic Arthritis: The GRAPPA Diagnostic Ultrasound Enthesitis Tool (DUET) Project.

Enthesitis is a key feature in psoriatic arthritis (PsA) and may be the initial site of musculoskeletal inflammation in patients with PsA. Ultrasound (US) optimizes the detection of enthesitis, but the lack of a validated sonographic enthesitis scoring system for PsA limits the ability to conduct US-based studies of approaches to improve the early diagnosis of PsA. Creating a sonographic enthesitis scoring system that reliably identifies PsA at early stages is an important step in optimizing early diagnosis and encouraging timely interventions that will ultimately improve longterm outcomes for patients with PsA. The Group for Research and Assessment of Psoriasis and PsA (GRAPPA) US working group has set a goal of improving the evaluation of enthesitis in patients with PsA by using US through the development of a Diagnostic Ultrasound Enthesitis Tool (DUET). This article summarizes the proposed DUET study design and methodology as discussed during the 2019 GRAPPA annual meeting in Paris, France.

SAT0570 CLINICAL SIGNIFICANCE OF FINGER EXTENSOR PARATENONITIS DETECTED BY MUSCULOSKELETAL ULTRASOUND

Background:The extensor tendons over fingers are devoid of a tendon sheath, so that the term paratenonitis is used to describe extra-articular hyperemia or anechoic fluid collections along the extensor tendons of the fingers. Although the grading of paratenonitis is found in one sonographic scoring system of RA known as German US7, the clinical significance of paratenonitis is not fully understood.Objectives:To determine the clinical significance of finger extensor paratenonitis detected by ultrasound (US), especially in the patients with RA.Methods:We reviewed 1200 reports of the US examination underwent in our division since April 2015. The items necessary for scoring US5 scores (the ‘hand-limited version’ of the German US7) have been routinely recorded. The cases with finger extensor paratenonitis over the dorsal metacarpophalangeal joint (MCPJ) were determined. The severity of articular synovitis in the perilesional MCPJ were subjectively graded for grey-scale (GS) and power Doppler (PD) on a four-step scale (0-3) and scored using EULAR-OMERACT combined scoring system. In RA patients, US5 scores were determined for the involved hands.Results:Paratenonitis was found in 44 fingers in the 38 hands of the 36 patients with rheumatic diseases/disorders including 25 patients with RA (11 early RA and 14 established RA). Non-RA diseases/disorders included 4 cases of undifferentiated arthritis, 2 cases of PsA, 1 case each of SLE, Sjogren syndrome, reactive arthritis and other disorders.The 44 fingers were classified according to the absence or presence of articular synovitis in the perilesional MCPJ into “isolated paratenonitis” or “paratenonitis accompanied by synovitis”. The distribution of paratenonitis over the 1st-5thfingers of the dominant or non-dominant hands is shown in Figure 1. Paratenonitis was relatively frequently found in the 3rdand 2ndfingers of the dominant hands. Interestingly, articular synovitis in the perilesional MCPJ were found significantly more frequent in the cases of MCP2 in the dominant hands (73%) than in the cases of MCP3 in the dominant hands (25%) (p=0.039).Among the 27 hands with paratenonitis of 25 RA patients, US5 scores were compared based on the absence or presence of moderate to severe articular synovitis in the perilesional MCPJ (the combined score &gt;1) (Figure 2). GS synovitis score, PD synovitis score and PD tenosynovitis score were significantly higher in those with moderate to severe perilesional MCP synovitis than in those without it (p=0.007, 0.0092 and 0.0458, respectively).Conclusion:Finger extensor paratenonitis over the dorsal MCPJ tends to occur in the 3rdand 2ndfingers of the dominant hand. In RA patients, paratenonitis accompanied by active perilesional MCPJ synovitis are presumably due to active disease, while isolated paratenonitis can also be caused possibly by degenerative changes due to overuse or deformity. Isolated paratenonitis may be more frequently found in the 3rdfinger than in the 2ndfinger of the dominant hand.

SUN-415 Is ‘’Visceral Adiposity Index’’ a Better Indicator of Metabolic Syndrome in Patients with Thyroid Nodules?

The Visceral Adiposity Index (VAI) is a mathematical index, based on waist circumference (WC), body mass index (BMI), triglycerides (TG) and HDL cholesterol (HDL) levels, indirectly expressing visceral adipose function, insulin sensitivity. In this study, we aimed to investigate the relationship between VAI and other metabolic syndrome parameters and thyroid nodules.The prospective and single center study included 58 patients with thyroid nodule admitted to the our clinic. As control group; 57 healthy volunteers with similar age, sex and body mass index were included. Nine nodules were detected in 9 healthy volunteers and they were transferred to the patient group. Biochemical parameters were obtained from medical charts. Anthropometric measurements and body composition analysis were performed by the same physician to calculate VAI and other parameters. The parenchymal structure was evaluated according to VESINC system on thyroid ultrasound by single person and nodule characteristics were also detected. Metabolic syndrome was defined according to NCEP Adult Treatment Panel III (NCEP ATP III) consensus report.We examined a total of 67 patients (mean age 48.51 ± 11.55; M/F: 6/61) and 48 healthy volunteers (mean age 47.19 ± 9.45, M/F: 5/43). There were no significant differences between the two groups in terms of gender and age (p>0.05 for all).VAI was significantly higher in the patient group than the control group (p <0.05, median VAI value 4.07 (IQR: 2.27-5.91); 2.97 (IQR: 2.03-4.29), respectively). According to the NCEP ATP III, the number of people with metabolic syndrome was significantly higher in the patient group than the control group (p =0.004). There was no significant difference between waist circumference, body fat percentage, visceral fat rating, BMI, waist-hip ratio and waist-height ratio between patient and control groups (p> 0.05 for all).VAI values were similar in patients according to size, shape, structure, echogenicity, limits, vascularity and presence of calcification of nodules (p>0.05 for all). In all of participants, according to VESINC sonographic scoring system, VAI score was significantly higher in person with heterogeneous thyroid parenchyma than homogeneous (p=0.03). And, those with parenchymal infiltration had significantly higher VAI than those without (p=0.001). However, VAI was similar in terms of parenchymal echogenicity and presence of cyst (p>0.05 for all).There was no significant correlation between VAI and TSH, Ft3, fT4, anti-TPO, anti-TG, total thyroid volume and number of nodule (p> 0.05).In our study, we demonstrated that metabolic syndrome is more common in patients with thyroid nodules. While VAI values were significantly different between the two groups, we found no significant difference in terms of other metabolic syndrome parameters. Therefore, VAI may be a better indicator of metabolic syndrome in patients with thyroid nodules.

Options for Assessing Joints and Entheses in Psoriatic Arthritis by Ultrasonography and Magnetic Resonance Imaging: How to Move Forward.

Psoriatic arthritis (PsA) is a heterogeneous disease with various manifestations of musculoskeletal inflammation. Recent advances in imaging, including ultrasound (US) and magnetic resonance imaging (MRI), allow for the accurate evaluation of the extent of inflammation and damage in the peripheral joints, spine, and entheses. The development and validation of outcome measures are critical steps in creating standardized evaluations of musculoskeletal inflammation and damage in psoriatic patients. At the 2017 meeting of the Group for Research and Assessment of Psoriasis and PsA (GRAPPA), recent work on outcome measures from the GRAPPA US and MRI working groups was summarized. The GRAPPA US group has been developing and validating a sonographic enthesitis scoring system in PsA. The GRAPPA MRI group focuses on the evaluation of whole-body MRI for the assessment of musculoskeletal inflammation in the joints and entheses in patients with PsA.

Technical note: Evaluation of a sonographic overbagging edema scoring system for show cows: Comparison with visual inspection

Overbagged udders are commonly seen at dairy cow shows due to prolonged milking intervals. The aims of this study were to describe the prevalence of udder edema in dairy cows at shows as determined by sonography and to suggest a sonographic scoring system, which was evaluated for reproducibility and repeatability. At 4 highly competitive Swiss dairy cow shows, 319 cows of various breeds were examined. Sonographic scans-1 from each fore quarter and 1 from the rear, representing both hind quarters-were collected by 3 experienced veterinarians at defined positions predisposed to overbagging edema. Sonographic scans were scored with the aid of a newly suggested scoring system (score 0 = no edema, grade 1 = slight edema, grade 2 = moderate edema, grade 3 = severe edema). Further, 139 video sequences from behind while the cows were walking and the same number of photographs of the udder each from the left, right, and behind were selected. The photographs and video sequences were visually scored for different parameters as 0 = not present or 1 = present except for abduction, which was scored on a visual analog scale (0 = no abduction; 100 = maximal imaginable abduction). Visual scores were then compared with the sonographic scoring (Pearson's chi-squared). The prevalence of udder edema scores 1, 2, and 3 was 14.0, 6.5, and 2.3%, respectively. Interobserver reliability for objective sonographic scoring (κ = 0.815) and intraobserver agreement (κ = 0.90 and 0.85 for 2 different observers) was estimated as "almost perfect." Interobserver agreements for visual parameters were κ = 0.40 or less except for teat shape (κ = 0.52). Classification of the videos resulted in better interobserver agreement; when rating hind limb abduction, Spearman correlation coefficient was 0.61, whereas κ = 0.61 for absence of udder movement. Udder movement and teat shape were significantly associated with the edema score. The higher inter- and intraobserver reliability of the sonographic edema scoring compared with the visual scoring system indicates that the newly suggested scoring system might be used in the future to objectively identify udder edema in cows at dairy shows.

Sonographic Scoring System to Classify the Degree of Myometrial Involvement and Extention of Adenomyosis

Sonographic Scoring System to Classify the Degree of Myometrial Involvement and Extention of Adenomyosis

Sonographic Prediction of Ovarian Malignancy in Adnexal Mass

Objective: To evaluate the role of ultrasound for preoperative diagnosis of ovarian malignancy in adnexal mass.Materials &amp; Methods: This prospective observational study was conducted on patients having adnexal mass (n-57) admitted consecutively for surgical exploration in Dept. of OB-GYN of BSMMU from January 2000 - March 2001. Abdominal ultrasonography was performed 10 days preoperatively and 5 sonographic criteria were used to calculate ultrasound score (0, 1 &amp; 3 ). Definitive diagnosis was based on histo-pathological study . Sensitivity , specificity , positive and negative predictive values of ultrasound score to diagnose ovarian malignancy were detected . Chi square &amp; student’s ‘t’ test were used for statistical analysis .Results: Sensitivity , specificity , positive and negative predictive values of ultrasound score at cut-off value of 3 were 78% , 80% , 47% and 94 % respectively .Conclusion: For pre-operative diagnosis of ovarian malignancy sonographic scoring system may be introduced easily into the clinical practice where other complementary tests are not available. Combination of serum CA125 and menopausal status into ultrasound score may further improve the diagnostic accuracy in prediction of ovarian malignancy preoperatively.Bangladesh J Obstet Gynaecol, 2012; Vol. 27(2) : 67-71

Effects of Fatty Infiltration of the Liver on the Shannon Entropy of Ultrasound Backscattered Signals

This study explored the effects of fatty infiltration on the signal uncertainty of ultrasound backscattered echoes from the liver. Standard ultrasound examinations were performed on 107 volunteers. For each participant, raw ultrasound image data of the right lobe of liver were acquired using a clinical scanner equipped with a 3.5-MHz convex transducer. An algorithmic scheme was proposed for ultrasound B-mode and entropy imaging. Fatty liver stage was evaluated using a sonographic scoring system. Entropy values constructed using the ultrasound radiofrequency (RF) and uncompressed envelope signals (denoted by HR and HE, respectively) as a function of fatty liver stage were analyzed using the Pearson correlation coefficient. Data were expressed as the median and interquartile range (IQR). Receiver operating characteristic (ROC) curve analysis with 95% confidence intervals (CIs) was performed to obtain the area under the ROC curve (AUC). The brightness of the entropy image typically increased as the fatty stage varied from mild to severe. The median value of HR monotonically increased from 4.69 (IQR: 4.60–4.79) to 4.90 (IQR: 4.87–4.92) as the severity of fatty liver increased (r = 0.63, p &lt; 0.0001). Concurrently, the median value of HE increased from 4.80 (IQR: 4.69–4.89) to 5.05 (IQR: 5.02–5.07) (r = 0.69, p &lt; 0.0001). In particular, the AUCs obtained using HE (95% CI) were 0.93 (0.87–0.99), 0.88 (0.82–0.94), and 0.76 (0.65–0.87) for fatty stages ≥mild, ≥moderate, and ≥severe, respectively. The sensitivity, specificity, and accuracy were 93.33%, 83.11%, and 86.00%, respectively (≥mild). Fatty infiltration increases the uncertainty of backscattered signals from livers. Ultrasound entropy imaging has potential for the routine examination of fatty liver disease.

Classifier Model Based on Machine Learning Algorithms: Application to Differential Diagnosis of Suspicious Thyroid Nodules via Sonography.

The purpose of this article is to construct classifier models using machine learning algorithms and to evaluate their diagnostic performances for differentiating malignant from benign thyroid nodules. This study included 970 histopathologically proven thyroid nodules in 970 patients. Two radiologists retrospectively reviewed ultrasound images, and nodules were graded according to a five-tier sonographic scoring system. Statistically significant variables based on an experienced radiologist's observations were obtained with attribute optimization using fivefold cross-validation and applied as the input nodes to build models for predicting malignancy of nodules. The performances of the machine learning algorithms and radiologists were compared using ROC curve analysis. Diagnosis by the experienced radiologist achieved the highest predictive accuracy of 88.66% with a specificity of 85.33%, whereas the radial basis function (RBF)-neural network (NN) achieved the highest sensitivity of 92.31%. The AUC value for diagnosis by the experienced radiologist (AUC = 0.9135) was greater than those for diagnosis by the less experienced radiologist, the naïve Bayes classifier, the support vector machine, and the RBF-NN (AUC = 0.8492, 0.8811, 0.9033, and 0.9103, respectively; p < 0.05). The machine learning algorithms underperformed with respect to the experienced radiologist's readings used to construct them, and the RBF-NN outperformed the other machine learning algorithm models.

A sonographic scoring system to assess the risk of thyroid malignancy.

Prediction of thyroid malignancy with fine needle aspiration cytology or individual ultrasound characteristics has several limitations. This study evaluates the usefulness of a combination of ultrasound characteristics in predicting malignancy in patients with thyroid nodules. We assessed 189 thyroid nodules using ultrasonography and histology. Each nodule was assigned a score based on ultrasonographic characteristics. This score was compared with histology to identify ability to predict malignancy. There were 28 malignant nodules. The scoring system was appropriate for clinical use, obtaining an area under ROC curve of 0.822 [p< 0.0001] 95% confidence. FNAC of nodules with a score of more than 4 can be recommended (100% sensitivity). Nodules with a score less than 8 can be offered total thyroidectomy when FNAC is inconclusive (97.5% sensitivity). A combination of ultrasonographic criteria increase the accuracy of predicting malignancy in thyroid nodules.

An overview of the development and application of the sonographic scoring system: differentiation of malignant from benign ovarian tumors.

Ultrasonography is routinely used for the examination of ovarian tumors regarding preoperative diagnosis and postoperative therapeutic evaluation. However, its sensitivity and specificity in determining benign from malignant tumors should be further improved. In this study, we review the methods of sonographic scoring system for differentiating benign from malignant ovarian tumors, and its development and application. We searched the Medline, EBSCO and China National Knowledge Infrastructure from inception to April 2015, we also used the Google Scholar search engine to obtain studies. The ultrasonic scoring system has important clinical value in the preoperative diagnosis of ovarian neoplasm, the sensitivity, specificity and accuracy are significantly higher than using conventional ultrasonography by various of ultrasonic techniques, including two-dimensional sonographic imaging, color Doppler imaging, power Doppler ultrasound, real-time three-dimensional ultrasound and contrast-enhanced ultrasonography. The sonographic scoring system can significantly improve the sensitivity, specificity and accuracy of ultrasonic diagnosis in ovarian tumors, and provides a semi-quantitative method for determining the nature of ovarian masses, guidance of the surgical treatment and evaluation of prognosis.

Effects of fatty infiltration in human livers on the backscattered statistics of ultrasound imaging.

Ultrasound imaging has been widely applied to screen fatty liver disease. Fatty liver disease is a condition where large vacuoles of triglyceride fat accumulate in liver cells, thereby altering the arrangement of scatterers and the corresponding backscattered statistics. In this study, we used ultrasound Nakagami imaging to explore the effects of fatty infiltration in human livers on the statistical distribution of backscattered signals. A total of 107 patients volunteered to participate in the experiments. The livers were scanned using a clinical ultrasound scanner to obtain the raw backscattered signals for ultrasound B-mode and Nakagami imaging. Clinical scores of fatty liver disease for each patient were determined according to a well-accepted sonographic scoring system. The results showed that the Nakagami image can visualize the local backscattering properties of liver tissues. The Nakagami parameter increased from 0.62 ± 0.11 to 1.02 ± 0.07 as the fatty liver disease stage increased from normal to severe, indicating that the backscattered statistics vary from pre-Rayleigh to Rayleigh distributions. A significant positive correlation (correlation coefficient ρ = 0.84; probability value (p value) < 0.0001) exists between the degree of fatty infiltration and the Nakagami parameter, suggesting that ultrasound Nakagami imaging has potentials in future applications in fatty liver disease diagnosis.

A novel sonographic scoring system for antenatal risk assessment of obstetric complications in suspected morbidly adherent placenta.

The purpose of this study was to evaluate a novel sonographic scoring system for risk assessment of complications in patients suspected of having morbidly adherent placenta. This retrospective study evaluated the association between maternal complications and a grayscale sonographic scoring system for adherent placenta before surgery. Criteria for adherent placenta included uteroplacental and uterobladder demarcation lines and the presence of lacunae. Placentas were classified into 4 stages: stage 0, normal placentation; stage 1, low probability of adherence; stage 2, moderate possibility of adherence; and stage 3, high suspicion of adherence. Placental adherence as assessed by a surgical team, estimated blood loss, and postoperative hospitalization days were determined for each group, as well as the rates of the need for packed blood cells, cryoprecipitate units, and hysterectomy. One hundred nine women were included in the study. Twenty-six (23.8%) women were given a score of stage 0, 22 (20.2%) stage 1, 28 (25.7%) stage 2, and 33 (30.3%) stage 3. Linear regression analysis demonstrated that the sonographic staging was the only variable significantly associated with the number of packed cells or cryoprecipitate units transfused (P< .001) and a clinical diagnosis of adherent placenta (P< .001). In addition, both sonographic staging and a history of cesarean delivery were significantly associated with hysterectomy (P = .01; P = .03, respectively), treatment with any blood products (P< .001; P= .01), and the duration of postoperative hospitalization (P< .001; P = .006). A scoring system based on simple grayscale parameters may be effective for antenatal risk assessment of maternal complications in cases of suspected morbidly adherent placenta.

Predicting Coverage of Transverse Subcostal Sonography With the Use of Previous Computed Tomography Before a Sonographic Liver Examination

The purpose of this study was to assess the coverage of transverse subcostal sonography in the supine position by using computed tomography (CT) performed before a sonographic liver examination as a predictor of sonographic coverage. A total of 124 patients (87 men and 37 women; mean age, 55.55 years; range, 24-79 years) who underwent abdominal CT and subsequent liver sonography were enrolled. All patients were assessed for the coverage of transverse subcostal sonography in the supine position by consensus of 2 radiologists. We evaluated the correlation between the level of the posterior rib against the liver dome on axial CT and a sonographic coverage scoring system using Spearman partial correlation analysis. The optimal cutoff value of the liver position and other potential factors associated with sonographic coverage were analyzed. Among age, sex, body mass index, interposition of bowel around the gallbladder fossa, atrophic changes from cirrhotic liver, and liver position, liver position was the only independent factor associated with sonographic coverage (P < .001). Liver position and the sonographic coverage score were moderately negatively correlated, with statistical significance (r = -0.44; P < .001). The optimal cutoff value for the level of the hepatic dome was at the 10th posterior rib on axial CT. Liver position is the only independent factor associated with the coverage of transverse subcostal sonography in the supine position. If it is above the 10th posterior rib level, we can predict difficulty in adequate sonographic coverage of the liver.

Prospective Evaluation of a Prenatal Sonographic Clubfoot Classification System

Background: The purpose of this study was to prospectively evaluate our recently described fetal sonographic classification system for prenatal diagnosis of clubfoot. Methods: Over 18 months, we prospectively enrolled consecutive pregnant patients evaluated for a prenatally diagnosed clubfoot. Prenatal sonographic scores assigned by a radiologist were compared to final clinical diagnosis and severity given by a pediatric orthopedic surgeon. Pearson's χ² test and logistic regression were used in statistical analyses on the subject level. Generalized estimating equations were used in analyses on the foot level to account for intrasubject correlation. Results: There were 50 subjects, with 26 unilateral and 24 bilateral clubfeet, according to the prenatal ultrasound (US). A total of 51 (69%) of 74 feet and 36 (72%) of 50 subjects had a postnatal diagnosis of clubfoot. The accuracy of diagnosis in cases of a severe, moderate, and mild US score was 94, 70, and 25%, respectively (p = 0.003 comparing moderate-severe vs. mild). US severity correlated with the Dimeglio classification scoring system (Spearman's correlation 0.30). Conclusion: The fetal sonographic scoring system is predictive of clinical severity after birth, and improves the ability to counsel families with a prenatal diagnosis of clubfoot.