Ultrasound Exam Research Articles

When gallbladder oedema comes as a chronic disease – diagnosis and treatment

Diagnosis of the gallbladder oedema is difficult during the clinical examination because the clinical signs are not specific for this disease. The causes of this pathology are multiple and can be divided into emergencies (such as anaphylactic shock, right-sided hearth failure, pericardial effusion) and chronic pathologies (such cholecystitis, pancreatitis or immune-mediated hemolytic anemia). Imagistics methods complete the information of the clinical exam and ultrasound is considered the golden standard for diagnosing this pathology. Normally, at the ultrasound exam, the gallbladder has a hyperechoic wall, with a diameter of 2-3 mm; while in case of gallbladder oedema, the wall is thick and has a triple stratification, with 2 hyperechoic rows, separated by a hypoechoic line. This pathognomonic description of the gallbladder oedema is also known as the ‘Halo Sign’ or ‘Double Rim Effect’. Making a correct differential for the appearance of the sign is vital for the outcome of the case. The main focus is to exclude every emergency cause in order to start treating the chronic pathologies. This paper presents the pathologies leading to gallbladder oedema, met at the Radiology and Emergencies Departments from the Faculty of Veterinary Medicine Iasi during the period march 2020 – may 2022. The clinical case presented was diagnosed and treated at the Center of Endoscopy and Minimally Invasive Surgery Bucharest.

The effect of a combined rehabilitation program on the temporomandibular joint in systemic sclerosis evaluated by ultrasound exam

PurposeTemporomandibular joint (TMJ) involvement is frequent in Systemic Sclerosis (SSc). Dysfunction and X-ray changes of TMJ were described only in few observational studies. Treatment as well has been seldom considered. Aim of the present study was to evaluate the effects on TMJ of two specifically designed physiotherapy protocols.MethodsThe study group included 26 SSc outpatients (22 females and 4 males with mean age ± SD 59.08 ± 10.31 years). Thirteen patients were randomly assigned to a treatment (protocol 1) including home exercises for TMJ and thirteen to a treatment (protocol 2) including home exercises and a combined procedure. The rehabilitation effects on the TMJ were evaluated by ultrasound examination (UE) in static and dynamic phases. UE was performed in all patients before and at the end of the treatment and after a follow up (8 weeks).ResultsBoth rehabilitation protocols induced a significant improvement (protocol 1: p < 0.01 and protocol 2: p < 0.005) of mouth opening with a long-lasting effect. Protocol 2 was more effective than protocol 1. A significant increase of bilateral condyle-head temporal bone distance was detected by UE at the end of both treatments. It was maintained at follow-up in patients treated with Protocol 2.ConclusionsThe present investigation shows that a rehabilitation program characterized by home exercises with a combined procedure is useful to recover the function of TMJ. The data also show that UE is helpful in the evaluation of TMJ in SSc and in the assessment of the efficacy of the rehabilitation programs.

Analysis of a twin pregnancy with false negative result for 22q11.2 deletion syndrome by expanded non-invasive prenatal testing

To explore the cause for a twin pregnancy with false negative result for 22q11.2 deletion syndrome by expanded non-invasive prenatal testing (NIPT-plus). A pregnant woman with twin pregnancy through in-vitro fertilization and negative result of NIPT-plus was selected as the study subject. Amniocentesis was conducted after ultrasonic finding of fetal abnormalities. In addition to conventional G-banded karyotyping, copy number variation sequencing (CNV-Seq) was used to detect chromosomal microdeletion and microduplication. Clinical data of the woman were analyzed to explore the reasons underlying the false negative result. NIPT-plus has yielded a negative result with 11.77 Mb unique reads and 3.05% fetal fraction. Both fetuses had a normal karyotype (46,XY and 46,XX). CNV-seq indicated that one of the fetuses was normal, whilst the other was diagnosed with a 2.58 Mb deletion in the 22q11.2 region. The false negative result may be attributed to the combined influence of low fetal fraction, high BMI, twin pregnancy through IVF and a relatively small deletion fragment. Ultrasonography exam following a low-risk result of NIPT-plus should not be neglected.

The Importance of Serial POCUS Exams – Dual Pathologies in Play

Serial point of care ultrasound (POCUS) exams are essential to assess acute pericardial effusions which can rapidly evolve into cardiac tamponade. A typical presentation includes dyspnea, tachycardia, and chest pain. Importantly, serial cardiac exams in such high-risk patients can detect other concurrent pathologies. We present an unusual case of a patient who initially presented with an acute circumferential pericardial effusion and upon serial POCUS exams developed an unexpected Takotsubo cardiomyopathy in the setting of cardiac tamponade.

Selection of Standards for Sonographic Fetal Femur Length by Use of z-scores.

This study aimed to evaluate which of four established norms should be used for sonographic assessment of fetal femur length (FL). Cross-sectional study using pooled data from four maternal-fetal medicine practices. Inclusion criteria were singleton fetus, gestational age (GA) 220/7 to 396/7 weeks, biometry measured, and fetal cardiac activity present. Four norms of FL were studied: Hadlock et al, the INTERGROWTH-21st Project (IG-21st), the World Health Organization Fetal Growth Curves (WHO), and the National Institutes of Child Health and Human Development Fetal Growth Studies, unified standard (NICHD-U). The fit of our FL measurements to each norm was assessed by these criteria: mean z-score close to 0, standard deviation (SD) of z close to 1, Kolmogorov-Smirnov D-statistic close to zero, Youden J-statistic close to 1, approximately 5% of exams <5th percentile, and approximately 5% of exams >95th percentile. In 26,177 ultrasound exams, our FL measurements had the best fit to the WHO standard (mean z-score 0.15, SD of z 1.02, D-statistic <0.01, J-statistic 0.95, 3.4% of exams <5th percentile, 7.0% of exams >95th percentile). The mean of the IG-21st standard was smaller than the other norms and smaller than our measurements, resulting in underdiagnosis of short FL. The mean of the Hadlock reference was larger than the other norms and larger than our measurements, resulting in overdiagnosis of short FL. The SD of the NICHD-U standard was larger than the other norms and larger than our observations, resulting in underdiagnosis of both short and long FL. Restricting the analysis to a subgroup of 7,144 low-risk patients without risk factors for large- or small-for- GA produced similar results. Of the norms studied, the WHO standard is likely best for diagnosis of abnormal FL. · There are >30 norms for fetal FL.. · It is unknown which norm should be used.. · Our data fit the World Health Organization standard better than the other norms..

The lateral approach water bath: A novel method of ultrasound imaging of the hand

BackgroundTraditional water baths for ultrasound exams place a hand into a pan of water and submerge an ultrasound probe into the water. While this improves ultrasound transmission and moves structures into the focal zone to make higher resolution images, this method does have limitations. Patients must be manipulated directly under the probe, which can be limited by pain or normal movement restrictions. The probe must also be held very still in water to minimize motion artifact. The lateral approach water bath method addresses such limitations by imaging through the side of a thin-walled plastic container without submerging the probe. This reduces much need for patient manipulation by imaging through the side of a column-shaped bath, which has 360 degrees of imaging freedom. It also stabilizes the probe directly against the flat, firm container to reduce image degrading motion artifact. We hypothesized that because of these improvements the lateral approach water bath might create higher quality images than traditional water baths. MethodsWe compared twenty images from each method, which were obtained with the same model and ultrasound operator at the same time. Two ultrasound fellowship trained blinded reviewers rated the images for quality and adequacy for clinical decision making on a scale from 1 to 5. ResultsImage quality was better for the lateral water bath, with an average rating of 4.2 compared to the traditional bath's 2.6 (p < 0.001). Adequacy to aid clinical decision making was better for the lateral approach bath with an average rating of 4.0 compared to the traditional bath's 2.6 (p < 0.001). The lateral bath also had a smaller range for image quality and thus greater consistency. ConclusionsThe lateral approach water bath is a method of hand imaging that produces higher quality, more consistent, and more clinically useful images than traditional water bath imaging.

Prophylactic treatment can modify vascular risk biomarkers in high-frequency episodic and chronic migraine patients: a pilot study

To evaluate whether preventive treatment can modify endothelial and oxidative biomarkers of vascular disease risk in patients with high-frequency episodic and chronic migraine. In this observational, prospective pilot study, 88 prophylactic treatment-naïve patients with episodic and chronic migraine and 56 healthy sex/age matched controls underwent ultrasonography exams and blood tests at baseline, and again in the migraine patients after 3 months’ treatment with metoprolol or topiramate. Biomarkers for endothelial function and oxidative stress were analyzed. At baseline, patients with migraine in the low-frequency episodic group had differences exclusively in nitrates 17.6 versus 27.33 µM; p = 0.046 compared to the controls. However, when comparing the group comprised of patients with high-frequency episodic migraine and chronic migraine versus controls, statistically significant differences appeared in hsCRP 2.68 versus 1.64 mg/dL; p = 0.049, vWF antigen (133% vs. 110%; p = 0.020, vWF activity (111% vs. 90%; p = 0.010) and isoprostane levels (181 vs. 238 µM; p = 0.05). Only in the chronic migraine subgroup did we found statistically significant differences in CIMT (0.60 vs. 0.54 mm; p = 0.042) which were significantly greater than in the controls. After treatment, patients who respond to preventive treatment exhibited significantly higher levels of nitrates (24.2–13.8 µM; p = 0.022) and nitrites (10.4–3.43 µM; p = 0.002) compared than non-responders. Moreover, biomarker levels improved in treatment-responsive patients with migraine; hsCRP levels decreased from 2.54 to 1.69 mg/dL (p < 0.05), vWF activity levels decreased from 124 to 103 IU/dL (p = 0.003) and prothrombin activity decreased from 1.01 to 0.93 (p = 0.01). These differences were also observed in the high-frequency and chronic migraine subgroup and reach statistical significance in the case of hsCRP, which decreased from 2.12 to 0.83 mg/dL (p = 0.048). Patients with migraines have differences in biomarker levels compared to controls, suggesting endothelial and oxidative dysfunction. The greatest differences in biomarker levels compared to controls are observed in migraine patients in the high-frequency and chronic migraine subgroups. Based on our results, preventive treatment is capable of modifying markers of endothelial dysfunction and oxidative stress in migraine patients, even in cases of chronic and high-frequency migraine.

Abstract 14117: Home Operated Ultrasound Exam for Detection of Worsening Heart Failure

Introduction: Acute Decompensated Heart Failure (ADHF) is associated with a high degree of morbidity and mortality. Dynamic lung ultrasound artifact called B-lines directly correlate with pulmonary vascular congestion (PVC) and can be seen on a limited lung ultrasound. Hypothesis: We assessed the ability of a recently hospitalized patient with ADHF to self-perform a lung ultrasound using a hand-held ultrasound and store images for physician interpretation. Methods: This was a prospective observational convenience sample of patients with known chronic heart failure admitted to an urban academic tertiary care center. The patient was educated on a 6 lung-zone image protocol, how to use the cloud archival system, and given a hand-held ultrasound transducer and iPad. The patients were asked to upload images three times a week, for 3 weeks. A B-line score for each interpretable lung zone was calculated. Results: Fifteen patients were enrolled, all of whom completed 7 or more scans. Average patient age was 60 years (range: 28- 86 years), 73% male, 60% white, and 47% obese. Five patients had ejection fraction &gt;50%, and average length of hospital stay was 6.3 days. Of the 792 potential images, 784 were obtained (99%) and 637 (81%) were interpretable. The right upper zone was most often interpretable (97%), whereas the left lateral zone was least (70%). Median patient B line score when indexed to 6 interpretable scans was 3.00. Indexed B line scores are shown for all 15 patients (Figure 1). Patient survey data identified the left lateral zone as the most challenging to obtain. Conclusions: This pilot study shows that patients with ADHF can be taught how to use a hand-held portable ultrasound device and obtain and upload lung ultrasound images to a cloud. Compliance with the study protocol was excellent. Further studies are needed to determine if patient-performed lung ultrasound can be useful to clinicians to detect and manage PVC in this patient population.

Aortic Steal Correlates with Acute Organ Dysfunction and Short-Term Outcomes in Neonates with Vein of Galen Malformation

Plain Language SummaryVein of Galen malformation is a rare, congenital intracerebral arteriovenous malformation with high morbidity and mortality in neonatal manifestation despite modern interdisciplinary strategies. Currently, there is no valid, noninvasive parameter for early prediction of clinical progression at the bedside. A typical finding of hemodynamically relevant vein of Galen malformation is flow reversal in the descending aorta (aortic steal). Therefore, we developed a new ultrasound method to quantify the percentage of reflux in the preductal aortic isthmus and integrated the measurement method into routine clinical practice. In this study, we retrospectively investigated the association between percentage of aortic steal, organ dysfunction parameters, mortality, and brain injury on magnetic resonance imaging (MRI) at baseline and follow-up in 12 neonates with vein of Galen malformation admitted between January 2021 and June 2022. Statistical analyses showed that the severity of organ dysfunction, mortality, and brain damage on MRI increased with increasing percentage of aortic steal. These correlations and associations showed a linear relationship between percentage reflux in the aortic isthmus and all outcome parameters. The potential of sonographically determined aortic steal to predict clinical progression and short- and long-term outcomes needs to be investigated in larger, prospective cohorts. If this marker proves as promising as the data from this study suggest, it could become an important diagnostic component for management and decision-making in critically ill neonates with vein of Galen malformation.

Gastrointestinal bleeding caused by a hidden gastrointestinal stromal tumor of the stomach

Gastrointestinal stromal tumors (GISTs) are the most common type of mesenchymal tumor of the gastrointestinal tract. This report presents a case of a large exophytic stomach GIST that was not visible at esophagogastroduodenoscopy (EGD). A 70-year-old female presented to the emergency room with presyncopal symptoms and a history of several episodes of melena. Blood tests revealed severe anemia. She underwent an EGD, which yielded negative results. Subsequently, she was hospitalized and scheduled for ileo-colonscopy and videocapsule enteroscopy (VCE). Abdominal ultrasound showed the presence of a mass in the epigastric region near the liver. Computed tomography (CT) scans confirmed the presence of a mass in the gastric wall that, at endoscopic ultrasound (EUS) exam and biopsy, was diagnosed as a tumor that originated from the muscular layer of the stomach. Surgery was performed to excise the tumor, and the diagnosis of GIST was confirmed by histomorphological and immunohistochemical findings. According to the postoperative assessment, the tumor was classified as high risk, for which the recommended treatment is imatinib.

Development of a novel observed structured clinical exam to assess clinical ultrasound proficiency in undergraduate medical education

ObjectivesA pilot study was performed to develop and test an observed structured clinical exam (OSCE) for clinical ultrasound in second-year medical students. The goal was to assess a longitudinal clinical ultrasound curriculum for medical students and to help determine readiness to perform ultrasound during clinical clerkships.MethodsThe OSCE contained 40 tasks over 30 min in a one-to-one examiner to examinee environment using standardized patients covering cardiac, pulmonary, and inferior vena cava (IVC) ultrasound exams along with 6 critical diagnoses. Examinees were assessed using a binary checklist approach. A two-way ANOVA analysis was performed to determine if there were differences between the day and session the OSCE was administered. Results are presented as mean ± standard deviation.ResultsOne hundred fifty-two students were tested with an overall mean score of 64.9 ± 17.6%. Scores between the cardiac, IVC, and lung sections varied—67.8% ± 18.8%, 62.4% ± 26.2%, and 57.1% ± 20.6%, respectively. One hundred twenty-six (82.9%) answered at least one critical diagnosis incorrectly. Students in the late session performed better than the early session (1: 60% vs 2: 69%, p = .001).ConclusionsStudents performed better in later sessions. Additionally, the number of questions left blank at the end of the exam suggests that the length of the OSCE should be evaluated. Incorporating critical diagnoses was challenging for examinees. The proposed OSCE is a valuable assessment tool that could be adapted to assess student’s readiness to use clinical ultrasound prior to clerkships.

Pregnancy and spontaneous cervical artery dissection: A propensity-matched retrospective cohort study

ObjectivesWe hypothesized that pregnant women would have an increased risk of spontaneous cervical artery dissection (sCeAD) affecting the carotid or vertebral arteries over one-year follow-up after the first trimester ultrasound compared to matched non-pregnant controls. Materials and MethodsWe queried a United States research network (TriNetX, Inc.) of de-identified medical records of >111 million patients, with data spanning 2008-2023. We included women aged ≥18 and excluded those with trauma and conditions potentially causative of sCeAD. Women were divided into cohorts based on a1 first trimester ultrasound and subsequent labor, delivery, or full-term pregnancy, or2 gynecological examination and no pregnancy. We used propensity matching to control for variables associated with sCeAD and calculated the risk ratio (RR) of sCeAD occurring over one-year follow-up from the index date of ultrasound or gynecological exam. ResultsAfter matching, the incidence rate of sCeAD in the pregnancy cohort was 8.0 (95% CI: 8.0-8.1) per 100,000 person-years, compared to 3.9 (95% CI: 3.9-3.9) per 100,000 person-years in the non-pregnancy cohort, yielding an RR (95% CI) of 2.06 (1.17-3.61; P= .0104). A cumulative incidence graph suggested that most cases of sCeAD in the pregnancy cohort occurred during pregnancy rather than the postpartum period. ConclusionsOur findings demonstrate that women have a twofold increased risk of sCeAD during pregnancy and the postpartum period compared to non-pregnant women. Further research is needed to determine whether maternal comorbidities such as preeclampsia account for these findings, and clarify when sCeAD occurs in relation to pregnancy or the postpartum period.

Obstructive jaundice as a rare complication of multiple pancreaticoduodenal artery aneurysms due to median arcuate ligament syndrome: a case report and review of the literature

BackgroundObstructive jaundice has various causes, and one of the rarest is pancreaticoduodenal artery aneurysm (PDAA), which is often associated with celiac axis stenosis caused by median arcuate ligament syndrome (MALS).Case presentationThe patient was a 77-year-old Azeri woman who presented with progressive jaundice, vague abdominal pain, and abdominal distension from 6 months ago. The intra- and extrahepatic bile ducts were dilated, the liver's margin was slightly irregular, and the echogenicity of the liver was mildly heterogeneous in the initial ultrasound exam. A huge cystic mass with peripheral calcification and compressive effect on the common bile duct (CBD) was also seen near the pancreatic head, which was connected to the superior mesenteric artery (SMA) and had internal turbulent blood flow on color Doppler ultrasound. According to the computed tomography angiography (CTA) findings, the huge mass of the pancreatic head was diagnosed as a true aneurysm of the pancreaticoduodenal artery caused by MALS. Two similar smaller aneurysms were also present at the huge aneurysm's superior margin. Due to impending rupture signs in the huge aneurysm, the severe compression effect of this aneurysm on CBD, and the patient's family will surgery was chosen for the patient to resect the aneurysms, but unfortunately, the patient died on the first day after the operation due to hemorrhagic shock.ConclusionIn unexpected obstructive jaundice due to a mass with vascular origin in the head of the pancreas, PDAA should be considered, and celiac trunk should be evaluated because the main reason for PDAA is celiac trunk stenosis or occlusion by atherosclerosis or MALS. The treatment method chosen (including transarterial embolization, open surgery, or combined method) depends on the patient's clinical status and radiological findings, but transarterial embolization would be safer and should be used as a first-line method.

Lingual thyroid ectopia

The lingual thyroid gland is an abnormal mass of ectopic thyroid tissue visible at the base of the tongue, caused by an embryological anomaly in the development of the thyroid gland. Identification and symptom-adapted treatment of ectopia are important in preventing hypothyroidism and development of obstructive symptoms. Purpose. To present a case of lingual ectopia of the thyroid gland in a child with an incidentally diagnosed formation of the root of the tongue based on primary ultrasound diagnosis. Material and methods. A 7-year-old boy without clinical signs of hypothyroidism during a routine examination revealed a voluminous asymptomatic formation of the root of the tongue. Results. Along the midline at the root of the tongue there is a rounded, non-displaced, painless formation about 20 mm in diameter. Regional lymph nodes are not enlarged. The picture of ectopic thyroid tissue in the root of the tongue, in the absence of thyroid in a typical site on the neck. There is subclinical hypothyroidism with a TSH level of 12.8 mсME/mL (normal 0.6–4.84). The presence of ectopia was confirmed by scintigraphy with Technetium-99m pertechnetate. Normal TSH level of 3.37 mcME/mL and a reduction in the volume of ectopic thyroid tissue from 3.3 mL to 2.13 ml revealed 3 months after levothyroxine therapy at a dose of 50 mcg/day. Conclusion. Ultrasound exam with Doppler mapping is mandatory and allows not only to identify ectopic tissue, but also to identify the absence of thyroid in a typical anatomical area on the neck. The study of the hormonal profile and subsequent scintigraphy make it possible to make a final diagnosis, assess the function of the ectopic organ and determine the option of drug and/or surgical treatment.

Iatrogenic hydronephrosis after ovariosalpingohysterectomy therapeutic correction

The ovariosalpingohysterectomy (OSH) is a relatively safe procedure. However, an iatrogenic is described to accidental ligature or traumatic of ureter, which could result to hydronephrosis, a disease due to superior urinary tract. The article has a objective to describe the case of a canine submitted to ureteroneocystostomy due to iatrogenic hydronephrosis after OSH. Was attend a canine, female, eight years old weighing 22kg, presenting urinary incontinence and nocturia. The patient underwent to a procedure of OSH five months ago, started to manifest symptoms of heat cycle after surgery. At the ultrasound exam found a remnant ovary syndrome and pyometritis in uterine colon, being subjected to a therapeutic approach OSH. Past some days, with new symptoms the ultrasonic exam has revealed a hydronephrosis of the right kidney and right hydroureter. The procedure was successfully done with no intercurrence. In spite of OSH has a very low casuistry of complications, when then occurs, the correct diagnosis due to right treatment is primordial to health and stabilization of the animal.

Retention Of A Focused Sports Musculoskeletal Ultrasound Exam In Physicians With Repeated Exposure

Retention Of A Focused Sports Musculoskeletal Ultrasound Exam In Physicians With Repeated Exposure

Diagnostic dilemma in a patient with history of medullary thyroid carcinoma and abnormal serum liver enzymes; a case report with six years follow up

BackgroundMedullary thyroid carcinoma (MTC) is a neuroendocrine tumor that originates from parafollicular C-cells. Calcitonin (Ctn) and carcinoembryonic antigen (CEA) are useful biomarkers for monitoring MTC cases.Case presentationHere, we describe a 48-year-old woman, who presented in 2014 with bilateral thyroid nodules. Report of fine needle aspiration was suspicious for MTC; initial laboratory evaluation showed serum Ctn level of 1567 pg/mL. After excluding type 2 multiple endocrine neoplasia syndrome clinically, total thyroidectomy and neck lymph node dissection were performed. The final histopathological diagnosis was right lobe MTC with neither vascular invasion nor lymph node involvement. On regular follow-up visits, Ctn and CEA levels have been undetectable, and repeated cervical ultrasonographic exams were unremarkable from 2014 to 2021. As liver enzymes became elevated in 2016, the patient was further evaluated by a gastroenterologist. Abdominopelvic ultrasonography revealed a coarse echo pattern of the liver parenchyma with normal bile ducts. A liver fibroscan showed a low fibrosis score (7kPa). The patient was recommended to use ursodeoxycholic acid. According to the progressive rise of liver enzymes with a cholestatic pattern in October 2020, a liver biopsy was performed that showed tiny nests of neuroendocrine-like cells with a background of primary biliary cholangitis (PBC). Immunohistochemical stainings were positive for chromogranin A (CgA), and synaptophysin and negative for Ctn, CEA, and thyroglobulin. Further imaging investigations did not reveal any site of a neuroendocrine tumor in the body. Considering normal physical exam, imaging findings, as well as normal serum levels of Ctn, CEA, CgA, and procalcitonin, the patient was managed as a PBC.ConclusionIn follow-up of a patient with MTC, we reported progressively increased liver enzymes with a cholestatic pattern. Liver biopsy revealed nests of neuroendocrine-like cells with a background of PBC, the findings that might suggest acquiring neuroendocrine phenotype by proliferating cholangiocytes.

Selection of Standards for Sonographic Fetal Head Circumference by Use of z-Scores.

This study aimed to evaluate which of five established norms should be used for sonographic assessment of fetal head circumference (HC). Cross-sectional study using pooled data from four maternal-fetal medicine practices. Inclusion criteria were singleton fetus, gestational age 220/7 to 396/7 weeks, biometry measured, and fetal cardiac activity present. Five norms of HC were studied: Jeanty et al, Hadlock et al, the INTERGROWTH-21st Project (IG-21st), the World Health Organization Fetal Growth Curves (WHO), and the National Institutes of Child Health and Human Development Fetal Growth Studies unified standard (NICHD-U). The fit of our HC measurements to each norm was assessed by these criteria: mean z-score close to 0, standard deviation (SD) of z close to 1, low Kolmogorov-Smirnov D-statistic, high Youden J-statistic, close to 10% of exams >90th percentile, close to 10% of exams <10th percentile, and close to 2.28% of exams >2 SD below the mean. In 23,565 ultrasound exams, our HC measurements had the best fit to the WHO standard (mean z-score 0.10, SD of z = 1.01, D-statistic <0.01, J-statistic 0.83-0.94). The SD of the Jeanty reference was much larger than all the other norms and our measurements, resulting in underdiagnosis of abnormal HC. The means of the IG-21st and NICHD-U standards were smaller than the other norms and our measurements, resulting in underdiagnosis of small HC. The means of the Hadlock reference were larger than all the other norms and our measurements, resulting in overdiagnosis of small HC. Restricting the analysis to a low-risk subgroup of 4,423 exams without risk factors for large- or small-for-gestational age produced similar results. The WHO standard is likely best for diagnosis of abnormal HC. The Jeanty (Chervenak) reference suggested by the Society for Maternal-Fetal Medicine had poor sensitivity for microcephaly screening. · There are >30 norms for fetal HC.. · It is unknown which norm should be used.. · The WHO standard fits our data best.. · The Chervenak reference is not sensitive for microcephaly..

Evaluation of the incorporation of an IOTA-ADNEX model in the discrimination of adnexal masses in our third-level hospital centre, taking into account the menopausal status of patients. Five years of experience

ObjectiveThe objectives were to estimate the performance of the IOTA-ADNEX model test after its incorporation into the ultrasound tests of our third-grade hospital gynecology service, as well as to assess whether its capacity of accuracy is modified when taking into account the patient's menopausal status. MethodsA cross-sectional study was conducted to clinically evaluate the diagnostic performance of the IOTA-ADNEX model test, which was performed between January 2016 and December 2021. The study included 573 women with an adnexal injury who underwent surgical excision within 180 days after ultrasound diagnosis and histological confirmation (gold standard). After the ultrasound exam, the injuries were classified using the ADNEX model. The study estimated the area under the receiver-operating-characteristics curve (AUC) of the ADNEX model for classifying between benign and malignant adnexal masses and compared the performance by menopausal state. Sensitivity and specificity were determined for different cut-off points. ResultsOut of the 573 women, 183 (31.9%) had a malignant tumor. The AUC of the ADNEX model for differentiating between benign and malignant adnexal masses at the time of ultrasound examination was 0.92 and the best malignancy threshold, detected by Youden index, was 22.5%. At this cut-off, the sensitivity of the ADNEX model was 91.8% and the specificity was 76.4%. However, it varies according to menopausal status: in the group of pre-menopausal patient, sensitivity was 86.1% (95% CI, 85.4%–86.8%) and specificity was 81.3% (95% CI, 85.4%–86.8%). In the postmenopausal group, sensitivity was 96.1% (95% CI, 95.6%–96.7%) and specificity was 68.5% (95% CI, 68.1%–68.8%). ConclusionsThe IOTA-ADNEX model is a reliable diagnostic tool to discard ovarian cancer. However, the accuracy of the test, at the same cut-off point, varies according to the menopausal state of the patient so it may be important to take it into account when taking decisions in clinical practice.

IVF Stimulation - personalized, optimized, and simplified using an advanced decision-support tool: A randomized trial

We assessed the effectiveness of a clinical decision support tool to reduce total cumulative follicle-stimulating hormone dosage used, to eliminate the need for ultrasound exams after day 5 of an individual superovulation cycle, and to improve the number of high-quality embryos obtained. The design we used was a Randomized Control Trial in a private fertility center. This study included 93 women aged 25–45 years undergoing IVF. 48 Test and 45 Control participants included normal and poor responders and patients with polycystic ovarian syndrome. A clinical decision support tool was used to forecast stimulatory hormone dosing for an individual cycle based on follicle size distribution on day 1 and day 5. Cumulative stimulatory hormone doses, oocytes retrieved, number of Mii oocytes, total embryos, high-quality embryos obtained during the cycle, and clinical pregnancy rates was the main outcome measures. Test participants required significantly lower cumulative FSH doses during superovulation cycles (average 1883 IU test, 2530 IU control, p &lt;0.01), with significantly higher numbers of total embryos (average 5.4 test, 3.5 control, p&lt;0.01), and high-quality embryos (average 3.1 test, 1.2 control, p&lt;0.01). Test participants had higher Mii follicles, although the difference was not statistically significant. The clinical pregnancy rate reported was significantly higher for test participants than control participants (52% test, 26% control, p&lt;0.05). The test group had more poor responders and PCOS patients than the control group. In conclusion, the clinical decision support tool eliminated the need for ultrasound exams after day 5, reduced the doses of stimulatory hormone required, yielded significantly higher numbers of high-quality embryos, and resulted in higher clinical pregnancy rates.