Ultrasound Interpretation Research Articles

The accuracy of ultrasound evaluation of amniotic fluid volume in singleton pregnancies: The effect of operator experience and ultrasound interpretative technique

The objective of this study was to evaluate the effect of operator experience and ultrasound interpretation technique on the accuracy of ultrasound estimates of amniotic fluid volume. Ultrasound evaluation was carried out by an obstetric resident, a nurse sonographer, a maternal-fetal medicine fellow, and a maternal-fetal medicine staff member to subjectively estimate (visual interpretation without sonographic measurements) amniotic fluid volume in 63 pregnancies. Amniotic fluid volume was also evaluated using ultrasound measurements based on the largest vertical pocket technique, the amniotic fluid index, and the two-diameter pocket method. The accuracy of these ultrasound estimates was assessed by comparing the ultrasound results to actual amniotic fluid volume as determined by a dye-dilution technique. For analysis, amniotic fluid volumes were classified as oligohydramnios, normal, or hydramnios using established volumetric criteria for singleton pregnancies. Subjective estimates ranged from 65% to 70% correct and did not differ by operator experience except for the more accurate diagnosis of hydramnios by the maternal-fetal medicine staff. The three sonographic measurements were similar in overall accuracy (59–67%). The two-diameter pocket method was, however, significantly more accurate in identifying oligohydramnios. It appears that neither operator experience nor sonographic technique greatly affects the accuracy of ultrasound estimates of amniotic fluid volume. © 1997 John Wiley & Sons, Inc. J Clin Ultrasound 25:249–253, 1997

Clinical Correlation of Ultrasonographic Findings in Macular Holes

Purpose Theoretically, idiopathic macular holes develop because of tangential vitreous traction on the fovea. The purpose of this study was to demonstrate ultrasonographically the vitreomacular relationships in a series of 44 consecutive patients with macular holes and to correlate the ultrasonographic findings with the clinical and intraoperative findings of these patients. Methods I examined 47 eyes with a macular holes by using contact lens biomicroscopy and clinically staged the macular hole and the status of the vitreous. A kinetic B-scan ultrasonographic examination of the vitreomacular relationships was performed in each study eye and in the fellow eye by using a contact method, with topical anesthesia. Results The clinical stage of macular hole in 47 eyes of 44 patients included eight holes in stage 1, five in stage 2, 22 in stage 3, and 12 in stage 4. The vitreous was attached to the macular region by ultrasound interpretation in seven of eight stage 1 holes, two of five stage 2 holes, 21 of 22 stage 3 holes, and zero of 12 stage 4 holes. The correlation between the clinical status of the vitreous and the ultrasonographic findings was high (94%). The status of the vitreous by ultrasound was confirmed intraoperatively in all 14 patients undergoing subsequent surgery. Conclusions Ultrasonographic examination of the vitreomacular relationships provides an accurate assessment of vitreomacular attachment or detachment. The ultrasonographic findings in these 47 eyes with macular holes support the vitreomacular traction theory of macular holes.

Clinical Correlation of Ultrasonographic Findings in Macular Holes

Theoretically, idiopathic macular holes develop because of tangential vitreous traction on the fovea. The purpose of this study was to demonstrate ultrasonographically the vitreomacular relationships in a series of 44 consecutive patients with macular holes and to correlate the ultrasonographic findings with the clinical and intraoperative findings of these patients. I examined 47 eyes with a macular holes by using contact lens biomicroscopy and clinically staged the macular hole and the status of the vitreous. A kinetic B-scan ultrasonographic examination of the vitreomacular relationships was performed in each study eye and in the fellow eye by using a contact method, with topical anesthesia. The clinical stage of macular hole in 47 eyes of 44 patients included eight holes in stage 1, five in stage 2, 22 in stage 3, and 12 in stage 4. The vitreous was attached to the macular region by ultrasound interpretation in seven of eight stage 1 holes, two of five stage 2 holes, 21 of 22 stage 3 holes, and zero of 12 stage 4 holes. The correlation between the clinical status of the vitreous and the ultrasonographic findings was high (94%). The status of the vitreous by ultrasound was confirmed intraoperatively in all 14 patients undergoing subsequent surgery. Ultrasonographic examination of the vitreomacular relationships provides an accurate assessment of vitreomacular attachment or detachment. The ultrasonographic findings in these 47 eyes with macular holes support the vitreomacular traction theory of macular holes.

Sonographic Evaluation of Solid Breast Masses

Recent developments in ultrasound technology and interpretation suggest that sonographers may be able to distinguish between benign and malignant breast masses more accurately than was previously believed possible. This article reviews and illustrates the sonographic signs that suggest benign and malignant disease, and discusses the accuracy and limitations of the method.

Histopathologic validation of angioscopy and intravascular ultrasound.

To establish a histopathologic basis for angioscopic and ultrasound image interpretation we studied 70 postmortem human arterial segments in vitro. We used 7- to 9-French fiber-optic angioscopes and 20- to 30-MHz intravascular ultrasound imaging catheters. Three observers assigned an angioscopic and ultrasound image classification to each vessel segment. The image and histological classification categories were then compared. The sensitivity, specificity, and accuracy of both methods separately or in combination for normal vessels were each greater than or equal to 95%. The predictive value was better for angioscopy than for ultrasound due to incorrect ultrasound interpretations of normal anatomy in the presence of thrombus. For stable atheroma the sensitivity, specificity, and accuracy of the individual methods were each greater than 90%. However, both angioscopy and ultrasound had classification errors in that disrupted atheroma was identified and classified as stable atheroma. Consequently, the predictive value was 74% for angioscopy and 78% for ultrasound. For disrupted atheroma the sensitivities for angioscopy and ultrasound were only moderate (73% and 81%, respectively), whereas the specificity, accuracy, and predictive value were each high (greater than 90%). For thrombus detection, the specificity, accuracy, and predictive value were high (greater than 93%) for each method. The sensitivity of angioscopy was 100%. However, sensitivity was lower for ultrasound (57%) due to false-negative interpretation of laminar clots in normal vessels and an inability to distinguish disrupted or stable atheroma from intraluminal thrombus. Contingency analyses showed that each imaging method alone or combined had significant agreement with the results obtained from histology (p less than 0.001). When assessing all cases in which angioscopy and ultrasound were concordant, there was a 92% agreement with the histological classification.

Detection of retained products of conception following spontaneous abortion in the first trimester.

A retrospective analysis was performed to determine whether ultrasound could reliably rule in or out retained products of conception (POC) in women after first-trimester spontaneous abortions (miscarriages). Ninety-seven first-trimester pregnancies with pathologically proven results from dilatation and curettage (D&C) were studied within 7 days of ultrasound examination (60% within 2 days), either by the abdominal or a combination of abdominal and vaginal approaches. Cases were eliminated if there was clinical evidence of a spontaneous evacuation of POC during the interval between the ultrasound and the D&C. POC were diagnosed only if chorionic villi were evident pathologically. The pertinent ultrasound findings were related to the endometrium (thickness, echogenicity, a gestational saclike structure or a space-occupying collection). The results indicated that ultrasound could correctly diagnose POC in all of the cases by detecting a gestational sac or collection (77 cases), or a thickened endometrium of greater than 5 mm (6 cases). Ultrasound was less reliable in ruling out retained POC. When only a thin endometrial stripe of less than 2 mm was present, there was little likelihood of having POC (1 of 7 cases) with a moderately thick endometrium of 2 to 5 mm not diagnostic. Vaginal ultrasound added little new information and failed to change the ultrasound interpretation.

Medical Diagnostic Ultrasound Instrumentation and Clinical Interpretation

Medical Diagnostic Ultrasound Instrumentation and Clinical Interpretation

Medical diagnostic ultrasound instrumentation and clinical interpretation. Report of the ultrasonography task force. Council on Scientific Affairs

Over the past 20 years, there has been a dramatic increase in the use of ultrasonography as an imaging modality. The introduction of real-time ultrasonography and Doppler units for the measurement of blood flow in the 1970s, recent advances in transducer design, signal processing, and miniaturization of electronics, along with the lack of radiation exposure, have been primarily responsible for the increased use of ultrasound. However, although ultrasonography can provide diagnostic information safely and easily, interpretation of the information requires an understanding of the physics behind ultrasound, how that physics is translated into ultrasound instrumentation, recognition of artifacts that are associated with the various types of ultrasonography, and identification of these artifacts in specific anatomic locations.

Comparison of Serum CA 125, Clinical Impression, and Ultrasound in the Preoperative Evaluation of Ovarian Masses

The ability to differentiate a malignant from a benign ovarian mass was assessed for four diagnostic procedures: serum CA 125, clinical examination, original ultrasound, and reviewer ultrasound interpretation. When these tests were used individually, the sensitivity and specificity of CA 125 levels were equal to those of a review ultrasound. Overall, the sensitivity of clinical impression and original ultrasound was poor. Sensitivity and specificity were highest for CA 125 assays in postmenopausal patients, especially when these were used as the second diagnostic test. Positive and negative predictive values significantly increased among postmenopausal patients when CA 125 was added to any of the other diagnostic tests examined. In conjunction with such tests, measurement of serum CA 125 significantly increased diagnostic accuracy and may thus have an important role in the preoperative evaluation of women with ovarian masses.

Imaging in Chronic Sinusitis: Disparity between Radiographic and Ultrasound Interpretation

Conventional radiographs of the paranasal sinuses were interpreted by two observers and were compared to A-mode ultrasound scans in 100 consecutive patients with classical symptoms of chronic sinusitis. Of the maxillary sinus radiographs 65% were reported as normal by one radiologist. There was poor agreeement between the observers in interpretation of the radiographs and both observers’ interpretations correlated poorly with ultrasound scans. Compared to radiographs, ultrasound had a sensitivity of 31% and specificity of 63% in detecting abnormalities. We suggest that positive imaging tests in chronic sinusitis may not truly reflect the incidence of a pathologic condition and that comparison of images with other parameters (e.g., response to treatment) is needed to ascertain the role of the images in chronic sinusitis.

465 Disparity between radiographic and ultrasound interpretation in chronic sinusitis(CS)

465 Disparity between radiographic and ultrasound interpretation in chronic sinusitis(CS)

Interobserver variability in neonatal cranial ultrasonography.

The reliability of cranial ultrasound diagnosis in the premature neonate was examined using data from an ongoing multicentre study of the epidemiology and long-term consequences of neonatal brain haemorrhage. First week ultrasound films (obtained at 4 hours, 24 hours and 7 days) from 60 study subjects were randomly selected for independent review by two groups of experienced interpreters, and results were recorded separately for observations (i.e. presence or absence of an abnormal echodense area on a film) and interpretations (i.e. presence or absence of haemorrhage or ventricular dilatation) in each hemisphere. Because of deaths in the first week of life, the total number of films examined was 138. Concordance on the presence or absence of an abnormal echodensity was examined for each individual film for three areas of interest: the germinal matrix, the ventricles and the parenchyma. Concordance on the presence or absence of haemorrhage or ventricular dilatation was examined only for the seventh-day film, or the final film prior to death. Finally, concordance was analysed with the diagnostic interpretations grouped into categories thought to differ prognostically for long-term outcome. In general, concordance was poorest for germinal matrix lesions and best for parenchymal lesions. Concordance was lower for observations made on each individual film than it was for interpretation of the final film in each case. Fifty-five of 60 cases (92%) were assigned to the same major prognostic category by both readers. Ultrasound review conferences were held periodically and there was evidence that concordance in ultrasound reading and interpretation improved during the course of the study.

Ultrasound investigation of the posterior fossa in the fetus.

One hundred and thirty normal pregnancies, ranging in gestational age from 15 to 40 weeks, were investigated to evaluate the capability of ultrasound to demonstrate the anatomy of the fetal posterior fossa. The cerebellum, including the cerebellar hemispheres, the superior and inferior vermis, the fourth ventricle, and the cisterna magna could be demonstrated easily. The ultrasound interpretation of the brain structures was verified by the anatomic dissection of the brains of 10 stillborn premature infants. A systematic approach to the prenatal ultrasound examination of the posterior fossa is described.

Uses of Ultrasound in Equine Internal Medicine

Ultrasound examination allows the diagnostician to examine peripheral soft tissues and many internal organs in a noninvasive manner. In most instances, ultrasound can be utilized to complement other diagnostic aids, but its increased use has revealed the unique advantages of this technique over more established diagnostic tools. The ease with which ultrasound interpretation can be learned and the increased availability of instruments make this approach to diagnosis a valuable asset in the diagnosis of many equine medical diseases.

Pelvic ultrasonography and the management of gestational trophoblastic disease

Pelvic ultrasonography was performed in 33 patients with persistent gestational trophoblastic disease (GTD) and the sonographic findings were compared in all patients with laparoscopic findings and histologic material from endometrial curettage and/or hysterectomy. Ultrasonography indicated trophoblastic uterine involvement in 17 patients (51.5%) and the ultrasound interpretation was histologically confirmed in all 17 patients by endometrial curettage and/or hysterectomy. Among the 16 patients in whom the uterus appeared normal by ultrasound, endometrial curettings demonstrated scanty fragments of trophoblastic tumor in 6 patients (37.5%). Furthermore, in all 16 patients in whom the uterus appeared normal by ultrasound, laparoscopy also revealed no uterine abnormalities. Ultrasonography appears to be accurate in detecting extensive trophoblastic uterine involvement and helpful in identifying resistant uterine foci. Pelvic ultrasonography should be an integral part of the pretreatment assessment of patients with persistent GTD.