Ultrasound Scan Imaging Research Articles

Inflammatory Myofibroblastic Tumour of the Submandibular Gland

A 77-year-old man presented with a two-month history of a left sided, firm, and non-tender submandibular mass. The patient was systemically well with no history of weight loss or night sweats. On examination, there were no oropharyngeal abnormalities and flexible nasendoscopy was normal. An ultrasound scan and magnetic resonance imaging (MRI) confirmed a 2.8 x 2.4 x 4.3cm irregular mass in level I of the neck with a chain of small lymph nodes. Following inconclusive fine needle aspirations (FNA) and a core biopsy, an excision of the submandibular gland was performed. The pathology revealed an inflammatory myofibroblastic tumour (IMT) of the submandibular gland. To complete treatment a selective neck dissection and post-operative radiotherapy was performed. IMTs are rare, poorly understood tumours that can occur anywhere in the body. The incidence in the head and neck regions accounts for a small number of all cases. We present a rare case of IMT in the submandibular gland.

Ultrasound imaging for measuring muscle and subcutaneous fat tissue thickness of the anterior thigh: A two-year longitudinal study in middle age

Background Ultrasound (US) imaging technique is widely used in research and clinical settings to assess the morphology and morphometry of neuromusculoskeletal structures. The technique has reported validity and reliability in measuring the size of various muscles under controlled conditions. The aim of the present study was to assess anterior thigh thickness using US imaging, in a healthy cohort of middle-aged older adults.Methods Participants included seventeen healthy older adults involved in regular moderate-vigorous activities (age range 39-66 years). US imaging scans of the anterior thighs two years since baseline measurements were performed. Images were analyzed off-line to compare US imaging measurements of muscle thickness and subcutaneous fat (SF) of the anterior thigh taken at baseline and after two years.Results There was no significant difference between muscle thickness measurements taken at baseline and after two years (Mean, standard deviation; baseline=2.80±0.71cm; follow-up=2.77±0.72cm, p=0.33). There was also no significant change in SF thickness (baseline=1.04±0.41cm; follow-up=1.06±0.40, p=0.33).Conclusions The results show there was no decline in anterior thigh muscle thickness or increase in SF in the healthy cohort studied using US imaging over a two-year period. These findings demonstrate the robustness of US imaging measurements over time.

Thermo-Mechanical Reliability of 1200V-450A IGBT Module Considering Voids in the Solder Layer

1200V-450A IGBT power modules are fabricated in this paper. We study both the steady state and transient thermal performance of the IGBT assemblies by the finite element method using commercial software ANSYS Workbench to better understand the characteristic. Furthermore, power cycling tests indicate that inelastic strain increase as the numbers of cycles increase. In addition, X-ray photographs and ultrasound scan images were compared before and after the experiment. The thrust force of bonding wires decrease with increasing numbers of cycles, as indicated by tested.

A novel approach to neuraxial anesthesia: application of an automated ultrasound spinal landmark identification

BackgroundNeuraxial procedures are commonly performed for therapeutic and diagnostic indications. Currently, they are typically performed via palpation-guided surface landmark. We devised a novel intelligent image processing system that identifies spinal landmarks using ultrasound images. Our primary aim was to evaluate the first attempt success rate of spinal anesthesia using landmarks obtained from the automated spinal landmark identification technique.MethodsIn this prospective cohort study, we recruited 100 patients who required spinal anesthesia for surgical procedures. The video from ultrasound scan image of the L3/4 interspinous space in the longitudinal view and the posterior complex in the transverse view were recorded. The demographic and clinical characteristics were collected and analyzed based on the success rates of the spinal insertion.ResultsSuccess rate (95%CI) for dural puncture at first attempt was 92.0% (85.0–95.9%). Median time to detection of posterior complex was 45.0 [IQR: 21.9, 77.3] secs. There is good correlation observed between the program-recorded depth and the clinician-measured depth to the posterior complex (r = 0.94).ConclusionsThe high success rate and short time taken to obtain the surface landmark with this novel automated ultrasound guided technique could be useful to clinicians to utilise ultrasound guided neuraxial techniques with confidence to identify the anatomical landmarks on the ultrasound scans. Future research would be to define the use in more complex patients during the administration of neuraxial blocks.Trial registrationThis study was retrospectively registered on clinicaltrials.gov registry (NCT03535155) on 24 May 2018.

SAT-104 Reversal of Nonalcoholic Fatty Liver Disease with Bariatric Surgery in South Asians: Has the Cure Been Finally Found? Real World Data From a Sri Lankan Tertiary Care Setting

Nonalcoholic fatty liver disease (NAFLD) ranges from non-progressive simple steatosis to progressive nonalcoholic steatohepatitis and can eventually progress to cirrhosis and even be complicated with hepatocellular carcinoma. The prevalence of NAFLD is alarming and is approximately 65-85% among obese individuals. In the United States, NAFLD is the commonest cause of chronic liver cell disease and it is predicted to become the most common indication for liver transplantation within the next 5 years. Unfortunately NAFLD has limited treatment options with generally suboptimal results. Although bariatric surgery has been found to have impressive rates of reversal of NAFLD in Caucasians, there is limited data on its effects among South Asians. In this study we aimed to find the effect of bariatric surgery on reversal of NAFLD among obese Sri Lankan patients. We did a retrospective analysis of medical records of 170 obese patients who underwent bariatric surgery at the Colombo South Teaching Hospital, Sri Lanka. Out of the patients 74.1% (n = 126) were females. The mean age was 38.1 ± 10.4 years. The mean pre-operative body weight and body mass index were 115.0 ± 23.0 kg and 45.1 ± 6.8 kg/m2 respectively. Laparoscopic sleeve gastrectomy was the commonest type of bariatric surgery (69.5%) performed, followed by laparoscopic mini gastric bypass (24.1%) and laparoscopic Roux-en-Y gastric bypass (4.9%). One patient underwent open sleeve gastrectomy. NAFLD was detected in 88.7% pre-operatively, according to ultrasound scan (USS) imaging (grade 1 fatty liver 29.8%, grade 2 fatty liver 58.9%). On USS imaging at 6 months after the procedure, the prevalence of fatty liver reduced to 29.4% (grade 1 fatty liver 19.6%, grade 2 fatty liver 9.8%). The pre-operative mean AST and ALT values showed a significant reduction at 6 months after the procedure (30.4 ±18.6 U/L vs 22.1 ±8.9 U/L, p<0.005 and 39.1 ±28.3 U/L vs 19.8 ±9.6 U/L, p< 0.001) as compared to baseline. The percentage of patients who had AST or ALT elevation, showed significant reduction at 6 months postoperatively as compared to baseline (35.2% vs 6.9%, p<0.01). In conclusion, bariatric surgery fully reversed NAFLD in 68.1% (p<0.001) and reduced the grade of NAFLD in 87.2% (p<0.001) of patients according to USS imaging. It significantly reduced baseline AST and ALT values by 27.3% and 49.3% respectively at 6 months post procedure. Thus bariatric surgery shows impressive levels of complete reversal and downgrading of NAFLD biochemically as well as ultrasonically in Sri Lankan patients with comparable efficacy to studies done in Caucasian populations. Bariatric surgery should be considered as a potential therapeutic option in obese South Asian patients with NAFLD, especially when it is of a higher grade.

SAT-111 Reversal of Nonalcoholic Fatty Liver Disease with Bariatric Surgery in South Asians: Does the Type of Surgery Matter?

Nonalcoholic fatty liver disease (NAFLD) is a common complication of obesity with prevalence rates of 65 - 85% in obese individuals. It can be associated liver cell injury eventually leading to cirrhosis. Weight loss is the primary modality of treatment of NAFLD which can be difficult to achieve and maintain in a majority of patients. Bariatric surgery has been shown to reverse NAFLD but the type of bariatric surgery that is most effective, especially in South Asian patients is not clear. In this study we aimed to compare the effectiveness of laparoscopic sleeve gastrectomy (LSG) versus laparoscopic mini gastric bypass (LMGB) in reversing NAFLD in obese Sri Lankans. We did a retrospective analysis of medical records of 155 obese patients who underwent LSG and LMBG at Colombo South Teaching Hospital, Sri Lanka. Overall 114 (73.5%) and 41 (26.5%) patients underwent LSG and LMBG respectively. Among patients who underwent LSG and LMGB, there was no statistically significant difference in the baseline body weight (112.5 ± 19.5 vs 120.2 ± 29.4 kg), BMI (44.7 ± 6.1 vs 45.9 ± 8.0 kg/m2), waist circumference (WC) (female: 118.9 ± 11.2 cm vs 117.9 ± 9.0 cm, male: 125.5 ±14.7 cm vs 130.7 ±15.9 cm) and body fat percentage (BFP) (female: 45.9 ± 3.1% vs 43.1 ± 9.5%, male: 40.9 ± 6.8% vs 39.4 ± 1.6%). There was no significant difference between patients who underwent LSG and LMBG, in decrease in weight (24.7 ±7.1 kg vs 32.6 ±14.7 kg, p=0.12) and decrease in BMI (10.0 ±2.9 kg/m2 vs 12.0 ±4.2 kg/m2, p=0.08) at 6 months post-procedure as compared to baseline, although LMBG showed a trend towards greater benefit. There was no statistically significant difference in the decrease in WC (19.0 ±9.9 cm vs 20.8 ±5.8) and decrease in BFP (7.4% ±5.8 vs 10.8% ±5.6). Overall 88.4% of patients had NAFLD by ultrasound scan (USS) imaging criteria. Patients with LSG and LMBG did not show a significant difference in baseline AST (31.8 ±21.1 vs 26.8 ±11.6 U/L, p>0.05) and ALT (41.1 ±30.3 vs 35.8 ±25.7, p>0.05). At 6 months post procedure, AST (21.6 ±8.1 vs 25.0 ±13.9 U/L, p=0.32) and ALT (19.1 ±9.4 vs 26.9 ±11.0 U/L, p<0.05) levels were lower in patients with LSG than patients with LMBG, although only ALT values reached statistical significance. Thus LSG showed a greater degree of AST (32.1% vs 6.7%, p<0.05) and ALT (53.5% vs 24.9%, p=0.001) reduction compared to LMBG. At 6 months post-procedure, patients who underwent LSG had less patients with elevated AST (4.4% vs 11.1%) and ALT (4.4% vs 12.5%) as compared to LMBG. Overall LSG showed a higher rate of complete reversal of NAFLD (75.0% vs 44.4%) and improvement of the grade of NAFLD (91.7% vs 66.7%) on USS imaging when compared with LMBG. In conclusion, our study reveal that LSG has a more favorable effect on complete reversal and improvement of NAFLD when compared with LMBG. This effect seems to be independent of weight loss. Thus LSG should be considered ahead of LMBG when bariatric surgery is planned for obese patients with NAFLD.

Evaluation of bladder shape using transabdominal ultrasound: Feasibility of a novel approach for the detection of involuntary detrusor contractions.

Conventional assessment of overactive bladder syndrome uses invasive pressure-measuring catheters to detect bladder contractions (urodynamics). We hypothesised that bladder shape changes detected and measured using transabdominal ultrasound scan could provide a non-invasive and clinically useful alternative investigation of bladder contractions. This feasibility study evaluated a novel transabdominal ultrasound scan bladder shape test during conventional urodynamics and physiological bladder filling. The aim was to initially evaluate and refine a non-invasive approach for detecting and quantifying bladder shape changes associated with involuntary bladder contractions. To develop measurement techniques and characterise bladder shape changes during bladder filling, healthy female volunteers (n=20) and women with overactive bladder symptoms who had previously undergone urodynamics (n=30) completed symptom questionnaires and bladder diaries. The bladder shape test protocol included consumption of 1 l water before undergoing serial transabdominal ultrasound scan imaging of the bladder during physiological bladder filling and during episodes of urgency. In a further group of women with overactive bladder (n=22), serial transabdominal ultrasound scan images were captured during urodynamics so that shape changes occurring with bladder contractions could be characterised. In both healthy volunteers and women with overactive bladder, the transverse view of the bladder provided the most reliable plane to characterise and measure bladder shape changes. A sphericity index derived from the ratio between maximum inscribed and minimum circumscribed ellipses (πac2(inner)/πac2(outer)) offered a reliable and reproducible measurement system. Of participants undergoing transabdominal ultrasound scan during urodynamics, there were significant measurable differences in sphericity index between patients with bladder contractions (n=12) and patients with acontractile bladders (p < 0.001). Bladder shape changes detected during physiological filling and urodynamics have provided preliminary evidence to support further research into bladder shape test as a non-invasive diagnostic tool to identify involuntary bladder contractions in patients with overactive bladder syndrome.

Tarsal tunnel syndrome: Anatomical facts and clinical implications

Introduction: Tarsal tunnel syndrome (TTS) associates with the posterior tibial nerve (PTN) entrapment at the medial side of the ankle. TTS is a major cause of heel pain. The diagnosis and treatments have several techniques. For accurate diagnosis and effective treatment, the surgeons need to have detailed anatomical knowledge of the arrangement of PTN. The aim of this present study is to describe anatomical aspects and TTS including its etiology, diagnosis, and treatments. Material and Methods: This literature review was done by searching the data from the following databases such as PubMed, Google Scholar, Springer, Elsevier (ScienceDirect), and book chapter. Results: This literature review showed anatomical variations of the PTN and its branches that used the malleolar-calcaneal axis for measurement of branching point. Moreover, these studies showed the origin and the number of branches. The diagnosis of TTS can be used numerous techniques such as neurophysiology, electromyography (EMG), ultrasound scanning (US), and magnetic resonance imaging. The treatment for TTS includes conservative approach, open surgery, and endoscopic procedures. Discussion and Conclusion: The anatomical knowledge of the neurovascular structures at the medial side of the ankle is not only considered for diagnostic purposes but also it ensures safe and effective operative procedures. This literature review will be beneficial for academics and clinicians.

Creation of Functional Neo-vagina in Vaginal Atresia

Vaginal atresia is one of the common congenital anomalies of the female lower genital tract due to incomplete canalization of Mullerian ducts. It mostly presents as primary amenorrhoea with attacks of severe lower abdominal pain at monthly interval in presence of appropriate Tanner staging secondary sex characteristics. It is diagnosed by clinical presentation, examination and imaging, usually Ultrasound scan and Magnetic Resonance Imaging. There are conservative non-surgical as well as surgical methods to correct it. A 13 years pubertal girl presented at Kathmandu Model Hospital with complaints of cyclic severe lower abdominal pain since one year with presence of appropriate secondary sexual characteristics. Ultrasound showed features suggestive of hematometra. She underwent drainage of hematocolpos with neo-vaginoplasty followed by intravaginal mould placement. She also underwent dilatation of neovagina thrice under IVA to maintain the vaginal length and function. We present here a case of isolated vaginal atresia, who underwent Mc Indoe Vaginoplasty followed by serial dilatation.

Modifying the physical process of ultrasound tomography scanning through compressive sensing

Latest research papers on ultrasound tomography feature a new way of performing the scanning procedure that is similar to computed tomography. The underlying work of computed tomography consists of scanning thin slices with a rotating narrow X-ray beam. Usually, one needs a large number of projections for many different angles to reconstruct an image. In this work, we consider the application of the compressive sensing framework together with randomization to arrange an economy representation of the ultrasound diagnostics data without essential loss of performance. Using this approach, we will be able to randomly select the angles of scanning instead of obtaining all possible projections. We start with a brief overview of ultrasound tomography techniques, after that we formulate the problem of our interest, and provide the appropriate decision with results of preliminary computer simulations.

Quality control of ultrasound for fetal biometry: results from the INTERGROWTH-21st Project.

To assess a comprehensive package of ultrasound quality control in the Fetal Growth Longitudinal Study of the INTERGROWTH-21st Project, a large multicenter study of fetal growth. Quality control (QC) measures were performed for 20 313 ultrasound scan images obtained prospectively from 4321 fetuses at 14-41 weeks' gestation in eight geographical locations. At the time of each ultrasound examination, three fetal biometric variables (head circumference (HC), abdominal circumference (AC) and femur length (FL)) were measured in triplicate on separately generated images. All measurements were taken in a blinded fashion. QC had two elements: (1) qualitative QC: visual assessment by sonographers at each study site of their images based on specific criteria, with 10% of images being re-assessed at the Oxford-based Ultrasound Quality Unit (compared using an adjusted kappa statistic); and (2) quantitative QC: assessment of measurement data by comparing the first, second and third measurements (intraobserver variability), remeasurement of caliper replacement in 10% (interobserver variability), both by Bland-Altman plots and plotting frequency histograms of the SD of triplicate measurements and assessing how many were above or below 2 SD of the expected distribution. The system allowed the sonographers' performances to be monitored regularly. A high level of agreement between self- and external scoring was demonstrated for all measurements (κ = 0.99 (95% CI, 0.98-0.99) for HC, 0.98 (95% CI, 0.97-0.99) for AC and 0.96 (95% CI, 0.95-0.98) for FL). Intraobserver 95% limits of agreement (LoA) of ultrasound measures for HC, AC and FL were ± 3.3%, ± 5.6% and ± 6.2%, respectively; the corresponding values for interobserver LoA were ± 4.4%, ± 6.0% and ± 5.6%. The SD distribution of triplicate measurements for all biometric variables showed excessive variability for three of 31 sonographers, allowing prompt identification and retraining. Qualitative and quantitative QC monitoring was feasible and highly reproducible in a large multicenter research study, which facilitated the production of high-quality ultrasound images. We recommend that the QC system we developed is implemented in future research studies and clinical practice. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.

Cesarean scar pregnancy - a new challenge for obstetricians.

Diagnosis and treatment of ectopic cesarean scar pregnancy has become a challenge for contemporary obstetrics. With an increase in the number of pregnancies concluded with a cesarean section and with the development of transvaginal ultrasonography, the frequency of cesarean scar pregnancy diagnoses has increased as well. The aim of the study is to evaluate various diagnostic methods (ultrasonography in particular) and analyze effective treatment methods for cesarean scar pregnancy. An ultrasound scan, Doppler examination and magnetic resonance imaging are all useful in early detection of asymptomatic cesarean scar pregnancy, thus enabling effective treatment and preservation of fertility. Dilatation and curettage is not recommended as it carries significant risk of bleeding and very high risk of hysterectomy and fertility loss. Systemic methotrexate treatment should not be applied on the routine basis due to its low efficacy, high risk of fertility loss and adverse effects. Local methotrexate therapy (under ultrasound or hysteroscopy guidance) should be considered a perfect management method as it offers fertility preservation in asymptomatic pregnant patients without concomitant hemodynamic disorders. Synchronous usage of several treatment methods is an effective way to manage cesarean scar pregnancy. The combination of local methotrexate with simultaneous aspiration of gestational tissues under ultrasound or hysteroscopy guidance seems optimal. Subsequently, the remaining gestational tissues can be removed hysteroscopically in combination with vascular coagulation at the implantation site. In more advanced cases, local methotrexate treatment should be considered followed by laparoscopic or laparotomic wedge resection with subsequent surgical correction of the cesarean section scar.

Automatic segmentation of gallbladder using bio-inspired algorithm based on a spider web construction model

In medical image processing, an accurate segmentation and classification are very important and this field still needs an effective computer-based algorithm for accomplishing the task. In gallbladder segmentation, only few automatic segmentation methodologies have been presented. The accuracy is very important in medical image processing for accurate diagnosis of the disease. In this paper, by exploiting the basic web building behavior of spiders, we developed a bio-inspired algorithm based on the spider web construction process for image segmentation process in medical images. The aim of this paper is to detect the shape of the gallbladder and to segment the gallstones and polyps located inside the gallbladder using a computer-based algorithm. It is necessary to apply a suitable preprocessing method in order to eliminate the irregularities presenting in the ultrasound scan images. In the preprocessing stage, histogram equalization and DooG filter are applied to enhance the contrast of the image. After that, the proposed spider web algorithm is applied in the segmentation process. The performance metrics of the proposed method are evaluated by implementing the proposed method to test the input dataset of 60 patients and it is compared with the results obtained from conventional segmentation methods. The values of DSC, OF, OV and PE for images with no lesions are 0.873167, 0.8389, 0.81705 and 0.81452.

Mondor\u2019s disease \u2013 a rare cause of chest pain: a case report

BackgroundChest pain is one of the common presenting symptoms encountered in an emergency department. Prompt history taking and careful clinical examination do help to differentiate cardiac chest pain from other causes. Mondor’s disease is a rare cause of chest pain which is often underdiagnosed due to lack of awareness. Mondor’s disease is a condition characterized by thrombophlebitis of the superficial veins of breast and anterior chest wall. The diagnosis is often made clinically.Case presentationHere we report a case of a 37-year-old Sri Lankan Tamil woman who presented with chest pain and was clinically diagnosed as having Mondor’s disease after a physical examination, which was confirmed with demonstration of thrombophlebitis by ultrasound scan imaging. Although it is a self-limiting condition, non-steroidal anti-inflammatory drugs are used in the treatment to hasten recovery in addition to giving reassurance.ConclusionsMondor’s disease is not considered a differential diagnosis for chest pain due to lack of awareness of this medical condition. Creating awareness of this condition via this case would help to cut down unnecessary investigations and valuable time spent in emergency departments, and it helps to identify a serious underlying cause especially carcinoma of the breast at its early stage.

Osteoma of the hyoid: an unusual cause of a neck lump

A 65-year-old man with a 2-month history of left-sided neck swelling presented through the cancer pathway. There was no associated ‘red flag’ symptoms, and clinical examination revealed a left anterior...

Partial fasciectomy is a useful treatment option for symptomatic plantar fibromatosis

Plantar fibromatosis is a rare, benign fibroproliferative disorder of the plantar fascia. It is considered as a low-grade tumour and it can be locally aggressive. It can present as painful swelling with impairment of local function. Upon failure of non-operative management, surgical treatment options include total fasciectomy or partial fasciectomy. Although surgical excision is the mainstay of treatment, recurrence rate can be up to 60%. The aim of this study was to determine the recurrence and complication rates of surgically treated plantar fibromatosis.A retrospective study was conducted involving patients who had a confirmed diagnosis and excision of plantar fibromatosis treated in our institution between 2011 and 2016. Demographic data, follow-up duration, recurrence and complications were reviewed.Eighteen patients underwent 19 operations. Mean age was 41.3 years (20–57). There were 12 male patients. The main presenting features were pain, swelling and impairment of function. They were investigated by ultrasound scan (12 feet, 63%) and/or magnetic resonance imaging (8 feet, 42%). Two patients (11%) had prior surgery at other institutions whilst 3 patients (17%) had multiple nodules at presentation. All patients underwent partial fasciectomy of the plantar fibromatosis. At up to 5 years follow-up, one patient (6%) had a recurrence in our series whilst 3 patients (17%) had scar related problems (2 patients with scar pain and one patient had hypersensitive scar that resolved after 12 months).Symptomatic plantar fibromatosis can be effectively treated with partial plantar fasciectomy.

The use of intraoperative epiaortic ultrasonography in monitoring patients over 75 years old treated with aortic valve replacement.

IntroductionEpiaortic ultrasound scanning (EAS) extended the use of ultrasound to the intraoperative diagnosis of aortic pathology. Surgical palpation of the ascending aorta underestimates the presence and severity of atherosclerotic plaques. Epiaortic ultrasound scanning has been used as an adjunct to transesophageal echocardiography (TEE) or as a primary direct diagnostic tool for imaging the ascending aorta as well as the aortic arch, which gained prominence as part of a multipronged intraoperative strategy to reduce atherosclerotic emboli.AimTo compare the epiaortic examination with transthoracic and transesophageal echo (transthoracic echocardiography (TTE) and TEE), X-ray, surgical intraoperative palpation, and postoperative neurological status.Material and methodsThe analyzed group consisted of 35 patients (mean age: 81.3 years) treated with aortic valve replacement (AVR), either alone (60%) or combined with coronary artery bypass grafting (CABG; 22.8%) or aortic aneurysm replacement (11.42%). In 2 patients, only CABG was performed because intraoperatively reevaluated strategy. Thierteen patients have got a history of diabetes, 10 chronic renal failure and 3 of cerebral stroke.ResultsIn more than 80% of patients, positive EAS results had an influence on the choice of aortic clamping site and in 50% of patients on the site of cannulation. Female sex, peripheral vascular disease, history of previous stroke, and calcifications in the ascending aorta in TTE have significant predictive value for recognizing atherosclerotic changes in EAS and the risk of postoperative neurological complications in octogenarians treated with AVR.ConclusionsEpiaortic ultrasound scanning imaging is superior to TTE and manual palpation in the detection and localization of ascending atherosclerosis. This technique should be introduced as a standard perioperative examination in older patients at risk of neurological complications.

Vasa previa prenatally diagnosed by ultrasound scanning and magnetic resonance imaging; report of 3 cases

Vasa previa prenatally diagnosed by ultrasound scanning and magnetic resonance imaging; report of 3 cases

Brain Dysplasia Associated with Ciliary Dysfunction in Infants with Congenital Heart Disease

To test for associations between abnormal respiratory ciliary motion (CM) and brain abnormalities in infants with congenital heart disease (CHD) STUDY DESIGN: We recruited 35 infants with CHD preoperatively and performed nasal tissue biopsy to assess respiratory CM by videomicroscopy. Cranial ultrasound scan and brain magnetic resonance imaging were obtained pre- and/or postoperatively and systematically reviewed for brain abnormalities. Segmentation was used to quantitate cerebrospinal fluid and regional brain volumes. Perinatal and perioperative clinical variables were collected. A total of 10 (28.5%) patients with CHD had abnormal CM. Abnormal CM was not associated with brain injury but was correlated with increased extraaxial cerebrospinal fluid volume (P < .001), delayed brain maturation (P < .05), and a spectrum of subtle dysplasia including the hippocampus (P < .0078) and olfactory bulb (P < .034). Abnormal CM was associated with higher composite dysplasia score (P < .001), and both were correlated with elevated preoperative serum lactate (P < .001). Abnormal respiratory CM in infants with CHD is associated with a spectrum of brain dysplasia. These findings suggest that ciliary defects may play a role in brain dysplasia in patients with CHD and have the potential to prognosticate neurodevelopmental risks.

The Prevalence of Non-Alcoholic Fatty Liver Disease in Children and Adolescents: A Systematic Review and Meta-Analysis.

Background & AimsNarrative reviews of paediatric NAFLD quote prevalences in the general population that range from 9% to 37%; however, no systematic review of the prevalence of NAFLD in children/adolescents has been conducted. We aimed to estimate prevalence of non-alcoholic fatty liver disease (NAFLD) in young people and to determine whether this varies by BMI category, gender, age, diagnostic method, geographical region and study sample size.MethodsWe conducted a systematic review and meta-analysis of all studies reporting a prevalence of NAFLD based on any diagnostic method in participants 1–19 years old, regardless of whether assessing NAFLD prevalence was the main aim of the study.ResultsThe pooled mean prevalence of NAFLD in children from general population studies was 7.6% (95%CI: 5.5% to 10.3%) and 34.2% (95% CI: 27.8% to 41.2%) in studies based on child obesity clinics. In both populations there was marked heterogeneity between studies (I2 = 98%). There was evidence that prevalence was generally higher in males compared with females and increased incrementally with greater BMI. There was evidence for differences between regions in clinical population studies, with estimated prevalence being highest in Asia. There was no evidence that prevalence changed over time. Prevalence estimates in studies of children/adolescents attending obesity clinics and in obese children/adolescents from the general population were substantially lower when elevated alanine aminotransferase (ALT) was used to assess NAFLD compared with biopsies, ultrasound scan (USS) or magnetic resonance imaging (MRI).ConclusionsOur review suggests the prevalence of NAFLD in young people is high, particularly in those who are obese and in males.