US Assessment Research Articles

Carotid Ultrasound Assessment prior to Coronary Artery Bypass Grafting – an Irish Cardiac Surgery Centre’s Experience

IntroductionCarotid stenosis is a risk factor for cerebrovascular accident(CVA) following coronary artery bypass grafting(CABG). Guidelines recommend selective pre-operative screening with Doppler US but non-selective application is commonplace. Recent data has questioned the efficacy of peri-operative carotid intervention, challenging the value of this practice. AimTo analyse the utility of carotid US assessment prior to CABG in our institution. MethodsThis was a retrospective review of all patients over 18 that underwent a non-emergency CABG in a single Irish cardiac surgery centre from January 2019 to December 2022. Results1161 subjects were included. 1084/1161(93.36%) underwent US assessment. 41/1084(3.8%) had ≥70% stenosis and 189/1084(17.5%) had ≥50% stenosis. 32/1084(2.95%) underwent confirmatory imaging and 7/1084(0.64%) underwent carotid intervention. Post-operative CVA occurred in 18/1161(1.55%) and ≥70%(p=0.024) and ≥50%(p<0.001) carotid stenosis were associated with same.Chronic kidney disease (OR=1.66,p=0.01), decreasing haemoglobin (OR=1.13,p=0.019), increasing age (OR=1.03,p=0.011) and being a current (OR=3.21,p<0.001) or ex- smoker (OR=1.82,p=0.004) were risk factors for ≥50% carotid stenosis on logistic regression. Multivessel coronary artery disease was not associated with carotid stenosis (p=0.563).Of those that underwent carotid intervention, 0/7(0%) suffered a CVA, but this protective effect failed to reach statistical significance for those with ≥70%(p=1) or ≥50%(p=1) carotid stenosis. ConclusionCarotid US screening altered the management of only a small proportion of CABG patients despite near universal application, challenging the effectiveness of this practice. Multivessel coronary artery disease was not associated with carotid stenosis despite European guidelines listing it as a screening criteria. Predictive models must be developed using identified risk factors to enable targeted pre-operative screening.

Integrating Contrast-enhanced US to O-RADS US for Classification of Adnexal Lesions with Solid Components: Time-intensity Curve Analysis versus Visual Assessment.

Purpose To compare the diagnostic performance of time-intensity curve (TIC) analysis and subjective visual assessment of contrast-enhanced US (CEUS) when integrated with the Ovarian-Adnexal Reporting and Data System (O-RADS) US risk stratification system for characterizing adnexal lesions with solid components. Materials and Methods In this prospective multicenter study conducted from September 2021 to December 2022, female individuals with suspected adnexal lesions containing solid components detected at routine US were enrolled. All participants underwent preoperative CEUS examinations. Histopathologic findings were used as the reference standard for diagnosis. Lesions were classified according to the O-RADS US system. Enhancement of solid tissue compared with the outer myometrium was evaluated using both TIC analysis and subjective visual assessment. The diagnostic performance of O-RADS alone and each CEUS assessment method when integrated with the O-RADS US system was assessed and compared using receiver operating characteristic curve analysis. Results A total of 180 lesions (80 malignant and 100 benign histopathologic outcomes) in 175 participants (median age, 47 years [IQR, 33-56]) were analyzed. Incorporating CEUS (assessed through both TIC analysis and subjective visual assessment) with O-RADS US showed significantly improved diagnostic performance over O-RADS US alone, with an area under the receiver operating characteristic curve (AUC) of 0.86 (95% CI: 0.80, 0.91) compared with 0.78 (95% CI: 0.71, 0.84). No evidence of a difference was observed between the AUCs of TIC analysis and subjective visual assessment in the enhancement evaluation of solid tissue with CEUS for adnexal malignancy categorization (P = .83). Conclusion Subjective visual assessment and TIC analysis of CEUS features when integrated with the O-RADS US scoring system showed comparable diagnostic performance in assigning adnexal malignancy risk. Keywords: Adnexal Lesions, Contrast-enhanced US, O-RADS, Time-intensity Curve Analysis Supplemental material is available for this article. © RSNA, 2024.

Contact Groups as Diplomatic Intervention Tools in Civil Wars: US Diplomacy

Summary American diplomacy employs contact groups to secure the United States’ national interests and fulfil its role as a superpower in several regions worldwide. This article explores three examples of contact groups formed by US diplomacy to intervene in the civil wars in Libya, Syria and Yemen. It tracks the groups’ formation process, meetings’ content and the US assessment of their influence on American interests and the course of the conflicts. The article concludes that the formation process was developed under sensitive compromises among the stakeholders of each conflict and led to the exclusion of some essential actors. The contact groups were influential at the tactical level and impacted the course of the conflicts in the short term, preventing humanitarian disasters, taking de-escalation steps and securing American interests, but they failed to achieve successful settlements.

Significance of Ultrasound in Assessment of Painful Knee: A Comparative Study to Magnetic Resonance Imaging

Abstract Background Knee pain is one of the most frequent symptoms that bring patients to the hospital. It affects approximately 25% of adults, with an increasing incidence nowadays the pain may result from the muscles, ligaments, tendons, and menisci, from trauma due to non-traumatic injuries like infection, bursitis, osteoarthritis, and tendinitis. Aim of the Work Aim of study is to evaluate the role of US in assessment of painful knee compared to conventional MRI sequences as an alternative cost-effective screening modality for an accurate diagnosis. Patients and Methods This study is a cross-sectional study was conducted at Ain Shams University Hospitals at Radiology department. Our study included forty patients complaining of acute knee pain from (1 day to 3 months’ duration). The main source of data for this study was the prospectively conducted scans and clinical history of the patients referred to the MRI section of the department of Radiology, Ain Shams University Hospitals at 6 months. Results Forty patients complaining of acute knee pain from. Every single one of them went through MRI and US assessments indiscriminately and independently, US succeeded in evaluating soft tissue structures pathologies including knee effusion, meniscal injury (degeneration, tear, and extrusion), MCL, LCL, bursitis. muscle, tendon injury and osteoarthritic changes. aside from the cruciate ligaments. US showed an overall sensitivity of 70.1% and specificity of 99.2% with accuracy of 95.2%. The overall PPV and NPV were 93.1% and 95.5% respectively. Conclusion US has proved that it can be used as an alternative cost effective screening modality for patients complaining of acute pain, US has reasonable sensitivity, specificity and accuracy in detecting knee effusion, meniscal injury including degeneration, tear, and extrusion, collateral ligaments, bursitis, baker cyst. Muscle, tendon injury and osteoarthritic changes, with no contraindications it can be used as the first choice in assessment of acute knee pain. MRI can be reserved for further workup if clinically warranted.

Noninvasive quantitative ultrasound fatty liver evaluation of hepato-renal index in pediatric patients using 3D-slicer

AimHepato-renal index (HRI) calculated by ultrasound images has been shown to be an effective, noninvasive tool to screen patients with steatosis. The aim of this study was to non-invasively explore a new method for the calculation, directly on DICOM images, of HRI in pediatric patients using 3D Slicer, a free and open-source software for medical image analysis, especially used for artificial intelligence data annotation. Previous studies in literature were based on non-medical image format (such as png and tiff) and analyzed by using ImageJ, a popular image analysis software.Materials and methodsDICOM images were collected retrospectively between November 2022 and December 2023 at a tertiary institution on any patient under 18 years referred to US assessment of suspected steatosis. The HRI was measured on sagittal images with a clear visualization of both the liver and the kidney by 3D Slicer. The HRI was calculated as the ratio of average pixel intensity values between the two ROIs. Also, we correlated the index with the qualitative operator assessment grade of steatosis made by two expert radiologists with more than 15 years of experience.Results49 patients (59% male, age 11.6 ± 2.6 year) were recruited. Of these, 29 (59%) had qualitative ultrasound confirmation of the diagnosis. The Bland–Altman plots showed a good agreement between the HRI indexes calculated with the standard tool ImageJ and 3D Slicer. Furthermore, the quantitative HRI calculated by the two software showed a correlation (Spearman’s coefficient = 0.52, P < 0.0001) with the qualitative operator measurement.ConclusionsFor the first time, an estimation of HRI directly on DICOM images was executed by using 3D Slicer, obtained quantitative information directly from clinically approved image format.

US of the Penis: Beyond Erectile Dysfunction.

High-frequency US, with a linear transducer and gray-scale, color, and spectral Doppler US techniques, is the primary imaging modality for evaluation of the penis. It can allow delineation of anatomy and assessment of dynamic blood flow; it is easily available and noninvasive or minimally invasive; it is cost effective; and it is well tolerated by patients. US assessment after pharmacologic induction of erection is an additional tool in assessing patients with suspected vasculogenic impotence, and also in selected patients with penile trauma and suspected Peyronie disease. Penile injuries, life-threatening infections, and vascular conditions such as priapism warrant rapid diagnosis to prevent long-term morbidities due to clinical misdiagnosis or delayed treatment. US can facilitate a timely diagnosis in these emergency conditions, even at the point of care such as the emergency department, which can facilitate timely treatment. In addition, color and spectral Doppler US are valuable applications in the follow-up of patients treated with endovascular revascularization procedures for vasculogenic erectile dysfunction. Image optimization and attention to meticulous techniques including Doppler US is vital to improve diagnostic accuracy. Radiologists should be familiar with the detailed US anatomy, pathophysiologic characteristics, scanning techniques, potential pitfalls, and US manifestations of a wide spectrum of vascular and nonvascular penile conditions to suggest an accurate diagnosis and direct further management. The authors review a range of common and uncommon abnormalities of the penis, highlight their key US features, discuss differential diagnosis considerations, and briefly review management. ©RSNA, 2024 Supplemental material is available for this article.

P125 Can musculoskeletal ultrasound assessment change management decisions in rheumatoid arthritis patients with moderate disease activity?

Abstract Background/Aims To evaluate the impact of musculoskeletal ultrasound (MSUS) assessment on treatment escalation decisions in patients with moderately active rheumatoid arthritis (RA) on csDMARDs. To determine the level of concordance between MSUS assessment and Disease Activity Score in 28 joints (DAS28) in patients with moderately active RA. Methods During a four-month period, consecutive patients with: an established diagnosis of RA, a DAS-28 of 3.2-5.1, inadequate response to at least 2 csDMARDs and indication to escalate to b/tsDMARDS were enrolled. All patients underwent a MSUS exam (B and PD modes) of the bilateral five-joint count including wrists and 2nd and 3rd MCP and PIP (5USJC). The US exam was extended to symptomatic joints (tender/swollen) of the DAS 28-joint score (28USJC) and a comprehensive 78 joint count (78USJC). For each of the three US exams a total US score and a EULAR/OMERACT US (EOUS) score was calculated. A five-point Likert scale (pre and post MSUS) assessed the patient and referring clinician’s desire to escalate treatment. After the referring clinician reviewed the MSUS assessment, patients were classified into two groups according to the escalation decision. The data was analysed to identify the differences between the two groups and the correlation between the DAS-28 score and the US assessment. Results 27 patients were included. The mean (SD) age was 56.1 years (12.5), 66.7% were female and the mean time (SD) since diagnosis was 87.8 (24.9) months. 63% were anti-CCP positive and 59% were RF positive. The mean (SD) DAS 28 PCR score was 4.4 (0.7). Following MSUS assessment, there was a change in the initial decision to escalate treatment in 66.7% patients. Using the Likert score, the desire to escalate treatment reduced post US assessment across all groups (statistically significant in the patient group). Treatment escalation was associated with a higher MSUS score (univariate analysis OR &amp;gt; 1) across all assessments (5USJC, 28USJC, 78USJC and EOUS (p &amp;lt; 0,05)). The 78USJC was most reliably aligned with the treatment decision (p = 0.009). A higher swollen joint count (SJC) and higher DAS-28 score correlated with treatment escalation (p &amp;lt; 0.05), whilst longer disease duration was associated with a lower likelihood of treatment escalation (p &amp;lt; 0.05). Comparing MSUS assessment and clinical assessment, results demonstrated poor concordance between all variables of the global DAS-28 score and MSUS score, with the exception of the SJC which showed statistically significant correlation. Conclusion The addition of the MSUS assessment to the DAS 28-score in RA patient with moderately active disease has impacted the management decision in in 66.7% of our patients. The addition of MSUS to clinical assessment may allow tailoring of treatment escalation decisions. This study demonstrated poor correlation between clinical assessment with DAS-28 score and MSUS assessment in all domains other than swollen joint score. Disclosure H. Crawshaw: None. L. Rubio-Cirilo: None. H. Johnson: None. S. Jamal: None. S. Hickey: None. J. Gunn: None. I. Ali: None. G. Coombes: None. C. Acebes: None.

Application of standardized methods to evaluate the environmental safety of polyvinyl alcohol disposed of down the drain.

The purpose of this research was to use polyvinyl alcohol (PVOH) 18-88 as a case study to evaluate the environmental fate, ecotoxicity, and overall safety profile of water-soluble, nonmodified PVOH polymers used in detergent films. An OECD 303A Wastewater Treatment Plant Simulation Study was conducted with dissolved organic carbon as the analytical endpoint to evaluate the removal of PVOH 18-88 during wastewater treatment. During the plateau phase, high levels of removal due to biodegradation were observed (average 97.4 ± 7.1, range: 88%-116%). The OECD 303A study quantitatively verified that surface water is the dominant receiving compartment for PVOH 18-88 post wastewater treatment. Acute algae, invertebrate, and fish embryo (fish embryo acute toxicity test [FET]) ecotoxicity studies quanitified the 50% lethal/effect concentration (L/EC50) for PVOH 18-88. Due to the potential for the chorion to impact PVOH 18-88 bioavailability, both chorionated and dechorionated FET tests were conducted. L/EC50 > 1000 mg/L for FET (chorionated and dechorionated), invertebrate, and algae were observed. The Sustainable Futures (US) and REACH (EU) frameworks were used to evaluate environmental risk. For the US assessment, the Exposure and Fate Assessment Screening Tool was used to predict the single day lowest flow over a 10-year period (1Q10) surface water concentration and the seven consecutive days of lowest flow over a 10-year period (7Q10) surface water concentration and compared with acute and chronic concentrations of concern. For the EUassessment, the European Union System for the Evaluation of Substances was used to predict local and regional exposure concentrations and compared to the predicted no effect concentration. For both regulatory assessments, the exposure concentrations were >2 orders of magnitude below the effect concentrations. Integr Environ Assess Manag 2024;20:1693-1705. © 2024 The Authors. Integrated Environmental Assessment and Management published by Wiley Periodicals LLC on behalf of Society of Environmental Toxicology & Chemistry (SETAC).

Simplified vs modified (reduced) ultrasound 6 joint score in assessing disease activity in rheumatoid arthritis patients

Introduction and aim. With increasing ultrasound US assessment opportunities for tight rheumatoid arthritis (RA) management, more simplified accurate US-assessment is desired in clinical practice. Aim of the work is assessing modified vs simplified ultrasound 6-joint scores relevance in assessing rheumatoid arthritis disease activity. Material and methods. Fifty-five RA patients were subjected to detailed history, clinical, and musculoskeletal examination with disease activity assessment by clinical disease activity index, simple disease activity index and disease activity score in 28 joints. Com plete blood count, erythrocyte sedimentation rate, C-reactive protein, rheumatoid factor, anti-cyclic citrullinated peptide antibodies were done. Patients underwent US examination (gray-scale and power Doppler) for wrist, 2nd and 3rd metacarpophalangeal and knee joints bilaterally. Synovitis composite score was added. Two US indices were constructed: simplified S6 and modified M6 joint scores. Results. Statistical significant positive correlations were high between S6/M6 score parameters (total, grey-scale (GS), power doppler (PD), Composite) and disease activity markers. Both M6 and S6 scores differentiated mild-moderate and moderate-severe disease activity patients. However, only S6 score differentiated remission from mild disease activity patients. Conclusion. Ultrasound 6-joint scores (especially simplified S6) were rapid, easy and sensitive ultrasound tools assessing rheu matoid arthritis disease activity in clinical practice.

Modern approaches to ultrasonographic assessment of carotid plaque in terms of its potential instability.

Aim: To identify potentially adverse characteristics of atherosclerotic carotid plaque in terms of stroke risk. Materials and Methods: The study is based on the analysis of US data obtained from 96 patients aged 47 to 84 years diagnosed with carotid stenosis. The patients were divided into 2 groups depending on the presence or absence of ischemic events. Examination methods: clinical, duplex US, brain MRI, statistical. In addition to the standard US criteria for the evaluation of carotid stenoses, superb microvascular imaging (SMI) and shear wave elastography (SWE) are used. Results: Statistically significant association of the following characteristics of plaques with the presence of ipsilateral ischemia focus was established: maximum thickness (p = 0,04), presence of microvascularization according to SMI data (p = 0,02), degree of carotid stenosis (statistically significant in the right carotid circulation [p = 0,04]), stiffness of the plaque according to SWE data (significantly in the right carotid circulation [p = 0,001]), type of plaque echogenicity according to Gray-Weale-Geroulakos classification (on the right carotid artery; p = 0,04). Conclusions: The presence of microvascularization according to SMI data and the low stiffness of the plaque according to SWE data can characterize the potential instability of the carotid plaque. These criteria should be added to the traditional US assessment of carotid plaques.

Prenatal diagnosis and postnatal outcome of fetal congenital knee dislocation: systematic review of literature.

Congenital knee dislocation (CKD) is a rare condition, affecting 1 in 100 000 newborns. Its prenatal diagnosis is challenging and not well described in the literature, especially when it appears isolated and not as part of a complex malformation or syndromic pattern. The purpose of this study was to provide a comprehensive review of the available literature on the prenatal diagnosis and postnatal outcome of CKD and to summarize the current evidence on this topic. A systematic review of the literature on the prenatal diagnosis of CKD was performed in PubMed, Scopus and EMBASE. A predefined combination of specific keywords was used, focusing on intrauterine manifestations, diagnostic methods, prenatal behavior, postnatal treatment and neonatal outcome as well as long-term outcome in terms of ambulation, motion and joint stability. The quality of studies was assessed using the National Institutes of Health tool for quality assessment of case series. A summary of results was carried out providing proportions and rates of diagnostic and prognostic features associated with this rare condition. In total, 20 cases were retrieved for analysis, of which 19 were obtained from the identified eligible studies (n = 16) and one was an unpublished case from our center. The median gestational age at prenatal diagnosis, which was made using ultrasound in most cases, was 20 weeks (range, 14-38 weeks). Bilaterality was observed in 11/20 (55%) cases. The condition was isolated in 7/20 (35%) cases and associated with other anomalies in 13/20 (65%) cases. An association was observed with oligohydramnios (4/20 (20%)), and an invasive procedure was performed in 13/20 (65%) cases, including 11 cases with an invasive procedure performed for diagnostic purposes. Genetic testing was normal in all isolated cases for which information was available (4/7), while a genetic syndrome was present in 10/13 (77%) non-isolated cases (Larsen, Noonan, Grebe, Desbuquois or Escobar syndrome). There were seven terminations of pregnancy, of which six were performed in cases with associated anomalies and one in an isolated case, 11 cases of postnatal survival, one case of intrauterine death and one of neonatal death. The fetal and neonatal deaths occurred in cases with associated anomalies or abnormal genetic findings. Postnatal treatment was mostly conservative, with only two reports (18% of the 11 surviving neonates) of surgical intervention, both in cases with associated anomalies. Postnatal follow-up was up to 1 year in most cases, and motor outlook appeared normal in all isolated cases. CKD is a rare fetal anomaly with a prenatal diagnosis achievable from the early second trimester, for which a favorable outcome can be expected when no associated anomalies are present. Prenatal diagnosis should include detailed ultrasound assessment and amniocentesis for extensive genetic studies, particularly in non-isolated cases. Early postnatal treatment achieves success in most cases without surgical intervention and leads to a normal motor outlook. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Diagnosis of calcium pyrophosphate crystal deposition disease by ultrasonography: how many and which sites should be scanned?

To develop the optimal US scanning protocol for the diagnosis of calcium pyrophosphate crystal deposition (CPPD) disease. In this cross-sectional study, consecutive patients with a crystal-proven diagnosis of CPPD disease, and age-, sex-matched disease controls with a negative synovial fluid analysis were prospectively enrolled in two Italian Institutions. Four rheumatologists, blinded to patients' clinical details, performed US examinations using a standardized scanning protocol including 20 joints (shoulders, elbows, wrists, metacarpophalangeal joints from second to fifth fingers, hips, knees, ankles). CPPD was identified as presence/absence, according to the OMERACT definitions. Reduced US scanning protocols were developed by selecting the most informative joints to be imaged by US using the LASSO technique. Patients were randomly divided into training and validation sets. Their diagnostic accuracy was tested comparing the area under the receiver operating characteristic curves. The number of participants enrolled was 204: 102 with CPPD disease and 102 disease controls [age, mean (s.d.): 71.3 (12.0) vs 71.1 (13.5) years; female: 62.8% vs 57.8%]. The median number of joints with US evidence of CPPD was 5 [interquartile range (IQR): 4-7] and 0 (IQR: 0-1) in patients with CPPD disease and controls, respectively (P < 0.01). The detection of CPPD in ≥2 joints using a reduced scanning protocol (bilateral assessment of knees, wrists and hips) showed a sensitivity of 96.7% (95% CI: 82.8, 99.9) and a specificity of 100 (95% CI: 88.8, 100.0) for the diagnosis of CPPD disease and had good feasibility [mean (s.d.): 12.5 (5.3) min]. Bilateral US assessment of knees, wrists and hips had excellent accuracy and good feasibility for the diagnosis of CPPD disease.

Quantitative Insight into PCA Formation following Different Chlorhexidine Activation Methods in Endodontic Treatment.

The aim of the study was a quantitative analysis of p-chloroaniline (PCA) formation during 2% CHX activation with US and MDI methods in a root canal-like environment with the HPLC-DAD method and, thus, a safety assessment of US and MDI agitation of CHX in endodontic treatment. Two percent CHX was activated with the US method using ISO 30 and 35 K-file, and the MDI method using ISO 30.06 and 35.06 GP cones for 15, 30, 60, and 90 s. PCA concentration was assessed with the HPLC-DAD method. PCA concentration was also assessed for 2% CHX after 0, 3, 18, and 21 days of storage in ambient conditions. PCA was detected in all samples in all methods of activation. The concentration of PCA was dependent on time of activation in US ISO 30 and ISO 35 group (p < 0.05). In the MDI ISO 30.06 and ISO 35.06 groups, a similar trend was observed but without statistical significance (p > 0.05). PCA was detected in shelf-stored 2% CHX and the concentration was related to the time of storage. PCA is released after CHX activation with US and MDI, but mean concentrations are not higher than those observed from self-degradation of shelf-stored 2% CHX.

Generalizability and Diagnostic Performance of AI Models for Thyroid US.

Background Artificial intelligence (AI) models have improved US assessment of thyroid nodules; however, the lack of generalizability limits the application of these models. Purpose To develop AI models for segmentation and classification of thyroid nodules in US using diverse data sets from nationwide hospitals and multiple vendors, and to measure the impact of the AI models on diagnostic performance. Materials and Methods This retrospective study included consecutive patients with pathologically confirmed thyroid nodules who underwent US using equipment from 12 vendors at 208 hospitals across China from November 2017 to January 2019. The detection, segmentation, and classification models were developed based on the subset or complete set of images. Model performance was evaluated by precision and recall, Dice coefficient, and area under the receiver operating characteristic curve (AUC) analyses. Three scenarios (diagnosis without AI assistance, with freestyle AI assistance, and with rule-based AI assistance) were compared with three senior and three junior radiologists to optimize incorporation of AI into clinical practice. Results A total of 10 023 patients (median age, 46 years [IQR 37-55 years]; 7669 female) were included. The detection, segmentation, and classification models had an average precision, Dice coefficient, and AUC of 0.98 (95% CI: 0.96, 0.99), 0.86 (95% CI: 0.86, 0.87), and 0.90 (95% CI: 0.88, 0.92), respectively. The segmentation model trained on the nationwide data and classification model trained on the mixed vendor data exhibited the best performance, with a Dice coefficient of 0.91 (95% CI: 0.90, 0.91) and AUC of 0.98 (95% CI: 0.97, 1.00), respectively. The AI model outperformed all senior and junior radiologists (P < .05 for all comparisons), and the diagnostic accuracies of all radiologists were improved (P < .05 for all comparisons) with rule-based AI assistance. Conclusion Thyroid US AI models developed from diverse data sets had high diagnostic performance among the Chinese population. Rule-based AI assistance improved the performance of radiologists in thyroid cancer diagnosis. © RSNA, 2023 Supplemental material is available for this article.

Assessment of Amniotic Fluid Volume in Pregnancy

Amniotic fluid (AF) is an integral part of the fetal environment and is essential for fetal growth and development. Pathways of AF recirculation include the fetal lungs, swallowing, absorption through the fetal gastrointestinal tract, excretion through fetal urine production, and movement. In addition to being a marker for fetal health, adequate AF is necessary for fetal lung development, growth, and movement. The role of diagnostic imaging is to provide a detailed fetal survey, placental evaluation, and clinical correlation with maternal conditions to help identify causes of AF abnormalities and thereby enable specific therapy. Oligohydramnios prompts evaluation for fetal growth restriction as well as genitourinary issues, including renal agenesis, multicystic dysplastic kidneys, ureteropelvic junction obstruction, and bladder outlet obstruction. Premature preterm rupture of membranes should also be clinically excluded as a cause of oligohydramnios. Clinical trials evaluating amnioinfusion are underway as a potential intervention for renal causes of oligohydramnios. Most cases of polyhydramnios are idiopathic, with maternal diabetes being a common cause. Polyhydramnios prompts evaluation for fetal gastrointestinal obstruction and oropharyngeal or thoracic masses, as well as neurologic or musculoskeletal anomalies. Amnioreduction is performed only for maternal indications such as symptomatic polyhydramnios causing maternal respiratory distress. Polyhydramnios with fetal growth restriction is paradoxical and can occur with maternal diabetes and hypertension. When these maternal conditions are absent, this raises concern for aneuploidy. The authors describe the pathways of AF production and circulation, US and MRI assessment of AF, disease-specific disruption of AF pathways, and an algorithmic approach to AF abnormalities. ©RSNA, 2023 Online supplemental material is available for this article. Quiz questions for this article are available through the Online Learning Center.

Mental Health Needs Due to Disasters: Implications for Behavioral Health Workforce Planning During the COVID-19 Pandemic.

Public health emergencies impact the well-being of people and communities. Long-term emotional distress is a pervasive and serious consequence of high levels of crisis exposure and low levels of access to mental health care. At highest risk for mental health trauma are historically medically underserved and socially marginalized populations and frontline health care workers (HCWs). Current public health emergency response efforts provide insufficient mental health services for these groups. The ongoing mental health crisis of the COVID-19 pandemic has implications for the resource-strained health care workforce. Public health has an important role in delivering psychosocial care and physical support in tandem with communities. Assessment of US and international public health strategies deployed during past public health emergencies can guide development of population-specific mental health care. The objectives of this topical review were (1) to examine scholarly and other literature on the mental health needs of HCWs and selected US and international policies to address them during the first 2 years of the pandemic and (2) to propose strategies for future responses. We reviewed 316 publications in 10 topic areas. Two-hundred fifty publications were excluded, leaving 66 for this topical review. Findings from our review indicate a need for flexible, tailored mental health outreach for HCWs after disasters. US and global research emphasizes the dearth of institutional mental health support for HCWs and of mental health providers who specialize in helping the health care workforce. Future public health disaster responses must address the mental health needs of HCWs to prevent lasting trauma.

The relationship between amniotic fluid index and accuracy of sonographic estimated fetal weight

Background: Ultrasound is the gold standard in evaluation of amniotic fluid volume and diagnosis of volume disorders as oligohydramnios and polyhydramnios. While the amniotic fluid may be thought of as an expansion of the foetus extracellular fluid compartment during the first two trimesters of pregnancy, most amniotic fluid is actually produced during the third trimester due to foetal micturition. We hypothesised a link between the amniotic fluid indexes (AFI) and estimated foetal weight (EFW), which might suggest that EFW be considered in amniotic fluid evaluation.Methods: This cross-sectional study was conducted on 75 pregnant cases (Age was >18 years) and carrying singleton pregnancy with GA from 18 weeks to 40 weeks (GA evaluation was based on menstrual history & early US assessment) for 1 year. All participants underwent full history taking, abdominal ultrasonography examination and assessment of amniotic fluid index.Results: The majority of included pregnancies showed cephalic presentation of the fetus. The overall AFI ranged from 2 to 30 cm, with a mean value of 17.2 (SD, 7.4) cm and a median value of 18 (IQR, 11) cm. The majority of included pregnancies showed a normal BPP. There was no significant association between AFI and EFW for all categories of gestational age, except in the 27 29 week’s group.Conclusions: The AFI and EFW numbers found in this research fell within a certain range. Nevertheless, these variables showed no statistically meaningful correlation with one another. Inferring from that, it seems unlikely that either measure is worth focusing on when the other is subject to fluctuation.

US Attenuation Imaging for the Evaluation and Diagnosis of Fatty Liver Disease.

This study aimed to determine whether the attenuation coefficient (AC) from attenuation imaging (ATI) was correlated with visual US assessment in patients with hepatic steatosis. Moreover, it aimed to assess whether the patient's blood chemistry results and CT attenuation were correlated with AC. Patients who underwent abdominal US with ATI between April 2018 and December 2018 were included in this study. Patients with chronic liver disease or cirrhosis were excluded. The correlation between AC and other parameters, such as visual US assessment, blood chemistry results, liver attenuation, and liver-to-spleen (L/S) ratio, were analyzed. AC values according to visual US assessment grades were compared using analysis of variance. A total of 161 patients were included in this study. The correlation coefficient between US assessment and AC was 0.814 (p < 0.001). The mean AC values for the normal, mild, moderate, and severe grades were 0.56, 0.66, 0.74, and 0.85, respectively (p < 0.001). Alanine aminotransferase levels were significantly correlated with AC (r = 0.317, p < 0.001). The correlation coefficients between liver attenuation and AC and between L/S ratio and AC were -0.702 and -0.626, respectively (p < 0.001). Visual US assessment and AC showed a strong positive correlation with the discriminative value between the groups. Computed tomography attenuation and AC showed a strong negative correlation.

Ultrasound Imaging-Based Methods for Assessing Biological Maturity during Adolescence and Possible Application in Youth Sport: A Scoping Review.

Bone maturity is an indicator for estimating the biological maturity of an individual. During adolescence, individuals show heterogeneous growth rates, and thus, differences in biological maturity should be considered in talent identification and development. Radiography of the left hand and wrist is considered the gold standard of biological maturity estimation. The use of ultrasound imaging (US) may be advantageous; however, its validity and reliability are under discussion. The aims of this scoping review are (1) to summarize the different methods for estimating biological maturity by US imaging in adolescents, (2) to obtain an overview of the level of validity and reliability of the methods, and (3) to point out the practicability and usefulness of ultrasound imaging in the field of youth sports. The search included articles published up to November 2022. The inclusion criteria stipulated that participants had to fall within the age range of 8 to 23 years and be free of bone disease and fractures in the region of interest. Nine body regions were investigated, while the hand and wrist were most commonly analyzed. US assessment methods were usually based on the estimation of a bone maturity stage, rather than a decimal bone age. Furthermore, 70% of the assessments were evaluated as applicable, 10% expressed restraint about implementation, and 20% were evaluated as not applicable. When tested, inter- and intra-rater reliability was high to excellent. Despite the absence of ionization, low costs, fast assessment, and accessibility, none of the US assessments could be referred to as a gold standard. If further development succeeds, its application has the potential to incorporate biological age into selection processes. This would allow for more equal opportunities in talent selection and thus make talent development fairer and more efficient.

The emerging role of ultrasound in detecting interstitial lung disease in patients with rheumatoid arthritis.

To investigate the potential role of US in the detection of ILD in a cohort of patients with RA. Patients with diagnosis of RA were consecutively enrolled. All patients underwent pulmonary examination, laboratory data, DLCO measure, chest HRCT and radiographs, and US examination. A healthy group was included as control group. US was performed according the 14-intercostal space scanning protocol using the following semiquantitative scale [0=normal (≤5 B-lines); 1=slight (≥6 and ≤15 B-lines); 2=moderate, (≤16 and ≥30 B-lines); 3=severe (≥30 B-lines)]. A total of 74 RA patients and 74 healthy controls were included. Thirty of 74 patients (40.5%) showed US signs of ILD with respect to the healthy controls (3 subjects, 4.1%) (P<0.001); whereas HRCT showed ILD in 27 (36.4%) of 74 patients. Among the 30 patients that showed US findings of ILD, 17 (56.6%) were asymptomatic from respiratory view-point. The sensitivity and specificity of US were 92% and 89% respectively. A positive correlation between US and HRCT findings were found (P<0.001) whereas no correlation was found with chest radiographs and DLCO findings. Positive association between US findings and DAS28-ESR, anti-CCP and RF (P<0.01 for each respectively) was found. Feasibility, represented by the mean time spent to perform the pulmonary US assessment was 7.8minutes (±SD 1.2, range 6 to 10minutes). Our results support the potential of US in detect accurately ILD in patients with RA and provide a rationale to consider it as a friendly screening tool to be implemented in early phases of the disease.