US Features Research Articles

Brain ultrasonography in the premature infant

Brain ultrasonography plays a central role in the detection and management of neonatal disease in the preterm infant. Although morphological study, using high-frequency transducers, remains the cornerstone of imaging, pulsed and colour Doppler scans provide additional information and improve the diagnostic and prognostic accuracy of ultrasonography. Particular features of normal brain US in the extremely preterm infant are reported. Cerebral haemorrhage and its different patterns (intraventricular haemorrhage and periventricular hemorrhagic infarction) are described. The value of Doppler techniques is emphasized, e.g. demonstration of coloured signal within the aqueduct of Sylvius, visualization of patency of the terminal veins, demonstration of Doppler spectrum fluctuations, recognition of low blood flow, and the detection of vasodilatation. The sonographic diagnosis of periventricular leucomalacia and its difficulties are documented. Some uncommon brain lesions of the premature infant are illustrated, e.g. gangliothalamic ischaemic damage, cortical necrosis, focal infarcts, etc. The importance of repeating the US examinations until near term is highlighted.

2216: Sonography in the diagnosis of nasal bone fractures in children

Objectives: To describe the sonographic findings of nasal bone fractures and evaluate the diagnostic value of US of nasal bone fractures in children.Methods: Twenty-three children with sustained nasal trauma underwent radiography (lateral view of the nose and Waters view), US and CT. The US findings were retrospectively reviewed and compared with plain radiographs and CT, which were used as gold standard.Results: Sonographic findings of nasal bone fractures were irregularity (n = 4), discontinuity (n = 14), displacement with discontinuity (n = 16) of the thin smooth echogenic line formed by ventral cortex of the nasal bone. Thirty four nasal bone fractures in 23 patients were identified by CT and US but only 17 by plain radiographs. US and CT demonstrated unilateral involvement of nasal bone fracture in ten bones and bilateral involvement in 12, while plain radiograph revealed unilateral involvement in seven and bilateral involvement in five.Conclusions: The US features of nasal bone fractures were similar to those of CT in detecting the location and degree of depression or displacement of nasal bone fractures. We believe that US is a very useful for the evaluation of such fractures, especially in children with equivocal abnormalities on plain radiographs. Objectives: To describe the sonographic findings of nasal bone fractures and evaluate the diagnostic value of US of nasal bone fractures in children. Methods: Twenty-three children with sustained nasal trauma underwent radiography (lateral view of the nose and Waters view), US and CT. The US findings were retrospectively reviewed and compared with plain radiographs and CT, which were used as gold standard. Results: Sonographic findings of nasal bone fractures were irregularity (n = 4), discontinuity (n = 14), displacement with discontinuity (n = 16) of the thin smooth echogenic line formed by ventral cortex of the nasal bone. Thirty four nasal bone fractures in 23 patients were identified by CT and US but only 17 by plain radiographs. US and CT demonstrated unilateral involvement of nasal bone fracture in ten bones and bilateral involvement in 12, while plain radiograph revealed unilateral involvement in seven and bilateral involvement in five. Conclusions: The US features of nasal bone fractures were similar to those of CT in detecting the location and degree of depression or displacement of nasal bone fractures. We believe that US is a very useful for the evaluation of such fractures, especially in children with equivocal abnormalities on plain radiographs.

2211: US features of the congenital cystic neuroblastoma in comparison with adrenal hemorrhagic pseudocyst

2211: US features of the congenital cystic neuroblastoma in comparison with adrenal hemorrhagic pseudocyst

3469: Focused abdominal sonography for gastrointestinal complications in pediatric bone marrow transplant recipients

Bone marrow transplantation(BMT) is widely used in the treatment of hematologic disorders and some solid tumors in children. A wide variety of complications may occur in BMT recipients and are a major cause of morbidity and death. The gastrointestinal tract is a frequently affected organ after BMT. Gastrointestinal complications include neutropenic colitis, CMV enterocolitis, pseudomembranous colitis, GVHD, pneumatosis intestinalis and post-transplantation lymphoproliferative disease (PTLD). In pediatric age, ultrasonography is used for modality of choice and essential tool for diagnosing these complications in critically ill recipients. We present US features of these many gastrointestinal complications with correlative other abdominal imaging, including plain radiography, contrast studies and enhanced CT scans.

2098: Hepatobiliary changes in the follow-up of patients with biliary atresia after kasai portoenterostomy: US and CT features

2098: Hepatobiliary changes in the follow-up of patients with biliary atresia after kasai portoenterostomy: US and CT features

Endocavitary Three-dimensional Ultrasonographic Assistance for Transvaginal or Transrectal Drainage of Pelvic Fluid Collections

Determine the feasibility of using three-dimensional ultrasonography (3D US) to assist in planning and performing endocavitary drainage of deep pelvic fluid collections. Retrospective review of images and medical records of 16 patients in whom endocavitary 3D US was used during transvaginal or transrectal drainage of 17 deep fluid collections. 3D US was assessed regarding its ability to display the relevant structures, whether new information was provided compared with pelvic computed tomography (CT) and conventional two-dimensional US (2D US) displays, and whether this information altered drainage techniques. Targeted fluid collections were visualized in all patients. 3D US added information in 11 of 16 patients (69%) that, in turn, resulted in adjustment of interventional technique in eight of 16 patients (50%). Specific features of 3D US that provided new information included the simultaneous display of three orthogonal US images, display of reconstructed US image plane orientations not possible with 2D US, and the ability to interactively scroll images through complex structures to assess for communication between the loculations. An attached needle guide was used in 15 of 16 patients to improve the precision of needle placement. Endocavitary 3D US is feasible for assistance in transvaginal and transrectal drainage procedures, usually adds new information, frequently alters interventional technique, and permits precise access needle placement.

Nonspecific Granulomatous Prostatitis

Nonspecific granulomatous prostatitis (NSGP) is a relatively uncommon type of chronic inflammation of the prostate, frequently mistaken for carcinoma on digital rectal examination, trans-rectal ultrasound (TRUS) and serum PSA test. It is presently the most frequent variety of granulomatous prostatitis observed at histological examination. The present study reviews the trans-rectal US results and serum PSA levels of 20 patients with biopsy-proven NSGP. Physical findings, laboratory data and US indicated malignancy in all cases. Sonographically (TRUS), the lesions appeared as single or multiple hypoechoic nodules, mainly localised in the peripheral zone of the gland, mimicking carcinoma. Mean serum PSA values were 13.3 ng/ml (range from 3.5 to 34 ng/ml), and only one patient had a value lower than 4 ng/ml. A sufficiently long period of follow-up (mean 19 months; range from 7 to 48 months) with TRUS and PSA was only possible in 11/20 patients. In 8/11 cases, serum PSA returned within normal range, and in 5/11 patients the US features slowly resolved, the hypoechoic nodules disappearing. Final diagnosis can only be obtained by prostatic biopsy. Several questions remain unanswered regarding the relationship between chronic prostatitis and prostatic carcinoma, natural history, the need for specific therapy and also the follow-up of this disease.

URINARY MATRIX CALCULI: OUR EXPERIENCE AT A SINGLE INSTITUTION

Matrix stones are an uncommon form of urinary calculi and may be mistaken for tumors involving the renal collecting system, thereby presenting a diagnostic and therapeutic dilemma to the practicing urologist. From 1980 to 2003 we identified 5 patients with urinary matrix stones referred to our tertiary medical center for evaluation and treatment. All 5 cases had complex clinical and radiographic features at presentation. We outline the clinical presentations, imaging findings and management, and review the literature of matrix stone disease. A high index of suspicion is required in diagnosing matrix calculi in addition to carefully selected radiographic imaging. Due to their variable appearance in standard radiological studies, the evaluation of matrix stones may require invasive techniques such as ureteroscopy for accurate diagnosis. Percutaneous removal is the primary treatment modality to render patients stone-free.

Imaging Features of Gray-Scale and Contrast-Enhanced Color Doppler US for the Differentiation of Transient Renal Arterial Ischemia and Arterial Infarction

ObjectiveTo characterize the imaging features on gray-scale and contrast-enhanced color Doppler US images which differentiate renal ischemia from renal infarction.Materials and MethodsThe segmental renal arteries of eight healthy rabbits were surgically ligated. In four of these rabbits, the ligated renal artery was released 60 minutes after arterial occlusion to cause transient ischemia. In the remaining four rabbits, the arterial ligation was retained to cause a permanent infarction. The gray-scale and contrast-enhanced color Doppler US imaging features of the involved renal parenchyma of both ischemia and infarction groups were compared with respect to the presence or absence of parenchymal swelling, echogenicity changes, tissue loss and perfusion defects.ResultsParenchyma swelling, echogenic changes, tissue loss and perfusion defects were found to be more extensive in the infarction than the ischemia group. The hyperechoic areas reperfused with blood flow recovered normal echogenicity and perfusion, whereas the hyperechoic areas without reperfusion became renal infarcts.ConclusionGray-scale and contrast-enhanced color Doppler US showed that the hyperechoic areas with reperfusion may reverse to normal parenchyma and allow the differentiation of renal ischemia from renal infarction.

Prenatal ultrasound findings in 93 cases of fetal infection with cytomegalovirus. Correlation with amniotic fluid viral load and outcome

CYTOMEGALOVIRUS. CORRELATION WITH AMNIOTIC FLUID VIRAL LOAD AND OUTCOME MASAMI YAMAMOTO, FRANCOIS JACQUEMARD, OLIVIER PICONE, JEANMARC COSTA, YVES VILLE, CHI Poissy-St Germain, Poissy, France, Institute de Puericulture de Paris, Service de Medicine Foetale, Paris, France, Universite Paris Ouest SQY-V CHI Poissy St Germain en Laye, Obstetrics and Gynecology Service, Poissy, France, American Hospital of Paris, Service de Biologie Moleculaire Marcel Dassault, Neuilly sur Seine, France OBJECTIVE: To identify all ultrasound findings in fetuses infected with CMV and its relation with amniotic fluid viral load and outcome. STUDY DESIGN: All cases of fetal cytomegalovirus infection from maternal primary infection and diagnosed by viral genome amplification by PCR in amniotic fluid, between 1997-2004 were reviewed for ultrasound features, time of maternal seroconversion and amniotic fluid viral load. RESULTS: 70 of 93 infected fetuses at 25 [17-36] weeks had ultrasound features of infection and 46% of them showed more than one abnormality. The most frequent findings were ventriculomegaly (27%), hyperechogenic bowel (24%), growth restriction (19%), intracerebral hyperechogenicity (19%), microcephaly (17%), oligohydramnios (11%), hepatosplenomegaly (9%) and isolated ascitis (7%). Amniotic fluid viral load (AFVL) was 2.4 ! 107 [102-4 ! 107] cp/mL increased with gestational age (R = 0.4, P = 7 ! 10-4). Termination of pregnancy was performed for infection in 63 (67%) of the cases as confirmed by postmortem examination. There was 1 neonatal death in a severe congenital infection with preterm delivery at 32 weeks and 1 case of severe neurological impairment. Fetuses without US features presented a normal follow-up. There was no correlation between amniotic fluid viral load and the presence or severity of ultrasound abnormalities nor with outcome. Maternal seroconversion in the first, second and third trimester presented US abnormalities in 56%, 44% and 25% of cases respectively. Ultrasound features were progressive with gestation in at least 46% of cases. The virus is excreted by fetal urine and accumulates in the amniotic fluid irrespective of the severity of the fetal infection. CONCLUSION: The earlier the seroconversion, the higher the incidence of US findings. AFVL does not contribute valuably to establish the prognosis of the disease. The absence of ultrasound findings on targeted serial ultrasound examination is reassuring.

OC086: Antenatal assessment of fetal infection with cytomegalovirus

Congenital cytomegalovirus (CMV) is a prevalent and potentially severe disease. The objective of this paper was to identify all ultrasound findings in fetuses infected with CMV. Retrospective analysis of all cases of congenital cytomegalovirus infections demonstrated by positive PCR in the amniotic fluid referred to three fetal medicine units, between 1997 and 2004. All third level ultrasound examination findings were collected. Estimated time of seroconversion and indication for amniocentesis were reviewed. 93 cases were amenable for analysis. 43 were detected by seroconversion, in which 20 (46%) showed ultrasound abnormalities. The other 50 patients were referred following the diagnosis of ultrasound abnormalities in the second or third trimester. The most frequent findings were Ventriculomegaly (27%), Hyperechogenic bowel (24%), IUGR (19%), Intracerebral hyperechogenic foci (19%), microcephaly (17%), Oligohydramnios (11%), hepatosplenomegaly (9%) and isolated ascitis (7%). Seroconversion in the first, second and third trimester presented US abnormalities in 56%, 44% and 25% of cases respectively. Amniotic fluid viral load (AFVL) was 2.4 million cp/ml [100cp/ml—40 million cp/ml]. Mean gestational age at amniocentesis was 25 [17–36] weeks. A correlation was found between AFVL and gestational age (Spearman Rank Test R = 0.4 p?0.0007), but not with the presence or severity of US features (Wilcoxon). Several ultrasound features are consistently present in fetal infection with cytomegalovirus. The earlier the seroconversion, the higher the incidence of US findings. AFVL does not contribute valuably to stablish the prognosis of the disease.

Demand-led Programmes: Challenging Labour-Market Inequalities or Reinforcing them?

Demand-led programmes have been a key feature of US welfare-to-work and are being enthusiastically embraced by UK policymakers. The author, drawing upon findings emerging from the evaluation of the New Deal Innovation Fund (round three), discusses the extent to which such interventions are capable of meeting the needs of disadvantaged groups. The key findings are that pilots are primarily benefiting groups closest to the labour market and need to engage community-based organisations if they are to become more inclusive. Yet the risk remains that in using the hiring requirements of employers as a basic standard of job readiness such interventions may legitimate discriminatory behaviour which is a significant cause of the inequalities that some groups face in the labour market.

Forme pseudotumorale de la tuberculose choroïdo-sclérale: À propos d’un cas

The authors report the US, CT and MR features of sclerochoroidal tuberculosis simulating a choroidal tumor in a 16 year old female presenting with acute unilateral visual loss. Fundoscopic examination and fluorescein angiography showed a tumor at the posterior pole of the globe. CT and MRI showed the choroidal process and cerebral lesions suggestive of tuberculomas. The evolution was favorable with antituberculous treatment. Ocular tuberculosis is rare, especially the pseudotumoral form. It can simulate a choroidal tumor. Radiologists should be familiar with this appearance because the lesion is reversible with antituberculous treatment.

Ultrasonographic findings after laparoscopic repair of paediatric female inguinal hernias: the 'vanishing rosebud'.

Laparoscopic surgery is a good alternative to the open technique for treating hernias in female paediatric patients. The laparoscopically inverted and sutured hernia sac forms a nodule, the long-term fate of which has not been previously studied radiologically. To describe the early and delayed US changes after laparoscopic inversion and suturing of paediatric female inguinal hernias. Twenty girls (age 1.5 months to 12 years; median 4.6 years) who underwent laparoscopic inguinal hernia repair were prospectively evaluated with US the day before and the day after the procedure. Delayed scans were obtained at 1, 6 and 12 months. The laparoscopic procedure involved inversion and suturing of the hernia sac, which resulted in a nodule that plugged the internal inguinal ring and resembled a rosebud laparoscopically. US detected the 'rosebud' in all cases on the first postoperative day. Initially appearing as a rounded or ovoid mass with a slightly hypoechoic texture, the 'rosebud' became progressively smaller, more hypoechoic and more lobulated on follow-up. It disappeared in all but two cases at 6 months and in all cases at 1 year. There was no US evidence of recurrence. The 'rosebud' formed by this laparoscopic procedure displays typical US features and temporal changes.

The contribution of ultrasound for the differential diagnosis of congenital and infantile nephrotic syndrome.

The aim of this study was to determine whether high-resolution ultrasound is able to differentiate between the various diseases associated with nephrotic syndrome (NS). We reviewed the US features of 15 patients less than 1 year presenting a NS whose exact type was defined by pathology nephrotic syndrome of Finnish type (NSFT, n=2); focal and segmental hyalinosis (FSH, n=3); minimal-change glomerular disease (MCGD, n=2); neonatal glomerulonephritis (n=1), and diffuse mesangial sclerosis (DMS, n=7). The US features studied included the size of the kidneys, cortical echogenicity, cortico-medullary differentiation (CMD), and borders. The images were reviewed on hard copies by two observers unaware of the final diagnosis. In each case a diagnosis was proposed based on the reading of the US features. Six patients with DMS displayed a peculiar US pattern: mild increase of renal size; and inhomogeneous (patchwork-like) parenchymal hyperechogenicity that included areas of the cortex and medulla. The NSFT and neonatal glomerulonephritis displayed some of the same US features: increased kidney size (+2 SD) and had homogeneous cortical hyperechogenity with persistent cortico-medullar differentiation. The kidneys in the 3 patients with SFH were sonographically normal (n=1) or displayed a mild cortical hyperechogenicity (n=2). Inhomogeneous parenchymal hyperechogenicity involving only segments of the cortex and medulla seems to be a specific US pattern for DMS. Ultrasound is less specific for the other types of CNS.

Sonographic comparison of the tubal ring of ectopic pregnancy with the corpus luteum cyst

Objective: Pregnant patients without a sonographically visible intrauterine pregnancy (IUP) and with a thick walled cystic adnexal structure present a dilemma. This study was designed to identify new US features that differentiate between a tubal ring sign of ectopic pregnancy (EP)and a corpus luteum (CL) cyst.

US features of localized form of xanthogranulomatous pyelonephritis

US features of localized form of xanthogranulomatous pyelonephritis

Us, Japan and the Euro Area: Comparing Business-Cycle Features

There has been much discussion of the differences in macroeconomic performance and prospects between the US, Japan and the euro area. Using Markov-switching techniques, in this paper we identify and compare specifically their major business-cycle features and examine the case for a common business cycle, asymmetries in the national cycles and, using a number of algorithms, date business-cycle turning points. Despite a high degree of trade and financial linkages, the cyclical features of US, Japan and the euro area appear quite distinct. Documenting and comparing such international business-cycle features can aid forecasting, model selection and policy analysis etc.

Hematocolpos in double vagina associated with uterus didelphus: US and MR findings

The malformative syndrome of double vagina in association with uterus didelphus and kidney agenesis is a rare condition, often asymptomatic: if this condition is accompanied by imperforated obstructed hemivagina, the clinical manifestations depend on the presence of hematocolpos. MRI plays an important role for diagnosis because it allows to characterize the nature of the lesion and to evaluate the anatomical details of the uterine malformation. The authors describe this complex genital malformation and discuss the main US and MRI features.

Hereditary polycystic kidney diseases in children: changing sonographic patterns through childhood

To determine which US changes occur with time in children affected by autosomal recessive (ARPKD) and autosomal dominant polycystic kidney disease (ADPKD) and whether any of these changes correlate with the onset of renal failure. We reviewed the US features of 29 patients (16 ARPKD, 13 ADPK) imaged by at least two US examinations. We analysed the size and echogenicity of the kidneys, corticomedullary differentiation (CMD), the presence, location and size of cysts and any other anomaly that developed with time. In order to determine whether a relationship could be found between any of the US changes and the onset of the renal failure (based on a glomerular filtration rate < 50 ml/min per 1.73 m2), a Pearson exact chi-square test was calculated. For ARPKD, renal size was above 4 standard deviations (SD) in 10 of 16 patients, but it remained stable during evolution (10/16). The kidneys appeared hyperechoic (16/16), without CMD in the majority (11/16) of patients. Changes in the appearance of CMD over time were observed in five patients. Small cysts (< 1 cm) were present at the time of diagnosis in seven patients, larger cysts (> 1 cm) in three. A diffuse microcystic pattern was observed in three patients. Diffuse hyperechoic foci developed in 14 patients--13 of whom had developed renal failure at the time of the examination or rapidly thereafter (statistical correlation P=0.0125). For ADPKD, renal size was between 0-2 SD in 7 of 13 patients and above 2 SD in the other 6. Renal echogenicity was normal in five, difficult to assess in five and the kidneys appeared hyperechoic without CMD in three patients. Cysts larger than 1 cm were present in 8 of 12 patients (> 3 cm in 5). In four patients, the cysts measured less than 1 cm. In the last child, the diagnosis had been made antenatally and the first cysts appeared at the age of 6 months. The size of the kidneys (13/13) and of the cysts (11/13) remained stable. No renal failure occurred. ARPKD may manifest with various US patterns and there may be evolution in the appearances over time. Our study confirms a significant relationship between the development of diffuse hyperechoic foci and the onset of renal failure. In older children, ARPKD and ADPKD may closely resemble each other. Large (> 3 cm) cysts are the US hallmark for the diagnosis of ADPKD; furthermore, fewer US changes occur with time during childhood in ADPKD.