Use Of Color Doppler Research Articles

New insights in the diagnosis of placenta accreta

In this case report we present a patient of 39 weeks pregnancy with a placenta accreta and discuss the new possilities of diagnosis of placental masses with respect to the related literature. The aim of our review was to assess the available useful procedures in an attempt to contribute to the decreasing the morbidity of this condition. Twenty-nine years-old gravida 2, para 0 was referred to our hospital at 38 weeks of gestation for planed delivery by cesarien section. She had a history of prior surgical pregnancy termination at 12 weeks of amenorrhea by dilation and curettage. The abnormal placentation was diagnosed during a routine sonographic examination at 22 weeks of gestation. 2D transvaginal ultrasound showed the total placenta praevia and the presence of multiple intraplacental lacunae. The placenta did not detach with gentle traction, so placenta accreta was suspected. Heavy bleeding hemorrage from the placental site induced the decision to perform an emergency hysterectomy. The prenatal diagnosis of placenta accreta before delivery allows multidisciplinary planning and minimize potential maternal or neonatal morbidity and mortality. Grayscale ultrasonography with the use of color Doppler is sufficient to diagnose placenta accreta. The knowlege of the ultrasound markers for placenta accreta is needed for both radiologist and obstetricians-gynecologist.

Effectiveness of fetal cardiac screening for congenital heart disease using a combination of the four-chamber view and three-vessel view during the second trimester scan.

We aimed to assess the accuracy and effectiveness of fetal cardiac screening for congenital heart disease (CHD) during the second trimester by general obstetricians in a non-selected population. In this multicenter, prospective cohort study of fetal cardiac screening, four-chamber and three-vessel views were recorded by obstetricians at 18-21 gestational weeks (GW). A total of 3005 fetuses that were scheduled for delivery at our institution were included. Thirty-seven newborns were born with CHD (1.2%). On excluding 23 cases of ventricular septal defects, the prenatal detection rate of CHD was 42.8%. Although six cases (75.0%) of severe structural abnormality were diagnosed prenatally, the prenatal detection rate of valvular abnormalities was 0%. One-point ultrasound screening of the fetal heart using a combination of four-chamber and three-vessel views at 18-21 GW by general obstetricians in a non-selected population may be useful for detecting severe structural abnormalities but not valvular abnormalities. However, this limitation may be improved by conducting another fetal cardiac screening at approximately 30 GW along with the routine use of color Doppler.

Primary splenic torsion in dogs: Case report

Splenic torsion is a rare condition in dogs. The torsion occurs in the vascular pedicle and usually occurs concomitantly with dilatation gastric volvulus, but the primary splenic torsion is rare. According to the literature, this disease usually affects dogs of big size and breeds of deep chest. Clinical signs, laboratory and radiographic findings are nonspecific and inconclusive for the accurate diagnosis of splenic torsion. Thus, ultrasound along with the use of color Doppler has been reported as fundamental tools for the suggestion of the diagnosis of splenic torsion, which is confirmed by exploratory laparotomy, usually followed by total splenectomy as a form of treatment. This study reports the case of a 3-year-old Pit Bull dog whose ultrasound examination was a tool of great diagnostic value for the detection of this disease.

B-Mode Ultrasound Combined with Color Doppler and Strain Elastography in the Diagnosis of Non-mass Breast Lesions: A Prospective Study

Non-mass breast lesions on ultrasound (US) are areas without an associated mass. The purpose of this study was to evaluate whether combining B-mode US with color Doppler US and strain elastography (SE) improves US differentiation between benign and malignant non-mass breast lesions and the decision for biopsy. In this prospective study, three different radiologists analyzed the US images of 77 non-mass lesions independently and recorded Breast Imaging Reporting and Data System (BI-RADS) categories for four data sets. The image characteristics and BI-RADS categories of the four data sets were analyzed by another radiologist. The final diagnosis was made on the basis of pathologic findings. Values for area under the receiver operating curve (AUC), sensitivity, specificity and accuracy were compared among the data sets. The AUC of B-mode US combined with both color Doppler US and SE was greater than that of B-mode US alone (0.666 vs. 0.828) (p = 0.011). The specificity of making the decision for biopsy increased from 6.5% to 38.7% when B-mode US was combined with color Doppler and SE, without a statistically significant change in sensitivity (p < 0.001). Combined use of color Doppler and SE could improve the diagnostic value of B-mode US in distinguishing benign from malignant non-mass breast lesions and the specificity of making the decision for biopsy of non-mass breast lesions.

Twinkle, twinkle little stone: an artifact improves the ultrasound performance!

Ultrasound is a noninvasive method used for the diagnosis of urinary lithiasis. When the length of the stone is lessthan 5 mm, its detection may be difficult. The twinkling artifact (TwA) is an intense alternating color signal behind calcificationsand stones in different organs. The aim of this paper was to evaluate the importance of the TwA in detecting kidney stonesless than 5 mm in length. We examined 230 patients with lumbar pain or a history of kidney stones.We excluded patients with stones larger than 5 mm. 174 patients corresponded to the inclusion criteria. We performed colorDoppler ultrasound and we noticed the presence of the twinkling artifact. The gold standard for the diagnosis was either computedtomography (CT) scan, intravenous urography (IVU) or the spontaneous elimination of the stones. We foundrenal stones in 123 patients. The twinkling artifact was present in 113 cases and absent in the rest of 10 patients. In two patientsthe artifact was present but the stones were not confirmed by CT. The twinkling artifact had sensitivity, specificity, positivepredictive value and negative predictive value of 99.12%, 90.91%, 99.12%, and 90.91% respectively. The twinklingartifact is a very useful color Doppler ultrasound tool for the detection of small urinary stones. We suggest the routineuse of color Doppler in all suspicious cases in order to avoid unnecessary irradiating and expensive radiological methods.

Retroperitoneal cellular schwannoma

We present the case of a female patient, 35 years old, who had a complaint of sporadic left flank pain for 5 years. She said she had no comorbidities. The results of the laboratory tests did not show abnormalities. Previous ultrasonography of the urinary tract (without the use of color Doppler) described a possible single cyst postero-inferiorly to the left renal pelvis. In recent ultrasound we observed that topography massive oval formation markedly hypoechoic with discrete intermingled flow. Subsequent abdominal computed tomography and magnetic resonance imaging characterized retroperitoneal mass along the hilum of the left kidney, associated with renal dimensional reduction and ipsilateral hydronephrosis. Histological diagnosis after tumor excision: cell schwannoma (Antoni A histological standard only).

비확장성 요관결석에 대한 컬러 도플러의 유용성

비확장성 요관결석에 대한 컬러 도플러의 유용성

Ultrasound Imaging for Ovarian and Deep Infiltrating Endometriosis

The main challenges of imaging for endometriosis are the detection of nonovarian disease and the evaluation of the extension of the disease into pelvic structures. Transvaginal ultrasonography (TVS) has been proposed as the first-line imaging technique because it allows extensive exploration of the pelvis. The "typical" endometrioma is a unilocular cyst with homogeneous low-level echogenicity (ground glass echogenicity) of the cyst fluid. The use of color Doppler helps avoid classifying malignancies as endometriomas, defining the presence of vascular flow in papillations. The real-time dynamic TVS examination of adhesions and pouch of Douglas (POD) obliteration, using the sliding sign technique, seems to be useful in the identification of women at increased risk for bowel endometriosis. Transvaginal ultrasound allows an accurate assessment of the vagina, particularly the areas of the posterior and lateral vaginal fornixes, the retrocervical area with torus uterinum and uterosacral ligaments, and the rectovaginal septum. The slightly filled bladder permits an evaluation of the bladder walls and the presence of endometriotic nodules which appear as hypoechoic linear or spherical lesions bulging toward the lumen, involving the serosa, muscularis, or (sub)mucosa of the bladder. Deep nodules of the rectum appear as hypoechoic lesions, linear or nodular retroperitoneal thickening with irregular borders, penetrating into the intestinal wall distorting its normal structure with the presence of few vessels observed with power Doppler evaluation. Adenomyosis can be observed with the two-dimensional (2D) TVS showing the typical myometrial features and 3D evaluation of the junctional zone. Although the sensitivity and specificity of TVS in the prediction of deeply infiltrating endometriosis and adenomyosis is high, their assessment by TVS is difficult and needs a great expertise.

Use of colour Doppler and M-mode ultrasonography to confirm the location of an epidural catheter - a retrospective case series

Epidural anesthesia and analgesia has a reported failure rate ranging from 13% to 32%. We describe a technique using colour Doppler and M-mode ultrasonography to determine the position of the epidural catheter after placement in adults. This retrospective review included 37 adult patients who received postoperative epidural analgesia and underwent technically difficult epidural catheter placement. The demographic characteristics, type of surgery, use of ultrasonography, method of insertion, intervertebral level, and success of epidural localization using colour Doppler were noted for each patient. Pain scores on postoperative day 1 and the presence of a patchy block were also reviewed. Colour Doppler study helped to indicate the catheter's path from the skin to the epidural space during saline injection in 33 patients (89%). Saline flow within the epidural space (catheter tip confirmation) was successfully detected with colour Doppler in 25 patients (67.5%) and with M-mode ultrasonography in 28 patients (75%). Appropriate dermatomal analgesia was noted in 35 patients (94.5%) during local anesthetic infusion. Our preliminary data suggest the feasibility of using colour Doppler and M-mode ultrasonography to confirm proper epidural catheter placement.

Sonomorphological, gray scale and color Doppler flow imaging evaluation of ovarian lesions

Background: Ultrasonography (USG) is considered the primary imaging modality for confirmation of the ovarian origin of the mass and characterization of the nature of the mass as benign or malignant. However, when morphologic features alone are applied to the prediction of ovarian malignancy, there is a tendency to over diagnose malignant tumors because of a substantial overlap between malignant and benign-appearing masses. Transvaginal color Doppler imaging with pulsed Doppler spectral analysis improves the characterization of ovarian masses by means of quantitative blood flow measurements obtained from tumor vessels. Color Doppler ultrasound helps identify solid, vascularized components in a mass. Objectives: To evaluate prospectively the relative usefulness of color Doppler, spectral Doppler, and gray scale sonography in differentiating benign from malignant adnexal masses. Materials and Methods: Patients with abdominal lump were screened for sonography. If on sonography patient having ovarian lesion then detailed study was carried out by gray scale, color, power Doppler and by spectral waveform analysis. Morphologic indexing of the adnexal masses was performed using the Sassone score. Flow results were recorded as being absent or present and further characterized as normal or increased, vessel location, and arrangement. Results: A total of 50 patients with 53 adnexal masses were enrolled into the study. Benign lesions were common in premenopausal age (30 [81%]) and malignant lesions (10 [77%]) were more common in the postmenopausal state. 23 out of 49 masses were considered suspicious of malignancy (Sassone score = 9), of which, 18 were malignant (including bilateral ovarian metastasis as a separate lesion) and 8 were benign. The sonomorphologic evaluation following Sassone scoring system had a sensitivity of 90%, specificity 75%, positive predictive value (PPV) 69% and negative predictive value (NPV) 92%. The sensitivity, specificity, PPV, and NPV of gray scale USG alone were 70%, 72.22%, 58.33%, and 81.25% respectively. While for gray scale with combined color and spectral Doppler USG the values were 90%, 91.66%, 85.71%, and 94.28%, respectively. Conclusion: Adding color Doppler to conventional sonography produced a specificity and PPV higher than those of conventional sonography alone and so gray scale USG in combination with Color Doppler and Spectral Doppler is proposed as the first and foremost diagnostic modality in patients with ovarian lesions.

Echocardiography in shock management.

Echocardiography is pivotal in the diagnosis and management of the shocked patient. Important characteristics in the setting of shock are that it is non-invasive and can be rapidly applied.In the acute situation a basic study often yields immediate results allowing for the initiation of therapy, while a follow-up advanced study brings the advantage of further refining the diagnosis and providing an in-depth hemodynamic assessment. Competency in basic critical care echocardiography is now regarded as a mandatory part of critical care training with clear guidelines available. The majority of pathologies found in shocked patients are readily identified using basic level 2D and M-mode echocardiography. A more comprehensive diagnosis can be achieved with advanced levels of competency, for which practice guidelines are also now available. Hemodynamic evaluation and ongoing monitoring are possible with advanced levels of competency, which includes the use of colour Doppler, spectral Doppler, and tissue Doppler imaging and occasionally the use of more recent technological advances such as 3D or speckled tracking.The four core types of shock—cardiogenic, hypovolemic, obstructive, and vasoplegic—can readily be identified by echocardiography. Even within each of the main headings contained in the shock classification, a variety of pathologies may be the cause and echocardiography will differentiate which of these is responsible. Increasingly, as a result of more complex and elderly patients, the shock may be multifactorial, such as a combination of cardiogenic and septic shock or hypovolemia and ventricular outflow obstruction.The diagnostic benefit of echocardiography in the shocked patient is obvious. The increasing prevalence of critical care physicians experienced in advanced techniques means echocardiography often supplants the need for more invasive hemodynamic assessment and monitoring in shock.

LO014: What ultrasonography characteristics predict surgical intervention for testicular torsion in adults?

Introduction: Testicular torsion is a time sensitive condition for which there can be significant delays to surgery or transfer to definitive care while trying to obtain an ultrasound to confirm the diagnosis. This study determines the test characteristics for each individual sonographic sign of testicular torsion associated with the patient requiring surgical intervention. Methods: A retrospective health records review of adult patients with acute, non-traumatic scrotal pain or swelling (defined as under 24 hours since onset) presenting to one of two Canadian academic tertiary care emergency departments between November 2009 and March 2013 was performed. A single data abstractor completed a case report form for each patient including demographics, individual ultrasound findings, final diagnosis, and need for surgical intervention. The sensitivity and specificity of each ultrasonographic sign (including testicular heterogeneity, decreased colour doppler, and decreased pulsed wave doppler) at predicting surgical intervention during the same hospital visit was calculated along with 95% confidence intervals. Results: During the study period there were a total of 876 emergency department visits for scrotal pain, of which 198 patients met our inclusion criteria. The included patients had a mean age of 36.2 years. Decreased blood flow to the painful testicle on colour doppler showed the best overall test characteristics with a sensitivity of 82.4% (95% CI 55.8%-95.3%) and specificity of 100% (95% CI 96.3%-100%) for predicting a need for surgical intervention for testicular torsion. Other ultrasound findings for testicular torsion included a heterogeneous appearance of the painful testicle (sensitivity 47.1% [95% CI 23.9%-71.5%], specificity 77.4% [95% CI 68.9%-84.2%]), and decreased arterial or venous flow on pulsed wave doppler (sensitivity 76.5% [95% CI 49.8%-92.1%], specificity 100% [95% CI 96.3%-100%]). Conclusion: Decreased blood flow to the painful testicle on colour doppler showed excellent specificity and can rapidly “rule-in” a need for surgical intervention for testicular torsion. Given that colour doppler is relatively easy to learn and perform, future studies should assess the use of colour doppler using point of care ultrasound to expedite surgical consultation.

Study of transcranial colour Doppler in the measurement of cerebral edema in birth asphyxia

Background: Perinatal asphyxia is an insult to fetus or newborn due to lack of oxygen /perfusion to various organs. Perinatal asphyxia occurs in 1 to 3 per 1000 live births and is related to gestational age and birth weight. Worldwide 4-9 million suffer from birth asphyxia. It occur in 9% of infants of 36 wks. Hypoxic ischemic brain injury is the most important consequence of perinatal asphyxia. Aim of study: To detect the measurement of cerebral blood flow in full term infants with birth asphyxia, by use of transcranial colour Doppler to measure RI (Resistive Index). Setting: Department of Paediatrics at MY hospital in collaboration with department of radiodiagnosis over a period of 1 yr from November 2013- October 14. Design: Observational study. Method: It included 40 consecutive cases of birth asphyxia who suffered from HIE. Measurement of cerebral blood flow velocity was done by the use of colour doppler ultrasound. Result: Resistive index values were lower in measured vessels in asphyxiated infant as compared by blood flow velocity, resistive index of ACA and MCA. It is observed in our study that maximum number of patients in asphyxiated group belongs to grade II HIE 87.5% (35), while in stage III there were 2.5% (1) and in stage I only 4 (10%) patients. Conclusion: Colour Doppler USG would be of practical importance in evaluating the cerebral blood flow velocity in neonate with HIE. A skillful detection of decrease in cerebral blood flow of neonate in postnatal first 12 hrs & treatment being based on such detection would contribute to a good prognosis.

Ultrasound evaluation of the striated urethral sphincter as a predictive parameter of urinary continence after radical prostatectomy.

The purpose of this study was to evaluate preoperatively the results of transrectal ultrasound (TRUS) in the detection of morphological, vascularization status of urethral rhabdosphincter (RS) and evaluate the correlation with urinary continence after radical prostatectomy (RP). 211 patients who underwent RP were prospectively studied using TRUS scan of the RS thickness. At the end of the examination a study was performed with the use of colour-Doppler for the assessment of the RS vascularity pattern. The level of continence was graded on a 5 point scale as: 1 = complete continence, 2 = 1 pad daily, 3 = 2-3 pads daily, 4 = 4 or more pads daily, and 5 = complete incontinence. It was possible to visualize the rhabdosphincter and its vascularity in all patients. Patients with normal continence (level 1 and 2) showed a sphincter-muscle thickness of 3.5 mm (± 0.4) and a hypoechoic ultrasound pattern. With respect to the other levels 3, 4 and 5 of urinary incontinence RS thickness was 2.8 mm (± 0.5), 2.1 mm (± 0.6), 1.7 (± 0.7) respectively. Incontinence after RP (≥ 3 level) was associated with urethral sphincter deficiency in the great majority of patients. Statistical significant differences were observed in the vascularity between continent and incontinent men in all measured vascularity variables (p &lt; 0.005). This study suggests that RS integrity is a good predictor of urinary continence after RP and this information can be important during the preoperative phase as part of the informed consent.

Clinical Study of varicose veins and their management

Varicose veins and their associated symptoms and complications constitute the most common chronic vascular disorders leading to surgical treatment. Though considerable advances in understanding of venous patho physiology and modern imaging techniques have revolutionized the concept of management of varicosity of lower limb, whether these inferences hold good for our population is a pertinent question.The objective of the study is: 1) Analysis of the clinical features of varicose vein. 2) To know the various treatment modalities adapted for the management of varicose veins.Varicosity of the lower limb is a common clinical entity with, age group of 31-40 being commonly affected. The involvement of long saphenous vein is the commonest. Clinical examination has a high predictive accuracy. The use of color Doppler is a valuable supplement to clinical examination for effective treatment of varicose veins.Operative line of treatment is a primary procedure in the management of varicose veins of lower limbs. LSV stripping up to mid calf is associated with less morbidity so also non-stripping of SSV. The present procedures enable the patient to lead almost normal life after surgery and the mortality rate is very negligible.

Introducing Final-Year Medical Students to Pocket-Sized Ultrasound Imaging: Teaching Transthoracic Echocardiography on a 2-Week Anesthesia Rotation

Problem: The availability of less expensive and smaller ultrasound machines has enabled the use of ultrasound in virtually all major medical/surgical disciplines. Some medical schools have incorporated point-of-care ultrasound training into their undergraduate curriculum, whereas many postgraduate programs have made ultrasound training a standard. The Chinese University of Hong Kong has charged its Department of Anaesthesia and Intensive Care to spearhead the introduction of ultrasound into the final-year medical curriculum by introducing handheld transthoracic echocardiography as part of perioperative assessment. Intervention: All 133 final-year students completed a 2-week anesthesia rotation, which began with a half-day session consisting of a lecture and hands-on practice session during which they learned 9 basic transthoracic echocardiography views using 4 basic ultrasound probe positions. Context: Each student was required to perform a transthoracic echocardiography-examine under supervision of 1 patient/week for 2 weeks, and their results were compared against that of the supervisor's. Most patients were elective cardiac surgery patients. One long question on transthoracic echocardiography was included in their end-of-year surgery examination paper. Students provided feedback on their experience. Outcome: Most students learned the basic transthoracic echocardiography views fairly efficiently and had variable, though generally favorable, success rates in identifying obvious cardiac anomalies, including use of color Doppler. A few common mistakes were identified but were easily correctable. Logistics for mobilizing enough bedside supervision were challenging. Students reported positive feedback on the teaching initiative. Lessons Learned: We were able to execute a successful short training course on transthoracic echocardiography during the final-year medical degree anesthesia rotation. Our initiative may set an example for other clinical departments to design similar courses pertinent to their specialties and syllabuses.

Aplicaciones de la ultrasonografía en el sistema nervioso central para neuroanestesia y cuidado neurocrítico

Ultrasonography performed by non-radiologist specialists is a tool that contributes to the diagnosis and monitoring of neurocritical patients. It is a non-invasive, low-cost, accurate and fast method that helps improve safety and timeliness in settings where prompt decision-making is imperative, such as in the operating room, critical care units or the emergency room.The objective is to conduct a narrative review, presenting ultrasound applications focused on the central nervous system that may be useful in neuroanesthesia and neurocritical care. A search was performed of related terms on databases in the medical literature. Relevant papers where selected and reviewed to perform a non-systematic review focusing on the visualization of the midline and lateral ventricles, the measurement of the optic nerve sheath as a surrogate marker of intracranial hypertension, and the use of colour Doppler for visualizing the middle cerebral artery.It is expected that the use of ultrasound examination of the central nervous system will continue to evolve given its advantages, good correlation with studies considered as the gold standard, and the growing availability of the device. Advancements in this field are expected to improve timeliness and provide objective guidance for decision-making. We recognize the importance of developing skills in the use of this method of exploration in those services where it is required.

Ultrasound applications in the central nervous system for neuroanaesthesia and neurocritical care

Ultrasonography performed by non-radiologist specialists is a tool that contributes to the diagnosis and monitoring of neurocritical patients. It is a non-invasive, low-cost, accurate and fast method that helps improve safety and timeliness in settings where prompt decision-making is imperative, such as in the operating room, critical care units or the emergency room.The objective is to conduct a narrative review, presenting ultrasound applications focused on the central nervous system that may be useful in neuroanaesthesia and neurocritical care. A search was performed of related terms on databases in the medical literature. Relevant papers where selected and reviewed to perform a non-systematic review focusing on the visualization of the midline and lateral ventricles, the measurement of the optic nerve sheath as a surrogate marker of intracranial hypertension, and the use of colour Doppler for visualizing the middle cerebral artery.It is expected that the use of ultrasound examination of the central nervous system will continue to evolve given its advantages, good correlation with studies considered as the gold standard, and the growing availability of the device. Advancements in this field are expected to improve timeliness and provide objective guidance for decision-making. We recognize the importance of developing skills in the use of this method of exploration in those services where it is required.

Challenges in Sonographic Detection of Fetal Major Structural Abnormalities at the First Trimester Anomaly Scan

ABSTRACT First-trimester (FT) ultrasound examination appears to have a very good sensitivity in the detection of fetal abnormalities, especially when an extended protocol that is achievable with reasonable resources of time, personnel and ultrasound equipment, is used. It has been shown that the efficiency of the routine anomaly scan varies widely between the studies performed both in early or mid-pregnancy. The analysis of technique and study designs reveals that in each gestational age, the extension of the investigational protocol is the most important factor in modulating the detection rate. Moreover, the use of similar basic checklists at the FT and second trimester (ST) examinations revealed comparable anomaly detection rates in large population groups. First trimester combined test have been demonstrated as a useful screening tool for genetic syndromes and consecutively the FT ultrasound scan became a routine examination in most prenatal diagnostic centers. Its performance in structural abnormalities detection has been communicated in high-, medium-risk populations or unselected low-risk variable number of patients and compared to the ST anomaly scan effectiveness. A detailed first-trimester anomaly scan using an extended protocol is an efficient screening method to detect major fetal structural abnormalities in low-risk pregnancies. It is a method that it is feasible at 12 to 13 + 6 weeks with ultrasound equipment and personnel already used for routine first-trimester screening. Rate of detection of severe malformations is greater in early- than in mid-pregnancy and on postnatal evaluation. Early heart investigation could be improved by an extended protocol involving use of color Doppler. How to cite this article Iliescu D, Cara M, Tudorache S, Antsaklis P, Ceausu I, Paulescu D, Novac L, Cernea N, Antsaklis A. Challenges in Sonographic Detection of Fetal Major Structural Abnormalities at the First Trimester Anomaly Scan. Donald School J Ultrasound Obstet Gynecol 2015;9(3):239-259.

Improved Detection Rate of Structural Abnormalities in the First Trimester Using an Extended Examination Protocol

Objective To assess the potential of first-trimester sonography in the detection of fetal abnormalities using an extended protocol that is achievable with reasonable resources of time, personnel and ultrasound equipment. Methods This was a prospective two-center 2-year study of 5472 consecutive unselected pregnant women examined at 12 to 13 + 6 gestational weeks. Women were examined using an extended morphogenetic ultrasound protocol that, in addition to the basic evaluation, involved a color Doppler cardiac sweep and identification of early contingent markers for major abnormalities. Results The prevalence of lethal and severe malformations was 1.39%. The first-trimester scan identified 40.6% of the cases detected overall and 76.3% of major structural defects. The first-trimester detection rate (DR) for major congenital heart disease (either isolated or associated with extracardiac abnormalities) was 90% and that for major central nervous system anomalies was 69.5%. In fetuses with increased nuchal translucency (NT), the first-trimester DR for major anomalies was 96%, and in fetuses with normal NT it was 66.7%. Most (67.1%) cases with major abnormalities presented with normal NT. Conclusions A detailed first-trimester anomaly scan using an extended protocol is an efficient screening method to detect major fetal structural abnormalities in low-risk pregnancies. It is feasible at 12 to 13 + 6 weeks with ultrasound equipment and personnel already used for routine first-trimester screening. Rate of detection of severe malformations is greater in early- than in mid-pregnancy and on postnatal evaluation. Early heart investigation could be improved by an extended protocol involving use of color Doppler. Copyright © 2013 ISUOG. Published by John Wiley & Sons Ltd.