Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine (J Ultrasound Med)

Publications in this journal

• Article: Ectopia cordis in a first-trimester sonographic screening program for aneuploidy.

  Waldo Sepulveda, Amy E Wong, Luis Simonetti, Enrique Gomez, Victor Dezerega, Jorge Gutierrez
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  ABSTRACT: We review the sonographic features, antenatal course, and perinatal outcomes in 7 cases of ectopia cordis diagnosed in the first trimester. Four cases were associated with a large omphalocele (pentalogy of Cantrell) and 2 with a body stalk anomaly. The remaining fetus had isolated thoracic ectopia cordis. Two pregnancies were terminated; 2 fetuses died in utero; 2 infants died after delivery; and 1 died at 3 months of age. We conclude that the diagnosis of ectopia cordis can easily be established during the first trimester. In agreement with the currently available literature, the prognosis of ectopia cordis in our series was uniformly poor.
  Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine 05/2013; 32(5):865-71.
• Article: Feasibility study of contrast-enhanced automated acoustic mammography.

  Diana Gaitini, Tamara Rothstein, Zahava Gallimidi, Haim Azhari
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  ABSTRACT: The feasibility of implementing image subtraction in through-transmission breast sonography was examined. Acoustic mammograms of women with suspicious findings were obtained using through-transmission imaging. Precontrast images were initially acquired. Then a perflutren liquid microsphere contrast agent solution was injected intravenously, and new sets of images were acquired. Precontrast-postcontrast subtraction images depicting the resulting changes were then obtained and visually compared with other imaging modalities. The ability to detect changes stemming from contrast agent injection in the through-transmission mode was verified. The comparability with x-ray mammography and magnetic resonance imaging was shown. Finally, the ability to compare images obtained before and several months after surgery was confirmed.
  Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine 05/2013; 32(5):825-33.
• Article: Frontonasal Fold Thickness-to-Nasal Bone Length Ratio as a Prenatal Sonographic Marker for Trisomy 21 in a Low-Risk Population.

  Ruben Gonzalez, Socrates Aedo, Victor Dezerega, Waldo Sepulveda
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  ABSTRACT: Objectives- To report normative data for the fetal nasal bone length (NBL), frontonasal fold (FNF) thickness, and the FNF/NBL ratio and to study their performance in the sonographic screening of trisomy 21 in a normal, unselected Latin American population. Methods- Women undergoing a routine sonographic examination between 16 and 32 weeks' gestation at a primary health care center in Santiago, Chile, were prospectively recruited for NBL and FNF thickness measurements. Pregnancies with maternal/fetal complications were subsequently excluded from analysis. Correlations between NBL, FNF thickness, and FNF/NBL ratio and gestational age were assessed with the Spearman correlation coefficient (ρ). To generate reference percentiles for NBL and FNF thickness, adjusted regression models were derived using a statistical method for calculating reference percentiles of fetal biometric parameters. Results- A total of 1922 cases complied with entry criteria. Both the NBL and the FNF thickness increased with gestational age. However, the FNF/NBL ratio remained constant (ρ= 0.016; P = .95), with a mean value of 0.68 and 95th and 99th percentile values of 0.84 and 0.90, respectively. During the study period, all 4 fetuses with trisomy 21 diagnosed in this low-risk population had an FNF/NBL ratio above the 99th percentile, whereas only 3 had NBL below the fifth percentile, and 3 had FNF thickness above the 95th percentile. Conclusions- The FNF/NBL ratio is a promising marker for the sonographic screening of trisomy 21 in the low-risk population; however, further prospective studies including larger numbers of fetuses with trisomy 21 are warranted to determine the clinical value of this marker. As the NBL is dependent on the ethnicity of the population screened, determination of normative data for NBL and the FNF/NBL ratio in different ethnic populations is also recommended before including this method in the routine screening for aneuploidy.
  Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine 05/2013; 32(5):795-800.
• Article: Transition from nerve stimulator to sonographically guided axillary brachial plexus anesthesia in hand surgery: block quality and patient satisfaction during the transition period.

  Cédric Luyet, Mihai Constantinescu, Manuel Waltenspül, Martin Luginbühl, Esther Vögelin
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  ABSTRACT: Objectives- Sonographic guidance for peripheral nerve anesthesia has proven increasingly successful in clinical practice; however, fears that a change to sonographically guided regional anesthesia may impair the block quality and operating room work flow persist in certain units. In this retrospective cohort study, block quality and patient satisfaction during the transition period from nerve stimulator to sonographic guidance for axillary brachial plexus anesthesia in a tertiary referral center were investigated. Methods- Anesthesia records of all patients who had elective surgery of the wrist or hand during the transition time (September 1, 2006-August 25, 2007) were reviewed for block success, placement time, anesthesiologist training level, local anesthetic volume, and requirement of additional analgesics. Postoperative records were reviewed, and patient satisfaction was assessed by telephone interviews in matched subgroups. Results- Of 415 blocks, 341 were sonographically guided, and 74 were nerve stimulator guided. Sonographically guided blocks were mostly performed by novices, whereas nerve stimulator-guided blocks were performed by advanced users (72.3% versus 14%; P < .001). Block performance times and success rates were similar in both groups. In sonographically guided blocks, significantly less local anesthetics were applied compared to nerve stimulator-guided blocks (mean ± SD, 36.1 ± 7.1 versus 43.9 ± 6.1 mL; P< .001), and less opioids were required (fentanyl, 66.1 ± 30 versus 90 ± 62 μg; P< .001). Interviewed patients reported significantly less procedure-related discomfort, pain, and prolonged procedure time when block placement was sonographically guided (2% versus 20%; P = .002). Conclusions- Transition from nerve stimulator to sonographic guidance for axillary brachial plexus blocks did not change block performance times or success rates. Patient satisfaction was improved even during the early institutional transition period.
  Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine 05/2013; 32(5):779-86.
• Article: Fetal progeria: prenatal sonographic findings in petty syndrome.

  Denise Pugash, Kasmintan A Schrader, Christopher P Dunham, Oana-Eugenia Popescu, Michael A Sargent, Anna M Lehman, Siu Li Yong, Lorne A Clarke
  Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine 05/2013; 32(5):881-3.
• Article: Point-of-Care Sonographic Diagnosis of an Enterovesical Fistula.

  Darrell Sutijono
  Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine 05/2013; 32(5):883-5.
• Article: Three-dimensional region-based segmentation for breast tumors on sonography.

  Yu-Len Huang, Dar-Ren Chen, Shun-Chan Chang
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  ABSTRACT: Because malignant and benign breast tumors show different shapes and sizes on sonography, information about tumor shapes and sizes is important for clinical diagnosis. Since sonograms include noise and tissue texture, accurate clinical diagnosis is highly dependent on clinical experience and expertise. However, manually sketching a 3-dimensional (3D) breast tumor contour is a time-consuming and complicated task. Automatic contouring, which provides a contour similar to that of manual sketching of a breast tumor on sonography, may improve diagnostic accuracy. This study presents an efficient method for automatically detecting 3D contours of breast tumors on 3D sonography. The proposed method applies a voxel nearest neighbor filter, a Wiener filter, and an unsharp filter to enhance contrast and reduce noise. After a 3D region-growing algorithm is used to obtain the contour of the breast tumor, postprocessing of the extracted contour is performed to diminish the shadow region of the tumor. This study evaluated 20 tumor cases comprising 10 benign and 10 malignant cases. The results of computer simulation reveal that the proposed 3D segmentation method provides robust contouring for breast sonograms. This approach consistently obtains contours similar to those obtained by manual contouring of a breast tumor and can reduce the time needed to sketch precise contours.
  Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine 05/2013; 32(5):835-46.
• Article: Contrast-enhanced sonography of juxtapleural pulmonary tuberculoma.

  Bing-Sheng Cao, Yu-Mei Liang, Xiao-Lin Li, Juan Deng, Geng-Chen Zhang
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  ABSTRACT: Objectives- The purpose of this study was to describe the findings of juxtapleural pulmonary tuberculoma on contrast-enhanced sonography and investigate their correlation with histologic findings. Methods- From April 2008 to April 2012, 21 patients with biopsy or clinically proven juxtapleural pulmonary tuberculomas underwent contrast-enhanced sonography with an intravenous bolus injection of 4.8 mL of a sulfur hexafluoride-filled microbubble contrast agent. Enhancement patterns and functional parameters (time to enhancement, time to peak enhancement, and peak signal intensity) derived from a time-intensity curve were evaluated. Enhancement patterns were correlated with their histologic findings. Results- A rim enhancement pattern was presented in 12 (57.1%), a homogeneous enhancement pattern in 5 (23.8%), and a heterogeneous enhancement pattern in 4 (19.1%) of 21 tuberculomas. A pathologic study confirmed that the nonenhancing center of the rim enhancement pattern corresponded to caseous or liquefied necrosis, and homogeneously enhanced portions corresponded to granulomatous inflammation. The medians (25th-75th interquartile ranges) for the time to enhancement, time to peak enhancement, and peak signal intensity were 14 seconds (9-14 seconds), 22 seconds (21-26 seconds), and 83 dB (55-92 dB), respectively. Conclusions- Contrast-enhanced sonography of juxtapleural pulmonary tuberculoma is feasible. Juxtapleural pulmonary tuberculomas usually show rim, homogeneous, or heterogeneous enhancement. Enhancement patterns of juxtapleural pulmonary tuberculomas are well correlated with their pathologic features.
  Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine 05/2013; 32(5):749-56.
• Article: Sonographic features of rare posterior fetal neck masses of vascular origin.

  Megan C Kaplan, Beverly G Coleman, Sara D Shaylor, Lori J Howell, Edward R Oliver, Steven C Horii, N Scott Adzick
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  ABSTRACT: The purpose of this series is to describe the grayscale and color Doppler sonographic characteristics as well as the histopathologic features of rare solid posterior neck masses identified on prenatal sonography in pregnant patients. We conducted a retrospective review of detailed fetal sonographic examinations of second- and third-trimester pregnancies referred to the Center for Fetal Diagnosis and Treatment at the Children's Hospital of Philadelphia for suspected fetal neck masses from June 1998 to December 2011. Eight predominately solid posterior neck masses were identified on 139 studies performed during the study period. Of the 7 cases in which follow-up was available, 6 were confirmed as hemangiomas, and 1 was confirmed as a kaposiform hemangioendothelioma with Kasabach-Merritt syndrome. The most common sonographic features were hypervascularity (7) and calcifications (5). Posterior solid fetal neck masses are rare anomalies. Hemangioma is the most common etiology and should be suggested as the likely diagnosis rather than teratoma, even in the presence of calcifications.
  Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine 05/2013; 32(5):873-80.
• Article: Reply.

  Nora Frulio, Herve Laumonier, Thibault Carteret, Christophe Laurent, Charles Balabaud, Paulette Bioulac-Sage, Florent Maire, Herve Trillaud
  Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine 05/2013; 32(5):889-90.
• Article: Does the use of automated fetal biometry improve clinical work flow efficiency?

  Jimmy Espinoza, Sara Good, Evie Russell, Wesley Lee
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  ABSTRACT: This study was designed to compare the work flow efficiency of manual measurements of 5 fetal parameters with a novel technique that automatically measures these parameters from 2-dimensional sonograms. This prospective study included 200 singleton pregnancies between 15 and 40 weeks' gestation. Patients were randomly allocated to either manual (n = 100) or automatic (n = 100) fetal biometry. The automatic measurement was performed using a commercially available software application. A digital video recorder captured all on-screen activity associated with the sonographic examination. The examination time and number of steps required to obtain fetal measurements were compared between manual and automatic methods. The mean time required to obtain the biometric measurements was significantly shorter using the automated technique than the manual approach (P < .001 for all comparisons). Similarly, the mean number of steps required to perform these measurements was significantly fewer with automatic measurements compared to the manual technique (P < .001). In summary, automated biometry reduced the examination time required for standard fetal measurements. This approach may improve work flow efficiency in busy obstetric sonography practices.
  Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine 05/2013; 32(5):847-50.
• Article: Inflammation markers correlate with common carotid intima-media thickness in patients perinatally infected with human immunodeficiency virus 1.

  Antonio Di Biagio, Raffaella Rosso, Paolo Maggi, Debora Mazzei, Claudia Bernardini, Loredana Nulvesu, Andrea Parisini, Elena Nicco, Fabrizio De Carli, Guido Rodriguez, Claudio Viscoli
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  ABSTRACT: Objectives- To investigate common carotid intima-media thickness in a cohort of patients who were vertically infected with human immunodeficiency virus 1 (HIV-1). Methods- We conducted a cross-sectional observational study. Human immunodeficiency virus 1-infected patients were compared with age-, sex-, and body mass index-matched healthy participants. Common carotid intima-media thickness was measured in all participants on both sides of the neck, and the mean intima-media thickness was calculated. Metabolic parameters and markers of inflammation were measured only in HIV-1-infected patients. Statistical analysis was performed by multiple regression and by a matrix of Pearson correlation coefficients. The Student t test was used to compare mean common carotid intima-media thickness values between groups. Results- Forty patients (21 female) with HIV-1 infection acquired from birth with a mean age ± SD of 16.3 ± 4.7 years and 27 healthy participants (11 female) with a mean age of 17.7 ± 4.6 years were included in the study. Mean common carotid intima-media thickness in the HIV-1-infected group (0.450 ± 0.088 mm) was significantly higher (P < .05) than in the control group (0.407 ± 0.079 mm). No significant association was found between intima-media thickness and a specific antiretroviral regimen, exposure to combined antiretroviral agents, and HIV status. In multiple regression analyses, higher levels of insulin (P= .007) and elevated levels of glycated hemoglobin (P= .01) were associated with intima-media thickness changes. Conclusions- Patients perinatally infected with HIV have increased common carotid intima-media thickness compared with healthy individuals. These changes were more pronounced with increasing age and inflammation markers. Interventions that improve cardiovascular risk profiles should be considered in HIV-infected young adults.
  Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine 05/2013; 32(5):763-8.
• Article: A microbubble contrast agent improves prediction of ablated areas during radiofrequency ablation: a rabbit liver study.

  Jie Hu, Fenglin Wu, Yang Sui, Tingting Xu
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  ABSTRACT: Objectives- The purpose of this study was to explore the effects of a microbubble contrast agent (SonoVue; Bracco SpA, Milan, Italy) on the spread of gas generated by heating during radiofrequency ablation in vivo. Methods- Radiofrequency ablation was performed with or without SonoVue on 2 areas per rabbit liver in 20 rabbits under sonographic guidance. They were divided into groups 1 and 2 on the basis of ablation with and without SonoVue. In group 1, SonoVue (0.05 mL/kg) was injected as an intravenous bolus. After radiofrequency ablation, 3 orthogonal diameters of hyperechogenicity and defects of enhancement on contrast-enhanced sonography were measured sonographically. Coagulated zones and ablation times were also evaluated. Results- There were no significant differences in the sizes of the hyperechoic areas, defects, or coagulated zones between the groups (P > .05). However, the total number of ablations with clearly visualized hyperechogenicity was 15 in group 1 versus 7 in group 2, as opposed to ablations with partial or not clearly visualized hyperechogenicity (P< .05). A comparison between hyperechoic and pathologic volumes provided correlation values of r(2) = 0.803 and r(2) = 0.624 for groups 1 and 2, respectively. In addition, the ablation time for group 1 was significantly shorter (P < .05). Conclusions- A microbubble agent would not change the size of the ablated area, but it can improve prediction of ablated areas and reduce the ablation time for achieving the same effects. Therefore, it might be useful to prevent unfavorable ablation of adjacent organs and vessels.
  Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine 05/2013; 32(5):787-93.
• Article: Localized or diffuse lesions of the submandibular glands in immunoglobulin g4-related disease in association with differential organ involvement.

  Satomi Asai, Kenji Okami, Naoya Nakamura, Shuichi Shiraishi, Ryousuke Sugimoto, Damdinsuren Anar, Shinji Sato, Hiromichi Matsushita, Yasuo Suzuki, Hayato Miyachi
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  ABSTRACT: Objectives- The purpose of this study was to assess the relationship between the sonographic characteristics of the submandibular glands and organ involvement at the initial presentation in patients with immunoglobulin G4 (IgG4)-related disease. Methods- We conducted a retrospective study that included 15 patients who had bilateral swollen submandibular glands and elevated serum IgG4 levels between January 2005 and December 2010. Results- In all 15 patients, sonography revealed the involvement of both sides of the submandibular glands. The sonographic appearance of each gland was classified into two types: localized tumor-forming and diffuse focal types. On the basis of this typing, all 15 patients were classified into two groups: a group with the localized tumor-forming type observed on one or both sides of the glands (n = 10) and a group with the diffuse focal type present on both sides (n = 5). All 10 patients in the former group had lesions in local exocrine organs, such as the lacrimal and parotid glands, with regional lymphadenopathy. In contrast, all 5 patients in the latter group had lesions in abdominal organs, such as autoimmune pancreatitis and sclerosing cholangitis. Conclusions- The sonographic patterns of the submandibular glands in patients with IgG4-related disease can be divided into two types: localized tumor-forming and diffuse focal. The distinctive patient groups defined by the sonographic patterns in both glands were associated with differential organ involvement and thus could be used as indicators of the disease extension and specific organ involvement.
  Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine 05/2013; 32(5):731-6.
• Article: Assessment of the accuracy of multiple sonographic fetal weight estimation formulas: a 10-year experience from a single center.

  Oshri Barel, Zvi Vaknin, Josef Tovbin, Arie Herman, Ron Maymon
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  ABSTRACT: Objectives- The primary aim of this study was to compare the accuracy of sonographic fetal weight estimation models. The secondary aim was to define the most accurate time (4-7 or 3 days before delivery) for evaluating fetal weight. Methods- In this retrospective cohort study, a total of 12,798 sonographic fetal weight estimations were analyzed, of which 9459 were performed within 3 days of delivery and 3339 within 4 to 7 days. The cohort included all singleton pregnancies recorded at a single medical center from January 2000 to December 2010, with 24 weeks' gestation minimum. Predicted birth weights were calculated according to 23 sonographic fetal weight estimation models; in total, 294,354 sonographic weight estimations were evaluated and compared to the actual birth weights. Results- The accuracy of the models in predicting birth weight differed considerably. The most accurate models used 3 or more fetal measurements followed by models using abdominal circumference only. The models developed by Sabbagha et al (Am J Obstet Gynecol 1989; 160:854-862) proved most accurate, with a mean percent error of -0.2% and greater than 92% of estimates within 15% of birth weight (P < .05). Nineteen sonographic fetal weight estimation models (82.6%) better predicted fetal weight at 4 to 7 days before delivery (P < .001). Twenty-two (95%) of the models were less accurate at the extreme ends of fetal weight. Conclusions- Different formulas for fetal weight estimation vary greatly; we recommend that each center should evaluate the most accurate formula according to its attending population. Estimation of fetal weight performed 4 to 7 days before delivery using most models was more accurate than estimations performed 3 days before delivery.
  Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine 05/2013; 32(5):815-23.
• Article: Cardiac Characterization of mdx Mice Using High-Resolution Doppler Echocardiography.

  Abdallah Fayssoil, Gilles Renault, Nicolas Guerchet, Carmen Marchiol-Fournigault, Françoise Fougerousse, Isabelle Richard
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  ABSTRACT: Objectives- Duchenne muscular dystrophy is an X-linked neuromuscular disorder. The heart is traditionally involved, leading to heart failure. The mdx mouse is a natural animal model of the disease. We conducted a prospective study to analyze left ventricular (LV) function in mdx mice at different ages using high-resolution Doppler echocardiography. Methods- Echocardiography was performed with a 30-MHz cardiac probe. Wild-type and mdx mice were scanned at 10 and 12 months. We measured the interventricular septal wall thickness, posterior wall thickness, and LV diameter in systole and diastole. The LV shortening fraction, LV ejection fraction, and LV mass were then calculated. Results- At 10 months, the shortening fractions in mdx and wild-type mice were relatively close (29% ± 5% versus 25% ± 4%). We found a significant difference in the posterior wall thickness change (40% ± 12% in mdx versus 28% ± 10% in wild-type; P = .048). The LV mass/body weight ratio was higher in mdx than wild-type mice (3.67 ± 0.25 versus 3.39 ± 0.26; P = .05). At 12 months, the LV mass was elevated in mdx mice compared to wild-type (152 ±16 versus 135 ± 3.7 mg; P = .04). The diastolic posterior wall thickness change was decreased in mdx mice at 12 months compared to wild-type (21% ± 7% versus 33% ± 4%; P = .01). The LV ejection fraction was not statistically different between mdx and wild-type mice (50% ± 6% versus 54% ± 2%). Conclusions- Ten-month-old mdx mice had a significantly higher posterior wall thickness than wild-type mice, but it was not significant at 12 months. In 12-month-old mdx mice, the posterior wall thickness change was significantly lower, and the LV mass was significantly higher. These findings indicate the role of LV function in the early stages of Duchenne muscular dystrophy.
  Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine 05/2013; 32(5):757-61.
• Article: Influence of Serum Prostate-Specific Antigen (PSA) Level, Prostate Volume, and PSA Density on Prostate Cancer Detection With Contrast-Enhanced Sonography Using Contrast-Tuned Imaging Technology.

  Shao Wei Xie, Hong Li Li, Jing Du, Jian Guo Xia, Yi Fen Guo, Mei Xin, Feng Hua Li
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  ABSTRACT: Objectives- The purpose of this study was to evaluate the influence of the serum prostate-specific antigen (PSA) level, prostate volume, and PSA density on prostate cancer detection with contrast-enhanced sonography using contrast-tuned imaging technology compared with baseline imaging (combination of grayscale and power Doppler imaging). Methods- In all, 161 patients were evaluated with grayscale, power Doppler, and contrast-tuned imaging. Biopsy was performed at 10 sites in each patient. When an abnormality was shown on any of these examinations, the biopsy was directed toward the abnormality. Cancer detection between contrast-tuned imaging and baseline imaging was compared for different subgroups according to PSA level (4-10, 10-20, and >20 ng/mL), prostate volume (<35, 35-50, 50-65, and >65 mL), and PSA density (<0.15, 0.15-0.30, 0.30-0.50, and >0.50). Results- In total, 413 sites were malignant in 78 patients. By biopsy site, the accuracy was greater for contrast-tuned imaging than for baseline imaging in all PSA level, prostate volume, and PSA density subgroups except 0.30 to 0.50 (all P < .05). Contrast-tuned imaging had significantly higher sensitivity in the subgroups with PSA levels between 4 and 20 ng/mL, prostate volumes between 35 and 65 mL, and PSA densities between 0.15 and 0.50 than baseline imaging (all P < .05); it also had significantly higher specificity for all PSA level subgroups except 10 to 20 ng/mL, all prostate volume subgroups except 35 to 50 mL, and all PSA density subgroups except 0.30 to 0.50 (all P < .05). Conclusions- Contrast-tuned imaging could improve cancer detection over baseline imaging in patients with different PSA levels, prostate volumes, and PSA densities.
  Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine 05/2013; 32(5):741-8.
• Article: Clinical relevance of sonographically estimated amniotic fluid volume: polyhydramnios.

  Adam T Sandlin, Suneet P Chauhan, Everett F Magann
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  ABSTRACT: Polyhydramnios is an excessive amount of amniotic fluid within the amniotic cavity. The etiology of polyhydramnios may be idiopathic, the consequence of fetal structural anomalies, or the consequence of various fetal and maternal conditions. The clinical importance of polyhydramnios is found in its association with adverse pregnancy outcomes and the risk of perinatal mortality. The antenatal management of polyhydramnios can be challenging as there are no formalized guidelines on the topic. The purpose of this review is to provide a literature-based overview on the subject of polyhydramnios in singleton pregnancies, demonstrate its clinical implications, and describe a practical approach to its management.
  Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine 05/2013; 32(5):851-63.
• Article: Discrepancies in reporting tissue material properties.

  Matthew W Urban, Ivan Z Nenadic, Shigao Chen, James F Greenleaf
  Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine 05/2013; 32(5):886-8.
• Article: Effect of an amniotic sheet on pregnancy outcomes.

  Ismet Gün, Murat Muhçu, Ercüment Müngen, Selim Kiliç, Vedat Atay
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  ABSTRACT: Objectives- Our aim was to evaluate whether the presence of an amniotic sheet affects obstetric and neonatal outcomes. Methods- : All singleton pregnant women with and without a sonographic diagnosis of an amniotic sheet between the 16th and 24th weeks of pregnancy were retrospectively identified. Two women without an amniotic sheet were randomly selected from the similar stratified periods as a control group for each case. The demographic characteristics and obstetric and perinatal outcomes were compared between the groups. Multivariable logistic regression was also performed for potential confounding factors. In addition, the subsequent pregnancies of 12 women with an amniotic sheet were followed during the antenatal and postnatal periods. Results- : The prevalence of an amniotic sheet was 1.13%. The risk factors for an amniotic sheet were primiparity, previous normal vaginal delivery, previous dilation and curettage, and previous abortions. When the groups were compared in terms of maternal and neonatal outcomes, the rates of a nuchal cord at birth, breech birth, birth weight of less than 2500 g, preterm delivery (<37 weeks), and neonatal intensive care unit admission were higher in the amniotic sheet group than the control group. There were 2 intrauterine deaths in the amniotic sheet group. In addition, an amniotic sheet was not observed again in any of the subsequent pregnancies of the 12 cases from the amniotic sheet group, and these pregnancies eventuated uneventfully. Conclusions- An amniotic sheet is associated with an increase in poor obstetric outcomes. Therefore, close monitoring of pregnancies after diagnosis is required.
  Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine 05/2013; 32(5):807-13.