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ABSTRACT: The diagnosis and treatment of cesarean scar pregnancy (CSP) is challenging. The objective of this study was to evaluate the diagnostic method, treatments, and long-term follow-up of CSP.
This is a retrospective case series of 26 patients between 6-14 postmenstrual weeks suspected to have CSP who were referred for diagnosis and treatment. The diagnosis was confirmed with transvaginal ultrasound. In 19 of the 26 patients the gestational sac was injected with 50 mg of methotrexate: 25 mg into the area of the embryo/fetus and 25 mg into the placental area; and an additional 25 mg was administered intramuscularly. Serial serum human chorionic gonadotropin determinations were obtained. Gestational sac volumes and vascularization were assessed by 3-dimensional ultrasound and used to monitor resolution of the injected site and outcome.
The 19 treated pregnancies were followed for 24-177 days. No complications were observed. After the treatment, typically, there was an initial increase in the human chorionic gonadotropin serum concentrations as well as in the volume of the gestational sac and their vascularization. After a variable time period mentioned elsewhere the values decreased, as expected.
Combined intramuscular and intragestational methotrexate injection treatment was successful in treating these CSP.
American journal of obstetrics and gynecology 04/2012; 207(1):44.e1-13. · 3.28 Impact Factor
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ABSTRACT: This review concentrates on 2 consequences of cesarean deliveries that may occur in a subsequent pregnancy. They are the pathologically adherent placenta and the cesarean scar pregnancy. We explored their clinical and diagnostic as well as therapeutic similarities. We reviewed the literature concerning the occurrence of early placenta accreta and cesarean section scar pregnancy. The review resulted in several conclusions: (1) the diagnosis of placenta accreta and cesarean scar pregnancy is difficult; (2) transvaginal ultrasound seems to be the best diagnostic tool to establish the diagnosis; (3) an early and correct diagnosis may prevent some of their complications; (4) curettage and systemic methotrexate therapy and embolization as single treatments should be avoided if possible; and (5) in the case of cesarean scar pregnancy, local methotrexate- and hysteroscopic-directed procedures had the lowest complication rates.
American journal of obstetrics and gynecology 03/2012; 207(1):14-29. · 3.28 Impact Factor
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ABSTRACT: Anatomy, pathology, and developmental changes of the fetal central nervous system (brain and spine) can be studied by prenatal sonography, using a transabdominal, or, and preferably, later in pregnancy in a cephalic presenting fetus, a transvaginal approach, with the possibility of obtaining coronal and sagittal views through the acoustic window provided by the fontanels and sutures of the skull. In a 3-dimensional sonography, both approaches may generate images in all 3 classic scanning planes (longitudinal, sagittal, and coronal). Guidelines exist concerning standard fetal anatomical survey, which includes fetal brain and spine as well as specific central nervous system examination, both basic and advanced. Normal anatomy of the fetal brain and spine in their various planes will be described with only few details on congenital anomalies.
Clinical obstetrics and gynecology 03/2012; 55(1):249-65. · 2.06 Impact Factor
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Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine 06/2011; 30(6):865-7. · 1.25 Impact Factor
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Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine 12/2010; 29(12):1825-8. · 1.25 Impact Factor
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ABSTRACT: To test the utility of three-dimensional (3D) ultrasound (US) inversion rendering technique in the evaluation of fluid-distended fallopian tubes.
Fifty-two patients with fluid-filled adnexal masses suspected of being abnormal fallopian tubes were scanned by two-dimensional and 3D transvaginal ultrasound (TVUS). Six patients had bilateral disease. The acquired volumes were then "inverted" to display a cast-like appearance of the fluid-filled structures. The ipsilateral ovaries were identified in all patients. Five patients had acute tubal disease.
Fifty-two of the 58 inversion renderings yielded acceptable images of hydrosalpinges. Only in four patients were the two-dimensional images more informative than the 3D-rendered and inverted views. In nine patients adjacent corpora lutea, ovarian cysts, and follicles within normal ovaries were also identified, but appeared separate from the fluid-filled tubes. The tubes in the patients with acute disease were all successfully inverted.
The 3D inversion technique is a simple and effective way to render fluid-filled spaces, which may be tortuous and follow various directions. The rendered images increased the confidence in diagnosing hydrosalpinx.
Journal of Clinical Ultrasound 09/2010; 38(7):372-6. · 0.81 Impact Factor
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ABSTRACT: The aim of this study was to evaluate a rapid 3-dimensional ultrasound-assisted technique for evaluation of the corpus callosum as an integral part of the anatomic survey.
Transabdominal 3-dimensioal gray scale and power Doppler volumes of the fetal brain were acquired in 102 consecutive healthy fetuses at 20-23 postmenstrual weeks. Offline analysis was performed by 2 of the authors using a systematic approach of "volume manipulation." Diagnostic-quality visualization of the corpus callosum and the pericallosal arteries on the median plane was recorded by the 2 examiners independently.
The median plane was easily obtained in all cases. Diagnostic-quality images of the corpus callosum were recorded in 93.1% and 99.0% and of the pericallosal arteries in 94.4% and 95.5% of the cases, by the 2 examiners, respectively.
Three-dimensional ultrasound enables a rapid and easy evaluation of the corpus callosum that may facilitate its inclusion as an integral part of the routine anatomic survey.
American journal of obstetrics and gynecology 02/2010; 202(2):201.e1-5. · 3.28 Impact Factor
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Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine 12/2009; 28(12):1735-42. · 1.25 Impact Factor
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Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine 10/2009; 28(10):1389-92. · 1.25 Impact Factor
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Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine 06/2009; 28(5):689-93. · 1.25 Impact Factor
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ABSTRACT: Over the past decade, prenatal diagnosis has shifted rapidly from the second trimester into the first trimester. Although the nuchal-translucency scan may detect a small proportion of fetal structural malformations, fetal anatomy is not routinely assessed until the fetal anatomical survey is performed in the second trimester between 18 and 22 weeks. The recent development of high-frequency transvaginal ultrasound transducers has led to vastly improved ultrasound resolution and improved visualization of fetal anatomy earlier in gestation. Several pilot studies of a first-trimester anatomic survey have reported detection rates comparable with those achieved in the routine second-trimester anatomic survey. As advanced ultrasound technology becomes more available, there is an urgent need to evaluate the diagnostic ability of a first-trimester anatomic survey and to determine the role of a first-trimester anatomic survey in the current screening paradigm.
Obstetrics and Gynecology 03/2009; 113(2 Pt 1):402-7. · 4.73 Impact Factor
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Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine 02/2009; 28(1):97-9. · 1.25 Impact Factor
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ABSTRACT: The developmental changes of the fetal central nervous system (CNS) during the second and third trimesters, specifically the brain, relate mostly to changes in size. However, other changes do occur in the fetal brain during the second and third trimester such as: the union of the cerebellar hemispheres, development of the corpus callosum (CC), and increasing complexity of the cerebral cortex. These changes follow a well-defined developmental timeline recognizable by sonography. The fetal neuroscan can be divided into a 'basic scan' which is performed transabdominally and a 'targeted Exam or neurosonogram' which uses a multiplanar approach, which preferably should be performed transvaginally. During the 'basic scan', several brain structures are imaged in addition to obtaining important biometric measurements. The 'neurosonogram' is a more extensive or detailed fetal study during which the emphasis is on the addition of coronal and sagittal planes. The easiest way to obtain these planes, if the fetus is in a cephalic presentation, is the transvaginal route. Three-dimensional (3D) sonography should, if possible, be performed transvaginally using the multiplanar approach. An added benefit of 3D sonography is the ability to display and render the volume in a variety of ways which may enhance the detection of pathology.
Prenatal Diagnosis 11/2008; 29(4):326-39. · 2.11 Impact Factor
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Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine 10/2008; 27(9):1375-80. · 1.25 Impact Factor
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ABSTRACT: The purpose of this series is to emphasize the importance of an exhaustive and appropriately conducted sonographic examination in the correct diagnosis of fetal cystic scalp lesions and the place of magnetic resonance imaging (MRI) in the diagnostic sequence.
Transabdominal and transvaginal 2- and 3-dimensional sonography with color and power Doppler imaging as well as 3-dimensional rendering techniques such as inversion and Doppler angiography were used. In 1 case, an MRI study was performed.
In 1 case, the MRI missed and the different sonographic techniques correctly made the diagnosis of a meningocele. In the second case, sonography was sufficient to establish the diagnosis of an epidermal cyst.
These 2 cases show the value of going the distance with the newly available high-frequency sonography. Ultimately, the correct diagnoses were made with the tools offered by sonography without the need for any other imaging modality.
Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine 10/2008; 27(9):1363-8. · 1.25 Impact Factor
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ABSTRACT: The widespread use of sonography as a screening tool for fetal anomalies has facilitated prenatal detection of several fetal conditions characterized by urinary tract dilatation. These conditions are more common in male fetuses and are generally a result of an anatomic defect causing obstruction along the urinary tract system. Although the prognosis of these conditions largely depends on the specific anomaly, several poor prognostic factors have been described. These factors include detection at an early gestational age, bilateral marked dilatation, a persistently obstructed bladder, oligohydramnios causing pulmonary hypoplasia, and the presence of associated fetal or chromosomal anomalies. We report a case in which a male fetus at 14 weeks' gestation had a diagnosis of rapidly progressing bilateral hydronephrosis, massive bladder dilatation, hydroureter, and a surprisingly normal amniotic fluid volume. Serial sonographic surveillance assisted us in obtaining the correct diagnosis, which was important for adequately consulting the patient regarding the fetal prognosis in the affected index pregnancy as well as the likelihood of recurrence in future gestations.
Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine 08/2008; 27(7):1099-104. · 1.25 Impact Factor
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ABSTRACT: Twin reversed arterial perfusion (TRAP) sequence, also known as acardiac malformation, is a rare complication unique to monozygotic multiple gestations. It occurs in approximately 1 per 35,000 pregnancies and in 0.3% of all monozygotic twin gestations. The malformation is characterized by the lack of a well-defined cardiac structure in one twin (acardiac), which acts as a parasite that is hemodynamically dependent on the normal (pump) twin. The malformation in the acardiac twin is always incompatible with survival regardless of its extent, whereas the prognosis of the pump twin may vary considerably. Common complications that affect the prognosis of the pump twin include complications of prematurity secondary to preterm delivery and polyhydramnios as well as congestive heart failure due to the expended cardiac demand. Without prompt detection, follow-up, and treatment, mortality rates for pump twins have been noted to be as high as 50% to 70%. Early sonographic diagnosis, appropriate follow-up, and intervention via cord occlusion when indicated are the mainstays of prenatal care in cases of TRAP sequence and have been associated with substantial improvements in survival. We report a case that emphasizes the added value of 3-dimensional (3D) and color Doppler techniques for both diagnosis of TRAP sequence and detection of poor prognostic features in the first or early second trimester.
Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine 08/2008; 27(7):1105-9. · 1.25 Impact Factor
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Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine 07/2008; 27(6):989-91. · 1.25 Impact Factor
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Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine 05/2008; 27(4):677-9. · 1.25 Impact Factor
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ABSTRACT: The purpose of this study was to evaluate the usefulness of virtual spherical tissue sampling using 3-dimensional (3D) ultrasound power Doppler angiography to enhance differentiation between normal and pathologic ovaries.
Twenty-seven cases with ovarian tumors were analyzed: 14 with invasive cancers and 13 with borderline tumors confirmed by surgery. The control subjects consisted of 53 healthy ovulating women. Ultrasound scans were done, and 3D volumes were analyzed with 3-/4-dimensional software for personal computers based on 3D vascularity indices: the vascularization index, flow index, and vascularization-flow index. A virtual spherical tissue sample of 1 cm3 was taken from the place of the highest vessel density contained completely within the contours of the ovary. Calculations for the whole solid volume were done for comparison.
Vascularity indices for both 1-cm3 spherical samples and whole dense parts of the ovaries were compared in the following groups: (1) ovarian tumors versus controls, (2) normal ovaries in the proliferative versus secretory phase, (3) invasive cancers versus borderline tumors, (4) invasive cancers versus normal ovaries, and (5) borderline tumors versus normal ovaries. Spherical 1-cm3 sampling achieved a higher degree of discrimination between the groups compared with the whole solid-part approach.
Spherical 1-cm3 sampling of ovarian tissue with 3D ultrasound power Doppler angiography is a sensitive and promising approach to differentiate between ovarian tumors and normal ovaries. It opens the possibility to implement objective computerized positioning, standardized comparison, and analysis of ovarian tumors.
Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine 04/2008; 27(3):425-33. · 1.25 Impact Factor
