-
[show abstract]
[hide abstract]
ABSTRACT: Luteoma of pregnancy is a rare, tumorlike ovarian mass that develops during pregnancy and regresses after delivery. Generally, these masses are discovered incidentally during cesarean delivery or tubal ligation. Some of these patients will develop hirsutism or virilization during late pregnancy with or without fetal masculinization due to circulating androgens. The imaging features of this entity have been only rarely reported. An incidentally discovered luteoma of pregnancy in a 23-year-old patient during routine obstetric ultrasound is described and the image features in ultrasound and magnetic resonance (MR) imaging are discussed and compared with other studies. The patient underwent surgery to extract this mass considering the imaging findings were suspicious for neoplasia and the size and location could have potentially caused dystocia. This type of mass can mimic ovarian neoplasia and a correlation with imaging and laboratory findings can avoid an unnecessary surgical procedure during pregnancy.
Journal of Magnetic Resonance Imaging 03/2009; 29(3):713-7. · 2.70 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Discordance of birth weight has been observed in twin pairs, though little is known about prenatal and early neonatal discordance of head and brain size, and the role that zygosity and chorionicity play in discordances of early brain development in twins.
To compare prenatal and neonatal discordances of head size in monozygotic-monochorionic (MZ-MC), monozygotic-dichorionic (MZ-DC), and same-sex dizygotic-dichorionic twin pairs (DZ).
Subjects prospectively had ultrasounds at 22 and 32 weeks gestational age, and magnetic resonance imaging (MRI) of the brain MRI after birth.
88 twin pairs recruited from two university hospital prenatal diagnostic clinics; 22 MZ-MC, 17 MZ-DC, and 49 same-sex DZ pairs.
Discordance of head circumference (HC) and weight at 22 weeks, 32 weeks and birth, as well as intracranial volume (ICV) on neonatal MRI.
There were no group differences in discordance of head circumference and weight on the 22 or 32 week ultrasounds, or at birth. MZ-MC twins tended to have numerically greater discordances of HC and weight. There was a significant group difference in ICV on neonatal MRI (ANOVA, p=0.0143), with DZ twins having significantly greater discordance than MZ-MC (p=0.028) or MZ-DC (p=0.0131) twins.
This study indicates that zygosity and chorionicity do not contribute to significant discordances of head size in late prenatal development. DZ twins do have significantly greater discordances of ICV on neonatal MRI, suggesting a relatively greater genetic influence on brain growth in the first weeks after birth.
Early human development 10/2008; 85(3):171-5. · 2.12 Impact Factor
-
John H Gilmore,
Lauren C Smith,
Honor M Wolfe, Barbara S Hertzberg,
J Keith Smith,
Nancy C Chescheir,
Dianne D Evans,
Chaeryon Kang,
Robert M Hamer,
Weili Lin,
Guido Gerig
[show abstract]
[hide abstract]
ABSTRACT: Many psychiatric and neurodevelopmental disorders are associated with mild enlargement of the lateral ventricles thought to have origins in prenatal brain development. Little is known about development of the lateral ventricles and the relationship of prenatal lateral ventricle enlargement with postnatal brain development.
We performed neonatal magnetic resonance imaging on 34 children with isolated mild ventriculomegaly (MVM; width of the atrium of the lateral ventricle >/= 1.0 cm) on prenatal ultrasound and 34 age- and sex-matched control subjects with normal prenatal ventricle size. Lateral ventricle and cortical gray and white matter volumes were assessed. Fractional anisotropy (FA) and mean diffusivity (MD) in corpus callosum and corticospinal white matter tracts were determined obtained using quantitative tractography.
Neonates with prenatal MVM had significantly larger lateral ventricle volumes than matched control subjects (286.4%; p < .0001). Neonates with MVM also had significantly larger intracranial volumes (ICV; 7.1%, p = .0063) and cortical gray matter volumes (10.9%, p = .0004) compared with control subjects. Diffusion tensor imaging tractography revealed a significantly greater MD in the corpus callosum and corticospinal tracts, whereas FA was significantly smaller in several white matter tract regions.
Prenatal enlargement of the lateral ventricle is associated with enlargement of the lateral ventricles after birth, as well as greater gray matter volumes and delayed or abnormal maturation of white matter. It is suggested that prenatal ventricle volume is an early structural marker of altered development of the cerebral cortex and may be a marker of risk for neuropsychiatric disorders associated with ventricle enlargement.
Biological psychiatry 10/2008; 64(12):1069-76. · 8.93 Impact Factor
-
Mary C Frates,
Carol B Benson,
J William Charboneau,
Edmund S Cibas,
Orlo H Clark,
Beverly G Coleman,
John J Cronan,
Peter M Doubilet,
Douglas B Evans,
John R Goellner, [......], Barbara S Hertzberg,
Charles M Intenzo,
R Brooke Jeffrey,
Jill E Langer,
P Reed Larsen,
Susan J Mandel,
William D Middleton,
Carl C Reading,
Steven I Sherman,
Franklin N Tessler
[show abstract]
[hide abstract]
ABSTRACT: The Society of Radiologists in Ultrasound convened a panel of specialists from a variety of medical disciplines to come to a consensus on the management of thyroid nodules identified with thyroid ultrasonography (US), with particular focus on which nodules should be subjected to US-guided fine needle aspiration and which thyroid nodules need not be subjected to fine-needle aspiration. The panel met in Washington, DC, October 26-27, 2004, and created this consensus statement. The recommendations in this consensus statement, which are based on analysis of the current literature and common practice strategies, are thought to represent a reasonable approach to thyroid nodular disease.
Ultrasound Quarterly 01/2007; 22(4):231-8; discussion 239-40. · 0.95 Impact Factor
-
Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine 01/2007; 25(12):1593-7. · 1.25 Impact Factor
-
Ultrasound Quarterly 04/2004; 20(1):19-21. · 0.95 Impact Factor
-
American Journal of Roentgenology 01/2004; 181(6):1695-704. · 2.78 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To establish diagnostic criteria for the diagnosis of fetal choroid plexus cysts across gestation.
Prenatal sonographic images of 166 fetuses without choroid plexus cysts were prospectively collected from 13 weeks to term. Texture characteristics of the choroid plexus regions were analyzed to quantify changes as a function of gestational age. A set of 20 fetal sonographic images with choroid plexus cysts were used to create cyst prototypes (1.5-2.5 mm), which were randomly embedded into normal choroid plexus images from varying gestational ages. A test set of 544 images was created, which included 408 images with choroid plexus cysts and 136 images without choroid plexus cysts. Four observers following a blinded study design evaluated the presence of choroid plexus cysts in the images. The influence of cyst size and gestational age on the detection of cysts was measured with receiver operating characteristic analysis and analysis of variance. Observer agreement was characterized by agreement kappa statistics.
Texture analysis indicated greater echo texture heterogeneity at earlier gestational ages. The receiver operating characteristic analysis showed a corresponding decrease in diagnostic accuracy for cyst detection at earlier gestational ages. The cyst detection threshold (area under the receiver operating characteristic curve, 0.8) was 2.4 mm (SE, 0.2 mm) for 13 to 21 weeks' gestation and decreased to 1.9 mm (SE, 0.17 mm) for 22 to 38 weeks' gestation. Average interobserver and intraobserver kappa statistics were 0.37 and 0.53, respectively.
Because of the changing echo texture of the choroid plexus through gestation, choroid plexus cysts must be at least 2.5 mm in diameter for confident diagnosis before 22 weeks' gestation and at least 2 mm after 22 weeks.
Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine 12/2003; 22(11):1219-27. · 1.25 Impact Factor
-
Edward G Grant,
Carol B Benson,
Gregory L Moneta,
Andrei V Alexandrov,
J Dennis Baker,
Edward I Bluth,
Barbara A Carroll,
Michael Eliasziw,
John Gocke, Barbara S Hertzberg,
Sandra Katarick,
Laurence Needleman,
John Pellerito,
Joseph F Polak,
Kenneth S Rholl,
Douglas L Wooster,
Eugene Zierler
[show abstract]
[hide abstract]
ABSTRACT: The Society of Radiologists in Ultrasound convened a multidisciplinary panel of experts in the field of vascular ultrasonography (US) to come to a consensus regarding Doppler US for assistance in the diagnosis of carotid artery stenosis. The panel's consensus statement is believed to represent a reasonable position on the basis of analysis of available literature and panelists' experience. Key elements of the statement include the following: First, all internal carotid artery (ICA) examinations should be performed with grayscale, color Doppler, and spectral Doppler US. Second, the degree of stenosis determined at grayscale and Doppler US should be stratified into the categories of normal (no stenosis), less than 50% stenosis, 50 to 69% stenosis, > or =70% stenosis to near occlusion, near occlusion, and total occlusion. Third, ICA peak systolic velocity (PSV) and the presence of plaque on grayscale and/or color Doppler images are primarily used in the diagnosis and grading of ICA stenosis. Two additional parameters (the ICA-to-common carotid artery PSV ratio and ICA end diastolic velocity) may also be used when clinical or technical factors raise concern that ICA PSV may not be representative of the extent of disease. Fourth, ICA should be diagnosed as normal when ICA PSV is less than 125 cm/second and no plaque or intimal thickening is visible, less than 50% stenosis when ICA PSV is less than 125 cm/second and plaque or intimal thickening is visible, 50 to 69% stenosis when ICA PSV is 125 to 230 cm/second and plaque is visible, > or =70% stenosis to near occlusion when ICA PSV is more than 230 cm/second and visible plaque and lumen narrowing are seen, near occlusion when there is a markedly narrowed lumen on color Doppler US, and total occlusion when there is no detectable patent lumen on grayscale US and no flow on spectral, power, and color Doppler US. Fifth, the final report should discuss velocity measurements and grayscale and color Doppler findings. Study limitations should be noted when they exist. The conclusion should state an estimated degree of ICA stenosis as reflected in these categories. The panel also considered various technical aspects of carotid US and methods for quality assessment, and identified several important unanswered questions meriting future research.
Ultrasound Quarterly 12/2003; 19(4):190-8. · 0.95 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Doppler assessment of the fetal middle cerebral artery peak systolic velocity may obviate the need for more invasive procedures in the alloimmunized patient. The purpose of this study was to compare middle cerebral artery peak systolic velocity measurements in the near field and far field.
Patients between 16 and 42 weeks of gestation with normal fetuses were eligible (n=151). Peak systolic velocity measurements were obtained at the proximal portion of each middle cerebral artery at its origin in the internal carotid artery, as well as the most distal portion before its division, for a total of 4 measurements per fetus. Comparisons were made among the 4 locations and the data were analyzed using a mixed-model analysis of variance adjusted for gestational age. Results were presented using both P values and 95% CIs. P values <.05 were considered statistically significant. Where appropriate, P values and 95% CIs were adjusted using the Tukey multiple comparison procedure. A subanalysis was performed using 11 patients to assess interobserver reliability, which was calculated using the intraclass correlation coefficient (ICC).
All four measurements were obtained for 120 fetuses (79%). The mean gestational age was 27.0 weeks. Statistically significant differences were noted between distal sites (95% CI, -0.05 to 0.01; P<.01) as well as the two sites on each vessel (95% CI, 0.03-0.07 and 0.07-0.12; P<.001 for both vessels). There was no significant difference between the two proximal locations (95% CI, -0.01 to 0.03; P=0.77).
By which of the 2 vessels the fetal middle cerebral artery peak systolic velocity is affected is selected, as well as the location on the vessel. If the near-field proximal site cannot be interrogated, the far-field proximal site may be the best alternative.
American Journal of Obstetrics and Gynecology 11/2003; 189(4):986-9. · 3.47 Impact Factor
-
Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine 08/2002; 21(7):811-5. · 1.25 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Enlargement of the cerebral lateral ventricles is observed in several neuropsychiatric disorders with origins in early brain development. Lateral ventricle size is also predictive of poor neurodevelopmental outcome in premature infants. 3D ultrasound offers an improved new methodology for the study of lateral ventricle volume in neonates. To assess the validity of ventricle volume measures obtained with 3D ultrasound, we compared the volumes obtained by 3D ultrasound with magnetic resonance imaging (MRI) in 7 neonates. Ventricle volumes were determined using a computer-assisted image analysis program, IRIS. There was excellent correlation between ventricle volumes obtained with 3D ultrasound and those obtained with MRI (Pearson r = 0.96, p = 0.0005) indicating that 3D ultrasound provides valid measures of overall lateral ventricle volume. 3D ultrasound can provide an economical and practical means studying lateral ventricle volume in neonates, a neurostructural marker of abnormal brain development. Neonatal Ventricle Volume Page 2
01/2001;
-
[show abstract]
[hide abstract]
ABSTRACT: The Brachmann-de Lange syndrome (BDLS) is diagnosed in children on the basis of a distinctive clinical phenotype which includes retarded physical growth. Because there are no genetic or biochemical tests at present, the antenatal detection of the syndrome may depend upon identification of some aspect of the phenotype in the fetus using ultrasound imaging. We studied the growth of 23 subsequently diagnosed fetuses with the BDLS using standard biometric parameters defined by prenatal ultrasound imaging. Sonographic studies were obtained through a national parents' group, the Cornelia de Lange Syndrome Foundation. Assessment of fetal growth was made using four standardized measurements: the biparietal diameter, head circumference, femur length, and abdominal circumference. These values were compared to established tables of normal fetal growth and established rations of fetal body proportions. The cross-sectional growth curve derived using all measurements collected as a composite group indicates that growth retardation would be first detected as early as 25 weeks. In five fetuses with measurements both before and after 25 weeks of gestation, longitudinal growth curves indicated that the diagnosis of “small for gestational age” would have been suggested between 20 and 25 weeks. The mean fetal weight estimates closely followed the fifth centile curve of normal fetuses both before and after 25 weeks. Cephalic indices in BDLS fetuses indicated either frank brachycephaly (25%), or were at the upper portion of the normal range. Femur lengths were relatively short (less than 90% of their expected length ) in 4 of the 11 fetuses where such information could be obtained. BDLS fetuses demonstrate early and symmetric intrauterine growth retardation. We conclude that fetal biometry can provide a valuable index in the assessment of a pregnancy suspected to be at risk for a severely affected BDLS child. © 1993 Wiley-Liss, Inc.
American Journal of Medical Genetics 11/1993; 47(7):1035 - 1041.
-
[show abstract]
[hide abstract]
ABSTRACT: OBJECTIVE. The goals of this study were to define the normal range of diameters in the deep veins of the thigh and to compare this range with diameters of veins with acute thrombus and of veins with chronic changes from prior deep venous thrombosis (DVT). SUBJECTS AND METHODS. The anteroposterior diameter of the vein and adjacent artery was measured at five predefined levels in 975 legs of patients referred for sonographic examination for suspectedDVT. The mean vein diameter and mean vein-to-artery ratio were calculated for normal veins, vein segments with acute DVT. and vein segments with chronic changes from prior DVT. RESULTS. The diameter of normal deep leg veins was largest at the level of the common femoral vein (mean diameter. 10.5 mm). The diameter progressively decreased until the mid superficial femoral vein and remained relatively constant (mean diameter, 6.4-6.8 mm) more caudally. Similarly. vein-to-artery ratios progressed from a mean ratio of I.3 in the common femoral vein to 1.2 at other levels. We found no significant differences in vein diameter between the right and the left legs. Vein segments with acute thrombus were larger than cor- responding segments of normal veins. However, we found considerable overlap in the ranges of diameter of veins with and without acute DVT. At corresponding levels, veins with chronic DVT tended to be narrower than normal veins: however, the differences were small. and this diameter range also substantially overlaps that of normal veins. CONCLUSION. When grouped. veins with acute DVT were larger than normal veins. Likewise, veins with chronic DVT were smaller than normal veins. Because we found that the ranges of diameters of veins overlapped for different groups of veins, size alone is unlikely to provide compelling evidence for the diagnosis of acute versus chronic DVT, except at extreme diameters. Diameters of veins as revealed by sonography should be inter- preted in the context of other sonographic findings.
-
[show abstract]
[hide abstract]
ABSTRACT: OBJECTIVE. The goal of this study was to determine the relative accuracy of interpreta- tion of sonography when viewed on a monitor or on film. MATERIALS AND METHODS. Four radiologists twice interpreted a series of 440 sonograms using the following sequences of display formats for initial and second interpreta- tions: film-film, film-monitor, monitor-film, and monitor-monitor. Reporting discrepancies between the initial and subsequent interpretation were reviewed by an arbitration panel un- aware of the display mode. Results were analyzed for differences in error rate attributable to film versus monitor display format, chronology of interpretation, individual observer, and ob- server seniority. RESULTS. We found no statistically significant difference in the error rate for film (10.3%) versus monitor display format (14.6%) (p = .09). Likewise, we found no significant differences in the error rates attributable to chronology of interpretation (p = .13), individual observer (p = .54), or observer seniority (p = .87). CONCLUSION. Interpretative accuracy is similar whether sonograms are interpreted on a monitor or on film.
-
[show abstract]
[hide abstract]
ABSTRACT: Periventricular leukomalacia and germinal matrix hemorrhages are major causes of neurodevelopmental abnormalities in the premature neonate. Although sonography is widely used to detect these abnormalities and is thought to be sensitive for hemorrhages and the later cystic stages of periventricular leukomalacia, its sensitivity for the more acute phase of periventncular leukomalacia remains to be determined. It has been difficult to study this issue because periventncular leukomalacia often is not lethal, and in postmortem studies there is usually a considerable interval between the time of in vivo imaging, if any, and the death of the patient. A "prospective" autopsy study was performed on brain specimens from infants who died at less than 1 year of age during a 10-month period. Thirty-five formalin-fixed brains were studied and sonographic images of these specimens were compared with histologic findings in whole brain sections to determine the sensitivity and specificity of sonography for the detection of germinal matrix hemorrhage and periventncular leukomalacia. Sonography identified germinal matrix hemorrhages as small as 5 mm, although smaller lesions were not visualized. Postmortem sonography had a sensitivity of 27% and specificity of 88% for all germinal matrix hemorrhages, but a sensitivity of 100% and specificity of 91% for hemorrhages larger than 5 mm. Penventncular leukomalacia, seen as hyperechoic areas in the periventricular white matter, was not detected as readily. For periventricular leukomalacia, the overall sensitivity and specificity were 50% and 87%, respectively. We conclude that sonography is useful for detecting the larger germinal matrix hemorrhages, but has more limited sensitivity in the early diagnosis of periventncular leukomalacia.
