Gina James

Value of Three-dimensional US for Optimizing Guidance for Ablating Focal Liver Tumors

PURPOSE To determine if three-dimensional ultrasound (3D US), by nature of its ability to simultaneously evaluate structures in three orthogonal planes and to study relationships of devices to tumor(s) and surrounding anatomic structures from any desired orientation, adds significant additional information to real-time 2D US used for placement of devices for ablation of focal liver tumors. MATERIALS AND METHODS Sixteen patients underwent focal ablation of 23 liver tumors during two intraoperative cryoablation (CA) procedures, three intraoperative radiofrequency ablation (RFA) procedures, 11 percutaneous ethanol injections (PEI) procedures, and six percutaneous RFA procedures. After satisfactory placement of the ablative device(s) with 2D US guidance, 3D US was used to reevaluate adequacy to device position. Information added by 3D US and resultant alterations in device deployment were tabulated. RESULTS 3D US added information in 20 of 22 (91%) procedures and caused the operator to readjust the number or position of ablative devices in 10 of 22 (45%) of procedures. Specifically, 3D US improved visualization and confident localization of devices in 13 of 22 (59%) procedures, detected unacceptable device placement in 10 of 22 (45%), and determined that 2D US had incorrectly predicted device orientation to a tumor in three of 22 (14%). CONCLUSIONS Compared to conventional 2D US, 3D US provides additional relationship information for improved placement and optimal distribution of ablative agents for treatment of focal liver malignancy.

Adjunctive 3D US for Achieving Portal Vein Access during Transjugular Intrahepatic Portosystemic Shunt Procedures

PURPOSE To evaluate the usefulness of information provided by three-dimensional ultrasound (3D US) and to determine whether 3D US decreased the number of passes required to obtain portal vein (PV) access during creation of transjugular intrahepatic portosystemic shunts (TIPS). MATERIALS AND METHODS Intermittent 3D US volume acquisitions were obtained during creation of TIPS in 20 patients. Useful information provided by 3D US was tabulated. The number of passes required to achieve PV access was recorded and results were compared retrospectively to 25 patients who underwent TIPS without 3D US. RESULTS 3D US documented that the operators opinion of which hepatic vein had been selected was incorrect in nine patients (45%), detected unfavorable PV anatomy that required modification of equipment or technique in seven patients (35%), permitted estimation of the trajectory required to access the targeted PV in all patients (100%), assisted in selecting the optimal point along the hepatic vein for origination of the needle pass in 11 patients (55%), allowed avoidance of a large hepatocellular carcinoma in one patient (5%), and confirmed that access into the main PV was intrahepatic in four patients (20%). The mean number of needle passes decreased from 10.4 in the historic control group to 4.6 in the 3D US group (P = .0001). CONCLUSION 3D US provided imaging information that detected technical errors and altered anatomy, and provided positional and directional information to significantly improve needle pass efficiency.

Three-dimensional ultrasonographic imaging of the neonatal brain in high-risk neonates: preliminary study.

The aim of this investigation was to compare the utility of three‐dimensional ultrasonography versus two‐dimensional ultrasonography in imaging the neonatal brain. Thirty patients in the neonatal intensive care unit underwent two‐dimensional and three‐dimensional ultrasonography. The resultant two‐ and three‐dimensional images recorded on film and three‐dimensional volumes (reviewed on a workstation) were evaluated independently. Comparable numbers of normal and abnormal studies were diagnosed by each modality. Axial images were considered useful in approximately 50% of three‐dimensional cases. Image quality, overall and in the far‐field, was rated higher on two‐dimensional images. Three‐dimensional sonographic acquisition time in the neonatal intensive care unit (1.7 min+/‐0.7 standard deviation) was significantly shorter than that for two‐dimensional sonography (9.0+/‐4.5 min). The total time for evaluation on the three‐dimensional workstation (4.4+/‐1.1 min) was significantly less than that for two‐dimensional images on film (10.6+/‐4.7 min). In conclusion, three‐dimensional ultrasonography is a promising, diagnostically accurate, and efficient imaging tool for evaluation of the neonatal brain; however, visualization must improve before it can replace two‐dimensional ultrasonography.

Three-dimensional Ultrasonography and Assessment of the First-Trimester Fetus

We used transvaginal three‐dimensional ultrasonography to assess the first‐trimester fetus and compared the findings with contemporaneous two‐dimensional ultrasonographic studies. Multiplanar three‐dimensional ultrasonography provided good visualization of fetal anatomy and allowed fetal measurement and assessment of nuchal translucency thickness. Three‐dimensional ultrasonography required significantly less time to perform and to interpret than two‐dimensional ultrasonography. Three‐dimensional ultrasonography is an effective means of assessing the first‐trimester fetus and offers potential advantages over two‐dimensional ultrasonography.

Prenatal detection of associated anomalies in fetuses diagnosed with cleft lip with or without cleft palate in utero.

The aim of this study was to determine the prenatal detection rate of associated anomalies in fetuses with a suspected cleft lip with or without cleft palate.

Current practices in determining amnionicity and chorionicity in multiple gestations

To evaluate the accuracy of amnionicity and chorionicity (A/C) diagnosis of referral physicians and a tertiary care center as compared to histopathologic diagnosis.

Effects of US on maternal–fetal bonding: 2D vs. 3D

Objective:  To compare the effects of two‐dimensional ultrasound (2DUS) vs. three‐dimensional ultrasound (3DUS) imaging on the maternal–fetal bonding process.

Three-dimensional ultrasound (3DUS) does not enhance maternal bonding during pregnancy

Purpose:  To assess the impact of 3DUS on maternal–fetal bonding during pregnancy.

Three-dimensional obstetric ultrasound (3DUS) is perceived by lay non-pregnant adults to be more valuable than two-dimensional ultrasound (2DUS)

Purpose:  To determine the impact of 3DUS on non‐pregnant lay adults.

P128Impact of patient initiated three‐dimensional ultrasound examination

Background