Roya Sohaey

Platelet Count/Spleen Diameter Ratio for the Noninvasive Diagnosis of Esophageal Varices: Results of a Multicenter, Prospective, Validation Study

BACKGROUND AND AIMS:Noninvasive assessment of esophageal varices (EV) may improve the management of patients with cirrhosis and decrease both the medical and financial burden related to screening. In this multicenter, international study, our aim was to prospectively validate the use of the platelet count/spleen diameter ratio for the noninvasive diagnosis of EV.METHODS:A total of 218 cirrhotic patients underwent screening endoscopy for EV. Platelet count/spleen diameter ratio ((N/mm3)/mm) was assessed in all patients and its diagnostic accuracy was calculated. On the basis of previous results, a platelet count/spleen diameter ratio cutoff of 909 was applied to this population. The diagnostic accuracy of the platelet count/spleen diameter ratio was further evaluated for both severity and etiology of disease subgroups.RESULTS:Prevalence of EV was 54.1%. The platelet count/spleen diameter ratio had 86.0% (95% CI, 80.7–90.4%) diagnostic accuracy for EV, which was significantly greater as compared with either accuracy of platelet count alone (83.6%, 95% CI 78.0–88.3%, P = 0.038) or spleen diameter alone (80.2%, 95% CI 74.3–85.3%, P = 0.018). The 909 cutoff had 91.5% sensitivity (95% CI 85.0–95.9%), 67.0% specificity (95% CI 56.9–76.1%), 76.6% positive predictive value, 87.0% negative predictive value, 2.77 positive likelihood ratio, and 0.13 negative likelihood ratio for the diagnosis of EV. Accuracy of the platelet count/spleen diameter ratio was maintained for both severity and etiology of disease subgroups.CONCLUSIONS:The platelet count/spleen diameter ratio may be proposed as a safe and reproducible means to improve the management of cirrhotic patients who should undergo screening endoscopy for EV.

Fetal Ventricular Mass Determination on Three-Dimensional Echocardiography Studies in Normal Fetuses and Validation Experiments

Background—Estimation of ventricular volume and mass is important for baseline and serial evaluation of fetuses with normal or abnormal hearts. Direct measurement of chamber wall volumes and mass can be made without geometric assumptions by 3D fetal echocardiography. Our goals were to determine the feasibility of using fast nongated 3D echocardiography for fetal volumetric and mass assessments, to validate the accuracy of the ultrasound system and the measurement technique, and if satisfactory, to develop normal values for fetal ventricular mass during the second and third trimesters. Methods and Results—This was a prospective outpatient study of 90 consecutive normal pregnancies during routine obstetric services at Oregon Health & Science University (Portland). Optimized 3D volumes of the fetal thorax and cardiac chambers were rapidly acquired and later analyzed for right and left ventricular mass by radial summation technique from manual epicardial and endocardial traces. Experiments to validate the ultrasound system and measurement technique were performed with modified small balloon models and in vivo and ex vivo small animal experiments. Our study established the feasibility of fetal ventricular mass measurements with 3D ultrasound technology and developed normal values for right and left ventricular mass from 15 weeks’ gestation to term. Conclusions—Nongated fast 3D fetal echocardiography is an acceptable modality for determination of cardiac chamber wall volume and mass with good accuracy and acceptable interobserver variability. The method should be especially valuable as an objective serial measurement in clinical fetal studies with structurally or functionally abnormal hearts.

Infected aortic aneurysms: CT appearance

Three patients with infected (mycotic) aortic aneurysms were diagnosed primarily by CT. In two patients findings included the presence of a saccular aneurysm ith an irregular lumen. perianeurysmal fluid, gas and/or hematoma, osteomyelitis in adjacent vertebral bodies. and disruption of intimal calcification. In one patient with sepsis there was rapid development of an aortic aneurysm. Computed tomography is of substantial benefit in the identification and characterization of infected aortic aneurysms. Certain features may strongly suggest the diagnosis without use of aortography.

Terminal myelocystocele and sacrococcygeal teratoma: A comparison of fetal ultrasound presentation and perinatal risk

SUMMARY: This case exemplifies the difficulty in differentiating cystic sacrococcygeal teratoma and terminal myelocystocele. Fetal sonography presentation and perinatal risks of sacrococcygeal teratoma and terminal myelocystocele are compared, and we emphasize the importance of obtaining fetal MR imaging to establish an accurate diagnosis.

Polyhydramnios and fetal intrauterine growth restriction: ominous combination.

The purpose of this study was to evaluate the significance of polyhydramnios combined with intrauterine growth restriction. During a 6 year period, 39 fetuses were identified by prenatal sonography as having both polyhydramnios and intrauterine growth restriction. Polyhydramnios was defined as a four‐quadrant amniotic fluid index of 24 or greater (mean 30.5, range 24 to 40). Intrauterine growth restriction was defined as estimated fetal weight less than the tenth percentile (Hadlock standards). The mean birth weight was 2213 g. Major anomalies were present postnatally in 92% (36 of 39) of fetuses. Among nine fetuses without sonographically detectable anomalies prenatally, six (67%) proved to have one or more anomalies at birth. Chromosome abnormalities were present in 38% (15 cases) including 10 fetuses with trisomy 18 and one with trisomy 13. The overall mortality rate was 59%. The combination of polyhydramnios and intrauterine growth restriction is ominous. The majority of fetuses have major anomalies or chromosome abnormalities, or both, even when other sonographic abnormalities are absent. Chromosome analysis and detailed fetal evaluation should be offered when polyhydramnios and intrauterine growth restriction are identified prenatally.

Sonohysterography: Technique, endometrial findings, and clinical applications

Transvaginal ultrasound-guided saline infusion sonohysterography (SHG) is a relatively new technique for evaluation of the uterine cavity. As new studies declare the clinical usefulness of this technique, SHG may quickly become part of the routine ultrasound evaluation of the female pelvis. In this article, the SHG procedure is described and normal findings are discussed. Common endometrial pathological findings such as atrophy, polyps, fibroids, hyperplasia, and carcinoma are reviewed. The newly touted roles of SHG for screening patients on long-term tamoxifen therapy and for evaluating patients with infertility are introduced. Finally, we present a practical ultrasound-based flow chart for the workup of menopausal and perimenopausal patients with abnormal uterine bleeding.

Imaging and Differential Diagnosis of Suprarenal Masses in the Fetus

Prenatal sonography and magnetic resonance imaging of suprarenal fetal masses is presented, along with clinical information and follow‐up. Imaging pearls and differential considerations for each diagnosis will be discussed. Fetal suprarenal mass diagnoses include neuroblastoma, extralobar pulmonary sequestration, congenital adrenal hyperplasia, partial multicystic dysplastic kidney, renal duplication, urinoma, gastric duplication cyst, and splenic cyst. Recognizing the range of malignant and benign suprarenal fetal masses that can present on prenatal imaging can help guide patient counseling and management.

Prenatal diagnosis of tethered spinal cord.

Tethered spinal cord is associated with closed and open neural tube defects. With prenatal screening, spinal defects are consistently diagnosed during fetal life. We show that the conus medullaris can be seen well with prenatal ultrasound, and the diagnosis of tethered spinal cord can be made during fetal life. In this pictorial essay, we show examples of tethered cord in a variety of fetuses with spine anomalies.

Amniotic fluid and the umbilical cord: The fetal milieu and lifeline

Amniotic fluid volume should be routinely assessed in every second and third trimester case. A review of amniotic fluid physiology and techniques for ultrasound evaluation of fluid volume is presented. The causes and significance of oligohydramnios and polyhydramnios are stressed. Umbilical cord abnormalities are often incidently observed at the time of amniotic fluid evaluation. The clinical significance of some common umbilical cord abnormalities such as a two-vessel cord and nuchal cord are discussed. Other, more uncommon entities such as cord mass lesions are also reviewed. Finally, the role of cord Doppler interrogation in determining fetal well-being is discussed.

First-trimester ultrasound: The essentials

A review of first-trimester ultrasound findings is presented. The normal first trimester, including practical embryology and pregnancy dating, is first discussed. Abnormal first-trimester findings, including sonographic evaluation of the failing pregnancy, ectopic pregnancy, gestational trophoblastic disease, and first-trimester cystic hygroma, are then stressed. This report reviews the spectrum of findings encountered by sonographers while evaluating early pregnancy.