Another look at ultrasound and magnetic resonance imaging for diagnosis of placenta accreta.

Objective: To compare the ability of magnetic resonance imaging (MRI) and ultrasound (US) in the diagnosis of placenta accreta, to examine the success of various sonographic and MRI features to correctly predict invasive placenta, and to define a specific role for MRI in placenta accreta.

Methods: After Institutional Review Board approval, a blinded retrospective review was undertaken of US and MRI findings from 45 patients who had an obstetrical US and placental MRI between August 2006 and January 2012. Correlation with clinical history and pathologic findings was performed.

Interstitial twin pregnancy: A unique case presentation.

Early recognition and timely treatment of an interstitial pregnancy is imperative to avoid the high morbidity and mortality of this type of ectopic pregnancy. We report a case of twin interstitial pregnancy that was initially missed on initial sonogram and was subsequently recognized at our institution by transvaginal sonography. The patient underwent open laparoscopic surgery with cornual wedge resection but suffered infundibulopelvic ligament hemorrhage and subsequently required ipsilateral salpingo-oophorectomy.

How much free fluid can a pregnant patient have? Assessment of pelvic free fluid in pregnant patients without antecedent trauma.

Background: The amount of free fluid that can normally be present in a pregnant patient is unknown. Evaluation of pelvic free fluid in a population of pregnant patients without early history of trauma would help determine what amount of free fluid should raise suspicion of intra-abdominal injury in those who have suffered trauma.

Methods: Patients presenting for routine obstetric ultrasound without an early history of trauma were offered participation in the study.

Fetal radiation dose during gestation estimated on an anthropomorphic phantom for three generations of CT scanners.

Objective: The purpose of this study is to determine fetal dose during four different stages of pregnancy for both pulmonary CT angiogram and abdominal and pelvic CT examination on 4-, 16-, and 64-MDCT scanners measured in an anthropomorphic phantom simulating a pregnant patient.

Materials And Methods: Pulmonary angiograms and abdominal and pelvic studies were performed on a phantom on 4-, 16-, and 64-MDCT scanners. Fetal positioning and mean fetal depth were determined using data from ultrasound examinations of a large cohort of patients.

Fetal magnetic resonance imaging: a review.

Purpose Of Review: To describe advances in magnetic resonance technology and the current indications and advantages of magnetic resonance imaging that have led to increased utilization in fetal medicine.

Recent Findings: The article covers the most common uses of magnetic resonance imaging in fetal medicine. The advantages of magnetic resonance imaging for the diagnosis of fetal malformations are described, in particular the advantages of magnetic resonance imaging in central nervous system malformations not optimally diagnosed by ultrasound are described.

The value of specific MRI features in the evaluation of suspected placental invasion.

Objective: The objective of this study was to determine imaging features that may help predict the presence of placenta accreta, placenta increta or placenta percreta on prenatal MRI scanning.

Subjects And Methods: A retrospective review of the prenatal MR scans of 10 patients with a diagnosis of placenta accreta, placenta increta or placenta percreta made by pathologic and clinical reports and of 10 patients without placental invasion was performed. Two expert MRI readers were blinded to the patients' true diagnosis and were asked to score a total of 17 MRI features of the placenta and adjacent structures.

Multicystic encephalomalacia after first-trimester intrauterine fetal death in monochorionic twins.

Multicystic encephalomalacia occurs in approximately 20% of surviving cotwins after second- and third-trimester intrauterine fetal death of one twin in monochorionic pregnancies. We report a case of multicystic encephalomalacia after the demise of a cotwin in the first trimester diagnosed by magnetic resonance imaging and confirmed pathologically.

Prenatal diagnosis for detection of aneuploidy: the options.

The value of all noninvasive prenatal tests must be viewed with the perspective of the consequences of invasive testing. Regarding second trimester noninvasive testing, biochemical screening is more accurate in establishing risk than maternal age alone. One or more major ultrasound abnormalities, nuchal thickening, or a shortened humerus should raise concern for Down syndrome regardless of the patient's a priori risk based on age or biochemical markers.

Feasibility of performing a virtual patient examination using three-dimensional ultrasonographic data acquired at remote locations.

Objective: To evaluate the feasibility of performing three-dimensional ultrasonographic studies that meet American Institute of Ultrasound in Medicine and American College of Radiology ultrasonographic examination guidelines with review off-line and at remote locations.

Methods: One hundred patients were studied at 2 institutions using high-end two-dimensional clinical ultrasonographic scanners and commercially available three-dimensional ultrasonography for a variety of organ systems (first- and second-trimester fetus, abdomen, and female pelvis). We evaluated several parameters, including measurements, completeness of organ visualization, abnormalities identified, image quality, number of volumes required, and discrepancies between interpretations.

The single umbilical artery in a high-risk patient population: what should be offered?

Objective: To determine whether fetal echocardiography is warranted in cases of single umbilical artery in a population at risk for aneuploidy.

Methods: All cases of fetal single umbilical artery identified over a 2-year period were reviewed for other sonographically detected abnormalities, fetal echocardiographic results, and karyotype.

Results: Sixty-five cases of single umbilical artery were diagnosed on the basis of initial sonograms.

Artifacts and the visualization of fetal distal extremities using three-dimensional ultrasound.

Objectives: To demonstrate that acoustic shadowing in 3D US may give rise to artifacts simulating limb defects and provide a solution to eliminate its occurrence.

Methods: Twenty second trimester fetuses (gestational age 15-24 weeks) were scanned with three-dimensional ultrasound (3D US) using a sagittal acquisition plane. Fetal tibia/fibula and radius/ulna pairs were assessed for completeness of imaging.

Three-dimensional ultrasound in the evaluation of fetal anomalies.

Objectives: To determine the additional information and clinical impact provided by three-dimensional ultrasound (3D US) imaging of fetal anomalies compared to conventional 2-dimensional ultrasound (2D US).

Materials And Methods: Sixty-three patients with 103 anomalies were scanned prospectively with both 2D and 3D US. Each anomaly was reviewed by one or more fetal imaging specialists to determine whether the 3D US data were advantageous, equivalent, or disadvantageous when compared with 2D US images.

Evaluation of the lower extremity veins in patients with suspected pulmonary embolism: a retrospective comparison of helical CT venography and sonography. 2000 ARRS Executive Council Award I. American Roentgen Ray Society.

Objective: In patients undergoing a combined CT angiographic and CT venographic protocol, the accuracy of helical CT venography for the detection of deep venous thrombosis was compared with that of lower extremity sonography.

Materials And Methods: Patients who had undergone a combined CT angiographic and CT venographic protocol and sonography of the lower extremities within 1 week were identified. The final reports were evaluated for the presence or absence of deep venous thrombosis.

New modalities for imaging the fetal heart.

Improvement in the prenatal diagnosis of congenital heart disease requires familiarity with advances ultrasound equipment and features and any new imaging methods that can effectively provide cardiac information from the fetus. This article discusses imaging the fetal heart with transvaginal ultrasound, Doppler ultrasound, intrauterine sonography, three-dimensional ultrasound (3DUS) and magnetic resonance imaging.

Fetal lip and primary palate: three-dimensional versus two-dimensional US.

Purpose: To determine if three-dimensional (3D) ultrasonography (US) improves the ability to define the location and extent of facial clefting prenatally compared with two-dimensional (2D) US.

Materials And Methods: Thirty-one fetuses suspected of having a facial cleft were examined prospectively with 2D and 3D US. Follow-up was performed in all fetuses.

Fetal skeletal dysplasia: three-dimensional US--initial experience.

Purpose: To compare the prenatal ultrasonographic (US) features of skeletal dysplasia by using two-dimensional (2D) and three-dimensional (3D) US to determine whether 3D US can reveal additional diagnostic information.

Materials And Methods: Seven pregnant women suspected of having skeletal dysplasia were examined by using 2D US and 3D US. Data regarding the thorax, spine, face, limbs, hands, and feet were compared.

Utility of minor ultrasonographic markers in the prediction of abnormal fetal karyotype at a prenatal diagnostic center.

Objective: This study was undertaken to assess the value of minor ultrasonographic markers in predicting significant karyotypic abnormalities.

Study Design: A total of 2743 fetuses (14-24 weeks' gestation) prospectively underwent a detailed ultrasonographic survey before genetic amniocentesis. Criteria for 8 minor ultrasonographic markers were established.

Prevalence of aneuploidy with a cardiac intraventricular echogenic focus in an at-risk patient population.

The objective of this study was to determine the relative risk for aneuploidy in the presence of a cardiac intraventricular echogenic focus in a patient population at high risk for aneuploidy. A retrospective cohort study was conducted on patients referred to a fetal diagnostic center who were undergoing amniocentesis. Records and second trimester sonograms were reviewed.

Three-dimensional ultrasound examination of the fetal hands: normal and abnormal.

Purpose: To assess particular features of fetal hand evaluation using three-dimensional ultrasound, and to determine whether any advantage is offered by three-dimensional over two-dimensional ultrasound in fetal hand evaluation.

Methods: Three-dimensional fetal data were collected prospectively from 44 hands in 40 fetuses from a predominantly high-risk patient population. All had a concurrent two-dimensional ultrasound examination of the hands.

Three-dimensional ultrasonography of the fetal distal lower extremity: normal and abnormal.

The objective of this study was to compare two-dimensional and three-dimensional ultrasonographic evaluation of fetal distal lower extremities. Data from two-dimensional and three-dimensional ultrasonographic examinations from 40 distal lower extremities in 33 fetuses from a predominantly high-risk patient population were compared. Three-dimensional ultrasonography routinely provided three orthogonal planes (coronal, sagittal, and axial) for distal lower extremity evaluation.