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Brown DL, Laing FC, Welch WR. Large calcifications in ovaries otherwise normal on ultrasound. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2007; 29:438-42. [PMID: 17274104 DOI: 10.1002/uog.3941] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
OBJECTIVE To evaluate calcifications >or= 5 mm in length in ovaries that are otherwise normal on ultrasound, and to determine whether such large ovarian calcifications are an indicator of ovarian neoplasm. METHODS This was a retrospective study reviewing pelvic ultrasound results at our unit between October 1994 and April 2002 to identify patients with ovarian calcifications that were >or= 5 mm in maximum length in otherwise normal ovaries, and who also had follow-up imaging studies. Patient medical histories were reviewed, calcification characteristics, including number, size, shape and laterality of calcifications, were recorded and follow-up imaging studies were reviewed to assess change in size of the calcification and to see if a neoplasm had developed. RESULTS The study group consisted of 28 patients. The mean length of imaging follow-up was 35.2 +/- 30.7 months. The mean size of the calcifications was 7.4 +/- 2.3 (range, 5-13) mm. The calcification remained stable in all 28 patients and no ovarian neoplasms developed in any of the patients. Histological confirmation was available in one patient and this revealed dystrophic calcification in a corpus albicans. CONCLUSION Calcifications ranging from 5 to 13 mm in length in otherwise normal ovaries remain stable on follow-up imaging and are not an indicator of current or future ovarian neoplasm. Published by John Wiley & Sons, Ltd.
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Goldstein RB, Bree RL, Benson CB, Benacerraf BR, Bloss JD, Carlos R, Fleischer AC, Goldstein SR, Hunt RB, Kurman RJ, Kurtz AB, Laing FC, Parsons AK, Smith-Bindman R, Walker J. Evaluation of the woman with postmenopausal bleeding: Society of Radiologists in Ultrasound-Sponsored Consensus Conference statement. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2001; 20:1025-1036. [PMID: 11587008 DOI: 10.7863/jum.2001.20.10.1025] [Citation(s) in RCA: 157] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
OBJECTIVES A panel of 14 physicians practicing medicine in the United States with expertise in radiology, obstetrics and gynecology, gynecologic oncology, hysteroscopy, epidemiology, and pathology was convened by the Society of Radiologists in Ultrasound to discuss the role of sonography in women with postmenopausal bleeding. Broad objectives of this conference were (1) to advance understanding of the utility of different diagnostic techniques for evaluating the endometrium in women with postmenopausal bleeding; (2) to formulate useful and practical guidelines for evaluation of women with postmenopausal bleeding, specifically as it relates to the use of sonography; and (3) to offer suggestions for future research projects. SETTING October 24 and 25, 2000, Washington, DC, preceding the annual Society of Radiologists in Ultrasound Advances in Sonography conference. PROCEDURE Specific questions to the panel included the following: (1) What are the relative effectiveness and cost-effectiveness of using transvaginal sonography versus office (nondirected) endometrial biopsy as the initial examination for a woman with postmenopausal bleeding? (2) What are the sonographic standards for evaluating a woman with postmenopausal bleeding? (3) What are the abnormal sonographic findings in a woman with postmenopausal bleeding? (4) When should saline infusion sonohysterography or hysteroscopy be used in the evaluation of postmenopausal bleeding? (5) Should the diagnostic approach be modified for patients taking hormone replacement medications, tamoxifen, or other selective estrogen receptor modulators? CONCLUSIONS Consensus recommendations were used to create an algorithm for evaluating women with postmenopausal bleeding. All panelists agreed that because postmenopausal bleeding is the most common presenting symptom of endometrial cancer, when postmenopausal bleeding occurs, clinical evaluation is indicated. The panelists also agreed that either transvaginal sonography or endometrial biopsy could be used safely and effectively as the first diagnostic step. Whether sonography or endometrial biopsy is used initially depends on the physician's assessment of patient risk, the nature of the physician's practice, the availability of high-quality sonography, and patient preference. Similar sensitivities for detecting endometrial carcinoma are reported for transvaginal sonography when an endometrial thickness of greater than 5 mm is considered abnormal and for endometrial biopsy when "sufficient" tissue is obtained. Currently, with respect to mortality, morbidity, and quality-of-life end points, there are insufficient data to comment as to which approach is more effective. The conference concluded by identifying several important unanswered questions and suggestions that could be addressed by future research projects.
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Frates MC, Doubilet PM, Durfee SM, Di Salvo DN, Laing FC, Brown DL, Benson CB, Hill JA. Sonographic and Doppler characteristics of the corpus luteum: can they predict pregnancy outcome? JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2001; 20:821-827. [PMID: 11503918 DOI: 10.7863/jum.2001.20.8.821] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
OBJECTIVE To determine whether there is a relationship between gray scale or Doppler characteristics of the corpus luteum and first-trimester pregnancy outcome. METHODS We conducted a prospective study of patients with spontaneous singleton pregnancies between 5 and 8 weeks' gestation. The corpus luteum size, sonographic appearance, resistive index, and peak systolic velocity were measured on transvaginal sonography. Maternal use of exogeneous progesterone was recorded. Only patients with known first-trimester outcome were included. RESULTS There were 201 study patients. The corpus luteum could be visualized in 197 (98%) and had a mean +/- SD size of 1.9 +/- 0.6 cm, a mean resistive index of 0.50 +/- 0.08, and a peak systolic velocity of 20.5 +/- 11.2 cm/s. There were 151 first-trimester survivors (75.1 %) and 50 spontaneous losses (24.9%). In a comparison of the survivors and losses, there was no significant difference in mean corpus luteum size (1.9 versus 1.7 cm; P = .10, t test), mean resistive index (0.50 versus 0.50; P = .71, t test), peak systolic velocity (21 versus 19 cm/s; P = .29, t test), or sonographic appearance (P = .78, chi2 test). The lack of association between corpus luteum characteristics and outcome persisted when cases were stratified by progesterone use and the presence or absence of a heartbeat on the study sonogram. CONCLUSION There is no apparent relationship between the characteristics of the corpus luteum and first-trimester pregnancy outcome.
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Abstract
For most women, pelvic sonography using a transvaginal probe is the imaging modality of choice for evaluating the uterus and adnexae. It is reliable for detecting ovarian cysts and other adnexal masses, and it can often determine if a lesion can be observed on serial examinations or if it requires more urgent attention. Uterine ultrasound is reliable for evaluating both the normal and abnormal endometrium and myometrium. In cases that are technically limited, or in those that are difficult to interpret, a tailored MR imaging examination often can be helpful.
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Frates MC, Visweswaran A, Laing FC. Comparison of tubal ring and corpus luteum echogenicities: a useful differentiating characteristic. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2001; 20:27-33. [PMID: 11149525 DOI: 10.7863/jum.2001.20.1.27] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
The purpose of this report is to compare the echogenicity of the tubal ring of an ectopic pregnancy and the corpus luteum with that of the ovary for improved detection of early ectopic pregnancy. In patients with ectopic pregnancy diagnosed at sonography on the basis of the presence of an adnexal tubal ring, echogenicity of the ring was compared with the echogenicity of the ovarian parenchyma. Twenty-six patients with tubal rings containing either a yolk sac or cardiac activity were included. Twenty-three (88%) of the 26 tubal rings had echogenicity equal to or greater than that of ovarian parenchyma. In 13 patients with ectopic pregnancy diagnosed on the basis of an empty tubal ring, 10 rings (77%) were more echogenic than the ovary. In 45 control patients with intrauterine pregnancy, the corpus luteum was more echogenic than the ovary in only 3 (7%). The tubal ring of an ectopic pregnancy is usually more echogenic than ovarian parenchyma, and the corpus luteum is usually equal to or less echogenic than the ovary. Echogenicity of an adnexal mass may help distinguish the tubal ring of an ectopic pregnancy from a corpus luteum.
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Laing FC. Transvaginal sonography in postmenopausal women with bleeding. AJR Am J Roentgenol 1998; 171:1155. [PMID: 9763014 DOI: 10.2214/ajr.171.4.9763014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Brown DL, Doubilet PM, Miller FH, Frates MC, Laing FC, DiSalvo DN, Benson CB, Lerner MH. Benign and malignant ovarian masses: selection of the most discriminating gray-scale and Doppler sonographic features. Radiology 1998; 208:103-10. [PMID: 9646799 DOI: 10.1148/radiology.208.1.9646799] [Citation(s) in RCA: 169] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To determine the gray-scale and Doppler sonographic features that best enable discrimination between malignant and benign ovarian masses and develop a scoring system for accurate diagnosis with these features. MATERIALS AND METHODS Gray-scale and Doppler sonographic features of 211 adnexal masses were correlated with the final diagnosis; the most discriminating features for malignancy were selected with stepwise logistic regression. RESULTS Twenty-eight masses were malignant and 183 benign. All masses with a markedly hyperechoic solid component or no solid component were benign. For masses with a nonhyperechoic solid component, additional features that allowed statistically significant discrimination of benignity from malignancy were, in decreasing order of importance, (a) location of flow at conventional color Doppler imaging, (b) amount of free intraperitoneal fluid, and (c) presence and thickness of septations. A scoring formula that made use of values based on the logistic regression equation had an area under the receiver operating characteristic curve of 0.98 +/- 0.01. The cutoff score with the highest accuracy had a sensitivity of 93% and specificity of 93%. CONCLUSION A solid component is the most statistically significant predictor of a malignant ovarian mass. A multiparameter scoring system that uses three gray-scale and one Doppler feature, developed by means of stepwise logistic regression, has high sensitivity and specificity for predicting malignancy.
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Di Salvo DN, Benson CB, Laing FC, Brown DL, Frates MC, Doubilet PM. Sonographic evaluation of the placental cord insertion site. AJR Am J Roentgenol 1998; 170:1295-8. [PMID: 9574605 DOI: 10.2214/ajr.170.5.9574605] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Velamentous and marginal umbilical cords are uncommon abnormalities of placental cord insertion that can entail significant fetal risk. We undertook this investigation to assess the ability of prenatal sonography to reveal abnormal insertions of the umbilical cord into the placenta. SUBJECTS AND METHODS Forty-six patients had both prenatal sonographic evaluation of the placental cord insertion site and postnatal pathologic examination. Distance from the insertion site to the nearest placental edge was categorized by sonography and pathology as normal if greater than 1 cm and abnormal if less than or equal to 1 cm. Sonographic and pathologic findings were compared. RESULTS Thirty-eight singleton and eight twin pregnancies, for a total of 54 cord insertions, were studied. Of the 43 sonographically normal insertions, 38 had normal pathologic findings, and the remaining five insertions had abnormal pathologic findings (all marginal cord insertions). All 11 insertions that showed abnormality on sonography were abnormal on pathologic examination (seven marginal and four velamentous insertions). Sonography was able to reveal a difference between the two types of abnormal insertions in only a single patient, in whom the cord insertion changed from marginal to velamentous during a 7-week interval. Sonography had an overall sensitivity of 69% (11/16), a specificity of 100% (38/38), and an accuracy of 91% (49/54) for revealing abnormal placental cord insertion sites. CONCLUSION Targeted sonographic examination of the placental site of umbilical cord insertion will reveal abnormal placental cord insertions, although distinguishing the specific type of abnormal insertion may require the use of color Doppler imaging.
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Laing FC, Brown DL, Price JF, Teeger S, Wong ML. Intradecidual sign: is it effective in diagnosis of an early intrauterine pregnancy? Radiology 1997; 204:655-60. [PMID: 9280240 DOI: 10.1148/radiology.204.3.9280240] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
PURPOSE To determine if the intradecidual sign at sonography is effective in the diagnosis of early intrauterine pregnancy. MATERIALS AND METHODS In 102 pregnant patients, transvaginal sonography revealed an intrauterine fluid collection without a yolk sac or embryo. Four observers (experienced sonologist, body imaging fellow, 1st-year radiology resident, and premedical student) determined independently whether the intradecidual sign was absent, present, or indeterminate. Interpretations were limited to visualization of only the uterus. RESULTS Follow-up revealed intrauterine pregnancy in 91 patients (outcome normal in 48 and abnormal in 43) and ectopic pregnancy in 11 patients. Among the four reviewers, sensitivity for diagnosis of an intrauterine pregnancy was 34%-66%, specificity was 55%-73%, accuracy was 38%-65%, positive predictive value was 91%-93%, and negative predictive value was 12%-16%. Three to five ectopic pregnancies were categorized incorrectly as demonstrating the intradecidual sign, depending on the reviewer. CONCLUSION The intradecidual sign does not appear to be sensitive or specific in diagnosis of an early intrauterine pregnancy. When an intrauterine fluid collection is present without an embryo or yolk sac (with positive pregnancy test results), a follow-up sonogram should be obtained unless contraindicated clinically.
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Laing FC, Frates MC, Feldstein VA, Goldstein RB, Mondro S. Hemobilia: sonographic appearances in the gallbladder and biliary tree with emphasis on intracholecystic blood. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 1997; 16:537-543. [PMID: 9315209 DOI: 10.7863/jum.1997.16.8.537] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
The purpose [corrected] of this study is to discuss the causes and sonographic appearances of blood in the gallbladder and biliary tree. Over a 12 year period, 18 patients with hemobilia had ultrasonographic examinations at one of three hospitals. Hemobilia was categorized as traumatic (50%), spontaneous (28%), or inflammatory (22%), with coagulopathy present in half of the cases. The sonographic appearances of intracholecystic blood varied, but with the exception of a single case, masslike intracholecystic material was present. Biliary dilatation occurred in five patients, with echogenic material visible in the extrahepatic bile duct in three of these cases.
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Frates MC, Benson CB, DiSalvo DN, Brown DL, Laing FC, Doubilet PM. Solid extratesticular masses evaluated with sonography: pathologic correlation. Radiology 1997; 204:43-6. [PMID: 9205221 DOI: 10.1148/radiology.204.1.9205221] [Citation(s) in RCA: 82] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE To determine if the sonographic appearance of solid extratesticular masses enables distinction of benign from malignant disease. MATERIALS AND METHODS Sonograms of 19 patients with palpable testicular masses who underwent biopsy were reviewed retrospectively. Appearances of masses on sonograms were correlated with pathologic diagnoses. RESULTS All masses were well defined and ranged in size from 5.7 to 66.7 mm (mean, 21 mm). On the sonograms, five masses were within the epididymis, and six were distinct from it; seven cases were indeterminate. The epididymis was surgically absent in the remaining patient. Sonographic echogenicity ranged from hypoechoic to hyperechoic relative to that of the testis. At pathologic evaluation, there were 16 (84%) benign and three (16%) malignant lesions. Benign lesions consisted of six adenomatoid tumors, two lipomas, two epidermoid inclusion cysts, two cases of sarcoidosis, and one case each of sperm granuloma, spermatic cord leiomyoma, benign inflammatory nodule, and fibroma. The malignant lesions consisted of scrotal wall liposarcoma, epididymal leiomyosarcoma, and recurrent spindle cell malignancy of the spermatic cord. No sonographic features of masses were useful for distinguishing benign from malignant lesions. CONCLUSION The frequency of malignancy (16%) contrasts with prior reports that suggest a very low rate of malignancy among these masses. Sonography is useful for identifying the extratesticular location of a mass but not for distinguishing the nature of the lesion.
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Frates MC, Doubilet PM, Brown DL, Benson CB, DiSalvo DN, Laing FC, Berck DJ, Hill JA. Role of Doppler ultrasonography in the prediction of pregnancy outcome in women with recurrent spontaneous abortion. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 1996; 15:557-562. [PMID: 8839402 DOI: 10.7863/jum.1996.15.8.557] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
We prospectively studied 96 patients with a history of recurrent spontaneous abortion to determine whether the resistive index of the main uterine artery or subchorionic vessels can allow prediction of pregnancy outcome. The subchorionic RI declined progressively for a mean of 0.54 at 6 weeks to 0.42 at 13 weeks (P < 10(-8), F-test). No significant difference was found in subchorionic RI values between outcomes for liveborn infants versus loss. Uterine artery RI values also declined significantly through the first trimester (P < 10(-8), F-test). Uterine artery RI values tended to be lower in pregnancies ending in loss than in successful gestations; however, there was too much overlap for this index to be clinically useful. In conclusion, first trimester RI does not allow prediction of pregnancy outcome in patients with recurrent abortion.
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Bussey LA, Laing FC. Sonohysterography for detection of a retained laminaria fragment. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 1996; 15:249-51. [PMID: 8919508 DOI: 10.7863/jum.1996.15.3.249] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
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David V, Laing FC. Paradoxical dilatation of the gallbladder after fat ingestion in patients with acute hepatitis. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 1996; 15:179-182. [PMID: 8622199 DOI: 10.7863/jum.1996.15.2.179] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
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David V, Laing FC. Paradoxical dilatation of the gallbladder after fat ingestion in patients with acute hepatitis. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 1995; 14:975-978. [PMID: 8583536 DOI: 10.7863/jum.1995.14.12.975] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
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Abstract
This review addresses the use of state-of-the-art sonography to evaluate patients with possible ectopic pregnancy (EP). The technical aspects for optimizing the examination are emphasized, and the role of color and pulsed Doppler imaging is discussed. The various sonographic criteria used to diagnose EP are critically analyzed. In addition, imaging findings for some of the more unusual forms of EP are discussed. The role of sonography in the treatment of EP is briefly considered.
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Benson CB, Brown DL, Doubilet PM, DiSalvo DN, Laing FC, Frates MC. Increasing curvature of the normal fetal ductus arteriosus with advancing gestational age. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 1995; 5:95-97. [PMID: 7719875 DOI: 10.1046/j.1469-0705.1995.05020095.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
In order to determine whether the configuration of the normal fetal ductus arteriosus changes with increasing gestational age, we prospectively collected oblique transverse sonographic images of the fetal thorax through the ductus arteriosus. Scans from 240 consecutive normal fetuses with gestational age 20 weeks or more were included in the study. The images were reviewed independently by two sonologists and the ductus arteriosus was graded as: (1) straight; (2) mildly curved (C-shaped, bending < 90 degrees from a straight line); or (3) markedly curved (C-shaped, bending > 90 degrees, or S-shaped). In cases where the two sonologists' gradings did not concur, the images were re-reviewed jointly by both sonologists and a grading was assigned by consensus. Forty-two cases were rejected, due to inadequate images. The ductus arteriosus was graded in 42 fetuses aged 20-25.9 weeks, 48 at 26-31.9 weeks, 74 at 32-37.9 weeks, and 34 at 38 weeks or more for a total of 198 cases. There was a significant trend to greater curvature with increasing gestational age (p < 0.0001). The frequency of a straight ductus arteriosus decreased steadily from 55% of fetuses aged 20-25.9 weeks to 3% of fetuses at 38 weeks or older, while the frequency of marked curvature increased from 2% in the youngest age group to 56% in the oldest. The proportion with mild curvature showed little variation throughout gestation. In summary, the configuration of the ductus arteriosus is variable but tends to become more curved as pregnancy proceeds. Marked curvature or tortuosity of the ductus arteriosus should not be misinterpreted as a great vessel anomaly.
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Laing FC, Benson CB, DiSalvo DN, Brown DL, Frates MC, Loughlin KR. Distal ureteral calculi: detection with vaginal US. Radiology 1994; 192:545-8. [PMID: 8029429 DOI: 10.1148/radiology.192.2.8029429] [Citation(s) in RCA: 107] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
PURPOSE To describe the use of vaginal ultrasonography to identify distal ureteral calculi and hydroureter. MATERIALS AND METHODS Abdominal and vaginal sonography were performed in 13 women with distal ureteral calculi. Indications for sonography included flank pain, hematuria, and suspected appendicitis. Six patients were pregnant. RESULTS In each patient, vaginal sonograms demonstrated a distal ureteral calculus; in only two cases was the calculus detected with transabdominal sonography. Distal hydroureter was identified with vaginal scanning in each patient but with abdominal scanning in only two. Hydronephrosis was absent in three patients, mild in six, and moderate in four. Symmetric ureteral jets were noted at transabdominal sonography in two of nine patients. Follow-up transvaginal scans obtained shortly after passage of stones in two patients revealed swelling of the trigone but normal ureteral jets. CONCLUSION In symptomatic female patients, use of vaginal sonography should be considered to evaluate the distal ureter for calculi, particularly if the results of transabdominal examination are normal or inconclusive.
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Bravo SM, Laing FC. Multiple bile duct hamartomas: von Meyenburg complexes detected on sonography and CT scanning. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 1994; 13:649-651. [PMID: 7933036 DOI: 10.7863/jum.1994.13.8.649] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
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Laing FC, Frates MC, Brown DL, Benson CB, Di Salvo DN, Doubilet PM. Sonography of the fetal posterior fossa: false appearance of mega-cisterna magna and Dandy-Walker variant. Radiology 1994; 192:247-51. [PMID: 8208946 DOI: 10.1148/radiology.192.1.8208946] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
PURPOSE To establish that incorrect scanning of the fetal posterior fossa may falsely create the appearance of a mega-cisterna magna (MCM) or Dandy-Walker variant (DWV). MATERIALS AND METHODS After routine sonography, 100 consecutive fetuses (gestational age range, 25-40 weeks) without abnormality underwent additional posterior fossa scanning in an attempt to create the appearance of an MCM (anteroposterior diameter larger than 10 mm) or DWV. Sonograms were obtained in a plane inferior to or angled more coronally than the routine axial plane. RESULTS The posterior fossa was depicted in 93 fetuses. Pseudo-MCM occurred in 35 (38%) of 93 fetuses: 12 (30%) of 40 fetuses aged 25.0-29.9 weeks, 11 (50%) of 22 fetuses aged 30.0-34.9 weeks, and 12 (39%) of 31 fetuses aged 35.0-40.0 weeks. Pseudo-DWV occurred in 40 (43%) of 93 fetuses: 20 (50%) of 40 fetuses aged 25.0-29.9 weeks, 12 (55%) of 22 fetuses aged 30.0-34.9 weeks, and eight (26%) of 31 fetuses aged 35.0-40.0 weeks. CONCLUSION Sonography of the posterior fossa in an angled semi-coronal plane should be avoided because it may create an appearance that mimics an abnormality.
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Frates MC, Benson CB, Doubilet PM, Di Salvo DN, Brown DL, Laing FC, Rein MS, Osathanondh R. Cervical ectopic pregnancy: results of conservative treatment. Radiology 1994; 191:773-5. [PMID: 8184062 DOI: 10.1148/radiology.191.3.8184062] [Citation(s) in RCA: 138] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
PURPOSE To review experience with early sonographic diagnosis and fertility-preserving treatment of cervical ectopic pregnancy. MATERIALS AND METHODS The authors evaluated 12 consecutive cases of cervical ectopic pregnancy diagnosed with ultrasound (US) and treated with methods that successfully preserved the uterus. Gestational age, sonographic findings, means of conception, and method of treatment were recorded. RESULTS Gestational age at diagnosis ranged from 5.0 to 7.9 weeks. Cardiac activity was documented in nine cases. Patients were treated as follows: transvaginal US-guided injection of potassium chloride into the embryo or gestational sac (n = 6), uterine artery embolization followed by dilation and evacuation (n = 4), dilation and evacuation after ligation of uterine artery branches (n = 1), and uterine artery embolization followed by administration of systemic methotrexate (n = 1). The cervical pregnancy was successfully ablated with one treatment in all cases. No patient required hysterectomy, and only one patient required transfusion. Two patients subsequently delivered healthy babies; three other patients have been able to conceive successfully. CONCLUSION When cervical ectopic pregnancy is diagnosed early, US-guided termination or other conservative procedures allow preservation of the uterus, thus maintaining potential fertility.
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Brown DL, Frates MC, Laing FC, DiSalvo DN, Doubilet PM, Benson CB, Waitzkin ED, Muto MG. Ovarian masses: can benign and malignant lesions be differentiated with color and pulsed Doppler US? Radiology 1994; 190:333-6. [PMID: 8284377 DOI: 10.1148/radiology.190.2.8284377] [Citation(s) in RCA: 99] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
PURPOSE To determine whether color and pulsed Doppler ultrasound (US) can be used to differentiate benign from malignant ovarian masses. MATERIALS AND METHODS Forty-four ovarian masses identified with sonography in 40 patients were confirmed at surgery (n = 35) or followed up to resolution with US (n = 9). Color and pulsed Doppler US were used to calculate the lowest pulsatility index (PI) and resistance index (RI) for each mass. RESULTS Color Doppler US enabled detection of arterial flow in 24 of 36 benign masses and six of eight malignant masses. PI was lower in malignant masses than in benign masses (P = .002), as was RI (P = .001). Both indexes demonstrated overlap between benign and malignant masses; therefore, no cutoff value for either index had both high sensitivity and high specificity for malignancy: For PI cutoff of 1.0, sensitivity and specificity were 100% and 46%, respectively; for RI cutoff of 0.4, 50% and 96%. CONCLUSIONS While PI and RI tend to be lower in malignant ovarian masses, neither index can be used reliably to differentiate benign from malignant lesions. In addition, lack of detectable flow by means of color Doppler US does not exclude ovarian malignancy.
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Brown DL, DiSalvo DN, Frates MC, Doubilet PM, Benson CB, Laing FC, Parness IA. Sonography of the fetal heart: normal variants and pitfalls. AJR Am J Roentgenol 1993; 160:1251-5. [PMID: 8498228 DOI: 10.2214/ajr.160.6.8498228] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Sonographic evaluation of the fetal heart is an important part of obstetric sonography. The sonographer and sonologist should be familiar with the sonographic appearance of the normal fetal heart and with common structural abnormalities. Occasionally, normal structures in or adjacent to the fetal heart may simulate an abnormality. Although one should seek consultative sonography in instances of uncertain or questionable findings, unnecessary referral and concern may be avoided in some cases if the sonologist is familiar with normal variants and pitfalls. In this pictorial essay, we present several such pitfalls that we and others have observed in the four-chamber view (Fig. 1) and in views of the ventricular outflow tracts (Figs. 2 and 3).
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