1
|
Dhanju G, Goubran A, Kirkpatrick I, Wiebe S, Fogel J. Antenatal diagnosis of bronchopulmonary sequestration: A case report and review of the literature. Radiol Case Rep 2024; 19:604-613. [PMID: 38111561 PMCID: PMC10726340 DOI: 10.1016/j.radcr.2023.10.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 10/26/2023] [Indexed: 12/20/2023] Open
Abstract
Congenital lung malformations are a constellation of pathologies that can be diagnosed antenatally by ultrasound and fetal MRI. Ultrasound is considered the modality of choice for a routine assessment of second-trimester scans worldwide. Bronchopulmonary sequestration (BPS) and congenital pulmonary airway malformation (CPAM) are the 2 most common echogenic chest masses discovered incidentally during routine ultrasound scans in the second trimester. This paper describes BPS and differentiates it from CPAM sonographically in utero. An extensive literature search involving antenatal ultrasound is undertaken to review the most up-to-date understanding of the BPS. Furthermore, a case study at our institution and the literature review will help better describe the salient features of BPS. A 41-year-old female G3P1 visits our department for a routine second-trimester ultrasound. An echogenic lesion with a cystic component is visualized in this scan. Based on the grayscale and color imaging, this complex echogenic lesion was reported as CPAM and was referred to fetal assessment for confirmation. The fetal assessment diagnosed the lesion as BPS because of the pathognomonic feeding vessel from the thoracic aorta. Regardless of the congenital lung mass, any large mass compromising fetal well-being is an indication for intervention. The prognosis of BPS in the absence of fetal hydrops is excellent. A robust collaboration among radiologists, obstetricians, and pediatricians is required for the best outcome for the pregnancy and the neonate.
Collapse
Affiliation(s)
- Gurinder Dhanju
- University of Saskatchewan, SK, Canada
- St. Boniface Hospital, Winnipeg, MB, Canada
| | | | | | | | | |
Collapse
|
2
|
Arechvo A, Lingman G, Thurn L, Jansson T, Jokubkiene L. Fusion imaging in brain structure measurements on a fetus phantom, combining real-time ultrasound with magnetic resonance imaging. Australas J Ultrasound Med 2021; 24:161-172. [PMID: 34765426 PMCID: PMC8409451 DOI: 10.1002/ajum.12246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 01/29/2021] [Indexed: 11/21/2022] Open
Abstract
Objectives To assess synchronisation of MRI and US in measuring foetus phantom head structures; inter‐method, intra‐ and inter‐observer differences on biparietal diameter (BPD), head diameter, anterio‐posterior head diameter (HAP) and lateral ventricle structures (VS). Methods Fusion Imaging (FI) has been performed by combining MRI and US simultaneously. Axial scans of 1.5 Tesla MRI on a foetus phantom were acquired and uploaded on a US machine (EPIQ 7G, Philips). A PercuNav US tracker allowed the system to recognise and display the position of the transducer. A fetal phantom tracker was used as a phantom reference. Real‐time US of the phantom head was performed by synchronising the uploaded MRI images using different landmarks. Synchronisation has been assessed by taking measurements after rotating the US probe by 90. Measurements were taken by three different observers twice. Differences in measurements between MRI and US, inter‐, intra‐observer differences in all measurements were assessed. Results BPD, HAP and VS measurements before rotation were 0.13 ± 0.06 cm, 0.46 ± 0.09 cm and 0.4 ± 0.23 cm (width) and mean 0.6 ± 0.25 cm (length) larger at MRI than at US using any number of landmarks. After US probe rotation VS were 0.3 ± 0.24 cm in width and 0.3 ± 0.27 cm in length. Intra‐ and inter‐observer differences in all measurements were small. Conclusions FI showed good synchronisation in measurements. BPD, HAP and VS were larger at MRI than US, likely a result of the way images are generated. Intra‐, inter‐observer differences between measurements were small. This can be important when reporting geometric measures from FI.
Collapse
Affiliation(s)
- Anastasija Arechvo
- Department of Obstetrics and Gynecology Skåne University Hospital Lund University Lund Sweden
| | - Göran Lingman
- Department Obstetrics and Gynecology IKVL Medical Faculty Lund University Lund Sweden
| | - Lars Thurn
- Department of Obstetrics and Gynecology Skåne University Hospital Lund University Lund Sweden
| | - Tomas Jansson
- Department of Clinical Sciences Lund Biomedical Engineering Lund University Lund Sweden.,Clinical Engineering Skåne Medical Services Lund Sweden
| | - Ligita Jokubkiene
- Department of Obstetrics and Gynecology Skåne University Hospital Lund University Lund Sweden
| |
Collapse
|
3
|
Watanabe N, Toh N, Takaya Y, Nakayama R, Yokohama F, Osawa K, Miyoshi T, Akagi T, Kanazawa S, Ito H. Usefulness of cardiac fusion imaging with computed tomography and Doppler echocardiography in the assessment of conduit stenosis in complex adult congenital heart disease. J Cardiol 2021; 78:473-479. [PMID: 34266716 DOI: 10.1016/j.jjcc.2021.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 05/20/2021] [Accepted: 06/19/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Noninvasive assessment of stenotic lesions in patients with complex adult congenital heart disease (ACHD) is challenging due to its complex morphology. The simultaneous two-screen display of multidetector-computed tomography (MDCT) and real-time echogram (STDME) technology can display a virtual multi-planar reconstruction from MDCT corresponding to the same cross-sectional image from transthoracic echocardiography (TTE). We investigated the usefulness of the STDME technology for stenosis severity assessment in complex ACHD patients. METHODS Twenty-four complex ACHD patients with stenotic lesions were enrolled in this study. All patients underwent TTE and the STDME technology within a week after MDCT. Peak velocity and pressure gradient (PG) across the stenotic site were measured using continuous wave Doppler. Cardiac catheterization was performed in 17 patients. RESULTS Nine out of the twenty-four patients had undergone repair with a conduit. Peak velocity and PG from the STDME technology were higher than those from TTE (peak velocity: 3.1 ± 1.1 vs. 2.8 ± 1.0 m/s; peak PG: 43 ± 28 vs. 34 ± 21 mmHg; both p < 0.01). Peak PG from the STDME technology showed significant correlations with those from catheterization in patients with a conduit (n=7) and those without a conduit (n=10) (r = 0.795 and 0.880, respectively; both p < 0.05), while peak PG from TTE was correlated with catheterization measurements only in patients without a conduit (r = 0.850, p < 0.05). CONCLUSIONS The STDME technology enables more accurate assessment of conduit stenosis severity than does TTE in complex ACHD patients.
Collapse
Affiliation(s)
- Nobuhisa Watanabe
- Center of Ultrasonic Diagnostics, Okayama University Hospital, Okayama, Japan
| | - Norihisa Toh
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan.
| | - Yoichi Takaya
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Rie Nakayama
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Fumi Yokohama
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Kazuhiro Osawa
- Department of Cardiovascular Medicine, Japanese Red Cross Okayama Hospital, Okayama, Japan
| | - Toru Miyoshi
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Teiji Akagi
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Susumu Kanazawa
- Department of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, Okayama, Japan
| | - Hiroshi Ito
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| |
Collapse
|
4
|
Kang X, Carlin A, Cannie MM, Sanchez TC, Jani JC. Fetal postmortem imaging: an overview of current techniques and future perspectives. Am J Obstet Gynecol 2020; 223:493-515. [PMID: 32376319 DOI: 10.1016/j.ajog.2020.04.034] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 04/19/2020] [Accepted: 04/28/2020] [Indexed: 12/19/2022]
Abstract
Fetal death because of miscarriage, unexpected intrauterine fetal demise, or termination of pregnancy is a traumatic event for any family. Despite advances in prenatal imaging and genetic diagnosis, conventional autopsy remains the gold standard because it can provide additional information not available during fetal life in up to 40% of cases and this by itself may change the recurrence risk and hence future counseling for parents. However, conventional autopsy is negatively affected by procedures involving long reporting times because the fetal brain is prone to the effect of autolysis, which may result in suboptimal examinations, particularly of the central nervous system. More importantly, fewer than 50%-60% of parents consent to invasive autopsy, mainly owing to the concerns about body disfigurement. Consequently, this has led to the development of noninvasive perinatal virtual autopsy using imaging techniques. Because a significant component of conventional autopsy involves the anatomic examination of organs, imaging techniques such as magnetic resonance imaging, ultrasound, and computed tomography are possible alternatives. With a parental acceptance rate of nearly 100%, imaging techniques as part of postmortem examination have become widely used in recent years in some countries. Postmortem magnetic resonance imaging using 1.5-Tesla magnets is the most studied technique and offers an overall diagnostic accuracy of 77%-94%. It is probably the best choice as a virtual autopsy technique for fetuses >20 weeks' gestation. However, for fetuses <20 weeks' gestation, its performance is poor. The use of higher magnetic resonance imaging magnetic fields such as 3-Tesla may slightly improve performance. Of note, in cases of fetal maceration, magnetic resonance imaging may offer diagnoses in a proportion of brain lesions wherein conventional autopsy fails. Postmortem ultrasound examination using a high-frequency probe offers overall sensitivity and specificity of 67%-77% and 74%-90%, respectively, with the advantage of easy access and affordability. The main difference between postmortem ultrasound and magnetic resonance imaging relates to their respective abilities to obtain images of sufficient quality for a confident diagnosis. The nondiagnostic rate using postmortem ultrasound ranges from 17% to 30%, depending on the organ examined, whereas the nondiagnostic rate using postmortem magnetic resonance imaging in most situations is far less than 10%. For fetuses ≤20 weeks' gestation, microfocus computed tomography achieves close to 100% agreement with autopsy and is likely to be the technique of the future in this subgroup. The lack of histology has always been listed as 1 limitation of all postmortem imaging techniques. Image-guided needle tissue biopsy coupled with any postmortem imaging can overcome this limitation. In addition to describing the diagnostic accuracy and limitations of each imaging technology, we propose a novel, stepwise diagnostic approach and describe the possible application of these techniques in clinical practice as an alternative or an adjunct or for triage to select cases that would specifically benefit from invasive examination, with the aim of reducing parental distress and pathologist workload. The widespread use of postmortem fetal imaging is inevitable, meaning that hurdles such as specialized training and dedicated financing must be overcome to improve access to these newer, well-validated techniques.
Collapse
Affiliation(s)
- Xin Kang
- Departments of Obstetrics and Gynecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Andrew Carlin
- Departments of Obstetrics and Gynecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Mieke M Cannie
- Radiology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium; Department of Radiology, UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Teresa Cos Sanchez
- Departments of Obstetrics and Gynecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Jacques C Jani
- Departments of Obstetrics and Gynecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium.
| |
Collapse
|
5
|
Moro F, Gui B, Arciuolo D, Bertoldo V, Borzi R, Romeo P, Petta F, Cambi F, Pasciuto T, Zannoni GF, Valentini V, Manfredi R, Scambia G, Testa AC. Fusion imaging of ultrasound and MRI in the assessment of locally advanced cervical cancer: a prospective study. Int J Gynecol Cancer 2020; 30:456-465. [PMID: 32193220 DOI: 10.1136/ijgc-2019-000902] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 12/13/2019] [Accepted: 12/26/2019] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Fusion imaging is a new diagnostic method that integrates MRI and ultrasound. It may improve the detection and staging of locally advanced cervical cancer. OBJECTIVE To evaluate the feasibility and accuracy of fusion imaging in patients with locally advanced cervical cancer. METHODS Patients with suspicion of locally advanced cervical cancer at clinical examination and/or imaging, who were candidates for neoadjuvant treatment (chemotherapy or chemoradiation) followed by surgery, were prospectively enrolled between March and November 2018. MRI, ultrasound, and fusion images were obtained before and after neoadjuvant treatment. Feasibility, success of the fusion examination, and time needed to perform fusion studies were evaluated. The rates of concordance between MRI and ultrasound before and after performing fusion, using Cohen, Spearman, and McNemar tests were calculated. The agreement between MRI and ultrasound examination, and the agreement between radiologist and gynecologist during the fusion technique in assessing local extension of disease and the presence of residual disease after neoadjuvant therapy, were also analyzed. The rates of concordance between MRI and ultrasound examination before and after performing fusion imaging, using Cohen's kappa and Spearman's rank correlation coefficient were calculated. A McNemar test was used to assess if there were statistical significant differences in the parameters' agreement before and after performing fusion imaging. RESULTS 40 patients were selected and of these, 33 were analyzed. A total of 52 fusion examinations were performed: 33 (63.5%) of 52 at the time of diagnosis and 19 (36.5%) of 52 after neoadjuvant treatment. Fusion imaging was feasible in 50 (96%) of 52 studies. The median overall time of fusion execution was 13 min (range 6-30) and the time spent in performing a fusion examination decreased from the first to the last examination (20 vs 6 min). The agreement between MRI and ultrasound parameters increased after performing fusion, particularly for parametrial infiltration (74% vs 86%, p=0.014 for the right posterior parametrium; 66% vs 80%, p=0.008 for the left posterior parametrium, 70% vs 82%, p=0.014 for the right lateral parametrium). CONCLUSIONS Fusion of MRI and ultrasound is feasible in patients with locally advanced cervical cancer and may increase the diagnostic accuracy of the single imaging methods. Fusion provides multiple diagnostic opportunities in gynecological oncology.
Collapse
Affiliation(s)
- Francesca Moro
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - Benedetta Gui
- Dipartimento di Diagnostica per Immagini, Radioterapia, Oncologia ed Ematologia, UOC di Radiologia e Neuroradiologia, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - Damiano Arciuolo
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - Valentina Bertoldo
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - Roberta Borzi
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - Paola Romeo
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - Federica Petta
- Dipartimento di Diagnostica per Immagini, Radioterapia, Oncologia ed Ematologia, UOC di Radiologia e Neuroradiologia, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - Francesco Cambi
- Dipartimento di Diagnostica per Immagini, Radioterapia, Oncologia ed Ematologia, UOC di Radiologia e Neuroradiologia, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - Tina Pasciuto
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - Gian Franco Zannoni
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy.,Istituto di Anatomia Patologica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Vincenzo Valentini
- Dipartimento di Diagnostica per Immagini, Radioterapia, Oncologia ed Ematologia, UOC di Radiologia e Neuroradiologia, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy.,Istituto di Radiologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Riccardo Manfredi
- Dipartimento di Diagnostica per Immagini, Radioterapia, Oncologia ed Ematologia, UOC di Radiologia e Neuroradiologia, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy.,Istituto di Radiologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giovanni Scambia
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy.,Istituto di Clinica Ostetrica e Ginecologica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Antonia Carla Testa
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy.,Istituto di Clinica Ostetrica e Ginecologica, Università Cattolica del Sacro Cuore, Rome, Italy
| |
Collapse
|
6
|
Millischer AE, Brasseur-Daudruy M, Mahallati H, Salomon LJ. The use of image fusion in prenatal medicine. Prenat Diagn 2019; 40:18-27. [PMID: 31508835 DOI: 10.1002/pd.5558] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 06/21/2019] [Accepted: 07/28/2019] [Indexed: 12/27/2022]
Abstract
Fusion imaging (FI), the simultaneous display of the same anatomical region using two imaging modalities, has been used in other areas of medicine for both diagnosis and guiding interventions. Examples include positron emission tomography-computed tomography (PET-CT) imaging in oncology and ultrasound-magnetic resonance imaging (US-MRI) fusion in biopsies of the prostate gland. The underlying principle is to take advantage of the complementary information in each modality to improve accuracy, be it diagnostic accuracy or targeting accuracy in biopsies. For example, PET-CT overlays the metabolic activity of lesions on the superb spatial and anatomical detail of CT. While the historical mainstay of fetal imaging has been ultrasound, advances in ultrafast MR imaging together with advances in fetal MRI over the past two decades, have resulted in the opportunity to explore fusion imaging in fetal medicine. We present an overview of the principles of US-MRI fusion imaging in prenatal medicine, report our local experience, and review the literature in this emerging area. We share our perspective on how FI can improve diagnostic confidence, be used as an educational tool, and potentially enhance guidance in certain fetal procedures.
Collapse
Affiliation(s)
- Anne-Elodie Millischer
- Hôpital Necker-Enfants Malades, AP-HP, Université Paris Descartes and Fetus and LUMIERE team, Imagine Institute, Paris, France
| | | | - Houman Mahallati
- Hôpital Necker-Enfants Malades, AP-HP, Université Paris Descartes and Fetus and LUMIERE team, Imagine Institute, Paris, France
| | - Laurent J Salomon
- Hôpital Necker-Enfants Malades, AP-HP, Université Paris Descartes and Fetus and LUMIERE team, Imagine Institute, Paris, France
| |
Collapse
|
7
|
Reith W, Haussmann A, Yilmaz U. [Fetal magnetic resonance imaging]. Radiologe 2019; 58:668-672. [PMID: 29808240 DOI: 10.1007/s00117-018-0405-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
CLINICAL ISSUE The most important prenatal screening method for the detailed assessment of the fetus is ultrasound, which is often combined with colour-coded Doppler sonography. In case of sonographically diagnosed fetal pathologies or technical limitations of the ultrasound, supplementary diagnostics may be necessary. STANDARD RADIOLOGICAL METHODS With fast MRI sequences, fetal MRI screening provides important additional information especially with regard to the most common congenital pathologies-central nervous system (CNS) pathologies (agenesis of the corpus callosum, ventriculomegaly, arachnoid cyst, pathologies of the posterior cranial fossa, dysfunction of the gyrification). Knowledge of the developmental stages of the CNS is very important for accurate clinical assessment and interpretation.
Collapse
Affiliation(s)
- W Reith
- Klinik für Diagnostische und Interventionelle Neuroradiologie, Universitätsklinikum des Saarlandes, Kirrberger Straße, 66424, Homburg-Saar, Deutschland.
| | - A Haussmann
- Klinik für Diagnostische und Interventionelle Neuroradiologie, Universitätsklinikum des Saarlandes, Kirrberger Straße, 66424, Homburg-Saar, Deutschland
| | - U Yilmaz
- Klinik für Diagnostische und Interventionelle Neuroradiologie, Universitätsklinikum des Saarlandes, Kirrberger Straße, 66424, Homburg-Saar, Deutschland
| |
Collapse
|
8
|
Zaghal AA, Hussain HK, Berjawi GA. MRI evaluation of the placenta from normal variants to abnormalities of implantation and malignancies. J Magn Reson Imaging 2019; 50:1702-1717. [PMID: 31102327 DOI: 10.1002/jmri.26764] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 04/18/2019] [Accepted: 04/18/2019] [Indexed: 11/06/2022] Open
Abstract
Even though the placenta has been known for millennia, it is still considered one of the most complex and least understood human organs. Imaging of the placenta is gaining attention due to its impact on fetal and maternal outcomes. MRI plays a vital role in evaluation of inconclusive cases by ultrasonography. It enables precise mapping of placental abnormalities for proper multidisciplinary planning and management. In this article we provide a comprehensive in-depth review of the role of antenatal MR in evaluating "The Placenta." We will describe the protocols and techniques used for MRI of the placenta, review anatomy of the placenta, describe MRI features of major placental abnormalities including those related to position, depth of implantation, hemorrhage, gestational trophoblastic neoplasia, and retained products of conception and discuss the added value of MRI in the management and preoperative planning of such abnormalities. Level of Evidence: 3 Technical Efficacy Stage: 5 J. Magn. Reson. Imaging 2019;50:1702-1717.
Collapse
Affiliation(s)
- Arwa A Zaghal
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Hero K Hussain
- Department of Radiology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ghina A Berjawi
- Department of Radiology, American University of Beirut Medical Center, Beirut, Lebanon
| |
Collapse
|
9
|
Pasupathy D, Denbow ML, Rutherford MA. The Combined Use of Ultrasound and Fetal Magnetic Resonance Imaging for a Comprehensive Fetal Neurological Assessment in Fetal Congenital Cardiac Defects: Scientific Impact Paper No. 60. BJOG 2019; 126:e142-e151. [PMID: 30916430 DOI: 10.1111/1471-0528.15620] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Heart problems are common in newborn babies, affecting approximately 5-10 in 1000 babies. Some are more serious than others, but most babies born with heart problems do not have other health issues. Of those babies who have a serious heart problem, almost 1 in 4 will have heart surgery in their first year. In the UK, pregnant women are offered a scan at around 20 weeks to try and spot any heart problems. In most cases there is not a clear reason for the problem, but sometimes other issues, such as genetic conditions, are discovered. In recent years the care given to these babies after they are born has improved their chances of surviving. However, it is recognised that babies born with heart problems have a risk of delays in their learning and development. This may be due to their medical condition, or as a result of surgery and complications after birth. In babies with heart problems, there is a need for more research on ultrasound and magnetic resonance imaging (MRI) to understand how the brain develops and why these babies are more likely to have delays in learning and development. This paper discusses the way ultrasound and MRI are used in assessing the baby's brain. Ultrasound is often used to spot any problems, looking at how the baby's brain develops in pregnancy. Advances in ultrasound technologies have made this easier. MRI is well-established and safe in pregnancy, and if problems in the brain have been seen on ultrasound, MRI may be used to look at these problems in more detail. While it is not always clear what unusual MRI findings can mean for the baby in the long term, increased understanding may mean parents can be given more information about possible outcomes for the baby and may help to improve the counselling they are offered before their baby's birth.
Collapse
|
10
|
Potential benefit of a simultaneous, side-by-side display of contrast MDCT and echocardiography over routine sequential imaging for assessment of adult congenital heart disease: A preliminary study. J Cardiol 2018; 72:395-402. [DOI: 10.1016/j.jjcc.2018.04.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 04/20/2018] [Accepted: 04/26/2018] [Indexed: 01/04/2023]
|
11
|
Hunter LE, Seale AN. EDUCATIONAL SERIES IN CONGENITAL HEART DISEASE: Prenatal diagnosis of congenital heart disease. Echo Res Pract 2018; 5:R81-R100. [PMID: 30012852 PMCID: PMC6107762 DOI: 10.1530/erp-18-0027] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 07/16/2018] [Indexed: 12/31/2022] Open
Abstract
This review article will guide the reader through the background of prenatal screening for congenital heart disease. The reader will be given insight into the normal screening views, common abnormalities, risk stratification of lesions and also recent advances in prenatal cardiology.
Collapse
Affiliation(s)
- Lindsey E Hunter
- Department of Paediatric Cardiology, Royal Hospital for Children, Glasgow, UK
| | - Anna N Seale
- Department of Paediatric Cardiology, Birmingham Children’s Hospital, Birmingham, UK
| |
Collapse
|
12
|
Nicot R, Rotten D, Opdenakker Y, Kverneland B, Ferri J, Couly G, Levaillant JM. Fetal dental panorama on three-dimensional ultrasound imaging of cleft lip and palate and other facial anomalies. Clin Oral Investig 2018; 23:1561-1568. [PMID: 30132143 DOI: 10.1007/s00784-018-2586-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 08/17/2018] [Indexed: 12/28/2022]
Abstract
OBJECTIVES Craniofacial deformities have a high psychosocial impact. The aim of this paper is to improve obstetric ultrasonography and prenatal detection of facial anomalies by providing a new fetal dental panorama. MATERIAL AND METHODS The present study describes a new modality to visualize the fetal tooth germs and an easy step-by-step diagnostic approach. Image acquisition was performed between 23 and 32 weeks of gestation using a Voluson E10 GE ultrasound machine with an RM6C transducer (GE Medical Systems, Zipf, Austria). Reconstruction was performed using Omniview from the axial image. Volume contrast imaging (VCI) was used with a thickness of 20 mm, and a render mode that combined "Rx mode" and "surface texture." RESULTS The resulting imaging allows a more precise visualization of the fetal dental arch and can be obtained between 14 and 28 weeks of gestation. The presence of dental anomalies can be a clue for the diagnosis of various congenital defects, in particular conditions with a shortage of other physical abnormalities, such as ectodermal dysplasia and Binder syndrome. CONCLUSIONS The creation of a precise fetal dental panorama allows an improved detection of facial deformities. CLINICAL RELEVANCE With the current paper, we want to increase prenatal diagnostics facial anomalies, and help to establish a tailored multidisciplinary treatment plan. This paper should be of interest to readers who are currently treating patients with craniofacial malformations and readers who are performing diagnostic prenatal sonography.
Collapse
Affiliation(s)
- Romain Nicot
- Center for Woman and Fetal Imaging, F-59800, Lille, France. .,Department of Oral and Maxillofacial Surgery and Stomatology, CHU Lille, F-59000, Lille, France.
| | - Daniel Rotten
- Department of Gynecology and Obstetrics, Hôpital Delafontaine, F-93200, Saint-Denis, France
| | - Yasmin Opdenakker
- Department of Oral and Maxillofacial Surgery, University Hospital Ghent, B-9000, Ghent, Belgium
| | - Bothild Kverneland
- Department of Maxillofacial Surgery, Necker Enfants Malades University Hospital, F-75015, Paris, France
| | - Joël Ferri
- Department of Oral and Maxillofacial Surgery and Stomatology, CHU Lille, F-59000, Lille, France.,International Association of Oral and Maxillofacial Medicine (IAOMM), F-59650, Villeneuve dAscq, France
| | - Gérard Couly
- Center for Woman and Fetal Imaging, F-59800, Lille, France
| | - Jean-Marc Levaillant
- Center for Woman and Fetal Imaging, F-59800, Lille, France.,Hôpital Privé Armand Brillard, Groupe Ramsay Générale de Santé, F-94130, Nogent-sur-Marne, France
| |
Collapse
|
13
|
Zhao Y, Yan N, Yu S, Zhang T, Wang C, He S, Gu G. Reduced Radiation Exposure and Puncture Time of Percutaneous Transpedicular Puncture with Real-Time Ultrasound Volume Navigation. World Neurosurg 2018; 119:e997-e1005. [PMID: 30121413 DOI: 10.1016/j.wneu.2018.08.038] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 08/04/2018] [Accepted: 08/06/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The present study introduced ultrasound volume navigation (UVN) to reduce the radiation exposure and puncture time of percutaneous transpedicular puncture in percutaneous vertebroplasty (PVP) or percutaneous kyphoplasty (PKP). METHODS We retrospectively reviewed the medical records of patients with osteoporotic vertebral compression fracture who had undergone PVP or PKP guided by UVN or fluoroscopy from September 2017 to December 2017. RESULTS We enrolled 10 patients (6 women, 4 men) with 24 pedicles involved in the present study. Significant reductions in fluoroscopy frequency (2.58 vs. 17.42; P < 0.01), exposure time (2.36 vs. 15.69 seconds; P < 0.01), and puncture time (4.13 vs. 19.21 minutes; P < 0.01) for each pedicle were observed in the UVN group compared with the fluoroscopy group. Obvious correlations among fluoroscopy frequency, exposure time, and puncture time for each pedicle were observed (P < 0.01). The visual analog scale scores and Oswestry Disability Index were both significantly improved after the procedures. All patients achieved excellent or good clinical outcomes. No complications were observed in any patient. CONCLUSIONS UVN could obviously reduce the radiation exposure and puncture time of percutaneous transpedicular puncture in PVP and PKP.
Collapse
Affiliation(s)
- Yongzhao Zhao
- Orthopedic Department, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Ning Yan
- Orthopedic Department, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Shunzhi Yu
- Orthopedic Department, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Tianqi Zhang
- Orthopedic Department, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Chuanfeng Wang
- Orthopedic Department, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Shisheng He
- Orthopedic Department, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China.
| | - Guangfei Gu
- Orthopedic Department, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China.
| |
Collapse
|
14
|
Werner H, Lopes J, Ribeiro G, Jésus NR, Santos GR, Alexandria HAF, Ruano R, Araujo Júnior E. Three-dimensional virtual cystoscopy: Noninvasive approach for the assessment of urinary tract in fetuses with lower urinary tract obstruction. Prenat Diagn 2017; 37:1350-1352. [DOI: 10.1002/pd.5188] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 10/29/2017] [Accepted: 11/09/2017] [Indexed: 01/15/2023]
Affiliation(s)
- Heron Werner
- Department of Radiology; Clínica de Diagnóstico por Imagem (CPDI); Rio de Janeiro RJ Brazil
| | - Jorge Lopes
- Department of Design; Pontifícia Universidade Católica (PUC-Rio); Rio de Janeiro RJ Brazil
| | - Gerson Ribeiro
- Department of Design; Pontifícia Universidade Católica (PUC-Rio); Rio de Janeiro RJ Brazil
| | - Nilson Ramires Jésus
- Department of Obstetrics and Gynecology; State University of Rio de Janeiro (UERJ); Rio de Janeiro RJ Brazil
| | - Gildasio Rocha Santos
- Department of Obstetrics and Gynecology; State University of Rio de Janeiro (UERJ); Rio de Janeiro RJ Brazil
| | | | - Rodrigo Ruano
- Department of Obstetrics and Gynecology, Mayo Clinic Fetal Diagnostic and Therapeutic Center; Mayo Clinic College of Medicine; Rochester MN USA
| | - Edward Araujo Júnior
- Department of Obstetrics, Paulista School of Medicine; Federal University of São Paulo (EPM-UNIFESP); São Paulo SP Brazil
| |
Collapse
|
15
|
Affiliation(s)
| | - Russell W Steele
- 1 University of Queensland, Herston, Queensland, Australia.,2 Tulane University, New Orleans, LA, USA
| |
Collapse
|
16
|
Rawlinson WD, Boppana SB, Fowler KB, Kimberlin DW, Lazzarotto T, Alain S, Daly K, Doutré S, Gibson L, Giles ML, Greenlee J, Hamilton ST, Harrison GJ, Hui L, Jones CA, Palasanthiran P, Schleiss MR, Shand AW, van Zuylen WJ. Congenital cytomegalovirus infection in pregnancy and the neonate: consensus recommendations for prevention, diagnosis, and therapy. THE LANCET. INFECTIOUS DISEASES 2017; 17:e177-e188. [PMID: 28291720 DOI: 10.1016/s1473-3099(17)30143-3] [Citation(s) in RCA: 470] [Impact Index Per Article: 67.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 12/13/2016] [Accepted: 12/20/2016] [Indexed: 01/25/2023]
Abstract
Congenital cytomegalovirus is the most frequent, yet under-recognised, infectious cause of newborn malformation in developed countries. Despite its clinical and public health importance, questions remain regarding the best diagnostic methods for identifying maternal and neonatal infection, and regarding optimal prevention and therapeutic strategies for infected mothers and neonates. The absence of guidelines impairs global efforts to decrease the effect of congenital cytomegalovirus. Data in the literature suggest that congenital cytomegalovirus infection remains a research priority, but data are yet to be translated into clinical practice. An informal International Congenital Cytomegalovirus Recommendations Group was convened in 2015 to address these questions and to provide recommendations for prevention, diagnosis, and treatment. On the basis of consensus discussions and a review of the literature, we do not support universal screening of mothers and the routine use of cytomegalovirus immunoglobulin for prophylaxis or treatment of infected mothers. However, treatment guidelines for infected neonates were recommended. Consideration must be given to universal neonatal screening for cytomegalovirus to facilitate early detection and intervention for sensorineural hearing loss and developmental delay, where appropriate. The group agreed that education and prevention strategies for mothers were beneficial, and that recommendations will need continual updating as further data become available.
Collapse
Affiliation(s)
- William D Rawlinson
- Serology & Virology Division, SEALS Microbiology, Prince of Wales Hospital, Sydney, NSW, Australia; School of Medical Sciences, University of New South Wales, NSW, Australia; School of Biotechnology and Biomolecular Sciences, University of New South Wales, NSW, Australia.
| | - Suresh B Boppana
- Department of Pediatrics & Microbiology, University of Alabama at Birmingham, AL, USA
| | - Karen B Fowler
- Department of Pediatrics & Microbiology, University of Alabama at Birmingham, AL, USA
| | - David W Kimberlin
- Division of Pediatric Infectious Diseases, University of Alabama at Birmingham, AL, USA
| | - Tiziana Lazzarotto
- Operative Unit of Clinical Microbiology, Laboratory of Virology, Polyclinic St. Orsola-Malpighi, Department of Specialised Experimental and Diagnostic Medicine, University of Bologna, Bologna, Italy
| | - Sophie Alain
- National Reference Center for Cytomegalovirus, CHU Limoges, Laboratoire de Bactériologie-Virologie, Université de Limoges, Limoges, France
| | - Kate Daly
- Congenital Cytomegalovirus Association, NSW, Australia
| | - Sara Doutré
- National Cytomegalovirus Foundation, Tampa, FL, USA
| | - Laura Gibson
- Departments of Medicine and Pediatrics, Division of Infectious Diseases and Immunology, University of Massachusetts Medical School, MA, USA
| | - Michelle L Giles
- Department of Obstetrics and Gynaecology and Department of Infectious Diseases, Monash University, VIC, Australia
| | | | - Stuart T Hamilton
- Serology & Virology Division, SEALS Microbiology, Prince of Wales Hospital, Sydney, NSW, Australia
| | - Gail J Harrison
- Department of Pediatrics and Pathology & Immunology, Baylor College of Medicine, TX, USA
| | - Lisa Hui
- Department of Perinatal Medicine, Mercy Hospital for Women, Heidelberg, VIC, Australia; Department of Obstetrics and Gynaecology, University of Melbourne, VIC, Australia
| | - Cheryl A Jones
- Marie Bashir Institute for Infectious Diseases and Biosecurity, Discipline of Paediatrics and Child Health, University of Sydney, Sydney, NSW, Australia; The Children's Hospital, Westmead, NSW, Australia
| | - Pamela Palasanthiran
- School of Women's and Child Health, University of New South Wales, NSW, Australia; Department of Immunology and Infectious Diseases, Sydney Children's Hospital, NSW, Australia
| | - Mark R Schleiss
- Center for Infectious Diseases and Microbiology Translational Research, Division of Pediatric Infectious Diseases and Immunology, University of Minnesota Medical School, MN, USA
| | - Antonia W Shand
- Menzies School Health Policy, University of Sydney, Sydney, NSW, Australia; Department of Maternal Fetal Medicine, Royal Hospital for Women, Sydney, NSW, Australia
| | - Wendy J van Zuylen
- Serology & Virology Division, SEALS Microbiology, Prince of Wales Hospital, Sydney, NSW, Australia; School of Medical Sciences, University of New South Wales, NSW, Australia
| |
Collapse
|
17
|
Nunes V, Cross J, Speich JE, Morgan DR, Strauss JF, Ramus RM. Fetal membrane imaging and the prediction of preterm birth: a systematic review, current issues, and future directions. BMC Pregnancy Childbirth 2016; 16:387. [PMID: 27938341 PMCID: PMC5148829 DOI: 10.1186/s12884-016-1176-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 12/01/2016] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Preterm premature rupture of membranes (PPROM) is the largest identifiable cause of preterm birth. There is currently no good screening test for PPROM in low-risk asymptomatic patients. Our goal was to identify how imaging methods can be utilized for examining the risks for PPROM in asymptomatic patients. METHODS This paper is a systematic review of the literature on fetal membrane thickness and its use for the prediction of PPROM. Four key studies are identified and reviewed; two in vitro studies and two in vivo ultrasound studies each using differing methodologies. Additionally reviewed is a study using Optical Coherence Tomography, an emerging technique using near-infrared technology to produce high-resolution images. RESULTS There is currently insufficient data to determine the association between fetal membrane thickness and PPROM by ultrasound. CONCLUSIONS Fetal membrane thickness could have relevant clinical ramifications for the prediction of PPROM. Suggested improvements in study methodology and design will lead to progress in this area of research, as well as the use of newer technologies. Larger sample sizes, histological comparison, uniform methodologies for data collection, longitudinal study design and expanding data analysis beyond fetal membrane thickness to other properties would expand our knowledge in this field. In addition, transvaginal ultrasound should be utilized to improve resolution, as well as emerging methodologies such as MRI fusion imaging using ultrasound and Shear Wave Elastography.
Collapse
Affiliation(s)
- Vanessa Nunes
- Department of Obstetrics & Gynecology, Virginia Commonwealth University, Richmond, VA USA
| | - Jennifer Cross
- Department of Obstetrics & Gynecology, Virginia Commonwealth University, Richmond, VA USA
| | - John E. Speich
- Department of Mechanical and Nuclear Engineering, School of Engineering, Virginia Commonwealth University, Richmond, VA USA
| | - Danielle R. Morgan
- Department of Obstetrics & Gynecology, Virginia Commonwealth University, Richmond, VA USA
| | - Jerome F. Strauss
- Department of Obstetrics & Gynecology, Virginia Commonwealth University, Richmond, VA USA
| | - Ronald M. Ramus
- Department of Obstetrics & Gynecology, Virginia Commonwealth University, Richmond, VA USA
| |
Collapse
|
18
|
Mourier E, Tarrade A, Duan J, Richard C, Bertholdt C, Beaumont M, Morel O, Chavatte-Palmer P. Non-invasive evaluation of placental blood flow: lessons from animal models. Reproduction 2016; 153:R85-R96. [PMID: 27845691 DOI: 10.1530/rep-16-0428] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 11/03/2016] [Accepted: 11/14/2016] [Indexed: 01/11/2023]
Abstract
In human obstetrics, placental vascularisation impairment is frequent as well as linked to severe pathological events (preeclampsia and intrauterine growth restriction), and there is a need for reliable methods allowing non-invasive evaluation of placental blood flow. Uteroplacental vascularisation is complex, and animal models are essential for the technical development and safety assessment of these imaging tools for human clinical use; however, these techniques can also be applied in the veterinary context. This paper reviews how ultrasound-based imaging methods such as 2D and 3D Doppler can provide valuable insight for the exploration of placental blood flow both in humans and animals and how new approaches such as the use of ultrasound contrast agents or ultrafast Doppler may allow to discriminate between maternal (non-pulsatile) and foetal (pulsatile) blood flow in the placenta. Finally, functional magnetic resonance imaging could also be used to evaluate placental blood flow, as indicated by studies in animal models, but its safety in human pregnancy still requires to be confirmed.
Collapse
Affiliation(s)
- E Mourier
- UMR BDRINRA, ENVA, Université Paris Saclay, Jouy en Josas, France .,PremUp FoundationParis, France
| | - A Tarrade
- UMR BDRINRA, ENVA, Université Paris Saclay, Jouy en Josas, France.,PremUp FoundationParis, France
| | - J Duan
- IADIInserm U947, University of Lorraine, CHRU of Brabois, Nancy, France.,CHRU of Nancypole de Gynécologie Obstétrique, Nancy, France
| | - C Richard
- UMR BDRINRA, ENVA, Université Paris Saclay, Jouy en Josas, France.,PremUp FoundationParis, France
| | - C Bertholdt
- IADIInserm U947, University of Lorraine, CHRU of Brabois, Nancy, France.,CHRU of Nancypole de Gynécologie Obstétrique, Nancy, France
| | - M Beaumont
- IADIInserm U947, University of Lorraine, CHRU of Brabois, Nancy, France.,CHRU of Nancypole de Gynécologie Obstétrique, Nancy, France
| | - O Morel
- IADIInserm U947, University of Lorraine, CHRU of Brabois, Nancy, France.,CHRU of Nancypole de Gynécologie Obstétrique, Nancy, France
| | - P Chavatte-Palmer
- UMR BDRINRA, ENVA, Université Paris Saclay, Jouy en Josas, France.,PremUp FoundationParis, France
| |
Collapse
|
19
|
Millischer AE, Salomon LJ, Porcher R, Brasseur-Daudruy M, Gourdier AL, Hornoy P, Silvera S, Loisel D, Tsatsaris V, Delorme B, Boddaert N, Ville Y, Sentilhes L. Magnetic resonance imaging for abnormally invasive placenta: the added value of intravenous gadolinium injection. BJOG 2016; 124:88-95. [DOI: 10.1111/1471-0528.14164] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2016] [Indexed: 11/26/2022]
Affiliation(s)
- A-E Millischer
- Service de Radiologie; Hôpital Necker Enfants Malades; Assistance Publique-Hôpitaux de Paris (APHP); Paris France
- EAfetus 7328; Université Paris Descartes; Paris France
| | - LJ Salomon
- EAfetus 7328; Université Paris Descartes; Paris France
- Service de Gynécologie-Obstétrique; Hôpital Necker-Enfants Malades; Assistance Publique-Hôpitaux de Paris (AP-HP); Université Paris Descartes; Paris France
| | - R Porcher
- Service de Statistiques; Hôpital Hotel-Dieu; Assistance Publique-Hôpitaux de Paris; Paris France
| | - M Brasseur-Daudruy
- Service de Gynécologie-Obstétrique; Hôpital Universitaire de Rouen; Rouen France
| | - A-L Gourdier
- Service de Radiologie; Hôpital Universitaire d'Angers; Angers France
| | - P Hornoy
- Service de Radiologie Cochin-Port Royal; Assistance Publique-Hôpitaux de Paris; Paris France
| | - S Silvera
- Service de Radiologie Cochin-Port Royal; Assistance Publique-Hôpitaux de Paris; Paris France
| | - D Loisel
- Service de Radiologie; Hôpital Universitaire d'Angers; Angers France
| | - V Tsatsaris
- Service de Gynécologie-Obstétrique; Hôpital Cochin-Port Royal; Assistance Publique-Hôpitaux de Paris; Paris France
| | - B Delorme
- Service de Radiologie; Hôpital Universitaire d'Angers; Angers France
| | - N Boddaert
- Service de Radiologie; Hôpital Necker Enfants Malades; Assistance Publique-Hôpitaux de Paris (APHP); Paris France
| | - Y Ville
- EAfetus 7328; Université Paris Descartes; Paris France
- Service de Gynécologie-Obstétrique; Hôpital Necker-Enfants Malades; Assistance Publique-Hôpitaux de Paris (AP-HP); Université Paris Descartes; Paris France
| | - L Sentilhes
- Service de Gynécologie-Obstétrique; Hôpital Universitaire Bordeaux; Bordeaux France
| |
Collapse
|
20
|
|
21
|
Chalouhi GE, Bernardi V, Gueneuc A, Houssin I, Stirnemann JJ, Ville Y. Evaluation of trainees' ability to perform obstetrical ultrasound using simulation: challenges and opportunities. Am J Obstet Gynecol 2016; 214:525.e1-525.e8. [PMID: 26546849 DOI: 10.1016/j.ajog.2015.10.932] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Revised: 10/06/2015] [Accepted: 10/29/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Evaluation of trainee's ability in obstetrical ultrasound is a time-consuming process, which requires involving patients as volunteers. With the use of obstetrical ultrasound simulators, virtual reality could help in assessing competency and evaluating trainees in this field. OBJECTIVE The objective of the study was to test the validity of an obstetrical ultrasound simulator as a tool for evaluating trainees following structured training by comparing scores obtained on obstetrical ultrasound simulator with those obtained on volunteers and by assessing correlations between scores of images and of dexterity given by 2 blinded examiners. STUDY DESIGN Trainees, taking the 2013 French national examination for the practice of obstetrical ultrasound were asked to obtain standardized ultrasound planes both on volunteer pregnant women and on an obstetrical ultrasound simulator. These planes included measurements of biparietal diameter, abdominal circumference, and femur length as well as reference planes for cardiac 4-chamber and outflow tracts, kidneys, stomach/diaphragm, spine, and face. Images were stored and evaluated subsequently by 2 national examiners who scored each picture according to previously established quality criteria. Dexterity was also evaluated and subjectively scored between 0 and 10. The Raghunathan's modification of Pearson, Filon's z, Spearman's rank correlation, and analysis of variance tests were used to assess correlations between the scores by the 2 examiners and scores of dexterity and also to compare the final scores between the 2 different methods. RESULTS We evaluated 29 trainees. The mean dexterity scores in simulation (6.5 ± 2.0) and real examination (5.9 ± 2.3) were comparable (P = .31). Scores with an obstetrical ultrasound simulator were significantly higher than those obtained on volunteers (P = .027). Nevertheless, there was a good correlation between the scores of the 2 examiners judging on simulation (R = 0.888) and on volunteers (R = 0.873) (P = .81). CONCLUSION An obstetrical ultrasound simulator is as good a method as volunteer-based examination for evaluating practical skills in trainees following structured training in obstetrical ultrasound. The threshold for success/failure should, however, be adapted as candidates obtain higher scores on the simulator. Advantages of the obstetrical ultrasound simulator include the absence of location and time constraints without the need to involve volunteers or to interfere with the running of ultrasound clinics. However, an obstetrical ultrasound simulator still lacks the ability to evaluate the trainees' ability to interact with patients.
Collapse
|
22
|
Gómez Huertas M, Culiañez Casas M, Molina García F, Carrillo Badillo M, Pastor Pons E. Complementary role of magnetic resonance imaging in the study of the fetal urinary system. RADIOLOGIA 2016. [DOI: 10.1016/j.rxeng.2016.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
23
|
Gómez Huertas M, Culiañez Casas M, Molina García F, Carrillo Badillo M, Pastor Pons E. Papel complementario de la resonancia magnética en el estudio del sistema urinario fetal. RADIOLOGIA 2016; 58:101-10. [DOI: 10.1016/j.rx.2015.12.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2015] [Revised: 12/11/2015] [Accepted: 12/16/2015] [Indexed: 12/11/2022]
|
24
|
Siauve N, Chalouhi GE, Deloison B, Alison M, Clement O, Ville Y, Salomon LJ. Functional imaging of the human placenta with magnetic resonance. Am J Obstet Gynecol 2015; 213:S103-14. [PMID: 26428488 DOI: 10.1016/j.ajog.2015.06.045] [Citation(s) in RCA: 84] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Revised: 06/15/2015] [Accepted: 06/17/2015] [Indexed: 11/29/2022]
Abstract
Abnormal placentation is responsible for most failures in pregnancy; however, an understanding of placental functions remains largely concealed from noninvasive, in vivo investigations. Magnetic resonance imaging (MRI) is safe in pregnancy for magnetic fields of up to 3 Tesla and is being used increasingly to improve the accuracy of prenatal imaging. Functional MRI (fMRI) of the placenta has not yet been validated in a clinical setting, and most data are derived from animal studies. FMRI could be used to further explore placental functions that are related to vascularization, oxygenation, and metabolism in human pregnancies by the use of various enhancement processes. Dynamic contrast-enhanced MRI is best able to quantify placental perfusion, permeability, and blood volume fractions. However, the transplacental passage of Gadolinium-based contrast agents represents a significant safety concern for this procedure in humans. There are alternative contrast agents that may be safer in pregnancy or that do not cross the placenta. Arterial spin labeling MRI relies on magnetically labeled water to quantify the blood flows within the placenta. A disadvantage of this technique is a poorer signal-to-noise ratio. Based on arterial spin labeling, placental perfusion in normal pregnancy is 176 ± 91 mL × min(-1) × 100 g(-1) and decreases in cases with intrauterine growth restriction. Blood oxygen level-dependent and oxygen-enhanced MRIs do not assess perfusion but measure the response of the placenta to changes in oxygen levels with the use of hemoglobin as an endogenous contrast agent. Diffusion-weighted imaging and intravoxel incoherent motion MRI do not require exogenous contrast agents, instead they use the movement of water molecules within tissues. The apparent diffusion coefficient and perfusion fraction are significantly lower in placentas of growth-restricted fetuses when compared with normal pregnancies. Magnetic resonance spectroscopy has the ability to extract information regarding metabolites from the placenta noninvasively and in vivo. There are marked differences in all 3 metabolites N-acetyl aspartate/choline levels, inositol/choline ratio between small, and adequately grown fetuses. Current research is focused on the ability of each fMRI technique to make a timely diagnosis of abnormal placentation that would allow for appropriate planning of follow-up examinations and optimal scheduling of delivery. These research programs will benefit from the use of well-defined sequences, standardized imaging protocols, and robust computational methods.
Collapse
Affiliation(s)
- Nathalie Siauve
- INSERM, U970, Sorbonne Paris Cite, Paris Cardiovascular Research Center-PARCC, Paris, France; EA FETUS and LUMIERE Unit, Université Paris-Descartes, Paris, France; Hôpital Européen Georges Pompidou, Paris, France
| | - Gihad E Chalouhi
- INSERM, U970, Sorbonne Paris Cite, Paris Cardiovascular Research Center-PARCC, Paris, France; EA FETUS and LUMIERE Unit, Université Paris-Descartes, Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpital Necker-Enfants Malades, Paris, France
| | - Benjamin Deloison
- INSERM, U970, Sorbonne Paris Cite, Paris Cardiovascular Research Center-PARCC, Paris, France; EA FETUS and LUMIERE Unit, Université Paris-Descartes, Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpital Necker-Enfants Malades, Paris, France
| | - Marianne Alison
- INSERM, U970, Sorbonne Paris Cite, Paris Cardiovascular Research Center-PARCC, Paris, France
| | - Olivier Clement
- INSERM, U970, Sorbonne Paris Cite, Paris Cardiovascular Research Center-PARCC, Paris, France; Hôpital Européen Georges Pompidou, Paris, France
| | - Yves Ville
- EA FETUS and LUMIERE Unit, Université Paris-Descartes, Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpital Necker-Enfants Malades, Paris, France
| | - Laurent J Salomon
- INSERM, U970, Sorbonne Paris Cite, Paris Cardiovascular Research Center-PARCC, Paris, France; EA FETUS and LUMIERE Unit, Université Paris-Descartes, Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpital Necker-Enfants Malades, Paris, France.
| |
Collapse
|
25
|
Millischer AE, Salomon LJ, Santulli P, Borghese B, Dousset B, Chapron C. Fusion imaging for evaluation of deep infiltrating endometriosis: feasibility and preliminary results. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2015; 46:109-117. [PMID: 25358293 DOI: 10.1002/uog.14712] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2014] [Revised: 09/08/2014] [Accepted: 10/21/2014] [Indexed: 06/04/2023]
Abstract
OBJECTIVE Magnetic resonance imaging (MRI) and ultrasound scanning complement each other in screening for and diagnosis of endometriosis. Fusion imaging, also known as real-time virtual sonography, is a new technique that uses magnetic navigation and computer software for the synchronized display of real-time ultrasound and multiplanar reconstructed MR images. Our aim was to evaluate the feasibility and ability of fusion imaging to assess the main anatomical sites of deep infiltrating endometriosis (DIE) in patients with suspected active endometriosis. METHODS This prospective study was conducted over a 1-month period in patients referred to a trained radiologist for an ultrasound-based evaluation for endometriosis. Patients with a prior pelvic MRI examination within the past year were offered fusion imaging, in addition to the standard evaluation. All MRI examinations were performed on a 1.5-T MRI machine equipped with a body phased-array coil. The MRI protocol included acquisition of at least two fast spin-echo T2-weighted orthogonal planes. The Digital Imaging Communications in Medicine dataset acquired at the time of the MRI examination was loaded into the fusion system and displayed together with the ultrasound image on the same monitor. The sets of images were then synchronized manually using one plane and one anatomical reference point. The ability of this combined image to identify and assess the main anatomical sites of pelvic endometriosis (uterosacral ligaments, posterior vaginal fornix, rectum, ureters and bladder) was evaluated and compared with that of standard B-mode ultrasound and MRI. RESULTS Over the study period, 100 patients were referred for ultrasound examination because of endometriosis. Among them were 20 patients (median age, 35 (range, 27-49) years) who had undergone MRI examination within the past year, with a median (range) time interval between MRI and ultrasound examination of 171 (1-350) days. All 20 patients consented to undergo additional evaluation by fusion imaging. However, in three (15%) cases, fusion imaging was not technically possible because of changes since the initial MRI examination resulting from either interval surgery (n = 2; 10%) or pregnancy (n = 1; 5%). Data acquisition, matching and fusion imaging were performed in under 10 min in each of the other 17 cases. The overall ability of each technique to identify and assess the main anatomical landmarks of endometriosis was as follows: uterosacral ligaments: ultrasound, 88% (30/34); MRI, 100% (34/34); fusion imaging, 100% (34/34); posterior vaginal fornix: ultrasound, 88% (30/34); MRI, 100% (34/34); fusion imaging, 100% (34/34); rectum: ultrasound, 100% (17/17); MRI, 82.3% (14/17); fusion imaging, 100% (17/17); ureters: ultrasound, 0%; MRI, 100% (34/34); fusion imaging, 100% (34/34); and bladder: ultrasound, 100%; MRI, 100%; fusion imaging, 100%. CONCLUSION Fusion imaging is feasible for the assessment of endometriotic lesions. Because it combines information from both ultrasound and MRI techniques, fusion imaging allows better identification of the main anatomical sites of DIE and has the potential to improve the performance of ultrasound and MRI examination.
Collapse
Affiliation(s)
- A-E Millischer
- Radiology, Centre de Radiologie Bachaumont IMPC-Paris, Paris, France
| | - L J Salomon
- Hôpital Universitaire Necker-Enfants Malades, AP-HP, Université Paris Descartes, Maternité; Société Française pour l'Amélioration des Pratiques Echographiques, SFAPE, Paris, France
| | - P Santulli
- Université Paris Descartes, Sorbone Paris Cité, Faculté de Médecine, Assistance Publique - Hôpitaux de Paris (AP-HP), Groupe Hospitalier Universitaire (GHU) Ouest, Centre Hospitalier Universitaire (CHU) Cochin, Department of Gynecology Obstetrics II and Reproductive Medicine, Paris, France
- Gynecology, Institut Cochin, Université Paris Descartes, CNRS (UMR 8104), Inserm, Unité de Recherche U1016, Paris, France
- Gynecology, Université Paris Descartes, Faculté de Médecine, EA 1833, ERTi, AP-HP, CHU Cochin, Paris, France
| | - B Borghese
- Université Paris Descartes, Sorbone Paris Cité, Faculté de Médecine, Assistance Publique - Hôpitaux de Paris (AP-HP), Groupe Hospitalier Universitaire (GHU) Ouest, Centre Hospitalier Universitaire (CHU) Cochin, Department of Gynecology Obstetrics II and Reproductive Medicine, Paris, France
- Gynecology, Institut Cochin, Université Paris Descartes, CNRS (UMR 8104), Inserm, Unité de Recherche U1016, Paris, France
| | - B Dousset
- Université Paris Descartes, Sorbone Paris Cité, Faculté de Médecine, Assistance Publique - Hôpitaux de Paris (AP-HP), Groupe Hospitalier Universitaire (GHU) Ouest, Centre Hospitalier Universitaire (CHU) Cochin, Department of Gynecology Obstetrics II and Reproductive Medicine, Paris, France
- Service de Chirurgie Viscerale Hopital Cochin-Paris, Paris, France
| | - C Chapron
- Université Paris Descartes, Sorbone Paris Cité, Faculté de Médecine, Assistance Publique - Hôpitaux de Paris (AP-HP), Groupe Hospitalier Universitaire (GHU) Ouest, Centre Hospitalier Universitaire (CHU) Cochin, Department of Gynecology Obstetrics II and Reproductive Medicine, Paris, France
- Gynecology, Institut Cochin, Université Paris Descartes, CNRS (UMR 8104), Inserm, Unité de Recherche U1016, Paris, France
| |
Collapse
|
26
|
Wong-On M, Til-Pérez L, Balius R. Evaluation of MRI-US Fusion Technology in Sports-Related Musculoskeletal Injuries. Adv Ther 2015; 32:580-94. [PMID: 26093660 DOI: 10.1007/s12325-015-0217-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Indexed: 12/20/2022]
Abstract
INTRODUCTION A combination of magnetic resonance imaging (MRI) with real-time high-resolution ultrasound (US) known as fusion imaging may improve visualization of musculoskeletal (MSK) sports medicine injuries. The aim of this study was to evaluate the applicability of MRI-US fusion technology in MSK sports medicine. METHODS This study was conducted by the medical services of the FC Barcelona. The participants included volunteers and referred athletes with symptomatic and asymptomatic MSK injuries. All cases underwent MRI which was loaded into the US system for manual registration on the live US image and fusion imaging examination. After every test, an evaluation form was completed in terms of advantages, disadvantages, and anatomic fusion landmarks. RESULTS From November 2014 to March 2015, we evaluated 20 subjects who underwent fusion imaging, 5 non-injured volunteers and 15 injured athletes, 11 symptomatic and 4 asymptomatic, age range 16-50 years, mean 22. We describe some of the anatomic landmarks used to guide fusion in different regions. This technology allowed us to examine muscle and tendon injuries simultaneously in US and MRI, and the correlation of both techniques, especially low-grade muscular injuries. This has also helped compensate for the limited field of view with US. It improves spatial orientation of cartilage, labrum and meniscal injuries. However, a high-quality MRI image is essential in achieving an adequate fusion image, and 3D sequences need to be added in MRI protocols to improve navigation. CONCLUSION The combination of real-time MRI and US image fusion and navigation is relatively easy to perform and is helping to improve understanding of MSK injuries. However, it requires specific skills in MSK imaging and still needs further research in sports-related injuries. FUNDING Toshiba Medical Systems Corporation.
Collapse
Affiliation(s)
- Manuel Wong-On
- Sports Medicine Fellowship University of Barcelona, Barcelona, Spain,
| | | | | |
Collapse
|
27
|
Sherwood V, Civale J, Rivens I, Collins DJ, Leach MO, ter Haar GR. Development of a hybrid magnetic resonance and ultrasound imaging system. BIOMED RESEARCH INTERNATIONAL 2014; 2014:914347. [PMID: 25177702 PMCID: PMC4142177 DOI: 10.1155/2014/914347] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Revised: 07/11/2014] [Accepted: 07/16/2014] [Indexed: 12/29/2022]
Abstract
A system which allows magnetic resonance (MR) and ultrasound (US) image data to be acquired simultaneously has been developed. B-mode and Doppler US were performed inside the bore of a clinical 1.5 T MRI scanner using a clinical 1-4 MHz US transducer with an 8-metre cable. Susceptibility artefacts and RF noise were introduced into MR images by the US imaging system. RF noise was minimised by using aluminium foil to shield the transducer. A study of MR and B-mode US image signal-to-noise ratio (SNR) as a function of transducer-phantom separation was performed using a gel phantom. This revealed that a 4 cm separation between the phantom surface and the transducer was sufficient to minimise the effect of the susceptibility artefact in MR images. MR-US imaging was demonstrated in vivo with the aid of a 2 mm VeroWhite 3D-printed spherical target placed over the thigh muscle of a rat. The target allowed single-point registration of MR and US images in the axial plane to be performed. The system was subsequently demonstrated as a tool for the targeting and visualisation of high intensity focused ultrasound exposure in the rat thigh muscle.
Collapse
Affiliation(s)
- Victoria Sherwood
- Division of Radiotherapy and Imaging, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, 123 Old Brompton Road, London SW7 3RP, UK
| | - John Civale
- Division of Radiotherapy and Imaging, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, 123 Old Brompton Road, London SW7 3RP, UK
| | - Ian Rivens
- Division of Radiotherapy and Imaging, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, 123 Old Brompton Road, London SW7 3RP, UK
| | - David J. Collins
- Department of Clinical Magnetic Resonance, CRUK and EPSRC Cancer Imaging Centre, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, 123 Old Brompton Road, London SW7 3RP, UK
| | - Martin O. Leach
- Department of Clinical Magnetic Resonance, CRUK and EPSRC Cancer Imaging Centre, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, 123 Old Brompton Road, London SW7 3RP, UK
| | - Gail R. ter Haar
- Division of Radiotherapy and Imaging, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, 123 Old Brompton Road, London SW7 3RP, UK
| |
Collapse
|
28
|
Brasseur-Daudruy M, Diguet A, Dacher JN, Verspyck E. Fusion échographie–IRM : une nouvelle approche du cerveau fœtal ? ACTA ACUST UNITED AC 2014; 42:365-8. [DOI: 10.1016/j.gyobfe.2014.03.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2014] [Accepted: 03/17/2014] [Indexed: 10/25/2022]
|
29
|
Quarello E, Bessis R, Devred P, Gorincour G. La fusion d’images, symbole moderne de collaboration entre obstétriciens et radiologues. ACTA ACUST UNITED AC 2014; 42:293-5. [DOI: 10.1016/j.gyobfe.2014.04.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2014] [Indexed: 11/30/2022]
|