Three-dimensional volume-rendered imaging of normal and abnormal fetal fluid-filled structures using inversion mode

Value of inversion imaging to diagnosis in differentiating malignant from benign breast masses

BACKGROUND

We aimed to evaluate the added value of inversion imaging in differentiating between benign and malignant breast masses when combined with the Breast Imaging Reporting and Data System (BI-RADS).

METHODS

A total of 364 patients with 367 breast masses (151 benign and 216 malignant) who underwent conventional ultrasound and inversion imaging prior to breast surgery were included. A 5-point inversion score (IS) scale was proposed based on the masses' internal echogenicity and distribution characteristics in the inversion images. The combination of IS and BI-RADS was compared with BI-RADS alone to evaluate the value of inversion imaging for breast mass diagnosis. The diagnostic performance of the BI-RADS and its combination with IS for breast masses were analyzed using area under the receiver operating characteristic curve (AUC), accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV).

RESULTS

The IS for malignant breast masses (3.96 ± 0.77) was significantly higher than benign masses (2.58 ± 0.98) (P < 0.001). The sensitivity, specificity, accuracy, PPV, and NPV of BI-RADS were 86.1%, 81.5%, 84.2%, 86.9%, and 80.4%, respectively, and an AUC was 0.909. By compared with BI-RADS, 72 breast masses were downgraded from suspected malignancy to benign, and 6 masses were upgraded from benign to suspected malignancy. Thus, the specificity was increased from 81.5 to 84.8%, it allows 72 benign masses avoid biopsy.

CONCLUSION

The combination of inversion imaging with BI-RADS can effectively improve the diagnostic efficacy of breast masses, and inversion imaging could help benign masses avoid biopsy.

Fetal Intra-abdominal Umbilical Vein Aneurysm

Importance

Fetal umbilical vein aneurysm is an uncommon anomaly that accounts for approximately 4% of umbilical cord abnormalities. The rate of intrauterine fetal death is reported to be approximately 4% to 5%, higher than the background rate of 0.7% that is generally reported during pregnancy.

Objective

The aim of this study was to review the pathophysiology, diagnosis, and clinical management of fetal umbilical vein aneurysm.

Evidence Acquisition

Advances in high-resolution ultrasound combined with color Doppler and 3-dimensional rendering have contributed to an increased understanding of the fetal venous circulation in recent years.

Results

When the diagnosis of umbilical vein aneurysm is made, the patient should undergo a detailed ultrasound evaluation of the fetal anatomy, including fetal echocardiography, to exclude associated anomalies. Amniocentesis should be offered when other anomalies are found. Patients should be informed about the potential for an unfavorable outcome of pregnancy and should undergo close ultrasound surveillance to assess the size of the aneurysm, as well as any evidence of thrombosis or signs of hydrops.

Conclusions

The main prognostic feature associated with a poor outcome of umbilical vein aneurysm seems to be the presence of other anomalies. Early diagnosis is associated with a somewhat worse prognosis, and most fetal deaths have been observed between 27 and 30 weeks of gestation. In the third trimester, it is reasonable to perform serial ultrasound examinations to assess fetal growth, the size of the aneurysm, and the blood flow pattern within the aneurysm.

HDlive rendering images of the fetal stomach: a preliminary report

PURPOSE

This study aimed to show reconstruction of the fetal stomach using the HDlive rendering mode in ultrasound.

METHODS

Seventeen healthy singleton fetuses at 18-34 weeks' gestational age were observed using the HDlive rendering mode of ultrasound in utero.

RESULTS

In all of the fetuses, we identified specific spatial structures, including macroscopic anatomical features (e.g., the pyrous, cardia, fundus, and great curvature) of the fetal stomach, using the HDlive rendering mode. In particular, HDlive rendering images showed remarkably fine details that appeared as if they were being viewed under an endoscope, with visible rugal folds after 27 weeks' gestational age.

CONCLUSION

Our study suggests that the HDlive rendering mode can be used as an additional method for evaluating the fetal stomach. The HDlive rendering mode shows detailed 3D structural images and anatomically realistic images of the fetal stomach. This technique may be effective in prenatal diagnosis for examining detailed information of fetal organs.

Morphological features and length measurements of fetal lateral ventricles at 16-25 weeks of gestation by magnetic resonance imaging

Normal growth of the lateral ventricles (LVs) was characterized three-dimensionally using magnetic resonance imaging (MRI) data from 16 human fetuses at 16-25 weeks of gestation. The LV was differentiated into four primary regions, the anterior horn, central parts, posterior horn, and inferior horn, at 16 weeks of gestation. The LV changed shape mainly by elongation and narrowing, which corresponded to the external and internal growth of the surrounding cerebrum. Six length parameters measured in the LV correlated with biparietal diameter by simple regression analysis (R(2) range, 0.56-0.93), which may be valuable for establishing a standardized prenatal protocol to assess fetal well-being and development across intrauterine periods. No correlation was found between biparietal diameter and LV volume (R(2) = 0.13).

Fetal ovarian cyst: 2- and 3-dimensional ultrasound as a new diagnostic method to rule out ovarian torsion

Owing to the improvement in obstetric ultrasound imaging, prenatal diagnosis of ovarian masses has increased considerably. Fetal ovarian cysts can be suspected when an ultrasound scan shows intra-abdominal structures in female fetuses in the presence of normal bowel and urinary structures. The most common complication is the adnexal torsion, causing partial or complete strangulation of blood supply via ovarian vessels, leading ovarian ischemia, or necrosis. Current information regarding the treatment of fetal ovarian cysts is based on personal experiences and some case series. The management is controversial, characterized by dissimilar approaches, such as “wait and see”, prenatal or postnatal aspiration, or neonatal surgery. In more than half of the cases, spontaneous regression occurs in the prenatal or postnatal period, probably due to the small size and simple aspect. Large cysts may cause both local effects (adnexal torsion, ovarian autoamputation), and distant effects (intestinal and urinary obstruction, adhesion with adjacent organs, abdominal and thoracic mass effect, pulmonary hypoplasia, hemoperitoneum, ascites, polyhyramniosis). In the absence of accurate guidelines for management, we must start with the development of more accurate methods for diagnosing associated complications such as torsion. This case report describes the role of three-dimensional (3-D) ultrasonography as potential diagnostic method for ruling out adnexal torsion when an ovarian cyst is present.

Four-dimensional echocardiography with spatiotemporal image correlation and inversion mode for detection of congenital heart disease

The aim of this study was to evaluate the use of 4-D echocardiography with inversion mode and spatiotemporal image correlation (IM-STIC) in the detection of normal and abnormal fetal hearts. We retrospectively studied 112 normal fetuses and 16 fetuses with a confirmed diagnosis of congenital heart disease. Two volumes were acquired from each of the fetuses using transverse and sagittal sweeps. Volumes were reconstructed with IM-STIC. In normal fetuses, IM-STIC facilitated visualization of the interior structures of the fetal heart and great vessels. The visualization rates of intended planes obtained from IM-STIC 4D data ranged from 55% to 100%. In 16 fetuses with congenital heart disease, IM-STIC was able to display the cardiac malformations using digital casting. Some of the malformations were suspected during pre-natal 2-D echocardiography, and their pre-natal IM-STIC diagnoses were confirmed by post-natal echocardiography, surgery and/or autopsy. Hence, 4-D IM-STIC allows better visualization of complex congenital heart disease and should be considered a very useful addition to 2-D echocardiography.

Antenatal three-dimensional sonographic features of fetal biliary atresia

We present antenatal three-dimensional (3D) sonographic features of fetal biliary atresia. A 38-year-old pregnant Japanese woman was referred to our ultrasound clinic because of a fetal intra-abdominal cyst at 19 weeks of gestation. Conventional two-dimensional (2D) sonography and 3D sonography with an inversion mode showed a round cyst with a tiny dip in the subhepatic area. At 34 weeks, conventional 2D sonography and 3D sonography with inversion and transparent X-ray modes clearly revealed a round to oval cyst connected with the gallbladder via the cystic duct. A diagnosis of choledochal cyst (type I) was suggested antenatally. However, the final diagnosis made by employing operative cholangiography during surgery was biliary atresia (type I cyst) at 25 days of life. To the best of our knowledge, this is the first report of biliary atresia employing antenatal 3D sonography with inversion and transparent X-ray modes.