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Grantz KL, Lee W, Chen Z, Hinkle S, Mack L, Cortes MS, Goncalves LF, Espinoza J, Gore-Langton RE, Sherman S, He D, Zhang C, Grewal J. The NICHD Fetal 3D Study: A Pregnancy Cohort Study of Fetal Body Composition and Volumes. Am J Epidemiol 2024; 193:580-595. [PMID: 37946325 DOI: 10.1093/aje/kwad210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 09/27/2023] [Accepted: 10/27/2023] [Indexed: 11/12/2023] Open
Abstract
There's a paucity of robust normal fractional limb and organ volume standards from a large and diverse ethnic population. The Fetal 3D Study was designed to develop research and clinical applications for fetal soft tissue and organ volume assessment. The NICHD Fetal Growth Studies (2009-2013) collected 2D and 3D fetal volumes. In the Fetal 3D Study (2015-2019), sonographers performed longitudinal 2D and 3D measurements for specific fetal anatomical structures in research ultrasounds of singletons and dichorionic twins. The primary aim was to establish standards for fetal body composition and organ volumes, overall and by maternal race/ethnicity, and determine whether these standards vary for twins versus singletons. We describe the study design, methods, and details about reviewer training. Basic characteristics of this cohort, with their corresponding distributions of fetal 3D measurements by anatomical structure, are summarized. This investigation is responsive to critical data gaps in understanding serial changes in fetal subcutaneous fat, lean body mass, and organ volume in association with pregnancy complications. In the future, this cohort can answer critical questions regarding the potential influence of maternal characteristics, lifestyle factors, nutrition, and biomarker and chemical data on longitudinal measures of fetal subcutaneous fat, lean body mass, and organ volumes.
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Ramasubramanian A, Riemann M, Brown A, Tukan A, Tiwari N, Abruzzo T, Goncalves LF. Three-Dimensional Ultrasound Imaging of Retinoblastoma and Its Correlation With Pathology. Ophthalmic Surg Lasers Imaging Retina 2024; 55:136-140. [PMID: 38270567 DOI: 10.3928/23258160-20240116-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
BACKGROUND AND OBJECTIVE Monitoring the response of retinoblastoma to globe-salvaging therapies is based on subjective assessments of changes determined by fundoscopy, ultrasound, and optical coherence tomography. Advances in organ-preserving therapies have increased the need for objective, quantitative estimates of tumor response to treatment. Primary tumor volume is a metric that can be objectively determined as a surrogate measure of treatment response. PATIENTS AND METHODS We evaluated the correlation of objective, quantitative estimates of tumor volume made with two-dimensional (2D) and three-dimensional (3D) ultrasound with gold standard pathological tumor volumes derived by analysis of enucleation specimens. RESULTS Twelve eyes in 12 patients undergoing primary enucleation were evaluated by 2D and 3D ultrasound during ophthalmic examination under anesthesia prior to enucleation. 2D- and 3D-ultra-sound measurements of tumor volume were both strongly correlated with pathological estimates of tumor volume (r = 0.69, P = 0.018; and r = 0.66, P = 0.027, respectively). CONCLUSIONS 2D- and 3D-ultrasound measurements of retinoblastoma primary tumor volume are highly correlated with pathological estimates. 3D measurements are easy to perform with volumetric probes and consider the irregular morphology of the tumor. Further study should be undertaken to evaluate the performance of these metrics as surrogate markers of tumor response to treatment. [Ophthalmic Surg Lasers Imaging Retina 2024;55:136-140.].
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Ramasubramanian A, Riemann M, Brown A, Abruzzo T, Goncalves LF. Microvascular flow ultrasound imaging for retinoblastoma. J AAPOS 2024; 28:103801. [PMID: 38211831 DOI: 10.1016/j.jaapos.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 09/27/2023] [Accepted: 10/08/2023] [Indexed: 01/13/2024]
Abstract
PURPOSE To present the results of a pilot study of microvascular flow imaging (MFI) in characterizing tumor vasculature of retinoblastoma. METHODS The medical records of consecutive patients with retinoblastoma presenting at our institution between July 2019 and June 2022 that were imaged using MFI were reviewed retroactively. Each patient underwent diagnostic evaluation according to standard of care by examination under anesthesia with fluorescein angiography and ocular ultrasound imaging, including color Doppler and MFI. RESULTS Thirteen eyes of 10 patients with retinoblastoma were included. MFI showed a prominent feeder vessel in 8 eyes, basket vasculature in 6 eyes and tumor bed vascularity in 10 eyes. MFI showed a more extensive vascular branching pattern that was not visible on color Doppler and fluorescein angiography in all eyes. CONCLUSIONS MFI of retinoblastoma patients could add information about tumor vascularity not detectable by color Doppler or fluorescein angiography. Further study is needed to determine whether this information could be used to predict prognosis for ocular salvage and tumor response to treatment.
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Affiliation(s)
| | | | - Alex Brown
- University of Arizona College of Medicine, Phoenix, Arizona
| | - Todd Abruzzo
- Phoenix Children's Hospital, Phoenix, Arizona; University of Arizona College of Medicine, Phoenix, Arizona; Mayo Clinic Alix School of Medicine, Scottsdale, Arizona; Creighton University, Phoenix, Arizona
| | - Luis F Goncalves
- Phoenix Children's Hospital, Phoenix, Arizona; University of Arizona College of Medicine, Phoenix, Arizona; Mayo Clinic Alix School of Medicine, Scottsdale, Arizona; Creighton University, Phoenix, Arizona
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Ramasubramanian A, Riemann M, Noss B, McInnis-Smith K, Goncalves LF. Microvascular Flow Ultrasound Imaging for Persistent Fetal Vasculature. Ophthalmol Retina 2024; 8:91-93. [PMID: 37739066 DOI: 10.1016/j.oret.2023.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 09/12/2023] [Accepted: 09/14/2023] [Indexed: 09/24/2023]
Affiliation(s)
| | - Monique Riemann
- Department of Ophthalmology, Phoenix Children's Hospital, Phoenix, Arizona
| | - Bryant Noss
- Department of Ophthalmology, Phoenix Children's Hospital, Phoenix, Arizona
| | - Kerri McInnis-Smith
- Department of Ophthalmology, Mayo Clinic Alix School of Medicine, Scottsdale, Arizona
| | - Luis F Goncalves
- Department of Ophthalmology, Phoenix Children's Hospital, Phoenix, Arizona; Department of Ophthalmology, Mayo Clinic Alix School of Medicine, Scottsdale, Arizona; Department of Radiology, University of Arizona College of Medicine, Phoenix, Arizona; Department of Radiology, Creighton University, Phoenix, Arizona
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Nguyen GV, Goncalves LF, Vaughn J, Friedman N, Wickland J, Cornejo P. Prenatal diagnosis of Poland-Möbius syndrome by multimodality fetal imaging. Pediatr Radiol 2023; 53:2144-2148. [PMID: 37423914 DOI: 10.1007/s00247-023-05712-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 06/21/2023] [Accepted: 06/22/2023] [Indexed: 07/11/2023]
Abstract
We describe prenatal diagnosis of Poland-Möbius syndrome using a combination of ultrasound and MRI. Poland syndrome was diagnosed based on absence of the pectoralis muscles associated with dextroposition of the fetal heart and elevation of the left diaphragm. Associated brain anomalies that led to the diagnosis of Poland-Möbius syndrome, included ventriculomegaly, hypoplastic cerebellum, tectal beaking, and a peculiar flattening of the posterior aspect of the pons and medulla oblongata, which has been reported by postnatal diffusion tensor imaging studies as a reliable neuroimaging marker for Möbius syndrome. Since abnormalities of cranial nerves VI and VII may be difficult to detect prenatally, careful attention to the appearance of the brain stem as illustrated in the current report may aid in the prenatal diagnosis of Möbius syndrome.
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Affiliation(s)
| | - Luis F Goncalves
- Department of Radiology, Phoenix Children's, 1919 E. Thomas Rd, Phoenix, AZ, 85016, USA.
- Department of Child Health, University of Arizona College of Medicine, Phoenix, AZ, USA.
- Department of Radiology, University of Arizona College of Medicine, Phoenix, AZ, USA.
- Department of Radiology, Creighton University School of Medicine, Phoenix, AZ, USA.
| | - Jennifer Vaughn
- Department of Radiology, Phoenix Children's, 1919 E. Thomas Rd, Phoenix, AZ, 85016, USA
- Department of Child Health, University of Arizona College of Medicine, Phoenix, AZ, USA
- Department of Radiology, University of Arizona College of Medicine, Phoenix, AZ, USA
- Department of Radiology, Creighton University School of Medicine, Phoenix, AZ, USA
- Department of Neuroradiology, Barrow Neurological Institute at Phoenix Children's, Phoenix, AZ, USA
| | - Neil Friedman
- Department of Radiology, Phoenix Children's, 1919 E. Thomas Rd, Phoenix, AZ, 85016, USA
- Department of Neurology, Barrow Neurological Institute at Phoenix Children's, Phoenix, AZ, USA
| | - Jessica Wickland
- Department of Child Health, University of Arizona College of Medicine, Phoenix, AZ, USA
- Department of Neonatology, Phoenix Children's, Phoenix, AZ, USA
| | - Patricia Cornejo
- Department of Radiology, Phoenix Children's, 1919 E. Thomas Rd, Phoenix, AZ, 85016, USA
- Department of Child Health, University of Arizona College of Medicine, Phoenix, AZ, USA
- Department of Radiology, University of Arizona College of Medicine, Phoenix, AZ, USA
- Department of Radiology, Creighton University School of Medicine, Phoenix, AZ, USA
- Department of Radiology, Mayo Clinic, Scottsdale, AZ, USA
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Bisht RU, Belthur MV, Singleton IM, Goncalves LF. Accuracy of Multimodality Fetal Imaging (US, MRI, and CT) for Congenital Musculoskeletal Anomalies. Children (Basel) 2023; 10:1015. [PMID: 37371247 DOI: 10.3390/children10061015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 05/14/2023] [Accepted: 05/30/2023] [Indexed: 06/29/2023]
Abstract
BACKGROUND Ultrasonography (US) is the first-line diagnostic tool used to assess fetal musculoskeletal (MSK) anomalies. Associated anomalies in other organ systems may benefit from evaluation via Magnetic Resonance Imaging (MRI). In this study, we compared the diagnostic accuracy of US and MRI to diagnose fetal MSK (primary objective) and non-MSK anomalies (secondary objective). We describe additional findings by low-dose computerized tomography (CT) in two cases incompletely characterized via US and MRI. MATERIALS AND METHODS This was an IRB-approved retrospective study of consecutive patients with suspected fetal MSK anomalies examined between December 2015 and June 2020. We compared individual MSK and non-MSK anomalies identified via US, MRI, and CT with postnatal outcomes. Sensitivity and specificity for US and MRI were calculated and compared. RESULTS A total of 31 patients with 112 MSK and 43 non-MSK anomalies were included. The sensitivity of MRI and US for MSK anomalies was not significantly different (76.6% vs. 61.3%, p = 0.3). Low-dose CT identified eight additional skeletal anomalies. MRI diagnosed a higher number of non-MSK anomalies compared to US (81.4% vs. 37.2%, p < 0.05). CONCLUSIONS Fetal MRI and US have comparable sensitivity for MSK anomalies. In selected cases, low-dose CT may provide additional information. Fetal MRI detected a larger number of non-MSK anomalies in other organ systems compared to US. Multimodality imaging combining all the information provided by MRI, US, and CT, if necessary, ultimately achieved a sensitivity of 89.2% (95% CI: 83.4% to 95.0%) for the diagnosis of musculoskeletal anomalies and 81.4% for additional anomalies in other organs and systems.
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Affiliation(s)
- Roy U Bisht
- University of Arizona College of Medicine-Phoenix, 475 N. 5th St., Phoenix, AZ 85004, USA
| | - Mohan V Belthur
- Department of Child Health & Orthopedics, University of Arizona College of Medicine-Phoenix, 1919 E. Thomas Rd., Phoenix, AZ 85004, USA
- Department of Surgery, Medical School, Creighton University, Omaha, NE 68178, USA
| | - Ian M Singleton
- University of Arizona College of Medicine-Phoenix, 475 N. 5th St., Phoenix, AZ 85004, USA
| | - Luis F Goncalves
- Department of Radiology, Phoenix Children's Hospital, 1919 E. Thomas Rd., Phoenix, AZ 85016, USA
- Child Health and Radiology, University of Arizona College of Medicine-Phoenix, 475 N. 5th St., Phoenix, AZ 85004, USA
- Radiology, Mayo Clinic, 5777 E. Mayo Blvd., Phoenix, AZ 85054, USA
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Severseike BO, Schafernak KT, Willard SD, Goncalves LF, Kothari AK, Eshun FK, Mangum R. Diagnostic challenges of renal medullary carcinoma and the role for cytologic assessment: Case report and literature review. J Clin Lab Anal 2023; 37:e24854. [PMID: 36843202 PMCID: PMC10020844 DOI: 10.1002/jcla.24854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 01/18/2023] [Accepted: 02/11/2023] [Indexed: 02/28/2023] Open
Abstract
BACKGROUND Renal medullary carcinoma (RMC) is a diagnostically challenging, aggressive primary renal malignancy associated with abysmal survival. Delays in diagnosis contribute to most patients having diffusely metastatic disease at the time of initial presentation. METHODS We present the case of a 13-year-old African American male with sickle cell trait who presented with a renal mass and hematuria. Evaluation included imaging, fluid cultures, and cytologic assessment. RESULTS Patient was diagnosed with RMC based on cytologic assessment of sub-centimeter fluid collections aspirated from the left kidney at the time of cortical biopsy for suspected renal mass. The additional fluid aspiration in conjunction with renal biopsy was an atypical but crucial step in early diagnosis. CONCLUSION Cytomorphologic evaluation of fluid biospecimens is not currently part of the standard work-up for patients with renal masses but, when available, can provide crucial information that reduces time to diagnosis. Prompt symptom recognition and treatment initiation may improve patient outcomes.
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Affiliation(s)
- Benjamin O. Severseike
- Phoenix Children's Hospital Residency Program Alliance (PCHRP)Phoenix Children's HospitalPhoenixArizonaUSA
| | - Kristian T. Schafernak
- Pathology and Laboratory MedicinePhoenix Children's HospitalPhoenixArizonaUSA
- Department of Child HealthUniversity of Arizona College of MedicinePhoenixArizonaUSA
- Creighton University School of MedicinePhoenixArizonaUSA
- Mayo Clinic Alix School of MedicinePhoenixArizonaUSA
| | - Scott D. Willard
- Department of Child HealthUniversity of Arizona College of MedicinePhoenixArizonaUSA
- Creighton University School of MedicinePhoenixArizonaUSA
- Mayo Clinic Alix School of MedicinePhoenixArizonaUSA
- Interventional RadiologyPhoenix Children's HospitalPhoenixArizonaUSA
| | - Luis F. Goncalves
- Department of Child HealthUniversity of Arizona College of MedicinePhoenixArizonaUSA
- Creighton University School of MedicinePhoenixArizonaUSA
- Mayo Clinic Alix School of MedicinePhoenixArizonaUSA
- Radiology DepartmentPhoenix Children's HospitalPhoenixArizonaUSA
| | - Alok K. Kothari
- Department of Child HealthUniversity of Arizona College of MedicinePhoenixArizonaUSA
- Creighton University School of MedicinePhoenixArizonaUSA
- Mayo Clinic Alix School of MedicinePhoenixArizonaUSA
- Center for Cancer and Blood DisordersPhoenix Children's HospitalPhoenixArizonaUSA
| | - Francis K. Eshun
- Department of Child HealthUniversity of Arizona College of MedicinePhoenixArizonaUSA
- Creighton University School of MedicinePhoenixArizonaUSA
- Mayo Clinic Alix School of MedicinePhoenixArizonaUSA
- Center for Cancer and Blood DisordersPhoenix Children's HospitalPhoenixArizonaUSA
| | - Ross Mangum
- Department of Child HealthUniversity of Arizona College of MedicinePhoenixArizonaUSA
- Creighton University School of MedicinePhoenixArizonaUSA
- Mayo Clinic Alix School of MedicinePhoenixArizonaUSA
- Center for Cancer and Blood DisordersPhoenix Children's HospitalPhoenixArizonaUSA
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Vij N, Goncalves LF, Llanes A, Youn S, Belthur MV. Prenatal radiographic evaluation of congenital transverse limb deficiencies: A scoping review. World J Orthop 2023; 14:155-165. [PMID: 36998387 PMCID: PMC10044319 DOI: 10.5312/wjo.v14.i3.155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 01/18/2023] [Accepted: 02/17/2023] [Indexed: 03/17/2023] Open
Abstract
BACKGROUND Congenital transverse deficiencies are horizontal deficiencies of the long bones that occur with a reported incidence as high 0.38%. They can occur alone or represent a manifestation of a various clinical syndromes. Diagnosis has traditionally comprised of conventional radiography and prenatal imaging studies. There has been much advancement regarding prenatal imaging modalities to allow for early diagnosis and appropriate treatment.
AIM To summarize the current state of knowledge on congenital transverse limb deficiencies and to provide an update regarding the radiographic evaluation of congenital transverse limb deficiencies.
METHODS This IRB-exempt scoping review followed the PRISMA-ScR checklist for scoping reviews strictly. Five search engines were searched for a total of 265 publications. Four authors reviewed these during the screening process. Of these, 51 studies were included in our article. Prenatal magnetic resonance imaging (MRI), 3D Ultrasound, and multidetector Computed tomography (CT) exist are emerging modalities that have the potential to improve diagnosis.
RESULTS Use of the appropriate classification system, three-dimensional ultrasonography with a maximum intensity projection, and appropriate use of prenatal MRI and prenatal CT can improve diagnosis and inter-provider communication.
CONCLUSION Further scholarly efforts are required to develop improve standardized guidelines regarding the pre-natal radiographic evaluation of congenital limb deficiencies.
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Affiliation(s)
- Neeraj Vij
- Department of Orthopedic Surgery, Phoenix Children’s Hospital, Phoenix, AZ 85016, United States
| | - Luis F Goncalves
- Department of Radiology, Phoenix Children's Hospital, Phoenix, AZ 85016, United States
| | - Aaron Llanes
- Department of Orthopedics, University of Arizona College of Medicine-Phoenix, Phoenix, AZ 85004, United States
| | - Sean Youn
- Department of Orthopedics, University of Arizona College of Medicine-Phoenix, Phoenix, AZ 85004, United States
| | - Mohan V Belthur
- Department of Orthopedic Surgery, Phoenix Children’s Hospital, Phoenix, AZ 85016, United States
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Rubert NC, Jategaonkar G, Plasencia JD, Lindblade CL, Bardo DME, Goncalves LF. Four-dimensional fetal cardiac imaging in a cohort of fetuses with suspected congenital heart disease. Pediatr Radiol 2023; 53:198-209. [PMID: 36198870 DOI: 10.1007/s00247-022-05500-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 07/07/2022] [Accepted: 08/29/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Fetal cardiac magnetic resonance imaging (MRI) requires high spatial and temporal resolution and robustness to random fetal motion to capture the dynamics of the beating fetal heart. Slice-to-volume reconstruction techniques can produce high-resolution isotropic images while compensating for random fetal motion. OBJECTIVE The objective of this study was to evaluate image quality for slice-to-volume reconstruction of four-dimensional balanced steady-state free precession (bSSFP) imaging of the fetal heart. MATERIALS AND METHODS A cohort of 13 women carrying fetuses with congenital heart disease were imaged with real-time bSSFP sequences. Real-time bSSFP sequences were post-processed using a slice-to-volume reconstruction algorithm to produce retrospectively gated 4-D sequences with isotropic spatial resolution. Two radiologists evaluated slice-to-volume reconstruction image quality on a scale from 0 to 4 using 11 categories based on a segmental approach to defining cardiac anatomy and pathology. A score of 0 corresponded to cardiac structures not visualized at all and four corresponded to high quality and distinct appearance of structures. RESULTS In 11 out of 13 cases, the average radiologist score of image quality across all categories was 3.0 or greater. In the remaining two cases, slice-to-volume reconstruction was not possible due to insufficient image quality in the acquisition. CONCLUSION Slice-to-volume reconstruction has the potential to produce isotropic images with high spatial and temporal resolution that can display the anatomy of the fetal heart in arbitrary imaging planes retrospectively. More rapid, motion-robust acquisitions may be necessary to successfully reconstruct the fetal heart in all patients.
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Affiliation(s)
- Nicholas C Rubert
- Phoenix Children's Hospital, 1919 E. Thomas Road, Phoenix, AZ, 85257, USA.
| | - Gaurav Jategaonkar
- Phoenix Children's Hospital, 1919 E. Thomas Road, Phoenix, AZ, 85257, USA
| | | | | | - Dianna M E Bardo
- Phoenix Children's Hospital, 1919 E. Thomas Road, Phoenix, AZ, 85257, USA
- Mayo Clinic, Scottsdale, AZ, USA
- University of Arizona, Phoenix, AZ, USA
- School of Medicine, Creighton University, Phoenix, AZ, USA
| | - Luis F Goncalves
- Phoenix Children's Hospital, 1919 E. Thomas Road, Phoenix, AZ, 85257, USA
- University of Arizona, Phoenix, AZ, USA
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Vaughn JA, Goncalves LF, Cornejo P. Intrauterine and Perinatal Infections. Clin Perinatol 2022; 49:751-770. [PMID: 36113933 DOI: 10.1016/j.clp.2022.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Imaging plays an important role in evaluating patients with suspected intrauterine and perinatal infections. Advances in fetal imaging including both ultrasound and MRI allow for increasingly more specific diagnosis if the radiologist is familiar with specific imaging features and patterns. Early imaging of neonates with suspected central nervous system infection is valuable to enable prompt treatment and differentiate infection from other conditions which can clinically present similarly. Ultrasound is a useful initial modality to screen for abnormalities however MRI with and without contrast remains the optimal examination to characterize infection, evaluate for potential surgical targets, and provide prognostic information.
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Affiliation(s)
- Jennifer A Vaughn
- Department of Radiology, Phoenix Children's Hospital, 1919 East Thomas Road, Phoenix, AZ 85016, USA; University of Arizona College of Medicine, Phoenix, AZ, USA; Creighton University School of Medicine, Phoenix, AZ, USA; Barrows Neurological Institute, Phoenix, AZ, USA.
| | - Luis F Goncalves
- Department of Radiology, Phoenix Children's Hospital, 1919 East Thomas Road, Phoenix, AZ 85016, USA; University of Arizona College of Medicine, Phoenix, AZ, USA; Creighton University School of Medicine, Phoenix, AZ, USA; Mayo Clinic, Scottsdale, AZ, USA
| | - Patricia Cornejo
- Department of Radiology, Phoenix Children's Hospital, 1919 East Thomas Road, Phoenix, AZ 85016, USA; University of Arizona College of Medicine, Phoenix, AZ, USA; Creighton University School of Medicine, Phoenix, AZ, USA; Barrows Neurological Institute, Phoenix, AZ, USA; Mayo Clinic, Scottsdale, AZ, USA
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11
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Llanes ACD, Van Tassel D, Wirth A, Goncalves LF, Belthur MV. Optimal Visualization of Os Subfibulare Using 3D Water Selective Cartilage Scan (3D_WATSc) MRI Sequencing: A Case Report. Cureus 2022; 14:e27469. [PMID: 36060334 PMCID: PMC9421124 DOI: 10.7759/cureus.27469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2022] [Indexed: 12/04/2022] Open
Abstract
Os subfibulare is an accessory ossicle of the lateral malleolus at the distal end of the fibula. In most instances, os subfibulare is found incidentally on radiographs. While os subfibulare typically remains asymptomatic, some cases may present with ankle pain or instability. To initiate appropriate treatment and maximize patient outcomes, it is crucial to accurately visualize the accessory ossicle. Here, we report a symptomatic case of os subfibulare diagnosed with ankle radiographs and a 3D water selective cartilage scan (3D_WATSc, Ingenia, Philips Healthcare, The Netherlands) magnetic resonance imaging sequence and treated surgically with open ossicle excision and a modified Broström procedure.
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12
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Abstract
Upper gastrointestinal series is considered the gold standard imaging test to evaluate for malrotation and midgut volvulus. US has been explored for this purpose in recent years and has been shown to be a good alternative because of its relatively good accuracy, fast learning curve for sonographers and radiologists, as well as convenience for children, clinical staff and radiologists in the neonatal intensive care unit. In this article we describe our experience and review the evidence supporting the use of emergency US primarily to diagnose midgut volvulus as well as its use as a problem-solving tool for the diagnosis of malrotation. The examination technique, normal and abnormal findings are described, with emphasis on the whirlpool and superior mesenteric artery cutoff signs to diagnose midgut volvulus.
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Affiliation(s)
- Mostafa Youssfi
- Department of Radiology, Phoenix Children's Hospital, 1919 E. Thomas Road, Phoenix, AZ, 85016, USA.,Department of Child Health and Radiology, University of Arizona College of Medicine, Phoenix, AZ, USA.,Department of Radiology, Mayo Clinic, Phoenix, AZ, USA.,Department of Radiology, Creighton University, Phoenix, AZ, USA
| | - Luis F Goncalves
- Department of Radiology, Phoenix Children's Hospital, 1919 E. Thomas Road, Phoenix, AZ, 85016, USA. .,Department of Child Health and Radiology, University of Arizona College of Medicine, Phoenix, AZ, USA. .,Department of Radiology, Mayo Clinic, Phoenix, AZ, USA. .,Department of Radiology, Creighton University, Phoenix, AZ, USA.
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13
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Hargis-Villanueva A, Lai K, van Leeuwen K, Weidler EM, Felts J, Schmidt A, Franklin WJ, Lindblade C, Martin GC, Patil AS, Goncalves LF. Telehealth multidisciplinary prenatal consultation during the COVID-19 pandemic: enhancing patient care coordination while maintaining high provider satisfaction. J Matern Fetal Neonatal Med 2022; 35:9765-9769. [PMID: 35337237 DOI: 10.1080/14767058.2022.2053101] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Comprehensive fetal care centers address congenital anomalies by developing pre- and post-natal care plans in a multidisciplinary format. To reduce exposure during the Coronavirus Infectious Disease-2019 (COVID-19) pandemic, the Centers for Medicare & Medicaid Services (CMS) broadened access to telehealth services. We assessed provider satisfaction with the rapid transition from in-person prenatal visits to multidisciplinary consultations via telehealth as an adaptive response to the pandemic. METHODS Patients referred to an urban academic fetal care center during the first 6 weeks of the COVID-19 pandemic underwent advanced imaging including fetal MRI, focused ultrasound, and fetal echocardiography. Subsequently, multidisciplinary telehealth consultations occurred with all providers attending virtually. Patients were given the option of attending the multidisciplinary telehealth consultation in a conference room in the hospital or from home. During these meetings, relevant images were reviewed with all participants via screen sharing through a secure video platform. Provider satisfaction with the telehealth paradigm was assessed using an electronic survey. RESULTS Twenty-two surveys were administered with a response rate of 82%. 89% of providers were highly satisfied with the telehealth format. 72% of providers would prefer the multidisciplinary telehealth format to an in-person visit for future visits after COVID-19 restrictions are lifted. 22% of providers would leave the choice to the patient's family. One provider preferred in-person visits. Some providers noted that virtual conferences limited the ability to draw pictures, show educational materials, and provide emotional support. CONCLUSION Providers were overwhelmingly supportive of continuing multidisciplinary telehealth conferences for complex prenatal consultations, even after restrictions are lifted, which has led to the continuation of this model for the duration of the pandemic. Providers highlighted the convenience and improved care coordination across specialties. Further studies to examine the patient experience with virtual consultations are warranted.
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Affiliation(s)
| | - Krista Lai
- Division of Pediatric Surgery, Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Kathleen van Leeuwen
- Division of Pediatric Surgery, Phoenix Children's Hospital, Phoenix, AZ, USA.,Department of Child Health, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA
| | - Erica M Weidler
- Division of Pediatric Surgery, Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Jessica Felts
- Division of Pediatric Surgery, Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Alicia Schmidt
- Division of Pediatric Surgery, Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Wayne J Franklin
- Department of Child Health, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA.,Division of Pediatric Cardiology, Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Christopher Lindblade
- Department of Child Health, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA.,Division of Pediatric Cardiology, Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Gregory C Martin
- Department of Child Health, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA.,Division of Neonatology, Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Avinash S Patil
- Department of Obstetrics and Gynecology, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA.,Valley Perinatal Services, Phoenix, AZ, USA
| | - Luis F Goncalves
- Division of Radiology, Phoenix Children's Hospital, Phoenix, AZ, USA
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14
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Goncalves LF, Lindblade CL, Cornejo P, Patel MC, McLaughlin ES, Bardo DME. Contribution of fetal magnetic resonance imaging in fetuses with congenital heart disease. Pediatr Radiol 2022; 52:513-526. [PMID: 34842935 DOI: 10.1007/s00247-021-05234-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 09/18/2021] [Accepted: 10/25/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Increasing evidence supports an association among congenital heart disease (CHD), structural brain lesions on neuroimaging, and increased risk of neurodevelopmental delay and other structural anomalies. Fetal MRI has been found to be effective in demonstrating fetal structural and developmental abnormalities. OBJECTIVE To determine the contribution of fetal MRI to identifying cardiovascular and non-cardiovascular anomalies in fetuses with CHD compared to prenatal US and fetal echocardiography. MATERIALS AND METHODS We performed a retrospective study of fetuses with CHD identified by fetal echocardiography. Exams were performed on 1.5-tesla (T) or 3-T magnets using a balanced turbo field echo sequence triggered by an external electrocardiogram simulator with a fixed heart rate of 140 beats per minute (bpm). Fetal echocardiography was performed by pediatric cardiologists and detailed obstetrical US by maternal-fetal medicine specialists prior to referral to MRI. We compared the sensitivity of fetal MRI and fetal echocardiography for the diagnosis of cardiovascular anomalies, as well as the sensitivity of fetal MRI and referral US for the diagnosis of non-cardiac anomalies. We performed statistical analysis using the McNemar test. RESULTS We identified 121 anomalies in 31 fetuses. Of these, 73 (60.3%) were cardiovascular and 48 (39.7%) involved other organ systems. Fetal echocardiography was more sensitive for diagnosing cardiovascular anomalies compared to fetal MRI, but the difference was not statistically significant (85.9%, 95% confidence interval [CI] 77.8-94.0% vs. 77.5%, 95% CI 67.7-87.2%, respectively; McNemar test 2.29; P=0.13). The sensitivity of fetal MRI was higher for diagnosing extracardiac anomalies when compared to referral US (84.1%, 95% CI 73.3-94.9% vs. 31.8%, 95% CI 18.1-45.6%, respectively; McNemar test 12.9; P<0.001). The additional information provided by fetal MRI changed prognosis, counseling or management for 10/31 fetuses (32.2%), all in the group of 19 fetuses with anomalies in other organs and systems besides CHD. CONCLUSION Fetal MRI performed in a population of fetuses with CHD provided additional information that altered prognosis, counseling or management in approximately one-third of the fetuses, mainly by identifying previously unknown anomalies in other organs and systems.
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Affiliation(s)
- Luis F Goncalves
- Department of Radiology, Phoenix Children's Hospital, 1919 E. Thomas Road, Phoenix, AZ, 85016, USA.
- University of Arizona College of Medicine, Phoenix, AZ, USA.
- Department of Radiology, Creighton University, Phoenix, AZ, USA.
- Department of Radiology, Mayo Clinic, Phoenix, AZ, USA.
| | - Christopher L Lindblade
- University of Arizona College of Medicine, Phoenix, AZ, USA
- Department of Radiology, Creighton University, Phoenix, AZ, USA
- Department of Radiology, Mayo Clinic, Phoenix, AZ, USA
- Department of Cardiology, Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Patricia Cornejo
- Department of Radiology, Phoenix Children's Hospital, 1919 E. Thomas Road, Phoenix, AZ, 85016, USA
- University of Arizona College of Medicine, Phoenix, AZ, USA
- Department of Radiology, Creighton University, Phoenix, AZ, USA
- Department of Radiology, Mayo Clinic, Phoenix, AZ, USA
| | - Mittun C Patel
- Department of Radiology, Phoenix Children's Hospital, 1919 E. Thomas Road, Phoenix, AZ, 85016, USA
- University of Arizona College of Medicine, Phoenix, AZ, USA
- Department of Radiology, Creighton University, Phoenix, AZ, USA
- Department of Radiology, Mayo Clinic, Phoenix, AZ, USA
| | - Ericka Scheller McLaughlin
- University of Arizona College of Medicine, Phoenix, AZ, USA
- Department of Radiology, Creighton University, Phoenix, AZ, USA
- Department of Radiology, Mayo Clinic, Phoenix, AZ, USA
- Department of Cardiology, Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Dianna M E Bardo
- Department of Radiology, Phoenix Children's Hospital, 1919 E. Thomas Road, Phoenix, AZ, 85016, USA
- University of Arizona College of Medicine, Phoenix, AZ, USA
- Department of Radiology, Creighton University, Phoenix, AZ, USA
- Department of Radiology, Mayo Clinic, Phoenix, AZ, USA
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15
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Ramasubramanian A, Riemann MC, Goncalves LF. Persistent Fetal Vasculature Imaged by Multi-modality Ultrasound. J Pediatr Ophthalmol Strabismus 2022; 59:68. [PMID: 34228564 DOI: 10.3928/01913913-20210316-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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16
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Rubert N, Bardo DME, Vaughn J, Cornejo P, Goncalves LF. Data Quality Assessment for Super-Resolution Fetal Brain MR Imaging: A Retrospective 1.5 T Study. J Magn Reson Imaging 2021; 54:1349-1360. [PMID: 33949725 DOI: 10.1002/jmri.27665] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 04/12/2021] [Accepted: 04/13/2021] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Super-resolution is a promising technique to create isotropic image volumes from stacks of two-dimensional (2D) motion-corrupted images in fetal magnetic resonance imaging (MRI). PURPOSE To determine an acquisition quality metric and correlate that metric with radiologist perception of three-dimensional (3D) image quality. STUDY TYPE Retrospective. SUBJECTS Eighty-seven patients, mean gestational age 29 ± 6 weeks. FIELD STRENGTH/SEQUENCE 1.5 T/2D fast spin-echo. ASSESSMENT Four radiologists (L.G., D.M.E.B., P.C., and J.V.; 31, 21, 7, and 7 years' experience, respectively) graded reconstructions on a 0 to 4 scale for overall appearance and visibility of specific anatomy. During reconstruction, slices were labeled as inliers based on correlation between a simulated vs. actual acquisition. The fraction of brain voxels in inlier slicers vs. total brain voxels was measured for each acquisition. STATISTICAL TESTS Paired sample t test, Pearson's correlation, intra-class correlation. RESULTS The average brain mask inlier fraction for all acquisitions was 0.8. There was a statistically significant correlation (0.71) between overall reconstruction appearance and number of acquisitions with inlier fraction above 0.73. There was low correlation (0.21, P = 0.05) between the number of acquisitions used in the reconstruction and overall score when no data quality measure was considered. Similar results were found for ratings of specific anatomy. Statistically significant differences in overall perception of image quality were found when using three vs. four, four vs. five, and three vs. five high-quality acquisitions in the reconstruction. Five high-quality acquisitions were sufficient to yield an average radiologist rating of 3.59 out of 4.0 for overall image quality. DATA CONCLUSION Reconstruction quality can be reliably predicted using the brain mask inlier fraction. Real-time super-resolution protocols could exploit this to terminate acquisition when enough high-quality acquisitions have been collected. To achieve consistent 3D image quality it may be necessary to acquire more than five scans to compensate for severely motion-corrupted acquisitions. LEVEL OF EVIDENCE 3 TECHNICAL EFFICACY: 1.
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Affiliation(s)
- Nicholas Rubert
- Department of Radiology, Phoenix Children's Hospital, Phoenix, Arizona, USA
| | - Dianna M E Bardo
- Department of Radiology, Phoenix Children's Hospital, Phoenix, Arizona, USA.,Departments of Radiology and Child Health, University of Arizona, Phoenix, Arizona, USA.,Department of Radiology, Mayo Clinic, Scottsdale, Arizona, USA.,Department of Radiology, Creighton University, Phoenix, Arizona, USA.,Department of Neuroradiology, Barrows Neurological Institute, Phoenix, Arizona, USA
| | - Jennifer Vaughn
- Department of Radiology, Phoenix Children's Hospital, Phoenix, Arizona, USA.,Departments of Radiology and Child Health, University of Arizona, Phoenix, Arizona, USA.,Department of Radiology, Creighton University, Phoenix, Arizona, USA.,Department of Neuroradiology, Barrows Neurological Institute, Phoenix, Arizona, USA
| | - Patricia Cornejo
- Department of Radiology, Phoenix Children's Hospital, Phoenix, Arizona, USA.,Departments of Radiology and Child Health, University of Arizona, Phoenix, Arizona, USA.,Department of Radiology, Mayo Clinic, Scottsdale, Arizona, USA.,Department of Radiology, Creighton University, Phoenix, Arizona, USA.,Department of Neuroradiology, Barrows Neurological Institute, Phoenix, Arizona, USA
| | - Luis F Goncalves
- Department of Radiology, Phoenix Children's Hospital, Phoenix, Arizona, USA.,Departments of Radiology and Child Health, University of Arizona, Phoenix, Arizona, USA
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17
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Goncalves LF, Ramasubramanian A, Grebe T, Riemann M, Moncrief D, Cornejo P. Prenatal diagnosis of bilateral retinoblastomas by multimodality fetal imaging: case report and review of the literature. Clin Imaging 2021; 78:121-126. [PMID: 33774578 DOI: 10.1016/j.clinimag.2021.03.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 01/28/2021] [Accepted: 03/09/2021] [Indexed: 10/21/2022]
Abstract
Retinoblastoma is the prototypic genetic tumor. Caused by mutations in the RB1 gene, retinoblastomas are heritable in 40% of the cases and, in such cases, tumors are bilateral in 80%, unilateral in 15%, and trilateral in 5% of the cases. Trilateral retinoblastoma is a term that describes bilateral retinoblastomas plus a midline suprasellar or pineal neuroectodermal tumor. Patients with a germline RB1 mutation have 45% chance of having an offspring with retinoblastoma. Prenatal diagnosis is important because the doubling time is fast, ranging from 7 to 15 days. Thus, late diagnosis during infancy is associated with larger tumors and increased risk of death, need for globe enucleation and vision loss. We report a case of bilateral retinoblastomas diagnosed by targeted high-resolution ultrasonography of the orbits at 32 weeks of gestation in a patient at risk. This report demonstrates the feasibility of accurately detecting even tiny retinoblastomas by ultrasound with current technology. We also review prenatally published cases to date and comment on the technical strengths and limitations of ultrasound and fetal MRI for prenatal diagnosis of retinoblastomas.
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Affiliation(s)
- Luis F Goncalves
- Phoenix Children's Hospital, Department of Radiology, United States of America; University of Arizona School of Medicine, Department of Child Health, United States of America; University of Arizona School of Medicine, Department of Radiology, United States of America; Mayo Clinic, Department of Radiology, United States of America; Creighton University, Department of Radiology, United States of America.
| | - Aparna Ramasubramanian
- Phoenix Children's Hospital, Department of Ophthalmology, United States of America; University of Arizona School of Medicine, Department of Child Health, United States of America
| | - Theresa Grebe
- Phoenix Children's Hospital, Department of Genetics, United States of America; University of Arizona School of Medicine, Department of Child Health, United States of America
| | - Monique Riemann
- Phoenix Children's Hospital, Department of Radiology, United States of America
| | - Dawn Moncrief
- Phoenix Children's Hospital, Department of Radiology, United States of America
| | - Patricia Cornejo
- Phoenix Children's Hospital, Department of Radiology, United States of America; University of Arizona School of Medicine, Department of Child Health, United States of America; University of Arizona School of Medicine, Department of Radiology, United States of America; Mayo Clinic, Department of Radiology, United States of America; Creighton University, Department of Radiology, United States of America
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18
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Bisht RU, Belthur MV, Singleton IM, Goncalves LF. Prenatal diagnosis of Sprengel's deformity in a patient with Klippel-Feil Syndrome. Clin Imaging 2021; 78:45-50. [PMID: 33756309 DOI: 10.1016/j.clinimag.2021.02.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 02/23/2021] [Accepted: 02/28/2021] [Indexed: 10/21/2022]
Abstract
We present a case of Klippel-Feil Syndrome, a congenital skeletal defect where multiple cervical vertebral bodies are fused. Klippel-Feil Syndrome has multiple associated anomalies, with a notable one being Sprengel's deformity. In this case, the patient was given a diagnosis of Klippel-Feil Syndrome prenatally after suspected cervical vertebrae fusion and Sprengel's deformity were seen on both fetal magnetic resonance imaging (MRI) and ultrasound. Prenatal diagnosis of Sprengel's deformity has been reported once in the literature. In this report, we present imaging findings of Sprengel's deformity seen in association with Klippel-Feil Syndrome using a combination of fetal ultrasound and MRI.
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Affiliation(s)
- Roy U Bisht
- University of Arizona College of Medicine - Phoenix, 475 N. 5th St., Phoenix, AZ 85004, United States of America
| | - Mohan V Belthur
- Dept. of Orthopedics, Phoenix Children's Hospital, 1919 E. Thomas Rd., Phoenix, AZ 85016, United States of America
| | - Ian M Singleton
- University of Arizona College of Medicine - Phoenix, 475 N. 5th St., Phoenix, AZ 85004, United States of America
| | - Luis F Goncalves
- Dept. of Radiology, Phoenix Children's Hospital, 1919 E. Thomas Rd., Phoenix, AZ 85016, United States of America; Professor of Child Health and Radiology, University of Arizona College of Medicine - Phoenix, 475 N. 5th St., Phoenix, AZ 85004, United States of America; Professor of Radiology, Mayo Clinic, 5777 E. Mayo Blvd., Phoenix, AZ 85054, United States of America.
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19
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England EC, Cornejo P, Neilson DE, Rao RP, Goncalves LF. Fetal brain small vessel disease 1 caused by a novel mutation in the COL4A1 gene. Pediatr Radiol 2021; 51:480-484. [PMID: 33057775 DOI: 10.1007/s00247-020-04847-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 08/10/2020] [Accepted: 09/08/2020] [Indexed: 11/28/2022]
Abstract
A singleton fetus was referred to fetal magnetic resonance imaging (MRI) at 25 weeks due to mild ventriculomegaly and an abnormal fetal echocardiogram showing cardiomegaly, right ventricular hypertrophy and tricuspid insufficiency. Patchy areas of ischemic infarction, extensive subacute and chronic hemorrhage not respecting vascular territories, encephaloclastic cysts and closed lip schizencephaly were identified. Cataract was detected postnatally. The anomalies were caused by a pathogenic mutation (c.353 G>A; p.G118D) in the COL4A1 gene. The phenotype seen in this case, i.e. small vessel cerebral disease with or without ocular anomalies caused by COL4A1 mutations, is likely an underrecognized cause of perinatal stroke. The pattern of abnormalities reported herein should prompt strong consideration for diagnosis and molecular testing.
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Affiliation(s)
| | - Patricia Cornejo
- Department of Radiology, Phoenix Children's Hospital, 1919 E. Thomas Rd., Phoenix, AZ, 85016, USA.,Department of Child Health, University of Arizona College of Medicine, Phoenix, AZ, USA.,Department of Radiology, University of Arizona College of Medicine, Phoenix, AZ, USA.,Department of Radiology, Mayo Clinic, Phoenix, AZ, USA.,Department of Radiology, Creighton University, Phoenix, AZ, USA
| | - Derek E Neilson
- Department of Radiology, Phoenix Children's Hospital, 1919 E. Thomas Rd., Phoenix, AZ, 85016, USA.,Department of Child Health, University of Arizona College of Medicine, Phoenix, AZ, USA
| | - Rashmi P Rao
- Department of Radiology, Phoenix Children's Hospital, 1919 E. Thomas Rd., Phoenix, AZ, 85016, USA.,Department of Child Health, University of Arizona College of Medicine, Phoenix, AZ, USA
| | - Luis F Goncalves
- Department of Radiology, Phoenix Children's Hospital, 1919 E. Thomas Rd., Phoenix, AZ, 85016, USA. .,Department of Child Health, University of Arizona College of Medicine, Phoenix, AZ, USA. .,Department of Radiology, University of Arizona College of Medicine, Phoenix, AZ, USA. .,Department of Radiology, Mayo Clinic, Phoenix, AZ, USA. .,Department of Radiology, Creighton University, Phoenix, AZ, USA.
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20
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Cornejo P, Feygin T, Vaughn J, Pfeifer CM, Korostyshevska A, Patel M, Bardo DME, Miller J, Goncalves LF. Imaging of fetal brain tumors. Pediatr Radiol 2020; 50:1959-1973. [PMID: 33252762 DOI: 10.1007/s00247-020-04777-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 05/13/2020] [Accepted: 07/08/2020] [Indexed: 12/12/2022]
Abstract
Congenital brain tumors, defined as those diagnosed prenatally or within the first 2 months of age, represent less than 2% of pediatric brain tumors. Their location, prevalence and pathophysiology differ from those of tumors that develop later in life. Imaging plays a crucial role in diagnosis, tumor characterization and treatment planning. The most common lesions diagnosed in utero are teratomas, followed by gliomas, choroid plexus papillomas and craniopharyngiomas. In this review, we summarize the pathogenesis, diagnosis, management and prognosis of the most frequent fetal brain tumors.
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Affiliation(s)
- Patricia Cornejo
- Department of Radiology, Phoenix Children's Hospital, 1919 E. Thomas Road, Phoenix, AZ, 85016, USA. .,Department of Neuroradiology, Barrows Neurological Institute, Phoenix, AZ, USA. .,Department of Radiology, University of Arizona College of Medicine, Phoenix, AZ, USA. .,Department of Radiology, Mayo Clinic Arizona, Phoenix, AZ, USA. .,Department of Radiology, Creighton University School of Medicine, Phoenix, AZ, USA.
| | - Tamara Feygin
- Department of Radiology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Jennifer Vaughn
- Department of Radiology, Phoenix Children's Hospital, 1919 E. Thomas Road, Phoenix, AZ, 85016, USA.,Department of Neuroradiology, Barrows Neurological Institute, Phoenix, AZ, USA.,Department of Radiology, University of Arizona College of Medicine, Phoenix, AZ, USA.,Department of Radiology, Creighton University School of Medicine, Phoenix, AZ, USA
| | - Cory M Pfeifer
- Department of Radiology, UT Southwestern, Dallas, TX, USA
| | - Alexandra Korostyshevska
- International Tomography Center of the Siberian Branch of the Russian Academy of Sciences, Novosibirsk, Russian Federation
| | - Mittun Patel
- Department of Radiology, Phoenix Children's Hospital, 1919 E. Thomas Road, Phoenix, AZ, 85016, USA.,Department of Radiology, University of Arizona College of Medicine, Phoenix, AZ, USA.,Department of Radiology, Creighton University School of Medicine, Phoenix, AZ, USA
| | - Dianna M E Bardo
- Department of Radiology, Phoenix Children's Hospital, 1919 E. Thomas Road, Phoenix, AZ, 85016, USA.,Department of Neuroradiology, Barrows Neurological Institute, Phoenix, AZ, USA.,Department of Radiology, University of Arizona College of Medicine, Phoenix, AZ, USA.,Department of Radiology, Mayo Clinic Arizona, Phoenix, AZ, USA.,Department of Radiology, Creighton University School of Medicine, Phoenix, AZ, USA
| | - Jeffrey Miller
- Department of Radiology, Phoenix Children's Hospital, 1919 E. Thomas Road, Phoenix, AZ, 85016, USA.,Department of Neuroradiology, Barrows Neurological Institute, Phoenix, AZ, USA.,Department of Radiology, University of Arizona College of Medicine, Phoenix, AZ, USA.,Department of Radiology, Mayo Clinic Arizona, Phoenix, AZ, USA.,Department of Radiology, Creighton University School of Medicine, Phoenix, AZ, USA
| | - Luis F Goncalves
- Department of Radiology, Phoenix Children's Hospital, 1919 E. Thomas Road, Phoenix, AZ, 85016, USA.,Department of Radiology, University of Arizona College of Medicine, Phoenix, AZ, USA.,Department of Radiology, Creighton University School of Medicine, Phoenix, AZ, USA
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21
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Abstract
The fetal inflammatory response syndrome (FIRS) is a condition whereby the fetus mounts an inflammatory response to intrauterine infection/inflammation. Clinical consequences include preterm premature rupture of membranes (PPROM), spontaneous preterm delivery, neonatal sepsis, bronchopulmonary dysplasia, and brain and other organ injury. Mechanisms leading to brain injury in FIRS have been investigated in animal and human studies. We review the neuroimaging findings of brain injury in FIRS, which overlap those of hypoxic-ischemic injury, and clinical correlation is necessary for a correct diagnosis. FIRS should be considered the primary diagnosis when neuroimaging findings such as periventricular leukomalacia are identified in preterm children born as a consequence of PPROM and spontaneous preterm labor. Additionally, FIRS should be considered in term infants who do not have the most common features of HIE (e.g. a sentinel event). Systematic histopathologic examination of the placenta and umbilical cord and/or detection of characteristic inflammatory markers in such cases are needed to establish the correct diagnosis.
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Affiliation(s)
- Luis F Goncalves
- Director of Fetal Imaging, Phoenix Children's Hospital, Professor of Radiology and Child Health, University of Arizona College of Medicine, Phoenix, AZ, Professor of Radiology, Mayo Clinic, Phoenix, AZ, Professor of Radiology, Creighton University, Director of MRI, Phoenix Children's Hospital, USA
| | - Patricia Cornejo
- Assistant Professor of Radiology and Child Health, University of Arizona College of Medicine, Phoenix, AZ, Assistant Professor of Pediatric Neuroradiology, Barrows Neurological Institute, Phoenix, AZ, Assistant Professor Radiology, Creighton University, USA
| | - Richard Towbin
- Emeritus-Radiologist-in-Chief, Phoenix Children's Hospital, Emeritus Professor of Radiology and Child Health, University of Arizona College of Medicine-Phoenix, Professor of Radiology Mayo Clinic, USA.
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22
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Abstract
Imaging of the reproductive tract is challenging and requires a general knowledge of congenital variations in anatomy. The anatomy of the developing fetus, whether a male phenotype or female phenotype, is also a dynamic process with many changes occurring during gestation. Families may ask details about the genitalia during prenatal imaging and when variations in what is thought to be normal are present, further investigation is sometimes needed to make sense of what is seen. This overview will describe categories of disorders of sex development (DSD), whether chromosomal or structural or both, and the current state of imaging of these anomalies.
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Affiliation(s)
- Luis F Goncalves
- Director of Fetal Imaging, Division of Pediatric Radiology, Phoenix Children's Hospital, Phoenix, AZ, United States.
| | - Halsey Hill
- St. Joseph's Hospital and Medical Center, Phoenix, AZ, United States
| | - Smita Bailey
- Division of Pediatric Radiology, Phoenix Children's Hospital, Phoenix, AZ, United States
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23
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Davis J, Novotny N, Macknis J, Alpay-Savasan Z, Goncalves LF. Diagnosis of neonatal neuroblastoma with postmortem magnetic resonance imaging. Radiol Case Rep 2017; 12:191-195. [PMID: 28228908 PMCID: PMC5310243 DOI: 10.1016/j.radcr.2016.08.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 08/24/2016] [Accepted: 08/29/2016] [Indexed: 11/28/2022] Open
Abstract
Postmortem magnetic resonance imaging (MRI) is emerging as a valuable tool to accompany traditional autopsy and has potential for use in cases when traditional autopsy is not possible. This case report will review the use of postmortem MRI with limited tissue sampling to differentiate between metastatic neuroblastoma and hepatoblastoma which could not be clearly differentiated with prenatal ultrasound, prenatal MRI, or emergent postnatal ultrasound. The mother presented to our institution at 27 weeks gestation after an obstetric ultrasound at her obstetrician's office identified a large abdominal mass. Fetal ultrasonography and MRI confirmed the mass but were unable to differentiate between neuroblastoma and multifocal hepatoblastoma. The baby was delivered by cesarean section after nonreassuring heart tones led to an emergent cesarean section. The baby underwent decompressive laparotomy to relieve an abdominal compartment syndrome; however, the family eventually decided to withdraw life support. At this time, we performed a whole body postmortem MRI which further characterized the mass as an adrenal neuroblastoma which was confirmed with limited tissue sampling. Postmortem MRI was especially helpful in this case, as the patient’s family declined traditional autopsy.
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Affiliation(s)
- James Davis
- Department of Diagnostic Radiology, Beaumont Hospital, Royal Oak, MI
| | - Nathan Novotny
- Department of Pediatric Surgery, Beaumont Hospital, Royal Oak, MI
| | | | | | - Luis F Goncalves
- Department of Diagnostic Radiology, Beaumont Hospital, Royal Oak, MI
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24
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Goncalves LF, Berger JA, Macknis JK, Bauer ST, Bloom DA. Grebe dysplasia - prenatal diagnosis based on rendered 3-D ultrasound images of fetal limbs. Pediatr Radiol 2017; 47:108-112. [PMID: 27677752 DOI: 10.1007/s00247-016-3705-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Revised: 07/26/2016] [Accepted: 09/02/2016] [Indexed: 10/20/2022]
Abstract
Grebe dysplasia is a rare skeletal dysplasia characterized by severe acromesomelic shortening of the long bones in a proximal to distal gradient of severity, with bones of the hands and feet more severely affected than those of the forearms and legs, which in turn are more severely affected than the humeri and femora. In addition, the bones of the lower extremities tend to be more severely affected than the bones of the upper extremities. Despite the severe skeletal deformities, the condition is not lethal and surviving individuals can have normal intelligence. Herein we report a case of Grebe dysplasia diagnosed at 20 weeks of gestation. Rendered 3-D ultrasound images of the fetal limbs, particularly of the characteristic tiny and globular-looking fingers and toes, were instrumental in accurately characterizing the phenotype prenatally.
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Affiliation(s)
- Luis F Goncalves
- Department of Obstetrics and Gynecology, Division of Fetal Imaging, Oakland University William Beaumont School of Medicine, 3601 W. 13 Mile Road, Royal Oak, MI, 48073, USA. .,Department of Radiology, Division of Pediatric Radiology, Oakland University William Beaumont School of Medicine, Royal Oak, MI, USA.
| | - Julie A Berger
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Oakland University William Beaumont School of Medicine, Royal Oak, MI, USA
| | - Jacqueline K Macknis
- Department of Pathology, Oakland University William Beaumont School of Medicine, Royal Oak, MI, USA
| | - Samuel T Bauer
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Oakland University William Beaumont School of Medicine, Royal Oak, MI, USA
| | - David A Bloom
- Department of Radiology, Division of Pediatric Radiology, Oakland University William Beaumont School of Medicine, Royal Oak, MI, USA.,Department of Pediatrics, Oakland University William Beaumont School of Medicine, Royal Oak, MI, USA
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25
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Goncalves LF. Re: Prenatal features of isolated subependymal pseudocysts associated with adverse pregnancy outcome. H. Esteban, E. Blondiaux, E. Audureau, C. Sileo, M. L. Moutard, A. Gelot, J. M. Jouannic, H. Ducou le Pointe and C. Garel. Ultrasound Obstet Gynecol 2015; 46: 678-687. Ultrasound Obstet Gynecol 2015; 46:648. [PMID: 26627922 DOI: 10.1002/uog.15784] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- L F Goncalves
- Oakland University William Beaumont School of Medicine, Departments of Radiology and Obstetrics and Gynecology, Royal Oak, MI, USA.
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26
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Boyer AC, Krishnan A, Goncalves LF, Williams L, Chaiyasate K. Prenatal Diagnosis of Nasal Glioma Associated with Metopic Craniosynostosis: Case Report and Review of the Literature. J Radiol Case Rep 2015; 9:1-8. [PMID: 26622922 DOI: 10.3941/jrcr.v9i4.2179] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Nasal gliomas (nasal glial heterotopia) are rare benign congenital frontonasal lesions occurring in approximately 1:20.000-40,000 live births. The diagnosis is rarely reported prenatally. Nasal gliomas are typically isolated lesions, with syndromic association being exceedingly rare. Metopic craniosynostosis can occur as an isolated abnormality or in association with multiple syndromes. This case is the first reported case of nasal glioma in association with craniosynostosis in the published literature.
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Affiliation(s)
- Andrew C Boyer
- Department of Diagnostic Radiology and Molecular Imaging, Oakland University William Beaumont School of Medicine, Royal Oak, MI, USA
| | - Anant Krishnan
- Department of Diagnostic Radiology and Molecular Imaging, Oakland University William Beaumont School of Medicine, Royal Oak, MI, USA
| | - Luis F Goncalves
- Department of Diagnostic Radiology and Molecular Imaging, Oakland University William Beaumont School of Medicine, Royal Oak, MI, USA ; Department of Obstetrics & Gynecology, Oakland University William Beaumont School of Medicine, Royal Oak, MI, USA
| | - Lindsay Williams
- Department of Pathology, Oakland University William Beaumont School of Medicine, Royal Oak, MI, USA
| | - Kongkrit Chaiyasate
- Department of Plastic and Reconstructive Surgery, Oakland University William Beaumont School of Medicine, Royal Oak, MI, USA
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Boyer A, Cameron L, Munoz-Maldonado Y, Bronsteen R, Comstock CH, Lee W, Goncalves LF. Clinical significance of amniotic fluid sludge in twin pregnancies with a short cervical length. Am J Obstet Gynecol 2014; 211:506.e1-9. [PMID: 24881831 DOI: 10.1016/j.ajog.2014.05.044] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Revised: 04/22/2014] [Accepted: 05/27/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The objective of the study was to determine the clinical significance of amniotic fluid (AF) sludge in twin pregnancies with a short cervix. STUDY DESIGN We evaluated twin pregnancies with a short cervical length that had an ultrasound between 16 and 26 weeks (n = 78). Pregnancy outcomes in those with sludge (n = 27) and those without (n = 51) were compared. Outcome variables included gestational age at delivery, premature rupture of the membranes, chorioamnionitis, funisitis, composite neonatal morbidity, and perinatal death. For statistical analysis, the first-born (A) and second-born (B) twins were studied separately. RESULTS The prevalence of AF sludge was 34.6% (27 of 78). Pregnancies with sludge delivered earlier (27.2 ± 5.6 weeks vs 31.0 ± 4.05 weeks, P < .01) and had a higher rate of extreme prematurity (<26 weeks: 52.2% [12 of 23] vs 15.6% [5 of 32]; P < .01). Both twins had higher rates of histological chorioamnionitis (twin A, 50.0% [13 of 26] vs 12.8% [6 of 47]; P < .01; twin B, 42.3% [11 of 26] vs 13.3% [6 of 45]; P < .01) and neonatal death (twin A, 33.3% [9 of 27] vs 3.9% [2 of 51]; P < .01; twin B, 33.3% [9 of 27] vs 6.0% [3 of 50]; P = .01). Higher rates of funisitis (23.1% [6 of 26] vs 4.3% [2 of 47]; P = .02) and composite neonatal morbidity were observed for twin A only (66.7% [14 of 21] vs 37.5% [18 of 48]; P = .04). CONCLUSION The presence of AF sludge in twin pregnancies with a short cervix is a risk factor for extreme prematurity, histological chorioamnionitis, and perinatal death. Twin A had higher rates of funisitis and neonatal morbidity in the presence of AF sludge.
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Abstract
Ischemic placental disease is a recently coined term that describes the vascular insufficiency now believed to be an important etiologic factor in preeclampsia, intrauterine fetal growth restriction, and placental abruption. Given the increased risk for poor maternal and fetal outcomes, early prediction and prevention of this disorder is of significant clinical interest for many. In this article, we review the second- and third-trimester serum and ultrasound markers predictive of ischemic placental disease. Limited first-trimester data is also presented. While current studies report a statistical association between marker levels and various adverse perinatal outcomes, the observed diagnostic accuracy is below the threshold required for clinical utility. An exception to this generalization is uterine artery Doppler for the prediction of early-onset preeclampsia. Metabolomics is a relatively new analytic platform that holds promise as a first-trimester marker for the prediction of both early- and late-onset preeclampsia.
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Affiliation(s)
- Zeynep Alpay Savasan
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Oakland University William Beaumont School of Medicine, Rochester, MI
| | - Luis F Goncalves
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Oakland University William Beaumont School of Medicine, Rochester, MI
| | - Ray O Bahado-Singh
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Oakland University William Beaumont School of Medicine, Rochester, MI.
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Abstract
Fetal MRI is now a well-established imaging modality for the diagnostic evaluation of fetuses with congenital anomalies. In this article, the authors provide a brief overview of the physical principles involved in fetal MRI imaging, the sequences that are used in clinical practice today, current indications, and limitations. A review of current evidence supports the following indications for fetal MRI: suspected central nervous system anomalies, neck and oropharyngeal masses, diaphragmatic hernia, abdominal masses or bowel pathology not fully characterized by ultrasonography, and suspected fetal infection. Other indications should be decided on a case-by-case basis with close collaboration between the departments of maternal-fetal medicine and radiology. More research is needed to determine the role of fetal MRI in functional neuroimaging at higher magnetic field strengths (3T).
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Ahn H, Hernández-Andrade E, Romero R, Ptwardhan M, Goncalves LF, Aurioles-Garibay A, Garcia M, Hassan SS, Yeo L. Mirror artifacts in obstetric ultrasound: case presentation of a ghost twin during the second-trimester ultrasound scan. Fetal Diagn Ther 2013; 34:248-52. [PMID: 24071724 DOI: 10.1159/000353702] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Accepted: 06/11/2013] [Indexed: 11/19/2022]
Abstract
Mirror artifacts are produced by the reflection of ultrasound waves after they propagate through a structure and encounter a strong and smooth interface capable of acting as a mirror. Ultrasound waves bounce back and forth between the mirroring interface and the reflective object and then eventually return to the transducer. The typical display of the mirror artifact consists of two similar structures separated and at similar distances from the reflective interface. We report a mirror artifact in a patient with a singleton gestation at 18 weeks. The image was interpreted as consistent with a twin gestation using transabdominal and transvaginal ultrasound. The differential diagnosis consisted of an abdominal heterotopic pregnancy. The presence of synchronized but opposite movements of both fetuses, and the blurred image of the second fetus, suggested a mirror artifact. The reflective surface was created by the interface located between a distended rectosigmoid filled with gas and the posterior uterine wall. Mirror artifacts can lead to diagnostic errors. This case illustrates how a distended rectosigmoid colon can generate an image that simulates either a twin gestation or an abdominal heterotopic pregnancy.
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Affiliation(s)
- Hyunyoung Ahn
- Perinatology Research Branch, Program for Perinatal Research and Obstetrics, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, MD, USA
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Hamill N, Romero R, Hassan S, Lee W, Myers SA, Mittal P, Kusanovic JP, Balasubramaniam M, Chaiworapongsa T, Vaisbuch E, Espinoza J, Gotsch F, Goncalves LF, Mazaki-Tovi S, Erez O, Hernandez-Andrade E, Yeo L. The fetal cardiovascular response to increased placental vascular impedance to flow determined with 4-dimensional ultrasound using spatiotemporal image correlation and virtual organ computer-aided analysis. Am J Obstet Gynecol 2013; 208:153.e1-13. [PMID: 23220270 DOI: 10.1016/j.ajog.2012.11.043] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Revised: 10/05/2012] [Accepted: 11/05/2012] [Indexed: 11/25/2022]
Abstract
OBJECTIVE We sought to determine if increased placental vascular impedance to flow is associated with changes in fetal cardiac function using spatiotemporal image correlation and virtual organ computer-aided analysis. STUDY DESIGN A cross-sectional study was performed in fetuses with umbilical artery pulsatility index >95th percentile (abnormal [ABN]). Ventricular volume (end-systole, end-diastole), stroke volume, cardiac output (CO), adjusted CO, and ejection fraction were compared to those of 184 normal fetuses. RESULTS A total of 34 fetuses were evaluated at a median gestational age of 28.3 (range, 20.6-36.9) weeks. Mean ventricular volumes were lower for ABN than normal cases (end-systole, end-diastole) with a proportionally greater decrease for left ventricular volume (vs right). Mean left and right stroke volume, CO, and adjusted CO were lower for ABN (vs normal) cases. Right ventricular volume, stroke volume, CO, and adjusted CO exceeded the left in ABN fetuses. Mean ejection fraction was greater for ABN than normal cases. Median left ejection fraction was greater (vs right) in ABN fetuses. CONCLUSION Increased placental vascular impedance to flow is associated with changes in fetal cardiac function.
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Butros SR, Goncalves LF, Thompson D, Agarwal A, Lee HK. Imaging features of idiopathic intracranial hypertension, including a new finding: widening of the foramen ovale. Acta Radiol 2012; 53:682-8. [PMID: 22761347 DOI: 10.1258/ar.2012.110705] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Idiopathic intracranial hypertension (IIH) is a clinical disorder of unknown etiology manifesting with increased intracranial pressure in the absence of hydrocephalus, an underlying mass lesion, and demonstrating normal cerebrospinal fluid composition. IIH may exhibit several non-specific imaging findings including: an empty sella, posterior globe flattening, tortuosity of the optic nerve, and optic nerve sheath distention. PURPOSE To introduce widening of the foramen ovale as a new imaging marker for IIH. MATERIAL AND METHODS IIH is a syndrome which may exhibit several previously described non-specific imaging findings including: an empty sella, posterior globe flattening, tortuosity of the optic nerve, and optic nerve sheath distention. We hypothesize that chronically elevated cerebrospinal fluid pressure can lead to osseous erosions and we propose widening of the foramen ovale as a new imaging marker for IIH. RESULTS Average foramen ovale sizes were increased in patients with IIH compared to controls (30.03 ± 7.00 mm(2) vs. 24.21 ± 5.97 mm(2), P < 0.001). For a cut-off value of 30 mm(2), the sensitivity of FO area to detect IIH was 50%, with 81% specificity. Classic findings were significantly more common in patients with IIH compared to controls including: empty sella (65.9% vs. 0%), posterior globe flattening (65.9% vs. 4.5%), vertical tortuosity of the optic nerve (54.5% vs. 9.1%), and optic nerve sheath distention (52.3% vs. 11.4%, all P values < 0.001). CONCLUSION Our study confirms the association of several classic imaging findings with IIH and supports widening of the foramen ovale as an additional imaging marker which may be incorporated into the evaluation of patients suspected to have this condition.
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Affiliation(s)
- Selim R Butros
- Wayne State University, Detroit Medical Center, Department of Radiology, Detroit, MI, USA
| | - Luis F Goncalves
- Wayne State University, Detroit Medical Center, Department of Radiology, Detroit, MI, USA
| | - Dustin Thompson
- Wayne State University, Detroit Medical Center, Department of Radiology, Detroit, MI, USA
| | - Ajay Agarwal
- Wayne State University, Detroit Medical Center, Department of Radiology, Detroit, MI, USA
| | - Ho K Lee
- Wayne State University, Detroit Medical Center, Department of Radiology, Detroit, MI, USA
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Hamill N, Yeo L, Romero R, Hassan SS, Myers SA, Mittal P, Kusanovic JP, Balasubramaniam M, Chaiworapongsa T, Vaisbuch E, Espinoza J, Gotsch F, Goncalves LF, Lee W. Fetal cardiac ventricular volume, cardiac output, and ejection fraction determined with 4-dimensional ultrasound using spatiotemporal image correlation and virtual organ computer-aided analysis. Am J Obstet Gynecol 2011; 205:76.e1-10. [PMID: 21531373 DOI: 10.1016/j.ajog.2011.02.028] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2009] [Revised: 01/18/2011] [Accepted: 02/14/2011] [Indexed: 12/21/2022]
Abstract
OBJECTIVE The objective of this study was to quantify fetal cardiovascular parameters using spatiotemporal image correlation (STIC) and virtual organ computer-aided analysis (VOCAL). STUDY DESIGN A cross-sectional study was performed in normal pregnancies (19-42 weeks) to evaluate ventricular volume, stroke volume (SV), cardiac output (CO), and ejection fraction (EF). The CO was also expressed as a function of estimated fetal weight and biometric parameters. RESULTS The following results were found: (1) 184 STIC datasets; (2) with advancing gestation, ventricular volume, SV, CO, and adjusted CO increased, whereas EF decreased; (3) right ventricular (RV) volume was larger than the left ventricular (LV) volume in systole (0.50 vs 0.27 mL; P < .001) and diastole (1.20 vs 1.03 mL; P < .001); (4) there were no differences between the LV and RV in SV, CO, or adjusted CO; and (5) LV EF was greater than the RV EF (72.2 vs 62.4%; P < .001). CONCLUSION Normal fetal cardiovascular physiology is characterized by a larger RV volume and a greater LV EF, resulting in similar LV and RV SV and CO.
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Affiliation(s)
- Neil Hamill
- Perinatology Research Branch, National Institute of Child Health and Human Development, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, and Detroit, MI, USA
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Soto E, Romero R, Richani K, Espinoza J, Chaiworapongsa T, Nien JK, Edwin SS, Kim YM, Hong JS, Goncalves LF, Yeo L, Mazor M, Hassan SS, Kusanovic JP. Preeclampsia and pregnancies with small-for-gestational age neonates have different profiles of complement split products. J Matern Fetal Neonatal Med 2010; 23:646-57. [PMID: 19900030 DOI: 10.3109/14767050903301009] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The activation of the complement system results in the generation of split products with pro-inflammatory properties. The objective of this study was to determine whether preeclampsia and small-for-gestational age (SGA) are associated with changes in the maternal plasma concentrations of anaphylatoxins C3a, C4a and C5a. METHODS A cross-sectional study was conducted in the following groups: (a) normal pregnant women (n = 134); (b) women who delivered an SGA neonate (n = 53); (c) preeclampsia with (n = 52) and without SGA (n = 54). Maternal plasma anaphylatoxin concentrations were determined by enzyme-linked immunoassay. RESULTS (1) Women with preeclampsia with or without SGA had a significantly higher median plasma C5a concentration than that of normal pregnant women and those with SGA alone (all P < 0.01); (2) women with SGA alone did not have an increase in plasma C5a concentration; (3) in contrast, the median maternal plasma concentration of C4a was lower in women with preeclampsia and SGA than that of those with a normal pregnancy (P = 0.001); (4) no changes in C3a were observed among the study groups. CONCLUSION Preeclampsia is associated with increased plasma concentration of C5a, regardless of the presence or absence of an SGA fetus. In contrast, there was no difference in the plasma C3a, C4a and C5a concentration in patients with SGA.
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Affiliation(s)
- Eleazar Soto
- Perinatology Research Branch, National Institute of Child Health and Human Development, NIH/DHHS, Bethesda, MD 20892, USA
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Hamill N, Romero R, Hassan SS, Lee W, Myers SA, Mittal P, Kusanovic JP, Chaiworapongsa T, Vaisbuch E, Espinoza J, Gotsch F, Carletti A, Goncalves LF, Yeo L. Repeatability and reproducibility of fetal cardiac ventricular volume calculations using spatiotemporal image correlation and virtual organ computer-aided analysis. J Ultrasound Med 2009; 28:1301-11. [PMID: 19778875 PMCID: PMC3071609 DOI: 10.7863/jum.2009.28.10.1301] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
OBJECTIVE The objective of this study was to quantify the repeatability and reproducibility of fetal cardiac ventricular volumes obtained using spatiotemporal image correlation (STIC) and Virtual Organ Computer-Aided Analysis (VOCAL; GE Healthcare, Kretztechnik, Zipf, Austria). METHODS A technique was developed to compute ventricular volumes using the subfeature Contour Finder: Trace. Twenty-five normal pregnancies were evaluated for the following: (1) to compare the coefficient of variation (CV) of ventricular volumes obtained using 15 degrees and 30 degrees rotation; (2) to compare the CV between 3 methods of quantifying ventricular volumes: (a) Manual Trace, (b) Inversion Mode, and (c) Contour Finder: Trace; and (3) to determine repeatability by calculating agreement and reliability of ventricular volumes when each STIC was measured twice by 3 observers. Reproducibility was assessed by obtaining 2 STICs from each of 44 normal pregnancies. For each STIC, 2 ventricular volume calculations were performed, and agreement and reliability were evaluated. Additionally, measurement error was examined. RESULTS (1) Agreement was better with 15 degrees rotation than 30 degrees (15 degrees: 3.6%; 95% confidence interval [CI], 3.0%-4.2%; versus 30 degrees: 7.1%; 95% CI, 5.8%-8.6%; P < .001); (2) ventricular volumes obtained with Contour Finder: Trace had better agreement than those obtained using either Inversion Mode (Contour Finder: Trace: 3.6%; 95% CI, 3.0%-4.2%; versus Inversion Mode: 6.0%; 95% CI, 4.9%-7.2%; P < .001) or Manual Trace (10.5%; 95% CI, 8.7%-12.5%; P < .001); (3) ventricular volumes were repeatable with good agreement and excellent reliability for both intraobserver and interobserver measurements; and (4) ventricular volumes were reproducible with negligible differences in agreement and good reliability. In addition, bias between STIC acquisitions was minimal (<1%; mean percent difference, -0.4%; 95% limits of agreement, -5.4%-5.9%). CONCLUSIONS Fetal echocardiography using STIC and VOCAL allows repeatable and reproducible calculation of ventricular volumes with the subfeature Contour Finder: Trace.
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Affiliation(s)
- Neil Hamill
- Perinatology Research Branch, NICHD, NIH, DHHS, Detroit, Michigan, USA
- Wayne State University School of Medicine, Department of Obstetrics and Gynecology, Detroit, Michigan, USA
| | - Roberto Romero
- Perinatology Research Branch, NICHD, NIH, DHHS, Detroit, Michigan, USA
- Wayne State University School of Medicine, Department of Obstetrics and Gynecology, Detroit, Michigan, USA
- Center for Molecular Medicine and Genetics, Wayne State University, Detroit, Michigan, USA
| | - Sonia S Hassan
- Perinatology Research Branch, NICHD, NIH, DHHS, Detroit, Michigan, USA
- Wayne State University School of Medicine, Department of Obstetrics and Gynecology, Detroit, Michigan, USA
| | - Wesley Lee
- William Beaumont Hospital, Royal Oak, Michigan, USA
| | | | - Pooja Mittal
- Perinatology Research Branch, NICHD, NIH, DHHS, Detroit, Michigan, USA
- Wayne State University School of Medicine, Department of Obstetrics and Gynecology, Detroit, Michigan, USA
| | - Juan Pedro Kusanovic
- Perinatology Research Branch, NICHD, NIH, DHHS, Detroit, Michigan, USA
- Wayne State University School of Medicine, Department of Obstetrics and Gynecology, Detroit, Michigan, USA
| | - Tinnakorn Chaiworapongsa
- Perinatology Research Branch, NICHD, NIH, DHHS, Detroit, Michigan, USA
- Wayne State University School of Medicine, Department of Obstetrics and Gynecology, Detroit, Michigan, USA
| | - Edi Vaisbuch
- Perinatology Research Branch, NICHD, NIH, DHHS, Detroit, Michigan, USA
- Wayne State University School of Medicine, Department of Obstetrics and Gynecology, Detroit, Michigan, USA
| | - Jimmy Espinoza
- Perinatology Research Branch, NICHD, NIH, DHHS, Detroit, Michigan, USA
- Wayne State University School of Medicine, Department of Obstetrics and Gynecology, Detroit, Michigan, USA
| | - Francesca Gotsch
- Perinatology Research Branch, NICHD, NIH, DHHS, Detroit, Michigan, USA
| | - Angela Carletti
- Wayne State University School of Medicine, Department of Obstetrics and Gynecology, Detroit, Michigan, USA
| | - Luis F. Goncalves
- Perinatology Research Branch, NICHD, NIH, DHHS, Detroit, Michigan, USA
- Wayne State University School of Medicine, Department of Obstetrics and Gynecology, Detroit, Michigan, USA
| | - Lami Yeo
- Perinatology Research Branch, NICHD, NIH, DHHS, Detroit, Michigan, USA
- Wayne State University School of Medicine, Department of Obstetrics and Gynecology, Detroit, Michigan, USA
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Chaiworapongsa T, Espinoza J, Gotsch F, Kim YM, Kim GJ, Goncalves LF, Edwin S, Kusanovic JP, Erez O, Than NG, Hassan SS, Romero R. The maternal plasma soluble vascular endothelial growth factor receptor-1 concentration is elevated in SGA and the magnitude of the increase relates to Doppler abnormalities in the maternal and fetal circulation. J Matern Fetal Neonatal Med 2008; 21:25-40. [PMID: 18175242 DOI: 10.1080/14767050701832833] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVES The soluble form of vascular endothelial growth factor receptor-1 (sVEGFR-1), an antagonist to vascular endothelial growth factor and placental growth factor, has been implicated in the pathophysiology of preeclampsia. Preeclampsia and pregnancy complicated with small for gestational age (SGA) fetuses share some pathophysiologic derangements, such as failure of physiologic transformation of the spiral arteries, endothelial cell dysfunction, and leukocyte activation. The objectives of this study were to: (1) determine whether plasma concentrations of sVEGFR-1 in mothers with SGA fetuses without preeclampsia at the time of diagnosis are different from those in patients with preeclampsia or normal pregnant women, and (2) examine the relationship between plasma concentrations of sVEGFR-1 and Doppler velocimetry in uterine and umbilical arteries in patients with preeclampsia and those with SGA. STUDY DESIGN A cross-sectional study was conducted to determine the concentrations of the soluble form of VEGFR-1 in plasma obtained from normal pregnant women (n = 135), women with SGA fetuses (n = 53), and patients with preeclampsia (n = 112). Patients with SGA fetuses and those with preeclampsia were sub-classified according to the results of uterine and umbilical artery Doppler velocimetry examinations. Plasma concentrations of sVEGFR-1 were determined by an ELISA. Since these concentrations change with gestational age, differences among various subgroups were statistically estimated with the delta value, defined as the difference between the observed and expected plasma sVEGFR-1 concentration. The expected values were derived from regression analysis of plasma sVEGFR-1 concentrations in normal pregnancy. Regression analysis and univariate and multivariate analysis were employed. RESULTS (1) Mothers with SGA fetuses had a mean plasma concentration of sVEGFR-1 higher than normal pregnant women (p < 0.001), but lower than patients with preeclampsia (p < 0.001). (2) Among patients with SGA fetuses, only those with abnormal uterine artery Doppler velocimetry had a mean plasma sVEGFR-1 concentration significantly higher than normal pregnant women (p < 0.001). (3) Among mothers with SGA fetuses in whom Doppler velocimetry was performed (n = 41), those with abnormalities in both the uterine and umbilical artery velocimetry had the highest mean delta of sVEGFR-1 plasma concentration (mean +/- standard deviation (SD): 0.69 +/- 0.29). Conversely, patients who had normal Doppler velocimetry in both uterine and umbilical arteries had the lowest mean delta (mean +/- SD: 0.09 +/- 0.29) of sVEGFR-1 plasma concentrations (ANOVA; p < 0.001). (4) Among patients with preeclampsia in whom Doppler velocimetry was performed (n = 69), those with abnormalities in both the uterine and umbilical artery velocimetry had the highest mean delta sVEGFR-1 plasma concentration (mean +/- SD: 1.01 +/- 0.22) among all groups classified (ANOVA; p < 0.001). (5) Among patients with SGA and those with preeclampsia, there was a relationship (Chi-square for trend p < 0.001 for both) between the severity of Doppler velocimetry abnormalities and the proportion of patients who had high delta sVEGFR-1 plasma concentrations (defined as a concentration two standard deviations (2SD) above the mean delta of normal pregnant women). (6) Multiple regression analysis suggested that the diagnostic category (e.g., SGA or preeclampsia), Doppler abnormalities, and gestational age at blood sampling were associated with an increase in plasma sVEGFR-1 concentrations (p < 0.001). CONCLUSIONS These observations provide support for the participation of the soluble receptor of vascular endothelial growth factor in the pathophysiology of SGA with abnormal uterine artery Doppler velocimetry and preeclampsia. An excess of sVEGFR-1 is released into the maternal circulation of patients with preeclampsia and those with SGA fetuses, as abnormalities of impedance to blood flow involve uterine and umbilical circulation.
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Affiliation(s)
- Tinnakorn Chaiworapongsa
- Perinatology Research Branch, National Institute of Child Health and Human Development, NIH/DHHS, Bethesda, MD 20892, USA
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Romero R, Kusanovic JP, Espinoza J, Gotsch F, Nhan-Chang CL, Erez O, Kim CJ, Khalek N, Mittal P, Goncalves LF, Schaudinn C, Hassan SS, Costerton JW. What is amniotic fluid 'sludge'? Ultrasound Obstet Gynecol 2007; 30:793-8. [PMID: 17899615 PMCID: PMC2494941 DOI: 10.1002/uog.5173] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Affiliation(s)
- R Romero
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland and Detroit, Michigan, USA.
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Bujold E, Chaiworapongsa T, Romero R, Gervasi MT, Espinoza J, Goncalves LF, Berman S, Yoon BH, Kim YM. Neonates born to pre-eclamptic mothers have a higher percentage of natural killer cells (CD3-/CD56+16+) in umbilical cord blood than those without pre-eclampsia. J Matern Fetal Neonatal Med 2004; 14:305-12. [PMID: 14986803 DOI: 10.1080/jmf.14.5.305.312] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE Maternal endothelial dysfunction and intravascular inflammation have been implicated in the mechanisms of disease responsible for the clinical syndrome of pre-eclampsia. Recently, the activation of the innate limb of the immune response (neutrophils and monocytes) in the fetal circulation has been reported in neonates born to mothers with pre-eclampsia. Natural killer (NK) cells are identified morphologically as a subpopulation of lymphocytes, but functionally as one component of the innate immune system. NK cells participate in the control of viral or bacterial infection, regulation of hematopoiesis, production of cytokines and cytotoxicity of neoplastic cells. Accumulating evidence suggests that the innate system is required for mounting an adequate adaptive response. NK cells, originally defined as effector cells of the innate immune system, may also play a role as regulatory cells for the adaptive immune system. This study was designed to determine the proportion of the NK cell subset of lymphocytes in umbilical cord blood of neonates born to mothers with and without pre-eclampsia. METHODS A cross-sectional study including neonates of mothers with (n = 48) and those without pre-eclampsia (control group) (n = 72) was conducted. Pre-eclampsia was diagnosed in the presence of hypertension and proteinuria. The control group consisted of neonates (premature and term) with no evidence of acute inflammation within the extraplacental membranes (chorioamnionitis). Umbilical cord blood was collected at the time of delivery, and assayed using monoclonal antibodies for selective cluster differentiation (CD) antigens in order to determine the proportion of NK cells as a percentage of total lymphocytes. The immunophenotypic characteristic was determined using flow cytometry, and NK cells were identified by positivity of CD16 and CD56 without CD3 (CD3-/CD56+16+). Log transformation of the percentage of NK cells was performed. Parametric statistics were used for analysis. Multiple regression analysis was utilized to examine the contribution of potentially confounding factors on the proportion of NK cells. A p value of < 0.05 was considered statistically significant. RESULTS Neonates born to mothers with pre-eclampsia had a significantly higher percentage of NK cells (CD3-/CD56+16+) than those in the control group (pre-eclampsia, mean +/- SD 17 +/- 9% vs. control, mean +/- SD 12 +/- 7.5%; p = 0.001). Multiple regression analysis suggested that umbilical cord blood pH of < 7.2, labor with vaginal delivery and maternal pre-eclampsia were associated with an increased percentage of NK cells in umbilical cord blood. CONCLUSIONS Pre-eclampsia is associated with a higher NK cell (CD3-/CD56+16+) subset of lymphocytes in umbilical cord blood than in the control group. This difference cannot be explained by fetal acidosis or the presence of labor.
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Affiliation(s)
- E Bujold
- Department of Obstetrics and Gynecology, Wayne State University/Hutzel Hospital, Detroit, Michigan 48201, USA
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Kalache K, Romero R, Goncalves LF, Chaiworapongsa T, Espinoza J, Schoen ML, Treadwell MC, Lee W. Three-dimensional color power imaging of the fetal hepatic circulation. Am J Obstet Gynecol 2003; 189:1401-6. [PMID: 14634577 DOI: 10.1067/s0002-9378(03)00774-9] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The purpose of this study was to describe the use of three-dimensional power Doppler ultrasonography to identify vascular congenital anomalies of fetal portosystemic and umbilical venous systems. STUDY DESIGN In a prospective study, the hepatic and umbilical venous systems were examined in 390 fetuses with two-dimensional ultrasonography, color, and spectral Doppler imaging. Fetuses suspected to have anomalies of the portal system and ductus venosus were additionally examined with three-dimensional power Doppler ultrasonography. RESULTS Vascular anomalies were identified in 8 fetuses (absent ductus venosus, n=4; direct connection between the umbilical vein and the right atrium, n=2; and direct connection between the umbilical vein and the inferior vena cava, n=2) out of the 310 in which the venous system could be adequately imaged (prevalence=2.6%). Three-dimensional power Doppler imaging showed the course of the umbilical vein, its relationship to the portosystemic circulation, and whether a ductus venosus was present. CONCLUSION Three-dimensional power Doppler ultrasonography can be used to image normal fetal hepatic and portal circulation, as well as identify anomalies of the fetal portosystemic and umbilical venous systems.
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Affiliation(s)
- Karim Kalache
- Perinatology Research Branch, National Institute of Child Health and Human Development, National Institutes of Health/DHHS, Bethesda, MD 20892, USA
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Manfro RC, Goncalves LF, Rauber M, Moura LA. Analysis of ICAM-1 and HLA-DR expression on renal allograft aspirates. Clin Transplant 1996; 10:379-83. [PMID: 8884112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
ICAM-1 and HLA-DR expressions were studied on parenchymal cells obtained by aspirative biopsies of renal allografts. Patients were evaluated during 3 months after transplantation. Conventional cytology and immunoperoxidase stainings using anti-ICAM-1 and anti-HLA-DR antibodies were employed. The value of the total corrected increment was significantly higher (p < 0.05) during acute rejection episodes than during acute tubular necrosis or stable renal function. The percentage of HLA-DR positive cells were higher in rejection than in stable function periods (p < 0.05). The percentage of ICAM-1 positive cells was higher in rejection than in acute tubular necrosis periods (p < 0.05). The sensitivities to the diagnosis of rejection were 71.8% (TCI), 68.4% (ICAM-1) and 55.0% (HLA-DR). The specificities were 87.3%, 81.3% and 68.4% respectively. Combinations of the tests resulted in increased sensitivity. We concluded that the use of these monoclonal antibodies improves the sensitivity of conventional aspiration cytology to the diagnosis of acute renal rejection.
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Affiliation(s)
- R C Manfro
- Renal Transplant Unit, Hospital de Cliinicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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Manfro RC, Karohl C, Goncalves LF, Senger MB, Thomé FS, Prompt CA. Liver function tests in hepatitis C virus infected kidney transplant recipients. Transplant Proc 1995; 27:1821-2. [PMID: 7725519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- R C Manfro
- Renal Transplant Unit, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
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Franceschini N, Goncalves LF, Prompt CA, Barros SG, Cerski CT, Costa CA. Liver histology in hepatitis B and C co-infection on hemodialysis patients. Nephron Clin Pract 1994; 68:515-6. [PMID: 7532796 DOI: 10.1159/000188322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
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Franceschini N, Goncalves LF, Prompt CA, Barros SG, Cerski CT, Costa CA. Fine needle aspirative biopsy of the liver in HBsAG-positive patients with end-stage renal failure. Ren Fail 1994; 16:491-9. [PMID: 7938757 DOI: 10.3109/08860229409045080] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
HBsAg-positive patients with end-stage renal failure have a high prevalence of asymptomatic chronic hepatitis. In order to determine the usefulness of hepatic cytology in the diagnosis of liver disease, the findings of hepatic needle core biopsy (NCB) and fine needle aspirative biopsy (FNAB) were compared in 15 HBsAg-positive uremic patients. The patients, aged 42 +/- 12 years, 14 males, were on hemodialysis for periods ranging from 13 to 105 months. The NCB was processed by standard histologic and immunohistochemical techniques and FNAB by the conventional technique, using the total corrected increment score (TCI). Plasma samples were collected for evaluation of hepatic function and for viral serologic tests. In 15 patients a diagnosis was made by NCB: normal, 7 cases; chronic persistent hepatitis, 4 cases; and chronic active hepatitis, 4 cases. When the patients were allocated into two groups according to the severity of the liver histologic findings [group I--minor changes (normal+chronic persistent hepatitis), 11 patients; group II--major changes (chronic active hepatitis), 4 patients], statistically higher values were found in the major changes group for alanine aminotransferase (49 +/- 33 vs. 24 +/- 11, p = 0.04), gamma-glutamyl transpeptidase [148 +/- 53 vs. 38 +/- 28, p < (minor) 0.02] and TCI (3.7 +/- 1.2 vs. 2.5 +/- 0.8, p = 0.04). In conclusion, liver FNAB can be useful as a screening procedure for the identification of liver histologic changes (minor or major) in uremic HBsAG-positive patients.
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Affiliation(s)
- N Franceschini
- Division of Nephrology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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