Showing papers in "Journal of Ultrasound in Medicine in 1984"

Examination of the infant hip with real‐time ultrasonography.

Abstract: Examination of the infant hip with a real-time sector scanner permits accurate and reliable determination of the anatomic structures and relationships of the hip joint. A technique using two transducer orientations has been found most effective. In 100 hip examinations, the method failed to differentiate an abnormal hip in only one instance.

Fatty infiltration of the liver: ultrasonographic and computed tomographic correlation.

Abstract: To evaluate the accuracy of ultrasonography in diagnosing fatty infiltration of the liver (FIL), the authors compared gray-scale B-mode ultrasonography and unenhanced computed tomographic (CT) liver images in a study of 47 patients. The CT scans, which served as the diagnostic standard, were classified as normal, Grade 1 (mild FIL), Grade 2 (moderate FIL), and Grade 3 (severe FIL). Applying predetermined sonographic textural criteria, two experienced radiologists independently graded each ultrasound study for the presence and severity of FIL. The overall accuracy of ultrasonography in detecting FIL was 85 per cent, with 100 per cent sensitivity and 56 per cent specificity. The sonographic/CT correlation in grading the severity of FIL was particularly good for Grade 2 and Grade 3 FIL. Ultrasound is a sensitive and reasonably accurate diagnostic tool in assessing fatty infiltration of the liver.

Respiratory movement of the pancreas: An ultrasonic study

Abstract: Respiratory movement of the pancreas was documented ultrasonically in 36 normal patients and volunteers. Pancreatic excursion from full inspiration to full expiration was measured in the plane of the superior mesenteric artery in supine, prone, and decubitus positions. Excursions ranged from 0 to 3.5 cm. The average respiratory excursion was 1.8 cm in the supine position, 1.9 cm when prone, and 2.2 cm in the lateral decubitus position. Such respiratory movement of the pancreas has obvious implications both for static B-mode ultrasound scanning and for CT scanning.

Estimation of gestational age from measurements of fetal long bones.

Abstract: The general practice of using fetal long bone growth charts to derive gestational age does not yield mathematically valid results. The authors tried to calculate gestational age from the lengths of long bones (femur, humerus, tibia, ulna) from 12 to 40 weeks of gestation. The combined use of the four bones allows a good estimation of gestational age that may be useful should the biparietal diameter measurement be unreliable, unobtainable, or abnormal.

Sonographic depiction of endometrial changes occurring with ovulation induction.

Abstract: Endometrial thickness and texture were evaluated with serial pelvic sonograms in ten normal, menstruating women and 107 patients undergoing ovulation induction for in vitro fertilization. Serial sonograms were performed in the control group every other day throughout the menstrual cycle, whereas the sonographic examinations of the ovulation induction patients were performed daily in a four- to eight-day time interval after their medications were completed and prior to laparoscopy for follicular aspiration. Endometrial thickness increased (defined as a persistent change greater than or equal to 1 mm) in 21 of 53 women (40 percent) who received human menopausal gonadotropin (HMG). Of the 54 women treated with clomiphene citrate (CC), five of 12 (42 percent) at 50 mg daily, 13 of 33 (39 percent) at 100 mg daily, and one of nine (11 percent) at 150 mg daily were found to have endometrial thickening. Although the frequencies of endometrial thickening in the high-dose CC and HMG groups were not significantly different (P = 0.09), the peak estradiol (E2) levels in the CC (150 mg) group (E2 = 944 +/- 165 pg/ml) were significantly higher (P less than 0.001) than those in the HMG group (E2 = 584 +/- 26 pg/ml). The relatively low frequency of endometrial thickening in women receiving CC (150 mg) despite very high E2 levels, and the decreased incidence of endometrial thickening relative to increasing dosages of CC may reflect an antiestrogenic effect of CC on the endometrium. In those patients undergoing ovulation induction, the texture of the endometrium remained the same in 98 cycles and changed during nine.(ABSTRACT TRUNCATED AT 250 WORDS)

Ultrasonography of the rotator cuff: technique and normal anatomy.

Abstract: The technique for ultrasound imaging of the rotator cuff is described and the normal anatomy of the region is illustrated. Ultrasonography of the shoulder appears to easily and rapidly display normal rotator cuff anatomy.

Aneurysms of the splenic artery : noninvasive diagnosis by pulsed Doppler sonography

Abstract: Aneurysms of the splenic artery are relatively rare but potentially life-threatening lesions that may be caused by atherosclerosis, infective emboli, infections, congenital factors, or trauma, and seem to be particularly frequent in patients with portal hypertension and in women of childbearing age. 1·2 In many cases, these lesions are asymptomatic, and are discovered incidentally during angiographic procedures performed for other reasons; when symptoms are present, they may be nonspecific and quite variable: vague discomfort or pain in the left hypochondrium, occasionally with radiation to the left shoulder, nausea and vomiting. When an aneurysm is large, it may present as a palpable mass with a systolic bruit over it. Incidences of rupture range from 8 to 46 per cent, and mortality rates are very high, especially when the aneurysms rupture into the stomach. 1 Although a plain radiograph of the abdomen may be of help if a ring of calcification can be seen on the axis of the splenic artery, the diagnosis is based mainly on abdominal angiography. The real-time sonographic appearances of aneurysms of the splenic artery in two patients have been recently described to be rounded hypoechoic masses located at the left hypochondrium. However, in both cases, although the lesions could be imaged, sonography did not provide evidence of their vascular nature, since no definite pulsations could be observed in them; in one of these cases the correct diagnosis was suggested by the closeness of the mass to the proximal splenic artery. Radiographic studies with contrast material were needed to confirm the diagnosis.3. 4 We report the findings in two cases of aneurysms of the splenic artery in which the condition was diagnosed noninvasively by use of pulsed Doppler sonography.

The effects of pulsed ultrasound on the fetus.

Abstract: Recent developments suggest that transient cavitation must be considered in assessing the safety of diagnostic uses of ultrasound. An analysis of the literature on exposure of the fetus to pulsed ultrasound reveals no direct evidence that diagnostic ultrasound produces any effect on the fetus.

Transvaginal pelvic ultrasonography.

Abstract: The most common technique for ultrasonographic evaluation of the pelvic organs is to have the patient drink approximately six B-ounce glasses of water an hour prior to the examination. Scanning is then routinely perlormed from the anterior abdominal surlace, using the bladder as an ultrasonic window (transabdominal). We have occasionally had difficulty with certain patients in precisely de· lineating pelvic structures, masses , or ovarian follicle size. A transvaginal technique has proven extremely effective with these patients, and is now commonly used in our practice. A recent report in the Japanese literature has demonstrated good correlation using transabdominal and transvaginal techniques for follicle size determination. 1 However, to our knowledge, no description of the transvaginal technique for routine pelvic ultrasonography has appeared in the English-language literature.

Ultrasound evaluation of benign sciatic nerve sheath tumors.

Abstract: The ultrasonograms of three patients with surgically proven benign tumors of the sciatic nerve sheath were reviewed. Two lesions were neurilemmomas and one was a neurofibroma. All lesions appeared hypoechoic and often demonstrated characteristics typically associated with cystic abnormalities. Although the sciatic nerve is not routinely delineated as a separate anatomic structure by ultrasound, neoplastic enlargements of the nerve can be demonstrated.

Xanthogranulomatous pyelonephritis: Sonographic-pathologic correlation of 16 cases

Abstract: Xanthogranulomatous pyelonephritis (XGP) is an uncommon renal inflammatory disease characterized by the destruction and replacement of normal parenchyma by sheets of lipid-laden histiocytes. The process may be diffuse or segmental. Sonograms of 16 cases of XGP (13 diffuse, three segmental) were retrospectively reviewed and correlated with their pathologic findings. The typical case of diffuse XGP demonstrates the following: renal enlargement, replacement of normal architecture by multiple fluid-filled masses, pelvic contraction or only moderate separation of the central echo complex, and a pelvic calculus. Although most cases have a large staghorn calculus, its sonographic demonstration may be difficult, perhaps as a consequence of peripelvic fibrosis. Atypical cases of diffuse XGP mimic pyelonephrosis with massive hydronephrosis and fluid--debris levels. In these atypical cases, a staghorn calculus is often conspicuously absent. Segmental XGP is recognized as an area of parenchymal destruction surrounding one calyx or one pole of duplication. Segmental XGP should be distinguished from focal xanthogranulomatous inflammation of the kidney, which is a distinct pathologic entity (cortical location, no pelvic communication, absent pyelitis). When typical gross pathologic features are present, sonography should make possible accurate identification of diffuse and segmental XGP.

Fetal ossification centers as predictors of gestational age in normal and abnormal pregnancies.

Abstract: The main fetal ossification centers appear ultrasonically as egg-shaped echo-rich areas. The calcaneal and talar ossification centers are seen at the level of the tarsus osseus, and the distal femoral epiphyseal and proximal tibial epiphyseal ossification centers are found at the level of the knee. Examination of 312 normal pregnancies between 20 and 40 weeks of gestation showed that the calcaneal ossification center was detectable for 24 weeks of gestation, the talar ossification center from 26 weeks, and the distal femoral epiphyseal and proximal tibial epiphyseal ossification centers, from 32 and 36 weeks, respectively. Corresponding figures found for 36 pregnancies showing intrauterine growth retardation (IUGR), examined between 34 and 40 weeks of gestation, were similar for the calcaneal and talar ossification centers but showed delays in the development of the epiphyseal ossification centers, which were particularly striking in cases of symmetrical IUGR. The amniotic fluid lecithin/sphingomyelin ratio was also evaluated in 51 normal pregnancies between 31 and 38 weeks of gestation and was found to be greater than or equal to 2 in every case where the distal femoral epiphyseal ossification center was greater than or equal to 6 mm in diameter. Evaluation of fetal ossification centers may be another useful means to evaluate gestational age in late pregnancy

Fetal weight estimation from lengths and volumes found by three-dimensional ultrasonic measurements.

Abstract: A custom-built computer system combined with a commercial real-time ultrasonic scanner was used to predict fetal weight. A special three-dimensional (3D) locating system provided 3D coordinates of fetal surface points imaged on multiple ultrasound scans. The 3D coordinates were used to develop length and volume variables that are not available with commercial instruments. Multiple regressions were used to compare these lengths and volumes with more conventional diameters and circumferences for their ability to predict fetal weight. Measurements were made on 41 live fetuses within 48 hours prior to delivery (weight range 1,985-4,734 g, mean weight 3,421 g). Combinations of 19 measured variables were analyzed against birth weight and the natural log of birth weight. The correlation between log birth weight and combinations including lengths from 3D measurements was R = .93, SE = 73 g/kg. When volumes from 3D measurements (which are much more difficult to obtain) were added, the correlation was R = .94, SE = 69 g/kg. These results suggest that lengths from 3D measurements have the potential to improve fetal weight prediction by 25-30 per cent over current methods, which have an approximate error of 100 g/kg. The relative lack of improvement with volumes from 3D measurements is probably the result of technical problems which may be overcome with further research.

Specificity of ultrasonography in the diagnosis of benign breast masses.

Abstract: Ultrasound has become increasingly important in the management of benign breast disease. The main reasons are its ability to distinguish between cystic and solid lesions, its special advantages in examining the dense breast, and the absence of potential radiation hazard. This paper evaluates the specificity of automated ultrasound in the diagnosis of benign lesions. The usefulness of the signs established for the diagnosis of benign masses is analyzed. Atypical lesions are discussed and the role of ultrasonography in the differential diagnosis of benign lesions is reviewed.

Entangled umbilical cords: a sign of monoamniotic twins.

Abstract: Figure 1. A. trans& verse real-time sana& gram of the sacraJ spine, demonstrat.ng a small myelomeningocele sac (arrowhead) and splaying (arrows) of the posterior spinal OS· silication centers. B. coronal real-time sonogram of the calvarium, demonstrating bilateral ventricutomegaly (V). one form of monozygotic twins, thought to occur from division of a single fertilized ovum at a critical period eight to 13 days after fertilization. Division of the fertilized ovum before three days results in dichorionic-diamniotic twins; division between three and eight days forms monochorionic-diamniotic twins; and division after 13 days produces conjoined twins. ~.4 . S Dizygotic twins form from fer· tilization of two different ova, and develop their own placental membranes which may fuse to varying degrees. :!,JJ Only monoamniotic twins (including conjoined twins) lack placental membranes separating the two fetuses and are contained within a single amniotic sac. While the absence of a sep· arating membrane by sonography may suggest the

The ghost artifact.

Abstract: A ghost artifact is produced when refraction of an ultrasound beam occurs in one part of a scanning plane. Image duplication or even triplication may result. This may lead to error of diagnosis and measurement. Ghost artifacts are commonly seen in transverse echograms of pelvic organs because the rectus muscle interposed between the transducer and the area of interest is acting as a lens and refracts the ultrasound beam. Three illustrative case reports are presented.

Preoperative ultrasonic measurements of the thickness of cutaneous malignant melanoma.

Abstract: Preoperative measurements of the thicknesses of pigmented skin lesions by high-resolution sonography have been studied. Fourteen nevi and 15 malignant melanomas were examined and their thicknesses compared with those measured on both paraffin and frozen sections. Linear regression coefficients of r2 = 9.22 and r2 = 9.23, respectively, were found. This good correlation suggests that sonography may be of value as a guide in predicting prognosis and in determining the proper course of treatment for patients with malignant melanoma.

A longitudinal study of fetal weight growth.

Abstract: In a longitudinal study of fetal growth, the authors attempted to provide normal values for estimating fetal weights at various gestational ages.

The sonographic appearance of the hemorrhagic ovarian cyst in adolescents

Abstract: Pelvic sonography was performed on ten teenaged girls who were proven by surgery to have hemorrhagic ovarian cysts. Pathologically, four were follicular ovarian cysts, while three were corpus luteal cysts, and the exact nature of three was undetermined. At sonography, these masses had variable appearances, ranging from anechoic to moderately echoic with septa and thick walls. All these features are nonspecific and can be encountered in other adnexal masses. The changing sonographic appearance of the hemorrhagic ovarian cyst due to clot lysis is helpful in establishing the diagnosis, and was demonstrated in two cases. These ten cases are discussed, the varied sonographic appearances are described and a review of pertinent literature is included.

Detection of fetal cardiac activity between 41 and 43 days of gestation.

Abstract: Using a high-resolution real-time arc sector scanner, fetal cardiac activity was detected in ten normal intrauterine pregnancies, including one triplet gestation, between 41 and 43 days of gestation. Fetal heart rates ranged from 96 to 120 beats/min (mean 110) and were detected contiguous with the yolk sac as a tiny blinking, flashing, and/or rocking echo with a regular rhythm. The mean gestational sac fluid diameters ranged from 8 to 16 mm and the crown-rump lengths, when measurable, were less than 4 mm. The demonstration of early fetal cardiac activity in utero reduces parental anxiety and indicates a favorable prognosis in patients with threatened abortion, and virtually excludes the diagnosis of ectopic pregnancy.

Ultrasonic refraction by the rectus abdominis muscles: the double image artifact.

Abstract: Using a real-time mechanical sector scanner in a transverse plane of section, the authors noticed that a double image of an intrauterine gestational sac or an intrauterine contraceptive device can be obtained when the transducer is passed over the midline of the abdomen. It was suggested that this is caused by refraction of the sound passing through the medial edges of both rectus abdominis muscles. The authors were able to reproduce this artifact in vitro using isolated human cadaver rectus muscles and imaging a single object in a water bath.

Antenatal sonographic diagnosis of epignathus.

Abstract: Received September 6, 1983, from the Departments of Obstetrics, Gynecology, and Pediatrics, Yale University School of Medi· cine, 333 Cedar Street, New Haven, Connect' cut 0651 o. Accepted lor publication November 3, 1983. Address correspondence and reprint requests to Dr. Chervenak. tionship to the jaw. 1 Recently, a teratoma originating from the fetal oral cavity was detected at the perinatal ultrasound unit of Yale New Haven Hospital. The purpose of this communication is to describe the sonographic and clinical findings of this case. Obstetrical and neonatal management are discussed.

The in utero findings in twin pentalogy of Cantrell.

Abstract: The antenatal sonographic diagnosis of omphalocele is well documented, 1 but because it has a verv strong association with other congenital anomalie~. the sonographer must be fully aware of these so that an accurate evaluation can be made. !!: A case of identical twins with secundum atrial septal defects, cleft sternums, abse nce ofventral diaphragms, diaphragmatic pericardia] defects, and omphalocele (Cantrell's pentalogy)l forms the basis for this report. To our knowledge Cantrell's pentalogy in twins has never been reported. The antenatal sonagraphic findings, obstetric approach . and postmortem findings are reported and a discussion of the literature is included.

Ultrasonographic diagnosis of schistosomal periportal fibrosis.

Abstract: Hepatosplenic schistosomiasis results from infestation by Schistosoma mansoni, a blood fluke. Presinusoidal periportal fibrosis is invariably the result of this infestation. The ultrasonic pattern of schistosomal periportal fibrosis in 22 patients in whom schistosomal hepatic involvement was proven histologically is described. Echogenic areas of pipestem fibrosis seen as tubular shadows, some containing central lucencies, were present in every case. These tubular shadows conformed to the structure of the portal veins, producing a characteristic appearance. In endemic areas this appearance may be the only clue to the diagnosis of hepatosplenic schistosomiasis, because patients may remain asymptomatic for years after the onset of the disease.

Chronic ectopic pregnancy.

Abstract: A chronic ectopic pregnancy is a form of tubal pregnancy in which there is gradual disintegration of the tubal wall with slow and/or repeated episodes of hemorrhaging leading to the formation of a pelvic mass. A review of 22 pathologically proven cases of this entity revealed the pelvic mass to be a hematocele, or a sealed-off inflammatory mass composed of blood clots, organized hematomas, and surrounding adhesions. Sonographically, the abnormality is manifested by an extrauterine, complex mass in the adnexa(e) and cul-de-sac. The mass may obliterate uterine margins and be confused for pelvic inflammatory disease, endometriosis, or uterine leiomyomas. With an increased awareness of this entity and its mildly symptomatic and protracted clinical course, a preoperative diagnosis should be possible.

The binocular distance: a new way to estimate fetal age.

Abstract: Fetal ocular biometry has been previously established and reported. The purpose of this communication is to report an equation to predict fetal age from the binocular distance. The error of the estimation is also reported. The potential value of this measurement is illustrated in a case of thanatophoric dysplasia.

A comparison of echo-Doppler and electromagnetic renal blood flow measurements.

Abstract: The linearity and accuracy of noninvasive ultrasonic method of measuring beat-to-beat renal blood flow was evaluated by correlation with standard electromagnetic flowmetry. Using a combined real-time ultrasonic imager and pulsed Doppler velocimeter known as a duplex scanner (DS), lumen diameter (D) and average blood velocity (V) within the imaged renal artery were recorded. Renal blood flow ( QDS ) was calculated offline using a microprocessor from the equation QDS = (pi x D2 x V)/4. This noninvasive method had previously been validated in vitro using a controlled hydraulic system which modeled steady-state flow (QT) where QDS = 0.98 QT + 7.75, SEE = +/- 13.2, r = +0.98, P less than 0.001. In three anesthetized dogs, simultaneous QDS and electromagnetic flow ( QEMF ) measurements (range 44-484 ml x min-1) were made in the proximal left renal artery. Linear regression analysis gave QDS = 0.43 QEMF + 40.5, r = 0.78, SEE = 33.8 ml x min-1, P less than 0.01; QDS = 1.2 QEMF + 2.9, r = 0.86, SEE = 20.8 ml x min-1, P less than 0.01; QDS = 0.86 QEMF + 0.2, r = 0.93, SEE = 53.4 ml x min-1, P less than 0.01. These results suggest that noninvasive QDS measurements of renal blood flow are linear and reasonably accurate compared with invasive QEMF in dogs. The method may have utility in the noninvasive measurement of beat-to-beat blood flow in human renal arteries.

Ultrasonic features of fallopian tube carcinoma.

Abstract: With the routine use of sonography in the evaluation of patients with pelvic masses, it is essential to be familiar with the sonographic features of fallopian tube carcinoma so that diagnosis can be made early and thus contribute to prompt management of these patients. The authors present the clinical manifestations, sonographic features, and pathologic correlations in three cases of fallopian tube carcinoma.

Determination of a splenic volumetric index by ultrasonic scanning.

Abstract: In a prospective study carried out to determine spleen size by a rapid and simple ultrasonic method, 45 normal subjects, 20 men and 25 women, average age 54 +/- 17 years (range 17-78) were studied. The three principal dimensions of the spleen, breadth, thickness, and height, were obtained with a compound scan technique; each dimension was measured at its largest point. The values obtained were multiplied by each other and the product arbitrarily divided by 27, which is the cube of the three values. This gave a splenic volumetric index (SVI), which, in 95 per cent of normal subjects, was between 8 and 34. There were no statistically significant differences related to age, sex, or morphotype when endomorphs, ectomorphs, and mesomorphs were examined. This SVI determination, based on standardized measurements, allows the distinction of normal from abnormal spleens in 10 minutes.

Ultrasonic visualization of varicosities in the female genital tract.

Abstract: The characteristic ultrasonic appearance of varicosities in the female genital tract is demonstrated by examinations of three pregnant and four nonpregnant patients. The ease and importance of differentiating this entity from pelvic masses and its role as a cause of painful symptoms are indicated.