Faculty Bibliography

In the past decade, three-dimensional (3D) sonographic technology has matured from a static imaging modality to near-real-time imaging. One of the more notable improvements in this technology has been the speed with which the imaged volume is acquired and displayed. This has enabled the birth of the near-real-time or four-dimensional (4D) sonographic concept. Using the 4D feature of the current 3D sonography machines allows us to follow moving structures, such as fetal motion, in almost real time. Shortly after the emergence of 3D and 4D technology as a clinical imaging tool, its use in guiding needles into structures was explored by other investigators. We present a case in which we used the 4D feature of our sonographic equipment to follow the course and motion of an instrument inserted into the uterus to occlude the umbilical cord of a fetus in a case of twin-twin transfusion syndrome

BACKGROUND: Omphalocele-exstrophy-imperforate anus-spinal defects (OEIS) complex is a rare sporadic condition. CASE: We identified an infant with major malformations resembling OEIS. He was the product of a 30-week triplet pregnancy conceived by in vitro fertilization (IVF) and evaluated by chorionic villi sampling (CVS). In this article, we review the possible pathogenetic mechanisms in this case, including IVF, multiple gestation, trauma to the uterus or uterine vessels following CVS, and placenta accreta. CONCLUSIONS: We conclude that the cumulative effects of all or some of these factors may have resulted in uteroplacental insufficiency adequate to produce this phenotype. This case provides additional evidence for the uterine vascular pathogenesis of OEIS complex in humans

OBJECTIVE: In scanning the female pelvis the clear images of transvaginal sonography (TVS) result from placing the transducer close to the region of interest. The advantages of TVS over transabdominal sonography (TAS) and transperineal sonography are well documented. Transrectal scanning is proposed mostly for ultrasound guidance in draining a pelvic abscess. Our aim was to investigate the applicability of transrectal scanning (TRS) for cases in which TVS is impossible. METHODS: Forty-two patients with an absolute or a relative contraindication to TVS were scanned transabdominally and transrectally. The TRS was performed using a transvaginal probe, which was lubricated and slowly advanced into the rectum. The technique used was similar to that of TVS. Images were compared for resolution and quality. RESULTS: All scans were completed without significant patient discomfort or complaints. TRS was clearly superior to TAS in 31 cases. In nine cases TAS furnished some clinical information but TRS yielded better images. Only in one such case was TAS similar in quality to TRS. In four obese patients TAS did not reveal sufficient pelvic anatomy to generate a clinical diagnosis, whereas TRS revealed two sets of normal ovaries and two patients with ovarian cysts. In the two cases with vaginal agenesis TRS revealed the diagnosis of Rokitansky-Kuster syndrome. In three of the four patients with ruptured membranes the cervix could be measured precisely. CONCLUSION: Transrectal scanning should be used liberally after proper patient selection and counseling. The images obtained are superior to TAS and comparable to those obtained by TVS

PURPOSE OF REVIEW: The aim of this review article is to familiarize the reader with the current developments dealing with ultrasound during the first trimester of pregnancy. RECENT FINDINGS: The main emphasis of this article is to review the anatomy seen during the first trimester and to bring to the reader the fact that the first anatomical survey of the fetus does not have to wait until the 18th to 20th week of gestation. The fetus can be surveyed adequately as early as the 12th week of gestation and ideally between the 13th and 14th weeks. Of course, not all malformations will be detected during the first trimester, and a follow-up scan between 20 and 23 weeks is indicated. SUMMARY: The ongoing improvements in ultrasound technology allow us to see more details of the embryo or fetus at earlier gestational ages than ever before. This is resulting in a rethinking of when the first anatomical survey should be performed

PURPOSE OF REVIEW: Three-dimensional (3D) ultrasound is a natural development of the imaging technology. Fast computers are essential to enable 3D and four-dimensional (4D) ultrasound pictures. A short review of the technical points and clinical aspects is presented. Our purpose is to acquaint the reader with the possibilities of this new technology and to increase awareness of its present clinical usefulness. A short review of technical information is provided. RECENT FINDINGS: The advantages of 3D and 4D ultrasound in certain areas are unequivocal. Its use in the workup of fetal anomalies involving the face, limbs, thorax, spine and the central nervous system are already applied by most centers. The use of this technology in applying color Doppler, in guiding needles for different puncture procedures as well in evaluating the fetal heart are under close research scrutiny. The bonding effect between the parents and their future offspring is becoming evident as 3D ultrasound is used. Consulting specialists understand fetal pathology better and can better plan postnatal interventions. 4D or real time 3D ultrasound was developed and is expected to achieve new meaning with the planned introduction of electronic transducer multilinear arrays. SUMMARY: 3D ultrasound is an extremely promising imaging tool to image the fetus. In spite of the scant outcome studies the potential of 3D ultrasound is understood by a large number of obstetricians, maternal fetal specialists and imaging specialists

OBJECTIVE: To describe the sonographic findings of sirenomelia during the first trimester on both two-dimensional sonography with color Doppler imaging and three-dimensional sonography. METHODS: Two cases of sirenomelia in primiparous patients with histories of infertility are described. The diagnosis was made on the basis of two-dimensional sonography, and three-dimensional sonography was used to further characterize the findings. RESULTS: Both fetuses had size-date discrepancies, increased nuchal translucency, large intra-abdominal vessels, and 2-vessel umbilical cords. Both pregnancies were terminated by dilation and curettage after the patients viewed the three-dimensional pictures of the fetuses. CONCLUSIONS: During the first trimester of pregnancy, rare and lethal anomalies can be diagnosed with a high degree of confidence if a thorough, age-dependent anatomic survey of the fetus is performed

This promising new technology is already taking 3D ultrasound one step further into 'almost' real time. Once real-time 3D or 4D U/S is perfected, it will help clinicians study fetal behavior, take a closer look at fetal anomalies, perform 4D biopsies, and more

OBJECTIVE: Endometrial polyps are relatively common in all groups of women. More polyps are being diagnosed with the widespread use of transvaginal ultrasound scanning and sonohysterography. The reported incidence of malignancy is low. The potential benefit of a noninvasive technique to distinguish benign from malignant polyps is obvious. This study was undertaken to evaluate endometrial polyps by color flow Doppler ultrasound scanning and histopathologic examination. STUDY DESIGN: This was an observational study of patients with an endometrial polyp on sonohysterography who underwent interrogation of their polyp with color Doppler ultrasound scanning and subsequently polypectomy. Polyp volume, resistive index, pulsatility index, indication for scan (bleeding vs incidental), and patient age were correlated with histopathologic type of the polyp (nonfunctional, proliferative, secretory, hyperplastic, or malignant). RESULTS: Of 61 patients studied, 42 patients (68.9%) were scanned for abnormal bleeding, and 19 patients (31.1%) had their polyps discovered incidentally. There were no statistically significant differences between histologic categories and the resistive index, pulsatility index, or size of the polyp. The age of patients with nonfunctional polyps was significantly greater than any other group (P <.001). Ninety-four percent of the functional polyps were discovered because of abnormal bleeding; 38% of the nonfunctional polyps were discovered incidentally (P <.001). CONCLUSION: The data suggest that the objective assessment of blood flow impedance (resistive index, pulsatility index) in endometrial polyps and the size of these polyps cannot replace surgical removal and pathologic evaluation to predict histologic type. Patients with nonfunctional polyps were older and less likely to have vaginal bleeding