The latest medical research on Radiology
The research magnet gathers the latest research from around the web, based on your specialty area. Below you will find a sample of some of the most recent articles from reputable medical journals about radiology gathered by our medical AI research bot.
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Neurodevelopment at age 2 and umbilical artery Doppler in cases of preterm birth after prenatal hypertensive disorder or suspected fetal growth restriction: the EPIPAGE 2 prospective population-based cohort study.Ultrasound in Obstetrics and Gynecology
To investigate the association of absent or reversed end diastolic flow (ARED) in umbilical artery Doppler ultrasound with poor neurological outcome at age 2 after very preterm birth associated with suspected fetal growth restriction (FGR) or maternal hypertensive disorders.
The study population included all very preterm singletons born because of suspected FGR or maternal hypertensive disorders included in EPIPAGE-2, a prospective, nationwide, population-based cohort of preterm births in France in 2011. We analyzed the association of ARED in the umbilical artery with severe or moderate neuromotor or sensory disabilities, and with an Age and Stages Questionnaire (ASQ) score below the threshold at age 2. ASQ is used to identify children at risk of developmental delay needing reinforced follow-up and further evaluation. We performed univariate and two-level multivariable logistic regression analyses.
The analysis included 484 children followed up at 2 years of age for whom prenatal umbilical Doppler ultrasound was available. Among them, 8 (1.5%) had severe or moderate neuromotor or sensory disabilities, and 156 (43.9%) had an ASQ score below the threshold. Compared to normal or reduced end diastolic flow in the umbilical artery (n=305), ARED (n=179) was associated with either severe or moderate neuromotor or sensory disabilities (adjusted OR 11.3, 95% CI 1.4-93.4) but not with an ASQ score below the threshold (adjusted aOR 1.2, 95% CI 0.8-1.9).
Among children born before 32 weeks of gestation because of suspected fetal growth restriction or hypertensive disorder who survived until age 2, prenatal ARED in the umbilical artery was associated with more frequent moderate or severe neuromotor or sensory disabilities. This article is protected by copyright. All rights reserved.
Universal chromosomal microarray analysis reveals high proportion of copy number variants in low risk pregnancies.Ultrasound in Obstetrics and Gynecology
This study's purpose was to evaluate the yield and utility of routine use of Chromosomal Microarray Analysis (CMA) for prenatal genetic diagnosis in a large cohort of pregnancies with normal Ultrasound (US), termed low risk pregnancies, compared to pregnancies with abnormal US findings, termed high risk pregnancies.
We reviewed all prenatal CMA results in our center between November 2013 and December 2018. The prevalence of the different CMA results in the Low Risk Pregnancies was compared with CMA results in the high risk pregnancies. Prevalence of the different CMA results in the groups were stratified according to specific indications for testing. We also searched medical records in order to evaluate subsequent US follow-up and the outcome of pregnancies in the low risk pregnancies with clinically significant abnormal CMA results.
In a cohort of 6431 CMAs performed in low risk pregnancies the prevalence of clinically significant early onset abnormal CMA results was 1.12% (72/6431), significantly lower than the prevalence in high risk pregnancies (4.98%, 66/1326). Some 0.42% (27/6431) of the low risk pregnancies had pathogenic or likely pathogenic Copy Number Variation (CNV) and another 0.7% (45/6431) had a susceptibility locus with more than 10% penetrance. Follow-up of the pregnancies revealed that 32% (23/72) of pregnancies were terminated when there was a clinically significant early onset CNV. In 17% (12/72) of these pregnancies US abnormalities were discovered later on, after genetic testing was performed.
Albeit lower than observed in high risk pregnancies, the background risk of identifying an abnormal clinically significant CMA result in pregnancies at a low a priori risk for these findings is substantial, and should be conveyed to all pregnant women. This article is protected by copyright. All rights reserved.
Fetal Cerebral Vascular Response to Maternal Hyperoxia in Congenital Heart Disease: Effects of Cardiac Physiology.Ultrasound in Obstetrics and Gynecology
Fetal cerebral vascular resistance is influenced by several factors in the setting of intact autoregulation to allow for normal cerebral blood flow and oxygenation. Maternal hyperoxia (MH) testing allows for acute alterations in fetal physiology and can be a tool to test cerebral vascular reactivity in late gestation fetuses. We utilized MH testing to evaluate cerebral vascular reactivity in fetuses with specific congenital heart disease (CHD).
This cross-sectional study compares fetuses with complex CHD to controls without CHD. CHD cases were grouped by physiology: left-sided obstructive lesion (LSOL), right-sided obstructive lesion (RSOL), and d-transposition of the great arteries (d-TGA). Subjects underwent MH testing during the 3rd trimester fetal echocardiogram. The pulsatility index (PI) was calculated for the middle cerebral artery (MCA), umbilical artery (UA) and branch pulmonary artery (PA). Comparisons were made between each CHD group and the control group at baseline and following MH.
60 pregnant women enrolled (CHD, n= 43; Control, n= 17). There were 27 fetuses with LSOL, 7 with RSOL and 9 with d-TGA. Mean gestational age was 33.9 weeks (95% CI: 33.6-34.2). At baseline, the MCA PI Z-score was lowest in the LSOL group (-1.8, 95% CI: -2.4, -1.2) compared with the control group (-0.8, 95% CI: -1.3, 0.3). In response to MH, the MCA PI Z-score increased significantly in the control and d-TGA groups but remained unchanged in the LSOL group and declined in the RSOL group. The change in MCA PI Z-score was significantly higher in the control group than the LSOL group (control= 0.9, 95% CI: 0.42, 1.4; LSOL= 0.12, 95% CI: -0.21, 0.45; p= 0.03). This difference was more pronounced in the LSOL subgroup with retrograde aortic arch flow. In all groups, the PA PI decreased at the same rate with MH and the UA PI was unchanged.
The fetal cerebral vascular response to MH varies based on underlying CHD diagnosis, suggesting that cardiovascular physiology may influence autoregulatory capacities of the fetal brain. Further studies are needed to determine clinical implications of these findings on long-term neurodevelopment in these at-risk children. This article is protected by copyright. All rights reserved.
Clinical utility of expanded noninvasive prenatal screening and chromosomal microarray analysis in high risk pregnancies.Ultrasound in Obstetrics and Gynecology
To evaluate the utility of expanded noninvasive prenatal screening (NIPS) for detection of chromosomal abnormalities in high-risk pregnancies compared with chromosomal microarray analysis (CMA).
This is a multicenter retrospective study of singleton high-risk pregnancies for chromosomal abnormalities. Subjects who underwent expanded NIPS and CMA sequentially during pregnancy from 2015 through 2019 were included in the analysis. The utilities of expanded NIPS and CMA in this cohort were compared.
Of the 943 high-risk pregnancies, 550 (58.3%) cases had positive NIPS results, while positive CMA results were detected in 308 (32.7%) cases. The concordance rates between NIPS and CMA were 82.3%, 59.6% and 25.0% for trisomy 21, 18 and 13, respectively. For rare aneuploidies and segmental imbalances, NIPS and CMA results were concordant in 7.5% and 33.3% of cases. CNVs smaller than 5Mb were more prominently detected by CMA, with an incidence of 6.5% (61/943) compared to that of 2.6% (24/943) by NIPS. Additional genetic aberrations were detected by CMA in 1 of 17 high-risk pregnancies who were given a negative or non-reportable NIPS result.
CMA allows for comprehensive detection of genome-wide chromosomal abnormalities in high-risk pregnancies. Instead of expanded NIPS, CMA should be offered for high-risk pregnancies. This article is protected by copyright. All rights reserved.
Prevalence of negative sliding sign representing pouch of Douglas obliteration during pelvic transvaginal ultrasound for any indication.Ultrasound in Obstetrics and Gynecology
This distorted anatomical state of pouch of Douglas (POD) obliteration can be predicted with a high degree of certainty and reproducibility using the dynamic transvaginal ultrasound (TVS) sliding sign technique. Studies on POD obliteration prediction have always focused on populations in tertiary care centers with high endometriosis prevalence. In addition to patients with symptomatic endometriosis, POD obliteration may exist in individuals with asymptomatic endometriosis or other etiologies such as pelvic inflammatory disease (PID), pelvic tuberculosis, or surgical scarring. For most abdominal or laparoscopic gynecological operations, preoperative awareness of POD obliteration is critical for surgical planning, surgical consent and optimal surgical management by skilled surgeons to optimize outcomes. Our primary aim is to determine the prevalence of a negative sliding sign, representing POD obliteration, in a cohort of patients undergoing TVS for any indication.
We conducted a prospective observational study at a high-volume ultrasound practice (July-August 2018). Clinical and surgical history, indication for TVS, and TVS findings were documented for consecutive women. The prevalence of TVS-confirmed POD obliteration, determined by interpretation of the sliding sign, was calculated for the entire cohort and for subgroups of women with and without "risk factors" for endometriosis. High-risk was defined as either 1) having a TVS referral for "endometriosis-type pelvic pain" or specifically "endometriosis" and/or 2) clinical symptoms or signs suggestive of endometriosis. Low-risk was defined as the absence of these features.
1043 consecutive women underwent TVS. After excluding women who underwent a transabdominal ultrasound, history of hysterectomy, and those with missing data, 909 were analyzed. Prevalence of a negative sliding sign in the entire cohort, low-risk, high-risk and were 47/909 (5.2%), 22/639 (3.4%), and 25/243 (10.3%) (P < 0.001).
We have demonstrated an overall prevalence of a negative sliding sign, suggesting POD obliteration, of 5.2% (or 1/20 women). The prevalence of negative sliding sign in low-risk women is not negligible (3.4% or 1/29 women). These women are most likely to have asymptomatic endometriosis or another important etiology of POD obliteration. The prevalence of a negative sliding sign is approximately 3 times higher in women with signs and/or symptoms of endometriosis (10.3% vs 3.4%). This article is protected by copyright. All rights reserved.
Long-term postnatal outcomes of fetuses with prenatally suspected septo-optic dysplasia.Ultrasound in Obstetrics and Gynecology
Septo-optic dysplasia (SOD) is a clinical syndrome characterized by varying combinations of optic nerve hypoplasia, pituitary gland hypoplasia and abnormal cavum septum pellucidum. It is suspected on prenatal imaging when there is non-visualization or hypoplasia of the septal leaflets. Long-term postnatal outcomes of fetuses with prenatally suspected SOD have been poorly documented. Our aims were to describe the natural history of deficient septal leaflets, to quantify the incidence of postnatally confirmed SOD, and to document the long-term visual, endocrine and neurodevelopmental outcomes of these infants.
An observational retrospective study of all fetuses with prenatal imaging showing isolated septal agenesis, assessed at a single tertiary centre over a 10-year period. Pregnancy, delivery, pre- and postnatal imaging and neonatal outcomes were reviewed for clinical confirmation of SOD. Long-term ophthalmologic, endocrine, developmental and genetic evaluations were assessed.
Of 214 fetuses presenting with septal absence on US and MRI, 18 (8.4%) were classified as suspected isolated septal agenesis concerning for SOD. Uniform prenatal MRI findings of suspected SOD included remnants of the septal leaflets of the cavum, fused forniceal columns, normal olfactory bulbs and tracts and a normal optic chiasm. Twelve fetuses were liveborn and five (27.8%) had postnatally confirmed SOD. Only two of these five had additional prenatal imaging features (pituitary cyst, microphthalmia and optic nerve hypoplasia) supporting a diagnosis of SOD. The other three confirmed SOD cases had no predictive prenatal or postnatal imaging findings which reliably differentiated between infants with and without confirmed SOD. At a median follow-up of 2.5 (2.5,7) years, visual and endocrine impairment were present in two (40%) and four (80%) cases, respectively. In those with visual and or endocrine impairment, developmental delay was common (80%) and mostly severe. Neonates with isolated septal agenesis and lack of visual or endocrine abnormalities to confirm SOD had normal development.
Only a quarter of individuals with isolated septal agenesis suggestive of SOD will have postnatal confirmation of the diagnosis. Clinical manifestations of SOD are variable, but neurodevelopmental delay may be more prevalent than formerly thought. This article is protected by copyright. All rights reserved.
Non-immune fetal hydrops: etiology and outcomes according to gestational age at diagnosis.Ultrasound in Obstetrics and Gynecology
Fetal hydrops is associated with increased perinatal mortality and morbidity. The etiology and outcomes of fetal hydrops may differ according to the gestational age (GA) at diagnosis. The aim of this study was to evaluate the causes, evolution and outcomes of non-immune fetal hydrops (NIFH) according to the GA at diagnosis.
This was a retrospective cohort study of all singleton pregnancies complicated by NIFH at the Fetal Medicine Unit at St George's University Hospital, London between 2000 and 2018. All fetuses had a detailed anomaly and cardiac ultrasound scans, karyotyping and infection screening. Prenatal diagnostic and therapeutic interventions, GA at diagnosis and delivery, as well as pregnancy outcomes were recorded. Regression analysis was used to test for potential association between possible risk factors and perinatal mortality.
We included 273 fetuses with NIFH. Etiologies varied significantly in the three trimesters. Excluding women declining invasive testing (n=30), the cause of NIFH was defined as "unknown" in 62 out of 243 cases (25.5%). Chromosomal aneuploidy was the commonest cause in the first trimester. It continued to be a significant etiologic factor in the second trimester along with congenital infections. In the third trimester, the most common etiology was cardiovascular abnormalities. Among the 152 (55.7%) women continuing the pregnancy, 48 (31.6%) had fetal intervention, including the insertion of pleuro-amniotic shunts, fetal blood transfusion and thoracocentesis. Fetal intervention was significantly associated with lower perinatal mortality (OR 0.30, 95% CI 0.14-0.61, p<0.001); this was confirmed also after excluding cases with a diagnosis of anemia or infections (OR 0.29, 95% CI 0.13-0.66, p=0.003). In fetuses not undergoing active fetal intervention (n=104), the GA at diagnosis was the only parameter which was significantly associated with the risk of perinatal mortality (OR=0.92, 95%CI: 0.85 to 0.99, p=0.035), while the body cavity involved and polyhydramnios were not (p >0.05).
Earlier GA at diagnosis was associated with an increased risk of aneuploidy and worse pregnancy outcomes, including higher risk of perinatal loss. Fetal therapy was significantly associated with lower perinatal mortality. This article is protected by copyright. All rights reserved.
Fetal cerebellar growth and Sylvian fissure maturation: International standards from the Fetal Growth Longitudinal Study of the INTERGROWTH-21st Project.Ultrasound in Obstetrics and Gynecology
To construct international ultrasound-based standards for cerebellar growth and Sylvian fissure maturation.
Healthy, well-nourished pregnant women, enrolled at <14 weeks of gestation in the Fetal Growth Longitudinal Study (FGLS) of INTERGROWTH-21st , an international multicenter, population-based project, underwent 3D serial fetal ultrasound scans every 5±1 weeks until delivery in study sites located in Brazil, India, Italy, Kenya and the UK. We measured the trans-cerebellar diameter and assessed Sylvian fissure maturation using 2D images extracted from the available 3D fetal head volumes acquired. For each Sylvian fissure maturation score (left and right), we calculated the mean gestational age and 95% CI. We assessed goodness of fit of the resultant model and the possibility of pooling data from the five sites using variance component analysis and standardized site differences. We modelled trans-cerebellar diameter and Sylvian fissure maturation using fractional polynomial regression and fitted centiles.
Of those children in the original FGLS cohort who had a developmental assessment at 2 years of age, 1,130 also had an available 3D fetal head volume. The socio-demographic characteristics and pregnancy/perinatal outcomes of the study sample confirmed the health and low-risk status of the population studied. In total, 3,016 and 2,359 individual volumes were available for trans-cerebellar diameter and Sylvian fissure analysis, respectively. Variance component analysis and standardized site differences showed that the five study populations were sufficiently similar on the basis of predefined criteria for the data to be pooled to produce international standards. A second-degree fractional polynomial provided the best fit for modelling trans-cerebellar diameter; we then estimated gestational age-specific 3rd , 50th and 97th smoothed centiles. Goodness of fit comparing empirical centiles to smoothed centile curves showed good agreement. The Sylvian fissure increased in maturation with advancing gestation with complete overlap of the mean gestational age and 95% CI between the sexes for each development score. No differences in maturation between the right and left hemispheres were observed.
We present here, for the first time, international standards for fetal cerebellar growth and Sylvian fissure maturation throughout pregnancy based on a healthy fetal population that exhibited adequate growth and development at 2 years of age. This article is protected by copyright. All rights reserved.
Early prenatal diagnosis of Scimitar syndrome.Ultrasound in Obstetrics and Gynecology
Scimitar venous anomaly is a rare congenital vascular anomaly characterized by partial or complete anomalous venous return and extra cardiac findin...
Redundancy of the foramen ovale flap may mimic aortic coarctation in the fetus.Ultrasound in Obstetrics and Gynecology
Aim of this study is to assess the relationships between a redundant foramen ovale flap (RFOF) - in the absence of a clearly restrictive foramen ovale - and ventricular disproportion in three group of foetuses: 1) foetuses with a final diagnosis of aortic coarctation (CoA); 2) foetuses referred for a suspicion of ventricular disproportion and/or CoA who did not develop CoA postnatally; 3) normal foetuses.
This is a retrospective study including 73 fetuses, allotted to three groups: 1) foetuses with a final diagnosis of isolated CoA (12 cases); 2) foetuses referred for a suspicion of ventricular disproportion and/or CoA who did not develop CoA postnatally (30 cases); 3) normal foetuses (31 cases). Four-dimensional volume datasets and clips were assessed offline. Diameters of the flap valve, left and right atrium, left and right ventricle and, where available, aortic isthmus and arterial duct were measured; areas of the flap valve, left and right atria and ventricles were measured, too. The left/right ratios for all segments of the heart as well as the ratio between flap diameter / left atrium diameter (FOFD/LAD ratio) and flap area / left atrium area were calculated. Regression analysis was performed to assess the relationships between FOF redundancy and ventricular disproportion. Means were compared with the ANOVA test.
Repeatability was fair, with all variables showing an ICC > 83%. In the pooled group of of normals or ventricular disproportion (61 cases), there was a linear correlation between prominence of the FOF and degree of ventricular disproportion (p < 0.01 and p < 0.05 for diameters' and areas' ratios, respectively). Categorising the FOF prominence, cases with FOFd/LAd ratio ≥ 0.65 were highly associated with ventricular disproportion (p = 0.006) Based on the degree of FOF prominence, 4 categories were described, ranging from no prominence/no ventricular disproportion (Stage 0) to severe prominence/ventricular disproportion + transient obstruction of the foramen ovale or mitral orifice. Then, comparing cases with FOFd/LAd ratio ≥ 0.65 vs those with neonatal evidence of coarctation, there was no statistically significant difference in degree of ventricular disproportion nor in the z-score of the aortic isthmus.
This study demonstrates that: 1) there is an association between RFOF and ventricular disproportion, independently of the association with a restrictive foramen ovale, and 2) the presence of a RFOF may fully simulate CoA. In fact, it determines both ventricular disproportion and a significant reduction in the diameter of the aortic isthmus, associated in some cases also with reverse isthmic flow. Future prospective studies are needed to evaluate whether focusing the sonologist's attention on the aspect of the FOV may reduce the rate of false positive diagnoses for CoA. This article is protected by copyright. All rights reserved.
How comparable is the clinical grading of obstetric anal sphincter injury with that determined by four-dimensional translabial ultrasound?Ultrasound in Obstetrics and Gynecology
To evaluate the agreement between grading of obstetric anal sphincter injuries (OASI) on translabial ultrasound (TLUS), using a newly developed algorithm and on examination, using the current clinical classification. A secondary aim was to assess correlation of tear severity, as defined on ultrasound, with symptoms of anal incontinence and/or fecal urgency.
A retrospective study on 260 patients seen at a perineal clinic between 2012 and 2018 after recent primary repair of OASI. All patients underwent a standardized interview including the St. Mark's anal incontinence score (SMIS) and four-dimensional (4D) TLUS. Post processing of ultrasound volume data was performed blinded against all other data. Using tomographic ultrasound imaging (TUI) a set of eight slices was obtained and the central six slices were evaluated for sphincter abnormalities. Slices with distortion, thinning or defects were rated abnormal. The following algorithm was used to grade OASI: 3a tear was diagnosed if <4/6 slices were abnormal at the external anal sphincter (EAS), 3b if EAS was abnormal in ≥4/6 slices and 3c/4th grade tears if both EAS and internal anal sphincter (IAS) were abnormal in ≥4/6 slices. Clinical grading of OASI was determined as per the Royal College of Obstetricians and Gynecologists (RCOG) guideline. Agreement between clinical and TLUS diagnosis of OASI was evaluated by weighted kappa.
Forty-five patients (17%) were excluded due to missing data or a repeated OASI, leaving 215 complete datasets for analysis. The average follow up interval was 2.4 months (range 1-11) after OASI and the mean age was 29 years (range 17-42). One hundred and seventy five (81%) were vaginally primiparous. OASI were graded clinically as 3a in 87 women, 3b in 80, 3c in 29 and 4 in 19. On imaging, full agreement between clinical and TLUS grading was noted in 107 (49.7%) with a weighted kappa of 0.398, in 96 there was disagreement by one category (44.6%) with a weighted kappa of 0.74, and in 12 (5.6%) there was disagreement by two categories. Twenty-four women (11%) were found to have a normal sphincter on imaging. Overall, potential clinical over-diagnosis was noted in 72 women (33%) and potential under-diagnosis In 36 (17%). Seniority of the diagnosing obstetrician did not significantly alter agreement between clinical and sonographic OASI grading (kappa 0.44, 0.43, and 0.34, for specialists, senior and junior residents, respectively). The association between symptoms of anal incontinence and/or fecal urgency and TLUS grading did not quite reach significance (P= 0.052).
Clinical and TLUS-based grading of OASI showed fair agreement. Clinical over-diagnosis may be increasingly common in our population, although under- diagnosis may still occur in a significant minority. This article is protected by copyright. All rights reserved.
Diagnostic accuracy of postmortem ultrasound vs 1.5T postmortem MRI for non-invasive perinatal autopsies.Ultrasound in Obstetrics and Gynecology
Non-invasive perinatal autopsies using imaging techniques have high parental acceptance, but limited access to post-mortem MRI (PMMR) has lead to alternative methods such as post-mortem ultrasound (PMUS) being investigated. The aim of this study was to determine the accuracy rate of both modalities in the same patient cohort, and determine whether PMUS could provide the same information as PMMR.
In this prospective, 5 year (2014 - 2019) single centre study, we performed 1.5 PMMR and PMUS in an unselected cohort of perinatal deaths. For the primary objective, the diagnostic accuracy rates for both modalities were calculated, using autopsy as reference standard. As a secondary objective, the concordance rates for five anatomical regions (brain, spine, thorax, heart and abdomen) and overall main diagnosis were calculated for both modalities.
136 cases underwent both PMUS and PMMR, of which 88 (64.7%) underwent autopsy. There was no significant difference in concordance rates for overall diagnosis compared to autopsy (PMUS 86.4% (95% CI: 77.7, 92.0) vs PMMR 88.6% (80.3, 93.7)) or for sensitivity and specificity rates for individual anatomical regions. There were more non-diagnostic PMUS examinations for the brain (22.8% vs 3.7%) and heart (14.7% vs 5.1%) than PMMR. If an 'imaging only' autopsy were to be performed, then PMUS would achieve the same diagnosis as 1.5T PMMR for 86.8% (80.0, 91.5%) cases, with the highest rates of agreement for spine (99.3%; 95.9 - 99.9%) and cardiac findings (97.3%; 92.4 - 99.1%), and lowest for brain diagnoses (85.2%; 76.9 - 90.8%).
Although there are fewer non-diagnostic cases using PMMR, a high concordance rate for overall diagnosis suggests that PMUS could be used for triaging cases where PMMR access is limited or unavailable. This article is protected by copyright. All rights reserved.