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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Prediction of large for gestational age neonates by routine third trimester ultrasound.Ultrasound in Obstetrics and Gynecology
First, to evaluate and compare the performance of routine ultrasonographic estimated fetal weight (EFW) and fetal abdominal circumference (AC) at 31+0 - 33+6 and 35+0 - 36+6 weeks' gestation in the prediction of large for gestational age (LGA) neonates born at ≥37 weeks' gestation. Second, to assess the additive value of fetal growth velocity between 32 and 36 weeks' gestation on the performance of EFW at 35+0 - 36+6 weeks' gestation for prediction of LGA neonates. Third, to define the predictive performance for LGA neonates of different EFW cut-offs at routine ultrasound examination at 35+0 - 36+6 weeks' gestation. Fourth, to propose a two-stage strategy for identifying pregnancies with LGA fetuses that may benefit from iatrogenic delivery during the 38th gestational week.
This was a retrospective study. First, data from 21,989 singleton pregnancies that had undergone routine ultrasound examination at 31+0 - 33+6 weeks' gestation and 45,847 that had undergone routine ultrasound examination at 35+0 - 36+6 weeks were used to compare the predictive performance of EFW and AC for LGA neonates with birthweight >90th and >97th percentiles born at ≥37 weeks' gestation. Second, data from 14,497 singleton pregnancies that had undergone routine ultrasound examination at 35+0 - 36+6 weeks' gestation and had a previous scan at 30+0 - 34+6 weeks were used to determine, through multivariable logistic regression analysis, whether addition of growth velocity, defined by a difference in EFW and AC Z-scores between the early and late third trimester scans divided by the time interval between them, improved the performance of EFW at 35+0 - 36+6 weeks in the prediction of delivery of LGA neonates born at ≥37 weeks' gestation. Third, in the database of the 45,847 pregnancies that had undergone routine ultrasound examination at 35+0 - 36+6 weeks' gestation the screen positive and detection rate of LGA neonates born at ≥37 weeks' gestation and at ≤10 days from the initial scan were calculated for different EFW percentile cut-offs between the 50th and 90th percentile.
First, the areas under the receiver operating characteristic curves (AUROC) of screening for LGA neonates were significantly higher with EFW Z-score than AC Z-score and at 35+0 - 36+6 than at 31+0 - 33+6 weeks' gestation (p<0.001). Second, the performance of screening for LGA neonates achieved by EFW Z-score at 35+0 - 36+6 weeks was not significantly improved by addition of EFW growth velocity or AC growth velocity. Third, in screening by EFW >90th percentile at 35+0 - 36+6 weeks' gestation the predictive performance for LGA neonates born at ≥37 weeks' gestation was modest (65% and 46% for neonates with birthweight >97th and >90th percentiles, respectively, at screen positive rate of 10%), but the performance was better for prediction of LGA neonates born at ≤10 days from the scan (84% and 71% for neonates with birthweight >97th and >90th percentiles, respectively, at screen positive rate of 11%). Fourth, screening by EFW >70th percentile at 35+0 - 36+6 weeks' gestation predicted 91% and 82% of LGA neonates with birthweight >97th and >90th percentiles born at ≥37 weeks' gestation, at screen positive rate of 32%, and the respective values of screening by EFW >85th percentile for prediction of LGA neonates born at ≤10 days from the scan were 88%, 81% and 15%. On the basis of these results it was proposed that routine fetal biometry at 36 weeks' gestation is a screening rather than diagnostic test for fetal macrosomia and that EFW >70th percentile should be used to identify pregnancies in need for another scan at 38 weeks and in the latter those with EFW >85th percentile should be considered for iatrogenic delivery during the 38th week.
First, the predictive performance for LGA neonates by routine ultrasonographic examination during the third trimester is higher if the scan is carried out at 36 than at 32 weeks, the method of screening is EFW than fetal AC, the outcome measure is birthweight >97th than >90th percentile and if delivery occurs within 10 days than at any stage after assessment. Second, prediction of LGA neonates by EFW >90th percentile is modest and the study presents a two-stage strategy for maximizing the prenatal prediction of LGA neonates. This article is protected by copyright. All rights reserved.
Learning curve for detection of the distal part of ureters by transvaginal sonography (TVS): a feasibility study.Ultrasound in Obstetrics and Gynecology
To investigate how many examinations it takes to be able to identify the distal part of normal ureters on transvaginal sonography (TVS).
Prospective study including women consecutively attending a gynecological outpatient clinic in a tertiary referral setting. Three trainees (T1, T2, T3) with a focus on gynecological surgery and TVS but with no experience with identifying ureters observed ten routine TVS examinations including identification of both ureters by an expert examiner (EA). All women underwent a standardized gynecological TVS with visualization of the pelvic part of both ureters by the EA. Afterwards, one of the three trainees who did not take part in the initial examination attempted to identify both ureters. A time limit was set to 150 seconds for successful identification of each ureter to be a feasible part of routine gynecological TVS in a tertiary referral setting. A successful examination was defined by identifying both ureters within the time limit. The level of efficacy for ureteral scanning was evaluated by the LC-CUSUM score.
From January 2017 until June 2017 a total of 140 women were included in the study leaving 135 patients for final analysis. T1, T2, T3 were able to identify the right ureter after 48 TVS examinations with an inter-trainee variability of 34-48 examinations, and the left ureter after 50 TVS examinations with and inter-trainee variability of 27-50 examinations.
Sonographers and/or gynecologists who are familiar with gynecological TVS should be able to become proficient in identifying both ureters after 48-50 TVS examinations. Detection of ureters is a feasible part of the TVS workup of patients attending a tertiary referral center clinic. This article is protected by copyright. All rights reserved.
Clinical impact of Doppler reference charts to manage fetal growth restriction: need for standardization.Ultrasound in Obstetrics and Gynecology
To assess clinical variability in the management of fetal growth restriction according to published Doppler reference values for the umbilical artery (UA), middle cerebral artery (MCA) and cerebroplacental ratio (CPR).
We performed a systematic search of MEDLINE, EMBASE, CINAHL, and the Web of Science databases between the years 1954 and 2018, and selected studies with the sole aim of creating fetal Doppler reference values for the UA, MCA and CPR. Variations between clinically relevant pulsatility index (PI) cut-off values were assessed. Simulation analysis was performed on a cohort of small-for-gestational-age (SGA) fetuses (n=617) to evaluate the impact of this variability on clinical management.
The 10 most cited articles for each index (UA-PI, MCA-PI and CPR) from a total of 40 studies that met the inclusion criteria were analyzed. Wide discrepancies in reported Doppler reference values were found. MCA-PI showed the greatest variability in clinically relevant cut-off values (MCA-PI<5th ) of up to 51% at term. However, the differences between the UA-PI (UA-PI>95th ) and CPR (CPR <5th centile) cut-off values at each gestational age were from 20-40% and 15-35%, respectively. As expected by a simulation analysis, these differences showed great variability in the clinical management of SGA fetuses despite using the same protocol.
Selection of Doppler reference values can result in significant variability in the clinical management of intrauterine growth-restricted fetuses that may lead to suboptimal outcomes and inaccurate research conclusions. Therefore, an attempt to standardize fetal Doppler reference ranges is mandatory. This article is protected by copyright. All rights reserved.
Sextuple rings of nuchal cord by breech presentation: a warning sign.Ultrasound in Obstetrics and Gynecology
A 30-year primigravida presented at 35 weeks and 5 days gestation with persistent breech for external cephalic version (ECV). Systematic ultrasound...
Interobserver variability in MRI assessment of the severity of placenta accreta spectrum disorders.Ultrasound in Obstetrics and Gynecology
To evaluate the level of agreement in the prenatal magnetic resonance imaging (MRI) assessment of the severity of placenta accreta spectrum (PAS) disorders in centers with high expertise in their diagnosis and management.
The MRI scans of women at risk of PAS were retrieved from the hospital electronic database and assessed by four different experts who were blinded to the final diagnosis. Each examiner was asked to judge the MRI scans according to the presence, depth and topography of placental invasion. The depth of invasion was defined as the degree of adhesion and invasion of the placenta through the myometrium and uterine serosa at the histopathological examination of the removed uterus (accreta, increta and percreta), while topography as the site of placental invasion within the uterus. The degree of inter-rater agreement (IRA) in calculating both the percentage of observed agreement among raters and the Fleiss kappa were used to analyze the data.
Forty-six women were included in the study. There was an excellent agreement among the four different examiners in the assessment of the overall presence of PAS disorders (IRA: 92.1, 95% CI 86.8-94.0; K: 0.90, 95% CI 0.89-1). However, there was significant heterogeneity in the agreement among the different examiners when assessing the different MRI signs suggestive of PAS. There was also an excellent agreement in the identification of the depth (IRA: 98.9, 95% CI 96.8-100; K: 0.95, 95% CI 0.89-1.0) of PAS disorders. Conversely, the agreement in assessing the topography of placental invasion was only moderate (IRA: 72.8, 95% CI 72.7-72.9; K: 0.56, 95% CI 0.54-0.66). More importantly, when assessing parametrial invasion, which is one of the most significant prognostic factors in women affected by PAS, the agreement was moderate in judging the presence of invasion on coronal (IRA: 86.6%. 95% CI 86.5-86.7, K-: 0.69, 95% CI 0.59-0.71) and axial (IRA: 78.6, 95% CI 78.5-78.7, K: 0.56, 95% CI 0.33-0.60) planes. Likewise, the agreement in judging the presence and the number of newly formed vessels in the parametrial tissue was moderate (IRA: 88.0, 95% CI 88.0-88.1, K: 0.59, 95% CI 0.45-0.68) and weak (IRA: 66.7, 95% CI 66.6-66.7, K: 0.22, 95% CI 0.12-0.37), respectively.
MRI has excellent inter-observer variability in detecting the presence and depth of placental invasion, while the agreement in describing the topography of invasion is less. The findings from this study highlight the need for a standardized MRI staging system of PAS disorders, in order to facilitate objective correlation between prenatal imaging, pregnancy outcomes and surgical management. This article is protected by copyright. All rights reserved.
Ultrasound morphometric and cytologic preoperative assessment of inguinal lymph node status in women with vulvar cancer: the MorphoNode study.Ultrasound in Obstetrics and Gynecology
To assess the accuracy of the ultrasound examination in the prediction of lymph node status (LN) in vulvar cancer patients.
This is a single institution retrospective observational study, conducted between December 2010 to January 2016. All women with a histological diagnosis of vulvar cancer triaged to inguinal surgery within 30 days from an ultrasound evaluation were included in the study. For each groin, 15 morphological and dimensional sonographic parameters of suspicion for lymph node involvement were examined. A Morphometric Ultrasound Pattern was expressed classifying the inguinal LN status in five groups, according to subjective judgment and then stratified in a positive/negative binomial judgment (MBA). In cases of positive MBA, a cytology was performed. Combining the information obtained from Morphometric Ultrasound Pattern and cytological results, a binomial Final Overall Assessment (FOA) was assigned for each groin. The final histology was considered as the reference standard. Patients with negative LNs and those with positive LNs, at histology, were compared and receiver-operating characteristics (ROC) curves were generated for statistically significant variables on univariate analysis to evaluate their diagnostic ability to predict negative LN status.
144 patients were included: 87 of them had negative inguinal LNs at histology and 57 had positive LNs. A total of 256 groins were analyzed: at histology 171 were negative and 85 showed at least one metastatic LN. The following parameters showed the best accuracy, with the best balance between specificity and sensitivity: cortex thickness of the dominant lymph node (cut-off = 2.5 mm) (sensitivity 90.0% and specificity 77.9%), the short axis (cut-off = 8.4 mm) (sensitivity 63.9% and specificity 90.6%), the Cortex/Medulla ratio (cut-off = 1.2 mm) (sensitivity 70.4% and specificity 91.5%), the combination of Short axis and Cortex/Medulla ratio (sensitivity 88.9% and specificity 82.4%), and the FOA analysis (sensitivity 85.9% and specificity of 84.2%).
Our results demonstrate that preoperative ultrasound with or without the combination of cytology have a high accuracy in assessing inguinal LNs in patients with vulvar cancer. In particular, the combination of two ultrasound parameters (Short axis and Cortex/Medulla ratio) provided the highest accuracy in discriminating negative and positive lymph nodes. This article is protected by copyright. All rights reserved.
Intra- and interrater reliability and agreement analysis for ultrasound measurements of pelvic floor muscle contraction: a cross-sectional study of primigravida and women with prolapse and incontinence.Ultrasound in Obstetrics and Gynecology
To determine the intra- and interrater reliability and agreement for ultrasound measures of pelvic floor contraction and to study any correlation between ultrasound and vaginal palpation for measurement of pelvic floor muscle contraction. We also aimed to develop an ultrasound scale for assessment of pelvic floor contraction.
We examined pelvic floor muscle contraction in 195 women scheduled for stress urinary incontinence surgery (n=65), prolapse surgery (n=65), and primigravida (n=65) with vaginal palpation (Modified Oxford Scale (MOS)) and two- and three-dimensional (2D/3D) transperineal ultrasound. Proportional change from rest to contraction in 2D and 3D levator hiatal anteroposterior (AP) diameter and 3D levator hiatal area were used as measures of contraction. One rater repeated all ultrasound measurements for intrarater reliability and agreement analysis, and three independent raters analysed 60 ultrasound volumes for interrater reliability and agreement using interclass correlation analysis (ICC). We identified the proportion of women with major levator ani injury using tomographic ultrasound. We used Spearman's rank (rs ) to correlate ultrasound measurements with palpation. The proportion of women allocated to each category (absent, weak, moderate, strong) by palpation was used to determine the cut-offs for the ultrasound scale.
Intrarater ICC was: 0.81 (95% CI 0.74, 0.85) for 2D AP diameter. Interrater ICC was 0.82 (95% CI 0.72-0.89) for 2D-AP diameter, 0.80 (95% CI 0.69-0.88) for 3D AP diameter and 0.72 (95% CI 0.56-0.83) for hiatal area. The prevalence of major levator injury was 22.6%. Correlation to MOS was rs = 0.52 for 2D AP diameter, rs = 0.62 for 3D AP diameter and rs = 0.47 for hiatal area, all p<0.001. The ultrasound contraction scale for proportional change in 2D AP diameter was <1%= absent, 2-14%= weak, 15-29%= normal and >30%= strong contraction.
Ultrasound seems to be an objective and reliable method for evaluation of pelvic floor muscle contraction. Proportional change in levator hiatal 2D AP diameter had the highest ICC and moderate correlation with vaginal palpation, and we constructed an ultrasound scale for assessment of pelvic floor muscle contraction based on this measure. This article is protected by copyright. All rights reserved.
Rare autosomal trisomies (RATs): a comparison of the detection through cell-free DNA and chorionic villus sampling.Ultrasound in Obstetrics and Gynecology
Direct chromosome preparations of chorionic villus samples (CVS) and cell-free (cf) DNA testing both involve analysis of the trophoblastic cell lineage. We compared the spectrum of rare autosomal trisomies (RATs) detected by these two approaches and assessed the available information on their clinical significance.
Data from 10 reports on genome-wide cfDNA testing were pooled to determine which chromosomes were most frequently involved and pregnancy outcome information was reviewed. CVS information was drawn from an updated database of 76,102 consecutive CVS analyses where trophoblastic and mesenchymal layers were analyzed and amniotic fluid (AF) cell analysis was recommended for RAT-positive cases. Chromosomes involved, confined placental mosaicism, true fetal mosaicism, and uniparental disomy (UPD) for imprinted chromosomes was assessed. RAT involvement was also compared to those present in spontaneous abortions.
RATs were present in 634 of 196,662 (0.32%) cfDNA samples and 237 of 57,539 (0.41% CVS trophoblast samples (P<0.01). Rates for cfDNA varied over 8-fold between reports. Confirmation of abnormality through amniocentesis was more likely when RATs were ascertained through cfDNA (15 of 237, 9.8%) compared to CVS trophoblasts (7 of 237, 3%) (P<0.01). cfDNA ascertained cases contained proportionately more trisomy 16, 15 and 22 which are associated with fetal loss. Of 153 cf-DNA RAT cases with outcome information, 41.2% were normal livebirths, 26.8% were fetal losses, 7.2% had phenotypic abnormality detected through ultrasound or other follow-up evaluation, 2.0% with a clinically significant UPD and 21% with fetal growth restriction/low birth weight.
Although there are strong parallels between RATs ascertained through these two methods, caution is needed in applying conclusions from CVS analysis to cfDNA testing, and vice versa. RATs identified through genome-wide cf-DNA tests have uncertain risks for fetal loss, growth restriction, or fetal abnormality. This article is protected by copyright. All rights reserved.
A variety of unusually abnormal vessels in tetralogy of fallot with absent pulmonary valve.Ultrasound in Obstetrics and Gynecology
Tetralogy of Fallot with absent pulmonary valve (TOF/APV) is a rare congenital heart disease, which can be associated with abnormalities of the pul...
Cutaneous small-vessel vasculitis after hysterosalpingo-foam sonography (HyFoSy).Ultrasound in Obstetrics and Gynecology
We present a case-report of a diffused skin immune reaction - cutaneous small-vessel vasculitis and systematic review of hypersensitivity reactions...
Comparison of brain microstructure after prenatal spina bifida repair by either laparotomy assisted fetoscopic or open approach.Ultrasound in Obstetrics and Gynecology
To assess brain microstructure in a cohort of fetuses and infants that underwent prenatal Fetoscopic or Open myelomeningocele (MMC) repair.
Longitudinal retrospective cohort study. A total of 57 fetuses who met Management of Myelomeningocele Study (MOMS) trial criteria underwent prenatal MMC repair (27 Fetoscopic and 30 Open) at 23-25.6 weeks of gestational age (GA). Presurgical MRI diffusion-weighted imaging (DWI) was obtained in 30 cases (14 Fetoscopic vs. 16 Open) and in 48 cases at 6 weeks post-surgery (24 Fetoscopic vs. 24 Open). At 1 year of age, MRI DWI scans from 23 infants were collected (5 Fetoscopic vs. 18 Open). Apparent diffusion coefficient (ADC) values from basal ganglia, frontal, occipital and parietal lobes, mesencephalon and genu as well as splenium of the corpus callosum were calculated. ADC values at each of these time points and the % change in the ADC values were compared. ADC values at 6 weeks after surgery for both of the prenatally repaired groups were compared to a control group of 8 healthy fetuses. Cases and controls were matched for GA at time of MRI. ADC values were compared using the t- test for independent samples (or Mann Whitney test if non-normally distributed) and multivariate analyses, adjusting for GA or age at MRI and mean ventricular width.
There were no differences in the degree of ventriculomegaly, GA at surgery, or GA/postnatal age at MRI between the groups. No differences in ADC values were seen between both groups. Additionally, there were no differences observed in the % change in ADC values either.
Fetoscopic MMC repair has no detectable effects on brain microstructure when compared to babies repaired by an open hysterotomy technique. Carbon dioxide insufflation of the uterine cavity during fetoscopy does not seem to have any isolated deleterious effects in fetal brain microstructure. This article is protected by copyright. All rights reserved.
Validation of ultrasound strategies to assess tumor extension and to predict high-risk endometrial cancer in women from the prospective IETA (International Endometrial Tumour Analysis) 4 cohort.Ultrasound in Obstetrics and Gynecology
To validate ultrasound measurements and subjective ultrasound assessment (SA) to detect deep myometrial invasion (MI), and cervical stromal invasion (CSI) in patients with endometrial cancer and to compare their performance between low and high-grade endometrial cancer, and to validate published prediction models to identify high-risk endometrial cancer (grade 3 endometrioid or non-endometrioid cancer and/or deep MI and/or CSI).
The study comprises 1538 patients from the prospective IETA4 multicenter study with endometrial cancer undergoing standardized expert transvaginal ultrasound examination. SA and ultrasound measurements were used to predict deep MI and CSI. We assessed the diagnostic accuracy of the Tumor/Uterine anteroposterior (AP) ratio to detect deep MI and the distance from the lower margin of the tumor to outer cervical os (Dist-OCO) to detect CSI, and validated two 2-step strategies to predict high-risk cancer. In the 2-step strategies the first step consists of biopsy grade 3/non-endometrioid cancers were classified as high-risk cancer, and the second step encompasses application of a mathematical model on the remaining tumors. The "subjective model" included biopsy grade (1 versus 2) and subjective assessment of deep MI/CSI (deep MI or CSI: yes or no), the "objective model" includes biopsy grade (1 versus 2) and minimal tumor-free margin. The two 2-step strategies were compared to simply classifying patients as high-risk if either deep MI or CSI was suspected based on SA or if biopsy showed grade 3/non-endometroid histotype (combining SA with biopsy grade). Histological assessment from hysterectomy was considered the reference standard.
Among patients with measurable lesions (n=1275), SA had a sensitivity and specificity of 70% and 80% to detect deep MI in grade 1-2 tumors versus 76% and 64% in grade 3/non endometrioid tumors. The corresponding percentages for detection of CSI were 51% and 94% versus 50% and 91%. Tumor AP diameter and Tumor/Uterine AP ratio were the best ultrasound measurements to predict deep MI, and Dist-OCO was best to predict CSI (area under receiver operating characteristics curve(AUC) of 0.77 and 0.72). The proportion of patients correctly classified as having high-risk cancer was 80% for simply combining SA with biopsy grade versus 80% and 74% for the subjective and objective 2-step strategies, respectively. The subjective and objective models had AUC of 0.76 and 0.75 when applied to grade 1-2 endometrioid tumors.
In the hands of experienced ultrasound examiners SA was superior to taking measurements for prediction of deep MI and CSI of endometrial cancer especially in grade 1-2 tumors. The mathematical models for prediction of high-risk cancer performed as expected. The best strategy to predict high-risk endometrial cancer was either to simply combine SA with biopsy grade or to use the subjective 2-step strategy, both having an accuracy of 80%. This article is protected by copyright. All rights reserved.