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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First-trimester fetal neurosonography: technique and diagnostic potential.Ultrasound in Obstetrics and Gynecology
Most of the brain abnormalities are present in fact also at first trimester but only a few of these are detected at such early stage. According to ...
Meta-analysis and systematic review to determine the optimal imaging modality for the detection of rectosigmoid deep endometriosis.Ultrasound in Obstetrics and Gynecology
To review the diagnostic accuracy and determine the optimum imaging modality for the detection of rectosigmoid deep endometriosis (DE) in women with a clinical history of endometriosis.
A systematic review was conducted using PubMed, Medline, Scopus, Embase and Google Scholar to identify studies published between January 1990 and May 2020. Studies were considered eligible if they were prospective and used any imaging modality pre-operatively to assess for the presence of DE in the rectum/rectosigmoid, which was then correlated with the surgical data as the reference diagnosis. The eligibility of studies was restricted to those having at least 10 affected and 10 unaffected women. The QUADAS-2 tool was used to assess quality. This study was prospectively registered with PROSPERO (CRD42017059872).
Of the 1,977 references identified, 30 studies (n = 3,374) were included in the analysis. The overall pooled sensitivity and specificity, from which the likelihood ratio of a positive test (LR+), likelihood ratio of a negative test (LR-) and diagnostic odds ratio (DOR) were calculated, were as follows for transvaginal ultrasound (TVS) 89% (95% CI 83 - 93%), 97% (95% CI 95 - 98%), 28.8 (95% CI 16.2 - 51.0), 0.12 (95% CI 0.08 - 0.18) and 248 (95% CI 104 - 594), for magnetic resonance imaging (MRI) 86% (95% CI 79 - 81%), 97% (96% CI 94 - 97%), 21.0 (95% CI 13.4 - 33.1), 0.15 (95% CI 0.09 - 0.23), and 144 (95% CI 70 - 297), for computed tomography (CT) 93% (95% CI 84 - 97%), 95% (95% CI 81 - 99%), 20.3 (95% CI 4.3 - 94.9), 0.07 (95% CI 0.03 - 0.19), and 280 (95% CI 28 - 2826), and for transrectal endoscopic sonography (RES) 92% (95% CI 87 - 95%), 98% (95% CI 96 - 99%), 37.1 (95% CI 21.1 - 65.4), 0.08 (95% CI 0.05 - 0.14), and 455 (95% CI 196 - 1054), respectively. There was significant heterogeneity and the studies were considered poor methodologically according to the QUADAS-2 tool.
The sensitivity of transvaginal sonography (TVS) for the detection of DE seems to be slightly better than magnetic resonance imaging (MRI), although RES was superior to both. Specificity of both TVS and MRI were excellent. As TVS is the simpler, faster, and more readily available, we believe it should be the first line diagnostic tool for the women with suspected DE. This article is protected by copyright. All rights reserved.
Prenatal diagnosis and planned peripartum care improves perinatal outcomes in fetuses with transposition with intact ventricular septum in low-resource settings.Ultrasound in Obstetrics and Gynecology
To report feasibility and impact of establishing a regional prenatal referral network on perinatal outcomes of fetuses with transposition of great arteries with intact ventricular septum(TGA-IVS) in a low-resource setting.
Retrospective study (January 2011 to December 2019). A regional network for prenatal diagnosis and referral was initiated in 2011. Consecutive fetuses with diagnosis of TGA-IVS included. Pregnancy and early neonatal outcomes were reported. Impact of timing of diagnosis (prenatal or after birth) on age at surgery, mortality and post-operative recovery were compared.
Total of 82 fetuses included. Diagnosis typically occurred in later stages of gestation (mean 26.7 + 6.6 weeks). Majority of affected pregnancies (78%) ended in live-births. Most live-births (84.4%) occurred in specialist pediatric cardiac centers. Delivery in specialist center was associated with significantly higher rate of surgical correction (98% vs 70% for maternity homes; p = 0.01) and overall lower neonatal mortality (3.7% vs. 50%; p=0.001). Prenatal detection rates and proportion of surgeries after prenatal diagnosis significantly increased over study period (2011-15: 11.1% Vs. 2016-19: 29%; p=0.001). Age at surgery was significantly lower for prenatal cases compared with those diagnosed post-natally (median 4 (1-23) vs. median 10 (1-91); p < 0.001). There was no significant difference in post-operative mortality (2% vs. 3.6%; p=0.5) between the two groups.
This study demonstrates the feasibility of creating a network for prenatal diagnosis and referral in low-resource settings for critical CHD such as TGA that enables planned peri-partum care in specialist pediatric cardiac centers and improved neonatal survival. This article is protected by copyright. All rights reserved.
Determination of fetal heart rate short term variation from umbilical artery Doppler waveforms.Ultrasound in Obstetrics and Gynecology
To evaluate the feasibility of using umbilical artery (UA) Doppler waveforms to measure fetal heart rate short term variation (STV) across gestation.
A prospective longitudinal study was conducted at two study sites in 195 women with pregnancies considered low risk. Pulsed wave Doppler of the UAs was performed at a 4-weekly interval between 14-40 weeks of gestation using a standardized imaging protocol. Up to 12 consecutive UA Doppler waveforms were analyzed using an off-line processing software. Fetal heart rate STV was calculated using average R-to-R intervals extracted from the waveforms and baseline corrected for fetal heart rate.
Baseline corrected short term fetal heart rate variation increased significantly with gestational age (conditional R2 = 0.37, p < 0.0001) and was inversely correlated with fetal heart rate (conditional R2 = 0.54, p < 0.0001). The short term variation ranged (median (interquartile range)) from 3.5 (2.9-4.1) ms at 14-20 weeks' gestation to 6.3 (4.8-7.7) ms at 34-40 weeks' gestation. The change in short term heart rate variation did not differ between study sites, different models of ultrasound machine or individual sonographers.
Umbilical artery Doppler waveforms offer a robust and feasible method to derive short term variation of the fetal heart rate. It needs to be emphasized that the umbilical-Doppler derived short term variation is not interchangeable with measurements derived with computerized cardiotocography. Accordingly, further investigations need to validate associations with outcome to determine the value of concurrent fetal cardiovascular and heart rate evaluation that are possible with the technique described here. This article is protected by copyright. All rights reserved.
Prediction of pre-eclampsia-related complications in women with suspected/confirmed pre-eclampsia: development and internal validation of a clinical prediction model.Ultrasound in Obstetrics and Gynecology
A clinical prediction model that could reliably predict the risk of preeclampsia (PE)-related pregnancy complications does not exist.
We aimed to develop a model to predict the composite outcome of PE-related pregnancy complications, consisting of maternal and fetal adverse within 7, 14 and 30 days in women with suspected or confirmed PE. Data of 384 women from a prospective, multicenter, observational cohort study (n=620) were used. For the development of the prediction model the possible contribution of clinical and standard laboratory variables as well as the biomarkers soluble Fms like tyrosine kinase-1 (sFlt-1), placental growth factor (PlGF) and their ratio was explored using a multivariable competing risk regression analysis. We assessed the discriminative ability of the model with the concordance (c-) statistic. A bootstrap validation procedure with 500 replications was used to correct the estimate of the prediction model performance for optimism and to compute a shrinkage factor for the regression coefficients to correct for overfitting.
Among 384 women with suspected/confirmed PE, 96 had PE-related adverse outcomes at any time after hospital admission. Important predictors of PE-related outcomes included sFlt-1/PlGF ratio (continuous), gestational age at time of biomarker measurement (continuous) and protein-to-creatinine ratio (continuous). The c-statistics (corrected for optimism) for developing a PE-related complication within 7, 14 and 30 days were 0.89, 0.88 and 0.87 respectively. There was limited overfitting as indicated by a shrinkage factor of 0.91.
We propose a simple clinical prediction model with good discriminative performance to predict short-term and longer term PE-related complications. Its usefulness in clinical practice awaits further investigation and external validation. This article is protected by copyright. All rights reserved.
Elective labor induction vs expectant management in women and children's educational outcomes at 8 years of age.Ultrasound in Obstetrics and Gynecology
To estimate the effect of elective induction of labour at 39 weeks of gestation on children's educational outcomes as measured by the Australian National Assessment Program-Literacy and Numeracy (NAPLAN) tests at year 3 (~8 years of age), compared with expectant management.
We merged perinatal data, including information regarding all infants in South Australia from 1999 to 2008, with children's school assessment data (i.e., NAPLAN data). The study population included all singleton births born without malformations at 39-42 weeks of gestation in vertex presentation. Children had to have undertaken year-3 NAPLAN (~8 years of age). We excluded births from women who had a contraindication to vaginal delivery and with conditions possibly justifying elective delivery before 39 weeks of gestation. Our outcome of interest was children's educational outcomes as measured by NAPLAN. The NAPLAN included five learning domains (reading, writing, spelling, grammar and numeracy). Each domain was categorised according to performing at or below versus above the National Minimum Standards (NMS). Average Treatment Effects (ATEs) of elective induction of labour at 39 weeks for children performing at/below the NMS for each domain were estimated using Augmented Inverse Probability Weighted (AIPW) estimator accounting for potential confounders.
Among 53,843 children born at 39-42 weeks with vertex presentation from 1999-2008 and those who were expected to participate in year 3 NAPLAN from 2008-2015, a total of 31,120 children had at least one year 3 NAPLAN domain. Of these (i.e., 31,120 children), 1,353 children were delivered after elective induction of labour at 39 weeks while 29,767 children were born following expectant management. The ATEs (mean differences) comparing elective induction of labour at 39 weeks with expectant management for children scoring at/below the NMS on each domain were: reading (0.01 (95% CI -0.02 to 0.03)), writing (0.02 (95% CI 0.00 to 0.04)), spelling (0.01 (95% CI -0.01 to 0.04)), grammar (0.02 (95% CI -0.01 to 0.04)) and numeracy (0.03 (95% CI -0.00 to 0.05)).
Elective induction of labour at 39 weeks of gestation did not affect children's standardised literacy and numeracy testing outcomes at eight years of age when compared with expectant management. This article is protected by copyright. All rights reserved.
Outcome of fetuses with congenital cytomegalovirus infection: a systematic review and meta-analysis.Ultrasound in Obstetrics and Gynecology
To report the outcome of fetuses with congenital Cytomegalovirus (CMV) infection and normal ultrasound at the time of diagnosis.
Medline, Embase, Cinahl and Cochrane databases were explored. Inclusion criteria were fetuses with confirmed CMV infection and normal ultrasound assessment at the time of initial evaluation. The outcomes observed were anomalies detected at follow-up ultrasound scan, at prenatal magnetic resonance imaging (MRI) and at postnatal assessment, perinatal mortality, symptomatic infections at birth, neurodevelopmental outcomes, hearing and visual deficits. Random-effect meta-analysis of proportions were used to analyze the data.
26 studies (2603 fetuses) were included. The overall rate of central nervous system (CNS) associated anomalies detected exclusively at follow-up ultrasound was 4.4% (95% CI 1.4-8.8; 32/523; 15 studies), while those detected exclusively by MRI or postnatally were 5.8% (95% CI 1.9-11.5; 19/357; 11 studies) and 3.2% (95% CI 0.3-9.0; 50/660; 17 studies), respectively. The rate of extra-CNS associated anomalies detected exclusively at follow-up ultrasound was 2.9% (95% CI 0.8-6.3; 19/523; 15 studies), while those detected exclusively by MRI or postnatally were 0% (95% CI 0.0-1.7; 0/357; 11 studies) and 0.9% (95% CI 0.3-1.8; 4/660; 17 studies), respectively. Both intrauterine death and perinatal death occurred in 0.7% of cases (95% CI 0.3-14.0; 2/824; 23 studies). A symptomatic infection was shown in 1.5% (95% CI 0.7-2.7; 6/548; 19 studies) of cases and the rate of overall neurodevelopmental anomalies was 3.1% (95% CI 1.6-5.1; 16/550; 19 studies), with hearing problems affecting 6.5% of children (95% CI 3.8-10.0; 36/550; 19 studies). Sub-analyses according to the trimester at infection were affected by the very small number of included cases and lack of comparison of the observed outcomes in the original studies. Fetuses infected in the first trimester had a relatively higher risk of having additional anomalies at follow-up ultrasound and MRI, symptomatic infection, abnormal neurodevelopmental outcome and hearing problems.
In fetuses with congenital CMV infection showing no anomalies on both US and MRI, the risk of adverse postnatal outcome is lower compared to what reported from previously published literature not considering the role of antenatal imaging assessment. The findings from this study can enhance prenatal counselling of pregnancies with congenital CMV infection with normal prenatal imaging. This article is protected by copyright. All rights reserved.
Differences in post-traumatic stress, anxiety and depression following miscarriage and ectopic pregnancy between women and their partners: a multicenter prospective cohort study.Ultrasound in Obstetrics and Gynecology
To investigate and compare post-traumatic stress, depression and anxiety in women and their partners over a 9-month period following miscarriage or ectopic pregnancy.
This was a prospective cohort study. Consecutive women and partners were approached in the early pregnancy units of three hospitals in central London. One, three and nine months after early pregnancy loss, recruits were emailed links to surveys containing the Hospital Anxiety and Depression Scale (HADS) and Post-traumatic Diagnostic Scale (PDS). The proportion of participants meeting screening criteria for moderate/severe anxiety or depression and post-traumatic stress (PTS) was assessed. Mixed-effects logistic regression was used to analyse differences between women and their partners and the evolution over time.
386 partners were approached after the woman in whom the loss had been diagnosed consented to participate. 192 couples were recruited. All partners were male. Response rates were 57%, 45% and 38% for partners, and 76%, 68% and 57% for women, at month 1, 3 and 9 respectively. For partners, 7% met the criteria for PTS at month 1, 8% at month 3 and 4% at month 9, compared to 34%, 26% and 21%, respectively, of women. Partners also experienced lower rates of moderate/severe anxiety (6% vs 30% at month 1, 9% vs 25% at month 3, 6% vs 22% at month 9) and depression (2% vs 10% at month 1, 5% vs 8% at month 3, 1% vs 7% at month 9). The odds ratios for morbidity in partners vs women after 1 month was 0.02 (95% CI, 0.004-0.12) for post-traumatic stress, 0.05 (95% CI, 0.01-0.19) for moderate/severe anxiety and 0.15 (95% CI, 0.02-0.96) for moderate/severe depression. Morbidity for each outcome decreased modestly over time, without strong evidence of a different evolution for women and their partners.
Partners experience far lower levels of post-traumatic stress, anxiety and depression than women after early pregnancy loss. This article is protected by copyright. All rights reserved.
Safety and efficacy of the Smart Tracheal Occlusion device in the diaphragmatic hernia lamb model.Ultrasound in Obstetrics and Gynecology
To investigate the efficacy and safety of the smart-TO device in fetal lambs with diaphragmatic hernia(DH).
Reversal of fetoscopic endoluminal tracheal occlusion(TO) to reestablish airway patency requires an invasive procedure. The "Smart-TO" balloon can be deflated by exposure to a strong magnetic field. There are no data available on its ability to reverse pulmonary hypoplasia, its tracheal side-effects, and how well it is expelled from the airways upon deflation. DH was created in fetal lambs on gestational day 70(GD; term=145). On GD95, TO was performed(n=7). At GD116, the presence of the balloon was confirmed on ultrasound(US), the ewe was walked around a 3T-Magnetic Resonance-scanner for balloon deflation, which was confirmed by US immediately after. At term, euthanasia was performed, and the fetus retrieved. Efficacy of occlusion was assessed by the lung-to-body-weight-ratio(LBWR) and lung morphometry. Safety parameters included tracheal side-effects assessed by morphometry and balloon location after deflation. Unoccluded lambs with DH (n=6) served as a comparator.
All balloons deflated successfully and were spontaneously expelled from the airways. In the DH+TO group in comparison to controls, the LBWR at birth was increased (1.90 (IQR 1.43-2.55) vs. 1.07 (0.93-1.46), p=0.005), as well as alveolar size (47.5 (IQR 45.6-48.1) vs. 24.6 (IQR 18.7-25.8), p=0.03), whereas airway complexity was lower (1.56 (IQR 1-1.81) vs. 2.23 (IQR 2.14-2.40), p=0.005). Tracheal changes on histology were minimal but more noticeable than in unoccluded lambs (2 (IQR 1-3) vs. 0 (0-1), p=0.03).
In fetal lambs with DH, tracheal occlusion with the Smart-TO balloon is effective and safe. This article is protected by copyright. All rights reserved.
Pelvic floor ultrasound: association between 2D perineal and 3D endovaginal ultrasound findings and symptoms in women presenting with mid-urethral sling complications.Ultrasound in Obstetrics and Gynecology
To present the characteristics of women attending a tertiary urogynaecology pelvic floor scan clinic with mid-urethral sling complications and examine the association between 2D perineal and 3D endovaginal ultrasound and symptoms.
A cross-sectional study of all women referred to a specialist pelvic floor ultrasound clinic from October 2016 to October 2018 with mid-urethral sling complications were included. They underwent a detailed history and had a 2D perineal (BK Medical, Herlev, Denmark, Type 8802; 4.3-6 MHz) and 3D endovaginal (BK Medical, Herlev, Denmark, Type 8838; 6-12 MHz, 360° rotational probe) ultrasound scan. Only symptomatic women with a single mid-urethral sling, without other pelvic floor mesh, prior mesh excision or bulking agents were included in analysis for association between scan findings and symptoms.
A total of 311 women were seen with a history of mid-urethral sling surgery. Eighty percent reported pain; 59% having it as their primary complaint. One third reported symptoms starting within 4 weeks of surgery. Analysis was performed on 172 scans for association with symptoms. Mid-urethral sling position within the rhabdosphincter was significantly associated with voiding dysfunction (OR 10.6 (95% CI 2.2, 50.9) p=0.003). Voiding dysfunction was highest in those with C shaped mid-urethral sling at rest and Valsalva manoeuvre (OR 3.2 (95% CI 1.3, 7.6) p<0.001). Position by the distal third of the urethral length was significantly associated with a higher rate of recurrent urinary tract infections (OR 2.9 (95% CI 1.3, 6.3) p=0.01).
Pelvic floor ultrasound can provide insight into the positioning and shape of a mid-urethral sling, which could explain some patient symptoms, guide management or surgical planning. This article is protected by copyright. All rights reserved.
Is pelvic floor muscle contractility an important factor in anal incontinence?Ultrasound in Obstetrics and Gynecology
Pelvic floor muscle contractility (PFMC) may contribute to anal continence (AI). The aim of our study was to assess associations between clinical and sonographic measures of PFMC and AI symptoms, while controlling for sphincter and levator trauma.
This is a retrospective study including 1383 women assessed at a tertiary center between 2013 and 2016. Patients were assessed by interview including St. Mark's incontinence score (SMIS), examination including Modified Oxford Scale (MOS) grading, and four dimensional (4D) translabial ultrasound (TLUS). Sonographic measures of PFMC, i.e. bladder neck (BN) cranioventral shift and levator hiatal anteroposterior (AP) diameter reduction, were measured offline using ultrasound volumes obtained at rest and on maximal pelvic floor contraction. The reviewer was blinded against all clinical data.
Mean age was 55, mean body mass index (BMI) 29. AI was reported by 221 (16%), with a mean SMIS of 12. Mean MOS grade was 2.3. On TLUS, mean BN cranioventral shift was 5.9 mm and mean AP diameter reduction 8.2 mm. Avulsion and EAS defects were diagnosed in 25% and 8.7% respectively. On univariate analysis, sonographic measures of PFMC were not associated with AI. Lower MOS was associated with symptoms of AI, however, statistical significance was lost on multivariate analysis.
Clinical and sonographic measures of PFMC were not significantly associated with AI symptoms once EAS and levator trauma were controlled for. This article is protected by copyright. All rights reserved.
Pregnancy and COVID-19: Pharmacologic Considerations.Ultrasound in Obstetrics and Gynecology
The Severe Acute Respiratory Syndrome-related Coronavirus-2 (SARS-CoV2) pandemic has sparked controversy regarding the use of certain routine and i...