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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Variation in outcome reporting in randomised controlled trials of interventions for the prevention and treatment of fetal growth restriction.Ultrasound in Obstetrics and Gynecology
Fetal growth restriction (FGR) contributes to stillbirth, prematurity, neonatal and infant mortality and morbidity. Although FGR is well known to be associated with adverse outcomes for the mother and offspring, effective interventions for the prevention of FGR are yet to be established. The majority of pregnancies complicated by FGR are not detected antenatally and there are limited effective interventions for established FGR. Trials reporting interventions for the prevention and treatment of FGR may be limited by heterogeneity in the underlying pathophysiology. Systematic evaluation of available trials is hampered by the variation in the outcomes measured and reported.
We conducted a systematic review of randomised controlled trials investigating therapies for the prevention and treatment of FGR up to August 2018. We searched Medline, EMBASE and the Cochrane Central Register of Controlled Trials and systematically assessed studies, extracted and categorised data on which outcomes were reported in the included studies.
The search identified 2609 citations of which 153 were selected for full text review and 72 were included in the final analysis. There were 44 trials relating to the prevention of FGR and 24 trials of interventions for the treatment of FGR. We identified 238 outcomes across the included studies. The most commonly reported were birthweight (88.2%), gestational age at birth (72.1%) and small for gestational age babies (67.6%). Few studies reported on any measure of neonatal morbidity (27.9%) and adverse effects of the interventions were reported in only 17.6% of trials.
Significant variation in outcome reporting exists across trials of therapies for both prevention and treatment of FGR. The clinical applicability of future research would be enhanced by the development of a core outcome set for use in future trials. This article is protected by copyright. All rights reserved.
History-indicated cervical cerclage in the management of twin pregnancy.Ultrasound in Obstetrics and Gynecology
Cervical cerclage when performed in twin gestation has been reported to be associated with poor outcome. However, the role of first-trimester history-indicated cerclage among women with twin pregnancy and a prior history of preterm birth has not been studied. We aimed to assess pregnancy outcomes among women with twin pregnancy who underwent first-trimester history-indicated cervical cerclage compared to expectant management.
A retrospective matched case-control study. The study group comprised all women with twin pregnancy who had undergone history-indicated cerclage during 2006-2017 at a university hospital. A control group of women with twin pregnancy who were managed expectantly was established by matching age, history of spontaneous preterm births (20-36 weeks), and delivery year.
Data from 82 women with twin gestation were analyzed, 41 who underwent first-trimester history-indicated cerclage and 41 matched control women who were managed expectantly. Gestational age at delivery was higher in the cerclage group than in those managed expectantly (median 35 vs 30 weeks, P<0.0001). Rates of spontaneous preterm birth rate at <24 weeks (2.4% vs. 19.5%; OR [95% CI]: 0.10 (0.12, 0.87), P=0.03), <28 weeks (12.2% vs. 34.1%; OR [95% CI]: 0.27 (0.09, 0.84), P=0.03), <32 weeks (22.0% vs. 56.1%; OR [95% CI]: 0.22 (0.08, 0.58), P=0.003) and <34 weeks (34.1% vs. 82.9%; OR [95% CI]: 0.11 (0.04, 0.30), P<0.0001) were significantly lower among the cerclage group than among the control group. Median birthweight was higher in the cerclage group (2,072 vs. 1,750 grams, P=0.003) with lower proportions of low-birth weight (<2,500 grams) (65.0% vs. 89.4%, P=0.001) and very low-birth weight infants (<1,500 grams) (21.3% vs. 37.9%, P=0.03) than in the expectant management group. Rates were also lower in the cerclage groups for stillbirth, admissions to the neonatal intensive care unit, respiratory distress syndrome, intraventricular hemorrhage, necrotizing enterocolitis, sepsis, neonatal mortality and composite adverse neonatal outcome.
History-indicated cerclage in women with twin pregnancy had an overall positive effect on maternal and neonatal outcomes. These data suggest the need for adequate randomized trials on cerclage placement among this subset of women. This article is protected by copyright. All rights reserved.
Prenatal ultrasound signs of diencephalic mesencephalic junction (DMJ) dysplasia.Ultrasound in Obstetrics and Gynecology
Diencephalic mesencephalic junction (DMJ) dysplasia is a rare malformation characterized by ill -defined junction of the diencephalon and mesenceph...
Longitudinal change in the cerebroplacental ratio and the risk of stillbirth.Ultrasound in Obstetrics and Gynecology
To investigate whether the longitudinal Doppler changes in small-for-gestational age (SGA) fetuses improves the prediction of those at risk of intrauterine fetal death (IUFD).
A longitudinal study using two cohorts of singleton pregnancies (SGA and appropriate for gestational age [AGA]). The inclusion criteria for the SGA cohort were singleton pregnancies at 20 weeks' gestation or beyond and diagnosed with SGA. The AGA fetuses consisted of singleton pregnancies deemed at high-risk of developing SGA which were followed up longitudinally but remained AGA. The last two measurements prior to birth were included in the analysis. Longitudinal models for Doppler variables were developed via linear-mixed models and predictive accuracies were tested with generalized linear models. A Bayesian framework was employed to compare model accuracies.
In total, 1549 AGA and 941 SGA babies were included in the analysis. There were 30 (3.2%) and no IUFD cases in the SGA and AGA group, respectively. Using the last measurements, the best models for the prediction of IUFD were the cerebroplacental ratio (CPR) (accuracy: 75.0%, 95% CI: 72.6-77.2%) and umbilical artery (UA) (accuracy: 71.0%, 95% CI: 68.6-73.4%) models. The posterior probability of the CPR model having a higher accuracy compared to the UA model was 97.2% (magnitude of change (MC): 3.9%, 95% credible intervals (CrI): 0.5 to 7.3%). The predictive accuracies of the UA (accuracy: 71.0% vs. 72.8% using the standard vs. longitudinal model, respectively), middle-cerebral artery (MCA) (accuracy: 64.6% vs. 63.8% using the standard vs. longitudinal model, respectively) and CPR models (accuracy: 75.0% vs. 74.9% using the standard vs. longitudinal model, respectively) were not significantly altered with longitudinal assessment. The posterior probabilities for accuracy improvement with longitudinal assessment were 50.1% (MC: <0.1%, 95% CrI: -3.3 to 3.3%), 35.2% (MC: -0.1%, 95% CrI: -4.5 to 2.8%) and 82.2% (MC: 1.9%, 95% CrI: -1.5 to 5.3%) for CPR, MCA and UA models, respectively. The change in Doppler parameters did not improve the predictive accuracy for IUFD compared to the last scan measurement.
The change in MCA, UA and CPR with advancing gestation was significantly different between live born AGA and SGA fetuses with less pronounced difference with advancing gestation. Longitudinal assessment of Doppler parameters was not useful in improving the detection of IUFD compared to a single point assessment. This article is protected by copyright. All rights reserved.
Systematic review and meta-analysis on the role of prenatal magnetic resonance imaging in the era of fetal neurosonography: mild and moderate ventriculomegaly.Ultrasound in Obstetrics and Gynecology
To report the rate of additional anomalies detected exclusively on prenatal MRI in fetuses affected by isolated mild or moderate ventriculomegaly (VM) according to the type of ultrasound protocol adopted (dedicated neurosonography vs standard assessment of fetal brain) and to explore whether the diagnostic performance of fetal MRI in detecting such anomalies is affected by gestational age at scan and laterality of ventricular dilatation.
The primary aim was to report the rate of additional anomalies detected exclusively on prenatal MRI in fetuses affected by isolated mild and moderate VM (ventricular dilatation between 10-15 mm) undergoing compared to those not undergoing dedicated neurosonography, defined as a detail assessment of fetal brain according to the International Society of Ultrasound in Obstetrics and Gynecology guidelines. Medline, Embase, Cinahl and Clinicaltrials.gov databases were searched. Additional anomalies were classified in: callosal, septal, posterior fossa, white matter, intra-ventricular hemorrhage, cortical, peri-ventricular heterotopia, peri-ventricular cysts and complex malformations. Furthermore, we calculated the rate of additional CNS anomalies missed at prenatal MRI and detected only at birth in fetuses who had early (≤24 weeks) compared to late (>24 weeks of gestation) MRI. A sub-analysis was performed according to the laterality (uni- vs bi-lateral VM) and the degree (mild vs moderate, defined as ventricular dilatation between 10-12 and 13-15 mm respectively) of ventricular dilatation. Finally, we explore whether MRI assessment led to a significant change in the prenatal management. Random-effect meta-analyses of proportions were used to analyze the data.
16 studies (1159 fetuses) were included in the systematic review. Overall, fetal MRI detected 10.0% (95% CI 6.2-14.5; 92/1159) of fetal anomalies not detected on ultrasound. However, when stratifying the analysis according to the type of ultrasound assessment performed, the rate of associated anomalies detected only on MRI was 5.0% (95% CI 3.0-7.0; 28/596) when dedicated neurosonography was undertaken compared to 16.8% (95% CI 8.3-27.6; 64/563) of anomalies detected in cases undergoing a standard assessment of fetal brain though the axial plane. The overall rate of additional anomalies detected only at birth and missed at prenatal MRI was 0.9% (95% CI 0.04-1.5, I2 : 0%; 8/1159). There was no difference in the rate of associated anomalies detected only after birth when fetal MRI was carried out before compared to after 24 weeks of gestation (p=0.265). The risk of detecting associated CNS abnormalities on MRI was higher for fetuses with moderate compared to mild VM (OR: 8.1, 95% CI 2.3-29.0, p= 0.001), while there was no difference for those presenting with bilateral compared to unilateral ( p= 0.333) dilatation. Finally, a significant change in perinatal management, mainly TOP for parental request, following MRI detection of associated anomalies was observed in 2.9% (95% CI 0.01-1.0) of fetuses undergoing neurosonography compared to 5.1% (95% CI 3.2-7.5) of those having standard assessment.
In fetuses undergoing dedicated neurosonography, the rate of CNS anomalies detected exclusively on MRI is lower compared to what has been previously reported. Early MRI has an excellent diagnostic performance in identifying additional CNS anomalies, although the findings from this review suggest that MRI performed in the third trimester may be associated with a better detection rate for some types of anomalies, such as cortical, white matter and intracranial hemorrhage. This article is protected by copyright. All rights reserved.
Added value of chromosomal microarray analysis above conventional karyotyping in stillbirth work-up: a systematic review and meta-analysis.Ultrasound in Obstetrics and Gynecology
To establish the added value of chromosomal microarray analysis (CMA) above normal karyotyping to assess the genetic causes of stillbirth.
A systematic search was performed to identify relevant studies published in English and Spanish using PubMed, SCOPUS and ISI Web of Knowledge databases, The Cochrane Library and PROSPERO database for meta-analysis, without publication time restrictions. Case-series of fetal losses ≥ 20 weeks of gestation, assessed by CMA with at least 5 subjects analyzed. For quality assessment, two reviewers independently assessed the risk of bias using the QUADAS-2 tool for assessing studies of diagnostic accuracy. For the meta-analysis, the incremental yield by single-proportion analysis using random-effects model (weighting by inverse of variance) was performed. Heterogeneity between studies was assessed using the X2 (Cochrane Q), H and I2 statistics, along with a sensitivity analysis and subgroup analysis on structurally abnormal (malformed or growth restricted) fetuses.
In this meta-analysis we included seven studies comprising 903 stillborn fetuses with normal karyotype. Test success rate achieved by conventional cytogenetic analysis was 75%, while for CMA this rate increased to 90%. The incremental yield of CMA above conventional karyotyping under random-effects model, was 4% (95%CI: 3%-5%) for pathogenic copy number variants (pCNV), and 8% (95%CI: 4%-17%) rate for variants of unknown significance (VOUS). Subgroup analysis showed 6% (95%CI: 4%-10%) pCNVs incremental yield in structurally abnormal fetuses and 3% (95%CI: 1%-5%) in those structurally normal. The pCNVs most commonly found was del22q11.21.
CMA, incorporated in the stillbirth work-up, improves both the test success rate and the detection of genetic anomalies above conventional karyotyping. To achieve a genetic diagnosis in stillbirth is particularly relevant for counseling purposes regarding future pregnancies. This article is protected by copyright. All rights reserved.
In-utero treatment of a large symptomatic rhabdomyoma with sirolimus.Ultrasound in Obstetrics and Gynecology
A healthy 27-year-old woman was referred to our hospital at 21 weeks gestation. Fetal echocardiography revealed multiple cardiac rhabdomyomas, with...
Spontaneous resolution of large pericardial effusion associated with right ventricular outpouching in four fetal cases.Ultrasound in Obstetrics and Gynecology
We report the diagnosis and management of four cases of right ventricular outpouching (RVO) in association with a large pericardial effusion. These...
Hysterotomy level at cesarean section and occurrence of large scar defects: a randomized single-blind trial.Ultrasound in Obstetrics and Gynecology
To study the effect of cesarean hysterotomy level on the occurrence of large uterine scar defects 6-9 months after delivery.
This was a two-center, randomized, single-blind trial of a surgical procedure with masked assessment of the principal outcome under study. Women in active labor (cervix dilatation ≥5 cm) were randomized into a high incision (HIGH) or a low incision (LOW) group. Hysterotomy was performed 2 cm above (HIGH) or 2 cm below (LOW) the plica vesicouterina. Women were examined with saline contrast sonohysterography to assess the appearance of the hysterotomy scar 6-9 months after delivery. The main outcome was occurrence of a large scar defect. A scar defect was defined as large if the remaining myometrial thickness over the defect was ≤2.5 mm. Secondary outcomes were operative complications, perinatal- and long-term outcomes.
122 patients were included in the trial and 114 were assessed with ultrasound. Large scar defects were seen in 4 (7%) of 55 women in the high incision group and in 24 (41%) of 59 women in the low incision group (P< 0.001) odds ratio 8.7 (95% CI 2.8-27.4).
The cesarean hysterotomy level in women in advanced labor is associated with the occurrence of large scar defects detected by transvaginal ultrasound 6-9 months after delivery. This article is protected by copyright. All rights reserved.
Local validation and calibration of preeclampsia screening algorithms.Ultrasound in Obstetrics and Gynecology
A recent Practice Guideline issued by the International Society of Ultrasound in Obstetrics and Gynecology recommends a combination of a priori fac...
Evaluation of automated tool for 2D fetal biometry.Ultrasound in Obstetrics and Gynecology
To determine whether an automated tool can automatically measure the fetal head circumference (HC), abdominal circumference (AC) and femur length (FL) on frozen 2D ultrasound images.
Ultrasound images from 100 pregnancies between 20 to 40 weeks of gestation were assessed, ensuring equal distribution of data throughout gestational age. For each pregnancy, three standard biometric variables (HC, AC, FL) were measured three times (nine independent image acquisitions). An algorithm (Philips Research) was then used to detect the structure and automatically place measurement calipers. This caliper placement was assessed in two ways. Firstly, clinical assessment was undertaken to determine whether the caliper placement was correct, defined as "acceptable for clinical management"; or whether minor or major adjustment was required. Secondly, the resulting automatic measurements were compared to manual measurements, taken in real time. Differences were calculated and expressed as percentages to correct for fetal growth with advancing gestation.
After exclusion of one pregnancy (due to technical failure), a total of 891 images, 297 for each biometric variable, were analyzed. The algorithm failed to place calipers for the AC in 9 images, whereas there were no failures on HC and FL. In the subjective quality assessment of automatic caliper placement, 475 images (53.3%) were judged to be clinically acceptable and did not require any adjustment, while 317 (35.6%) and 90 images (10.1%) required minor and major adjustments respectively. The mean error (ME) between manual and automatic HC was -0.21cm (-0.81%) with 95% limits of agreement (LOA) between -3.73% and 2.12%. For AC and FL the ME was 0.72cm (2.40%) with LOA between -9.48% and 14.27%; and 0.21cm (3.76%, LOA between -8.38% and 15.91%), respectively.
The automated tool correctly identified the biometric variable in 99% of frozen images. The resulting measurements have a high degree of accuracy and compare well with previously published manual to manual agreement. The measurements exhibited bias, with the automated tool underestimating biometry; this could be overcome by further improvements in the algorithm. Nevertheless, adjustable calipers for manual correction remains a requirement. This article is protected by copyright. All rights reserved.
How to assess the ureters during pelvic ultrasound.Ultrasound in Obstetrics and Gynecology
In this paper, we describe a '6 step' detailed approach to ultrasound assessment of the ureters during pelvic ultrasound examination. We discuss tips and common examination findings.
The pelvic segments of normal ureters can be identified in almost all women on transvaginal ultrasound examination and the method described is useful in detecting urinary tract abnormalities. This article is protected by copyright. All rights reserved.