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Background Attenuation coefficient (AC) and shear-wave speed (SWS) are established US markers for assessing patients with metabolic dysfunction-associated steatotic liver disease (MASLD), while shear-wave dispersion slope (DS) is not. Purpose To assess the relationship between the multiparametric US imaging markers DS, AC, and SWS and liver histopathologic necroinflammation in patients with MASLD. Materials and Methods This international multicenter prospective study enrolled consecutive patients with biopsy-proven MASLD between June 2019 and March 2023. Before biopsy, all participants underwent multiparametric US, and measurements of DS, AC, and SWS were obtained. Multivariable linear regression analyses were performed to assess the association of clinical variables and imaging markers with pathologic findings. The diagnostic performance of imaging markers for determining inflammation grade, steatosis grade, and fibrosis stage was assessed using the area under the receiver operating characteristic curve (AUC). Results A total of 124 participants (mean age, 53 years ± 15 [SD]; 62 males) were evaluated. In multivariable regression, lobular inflammation was associated with DS (regression coefficient, 0.06; P = .02), alanine aminotransferase level (regression coefficient, 0.002; P = .002), and Hispanic or Latino ethnicity (regression coefficient, -0.68; P = .047), while steatosis was associated with AC (regression coefficient, 3.66; P < .001) and fibrosis was associated with SWS (regression coefficient, 2.02; P < .001) and body mass index (regression coefficient, 0.05; P = .02). DS achieved an AUC of 0.72 (95% CI: 0.63, 0.82) for identifying participants with inflammation grade A2 or higher (moderate to severe inflammation). AC showed excellent performance for identifying participants with grade S1 (mild) or higher steatosis (AUC, 0.92 [95% CI: 0.87, 0.97]), while SWS showed excellent performance for identifying participants with fibrosis stage F2 or higher (clinically significant fibrosis) (AUC, 0.91 [95% CI: 0.86, 0.96]). Of the three US markers, SWS showed the highest AUC (0.81 [95% CI: 0.74, 0.89]) for the diagnosis of metabolic dysfunction-associated steatohepatitis. Conclusion Of the three US imaging markers (DS, AC, and SWS), DS was most associated with lobular inflammation grade at histologic examination and demonstrated fair diagnostic performance in distinguishing moderate to severe lobular inflammation. ClinicalTrials.gov Identifier: NCT04012242 Published under a CC BY 4.0 license. Supplemental material is available for this article. See also the editorial by Yin in this issue.
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Fígado Gorduroso , Cirrose Hepática , Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Estudos Prospectivos , Cirrose Hepática/diagnóstico por imagem , Fígado Gorduroso/diagnóstico por imagem , Fígado Gorduroso/complicações , Ultrassonografia/métodos , Adulto , Fígado/diagnóstico por imagem , Fígado/patologia , Idoso , Inflamação/diagnóstico por imagem , Biomarcadores/sangueRESUMO
OBJECTIVES: Weight percentiles are generally reported without any indication of error. This variation can lead a fetus being mistakenly classified erroneously as having intrauterine growth restriction (IUGR) or macrosomia. The goal of this study was to compare estimated weight percentiles with the actual observed weight percentile for each gestational age in a large cohort of fetuses being scanned in our institution. METHODS: After IRB approval the radiology information system data base was retrospectively searched for all obstetrical US reports obtained during the late second and third trimesters from July 1, 2014, until July 1, 2020. Demographic information, fetal weight, and weight percentile information were obtained from these reports. Quantile-quantile plots were created for all gestational ages and all ethnicities. RESULTS: Our study included 6259 ultrasounds in 4060 patients. Mean maternal age of the total group was 31.68 years (ranging 15-53 years). When all subjects were considered, the median values in our QQ plots approximated the line of identity. However, there was considerable variation for a given estimate, implying that estimated fetal weight percentiles are only very rough predictors of the actual percentile. CONCLUSION: Estimated fetal weight percentiles are only very rough predictors of the actual percentile. We therefore suggest that estimates of the weight percentile should be reported along with an estimate of the expected variation. Recognition of variations in weight percentile should be considered in the greater clinical context, and could potentially prevent misdiagnosis of growth restriction and macrosomia as well as the subsequent overutilization of resources, unnecessary interventions, and maternal stress.
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Peso Fetal , Doenças do Recém-Nascido , Gravidez , Recém-Nascido , Feminino , Humanos , Adulto , Macrossomia Fetal , Estudos Retrospectivos , Ultrassonografia Pré-Natal , Retardo do Crescimento Fetal/diagnóstico por imagem , Idade Gestacional , Recém-Nascido Pequeno para a Idade Gestacional , Feto , Peso ao Nascer , Desenvolvimento FetalRESUMO
INTRODUCTION: Access to health care in developing countries is scarce. One solution to this problem has been for doctors from the USA to provide single-visit care through short-term medical service trips. There is interest in using ultrasound imaging as a portable diagnostic tool; however, data describing its usefulness are scarce. Therefore, the goal of this study was to determine the usefulness of portable ultrasound imaging during a medical service trip to rural Guatemala. METHODS: A multidisciplinary team of physicians examined patients at a mobile clinic in Antigua, Guatemala. Patients with clinical indications for ultrasound had their suspected diagnoses recorded before ultrasound testing. After imaging, updated diagnoses were recorded and compared with the pre-test suspected diagnoses to determine how often ultrasound results changed the medical management of the patients and to assess the most common indications for ultrasound imaging. RESULTS: During the trip, 205 patients were seen. Of these, 24 (12%) were given ultrasound exams. The results of 13 (54%) exams altered their medical management, and the remaining 11 (46%) exams confirmed the pre-test suspected diagnoses. The most common indications for ultrasound testing were suspected cardiac (11 patients, 46%) and gastrointestinal (8 patients, 33%) diseases. CONCLUSION: Portable ultrasound imaging improved the medical team's ability to diagnose disease and clinically manage patients in a rural medical service trip. Ultrasound imaging may provide a low-cost solution to the growing demand for care in developing countries.
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Médicos , População Rural , Atenção à Saúde , Guatemala , Humanos , UltrassonografiaRESUMO
OBJECTIVES: Poor fetal growth is one of the most important findings on an obstetric ultrasound (US) examination. First-trimester US is the most accurate means for dating pregnancies; however, dating based on last menstrual period remains the standard for determining gestational age. Discrepancies between menstrual and US dating can lead to the overdiagnosis of in utero growth restriction (IUGR). This article will demonstrate that as long as the fetal growth falls along a curve that parallels normal growth curves, appropriate growth has occurred regardless of the gestational age and weight percentile that has been assigned to the fetus. METHODS: Following Institutional Review Board approval (HSD-00002969), 860 third-trimester fetal US examinations were retrospectively evaluated from January 1 through July 1, 2017, to determine whether they had normal growth curves. Outcome data on all cases were obtained from review of the medical records. RESULTS: Of 216 fetuses (25%) suspected of IUGR based on a weight below the 10th percentile, 6 developed true IUGR: 5 that led to emergent delivery of fetuses weighing less than a 1000 g and 1 in utero fetal demise. The remaining 210 fetuses all had normal outcomes. CONCLUSIONS: As long as the fetal growth falls along a curve that parallels normal growth curves, appropriate growth has occurred regardless of the gestational age and weight percentile that has been assigned to the fetus.
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Desenvolvimento Fetal , Retardo do Crescimento Fetal , Feminino , Retardo do Crescimento Fetal/diagnóstico por imagem , Idade Gestacional , Humanos , Gravidez , Terceiro Trimestre da Gravidez , Estudos Retrospectivos , Ultrassonografia Pré-NatalRESUMO
This article reviews the most current methods and technological aspects of high-intensity focused ultrasound (HIFU), which is termed histotripsy. The rationale for focal therapy for prostate carcinoma rather than prostatectomy, which is being used extensively throughout Europe and Asia, is presented, and an argument for why HIFU is the modality of choice for primary therapy and recurrent disease is offered. The article presents a review of the technical advances including higher ultrasound beam energy than current thermal HIFU which allows for more accurate tissue targeting, less collateral tissue damage, and faster treatment times. Finally, the article presents a discussion about the advantage of ultrasound guidance for histotripsy in preference to magnetic resonance imaging guidance primarily based on cost, ease of application, and portability.
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Ablação por Ultrassom Focalizado de Alta Intensidade/métodos , Neoplasias da Próstata/diagnóstico por imagem , Neoplasias da Próstata/cirurgia , Ultrassonografia de Intervenção/métodos , Humanos , Masculino , Próstata/diagnóstico por imagem , Próstata/cirurgiaRESUMO
In this article, we describe our experience with shear wave propagation imaging (SWPI) as an adjunct to 2-dimensional (2D) shear wave elastography (SWE) in a cohort of patients being evaluated for diffuse liver disease. Two-dimensional SWE has been extensively studied in previous publications; however, 2D SWE using propagation images has not been widely described in the literature to date. We observed that when certain artifacts occurred on the color elastograms, highly characteristic changes to shear wave propagation contours were seen, which can help clarify the cause of the artifacts. To our knowledge, the use of SWPI to explain the etiology of artifacts has never been published before. The artifacts described in this article include the capsule reverberation artifact, penetration limitation or dropout artifact, artifact due to blood vessels, shadowing artifact, tissue motion artifact, and near-field distortion/precompression artifact. Hence, the purpose of this article is to show examples of common artifacts seen on 2D SWE as depicted on corresponding SWPI to demonstrate that both types of image displays are complementary to each other.
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Artefatos , Técnicas de Imagem por Elasticidade/métodos , Hepatopatias/diagnóstico por imagem , Humanos , Fígado/diagnóstico por imagemRESUMO
OBJECTIVE: Common fetal anomalies of the kidneys and urinary tract encompass a complex spectrum of abnormalities that can be detected prenatally by ultrasound. Common fetal anomalies of the kidneys and urinary tract can affect amniotic fluid volume production with the development of oligohydramnios or anhydramnios, resulting in fetal pulmonary hypoplasia and, potentially, abnormal development of other fetal structures. CONCLUSION: We provide an overview of common fetal anomalies of the kidneys and urinary tract with an emphasis on sonographic patterns as well as pathologic and postnatal correlation, along with brief recommendations for postnatal management. Of note, we render an updated classification of fetal abnormalities of the kidneys and urinary tract based on the presence or absence of associated urinary tract dilation. In addition, we review the 2014 classification of urinary tract dilation based on the Linthicum multidisciplinary consensus panel.
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Doenças Fetais/diagnóstico por imagem , Doenças Fetais/fisiopatologia , Doenças Fetais/terapia , Anormalidades Urogenitais/diagnóstico por imagem , Anormalidades Urogenitais/fisiopatologia , Anormalidades Urogenitais/terapia , Feminino , Humanos , Gravidez , Diagnóstico Pré-NatalRESUMO
OBJECTIVES: The purpose of this study was to compare Superb Microvascular Imaging (SMI; Toshiba America Medical Systems, Tustin, CA) with conventional color flow Doppler (CFD) and power Doppler (PD) imaging in the liver to distinguish between malignant and benign liver neoplasms. METHODS: After Institutional Review Board approval (number 449984-ED), patients undergoing routine pre-radiofrequency ablation planning ultrasound examinations for suspected hepatocellular carcinomas (HCCs) of less than 2 cm in diameter between January 1, 2015, and July 1, 2016, were prospectively identified. Four readers reviewed the ultrasound images independently for the presence or absence of flow centrally and along the periphery of the lesion. RESULTS: Higher peripheral vessel grades were found on SMI than CFD (P < .001) and PD (P < .001) imaging: in particular, more grade 2 (39% versus 16% and 11%, respectively) and grade 3 (8% versus 0% and 0%). Overall, more central and peripheral vessels were found on SMI than CFD and PD imaging for both HCC lesions (P < .001) and benign lesions (P < .001). Vascular grades were significantly higher in HCC lesions than benign lesions in nearly all cases, although the corresponding area under the curve values were relatively low, at 0.54 to 0.59 for the central vessel grades and 0.63 to 0.64 for the peripheral vessel grades. CONCLUSIONS: More central and peripheral vessels were found around liver lesions on SMI than on CFD and PD imaging. Although there was significantly more vascularity on the periphery of malignant liver lesions than benign lesions, the overall diagnostic performance based on this criterion alone was relatively low, with an area under the curve of 0.64.
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Carcinoma Hepatocelular/irrigação sanguínea , Carcinoma Hepatocelular/diagnóstico por imagem , Neoplasias Hepáticas/irrigação sanguínea , Neoplasias Hepáticas/diagnóstico por imagem , Microvasos/diagnóstico por imagem , Ultrassonografia Doppler/métodos , Diagnóstico Diferencial , Ecocardiografia Doppler em Cores , Feminino , Humanos , Fígado/irrigação sanguínea , Fígado/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Reprodutibilidade dos Testes , Sensibilidade e EspecificidadeRESUMO
OBJECT: The aim of this study was to perform in vitro T2 mapping of serial dilutions of pharmaceutical surfactant. MATERIALS AND METHODS: Magnetic resonance imaging. Magnetic resonance scanning was performed on serial dilutions of surfactant on large bore clinical magnets at a field strength of 1.5 T Philips and 3.0 T (Achieva TX, Philips Healthcare, the Netherlands). RESULTS: The curves demonstrate a small increasing trend between surfactant concentration and R2 (shortened T2's), with a 7.3% increase in R2 for each doubling of surfactant concentration (95% confidence interval: 6.1-8.6%, p < 0.001). CONCLUSIONS: The increasing lung/liver T2 signal ratio seen in fetal lungs with increasing gestational age is not due to increasing surfactant concentration. © 2016 John Wiley & Sons, Ltd.
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Pulmão/diagnóstico por imagem , Pulmão/metabolismo , Imageamento por Ressonância Magnética , Diagnóstico Pré-Natal/métodos , Tensoativos/metabolismo , Feminino , Maturidade dos Órgãos Fetais , Feto/metabolismo , Idade Gestacional , Humanos , Espectroscopia de Ressonância Magnética/métodos , Gravidez , Tensoativos/análiseRESUMO
OBJECTIVES: This study evaluates the sensitivity and specificity of stenosis index (SI), which accounts for the entire spectral Doppler waveform, to detect significant transplant hepatic arterial stenosis. MATERIALS AND METHODS: In this institutional review board-approved, HIPAA compliant study, we retrospectively analyzed 69 patients who had catheter angiography for suspected transplant hepatic arterial stenosis (THAS) between January 2006 and December 2010; all patients had Doppler ultrasound within 30 days before angiography. Patients with angiographic stenosis requiring intervention were considered positive for THAS. Stenosis index was calculated from each patient's spectral Doppler ultrasound images by obtaining the ratio of the area under the high-frequency signal to low-frequency signal in the spectral Doppler. Resistive index (RI) and pulsatility index (PI) were also calculated. Receiver operator curve analysis was performed and the area under the curve (AUC) was compared among the three metrics. RESULTS: Forty-eight of 69 patients had THAS by angiography requiring intervention; 21patients had no angiographic evidence of THAS. SI was significantly different (P < .001) between patients with THAS (SI = 1.04 ± 0.20) and those without THAS (SI = 1.39 ± 0.30). Stenosis index had an AUC of 0.86 for detecting THAS, which was significantly higher than that from RI (AUC = 0.68, P = .038 for the comparison) and PI (AUC = 0.70, P = .029). For SI < 1.35, the sensitivity for THAS was 94% and specificity was 52%. For RI < 0.5, the sensitivity was 96% and the specificity was 29%. CONCLUSIONS: Stenosis index is more accurate than the resistive index and the pulsatility index for detecting transplant hepatic artery stenosis.
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Artéria Hepática/diagnóstico por imagem , Artéria Hepática/fisiopatologia , Transplante de Fígado , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/fisiopatologia , Ultrassonografia Doppler/métodos , Adulto , Constrição Patológica/diagnóstico por imagem , Constrição Patológica/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Estudos Retrospectivos , Sensibilidade e EspecificidadeRESUMO
OBJECTIVE: Hepatocellular carcinomas (HCCs) that arise in noncirrhotic livers have several histologic and biochemical features that distinguish them from HCCs occurring in the setting of cirrhosis. Because the presentation, management, and prognosis of these entities are distinct, the accurate preoperative characterization of these lesions is of great clinical significance. We review the pathogenesis, imaging appearance, and clinical implications of noncirrhotic HCCs as they pertain to the clinical radiologist. CONCLUSION: HCCs that develop in noncirrhotic patients have distinct etiologic, cytogenetic, histopathologic, and clinical features. Despite a larger tumor burden at the time of HCC diagnosis, noncirrhotic patients with HCC have better overall survival and disease-free survival than cirrhotic patients with HCC. Knowledge of the precise clinical and imaging features of this entity and of other diagnostic considerations for the noncirrhotic liver is essential for improved patient care.
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Carcinoma Hepatocelular/patologia , Diagnóstico por Imagem , Neoplasias Hepáticas/patologia , Biomarcadores Tumorais/análise , Carcinoma Hepatocelular/etiologia , Carcinoma Hepatocelular/terapia , Meios de Contraste , Diagnóstico Diferencial , Humanos , Cirrose Hepática/patologia , Neoplasias Hepáticas/etiologia , Neoplasias Hepáticas/terapia , Prognóstico , Fatores de Risco , Análise de SobrevidaRESUMO
A complete fetal ultrasonographic (US) study includes assessment of the umbilical cord for possible abnormalities. Knowledge of the normal appearance of the umbilical cord is necessary for the radiologist to correctly diagnose pathologic conditions. Umbilical cord abnormalities can be related to cord coiling, length, and thickness; the placental insertion site; in utero distortion; vascular abnormalities; and primary tumors or masses. These conditions may be associated with other fetal anomalies and aneuploidies, and their discovery should prompt a thorough fetal US examination. Further workup and planning for a safe fetal delivery may include fetal echocardiography and karyotype analysis. Doppler US is a critical tool for assessment and diagnosis of vascular cord abnormalities. US also can be used for follow-up serial imaging evaluation of conditions that could result in fetal demise. Recent studies suggest that three- or four-dimensional Doppler US of the fetal umbilical cord and abdominal vasculature allows more accurate diagnosis of vascular abnormalities. Doppler US also is invaluable in assessment of fetal growth restriction since hemodynamic changes in the placenta or fetus would appear as a spectral pattern of increased resistance to forward flow in the fetal umbilical artery. Early detection of umbilical cord abnormalities and close follow-up can reduce the risk of morbidity and mortality and assist in decision making.
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Cordão Nucal/diagnóstico por imagem , Ultrassonografia Pré-Natal/métodos , Cordão Umbilical/anormalidades , Cordão Umbilical/diagnóstico por imagem , Cisto do Úraco/diagnóstico por imagem , Neoplasias Vasculares/diagnóstico por imagem , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Gravidez , Cordão Umbilical/irrigação sanguíneaRESUMO
OBJECTIVE: The purpose of this study was to retrospectively determine whether the ratio of fetal lung-to-liver signal intensities at single-shot fast spin-echo MRI is associated with fetal gestational age. MATERIALS AND METHODS: All fetal MRI examinations over a 4-year period were reviewed. All MRI examinations were performed with a 1.5-T magnet for indications other than lung maturity. Only examinations performed with a single-shot fast spin-echo sequence of the fetal chest and abdomen were included in the study. Images from a total of 82 fetal MRI examinations were evaluated. Gestational age ranged from 20 weeks to 39 weeks 3 days. Two board-certified subspecialty-trained radiologists with 11 and 17 years of experience blinded to estimated gestational age (EGA) reviewed the images independently. The regions of interest (ROIs) of the fetal lung and liver were drawn in the same plane and on the same image in each case. Fetal EGA was determined either by first-trimester ultrasound when available or by last menstrual period. Linear regression analysis was used to analyze the relation between the lung-to-liver signal-intensity ratio (LLSIR) in the ROIs and fetal EGA for both readers. The association between the LLSIRs estimated by the two readers was assessed by Bland-Altman plot. RESULTS: Summary statistics for LLSIR showed a median value of 2.29 for reader 1 and 2.21 for reader 2. The mean value for reader 1 was 2.4 and for reader 2 was 2.5. The Pearson correlation coefficients between the LLSIR and EGA variables were 0.44 for reader 1 and 0.45 for reader 2. Linear regression analysis showed a statistically significant association between LLSIR and EGA for both readers (p < 0.0004). This ratio increased in a linear manner as EGA progressed. CONCLUSION: Fetal LLSIR at single-shot fast spin-echo MRI is associated with fetal gestational age.
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Maturidade dos Órgãos Fetais , Fígado/embriologia , Pulmão/embriologia , Imageamento por Ressonância Magnética/métodos , Adolescente , Adulto , Feminino , Idade Gestacional , Humanos , Gravidez , Estudos RetrospectivosRESUMO
ABSTRACT: Nonalcoholic fatty liver disease (NAFLD) is a primary cause of parenchymal liver disease globally. There are currently several methods available to test the degree of steatosis in NAFLD patients, but all have drawbacks that limit their use.The objective of this study is to determine if a new technique, ultrasound (US) attenuation imaging (ATI), correlates with magnetic resonance proton density fat fraction imaging and hepatic echogenicity as seen on gray scale US imaging.Fifty-four patients were recruited at the University of Washington Medical Center from individuals who had already been scheduled for hepatic US or magnetic resonance imaging (MRI). All participants then underwent both hepatic MRI proton density fat fraction and US. Ultrasound images were then evaluated using ATI with 2 observers who individually determined relative grayscale echogenicity.Analysis showed positive correlation between ATI- and MRI-determined fat percentage in the case group (Spearman correlation: 0.50; P = 0.015). Furthermore, participants with NAFLD tended to have a higher ATI than controls (median: 0.70 vs 0.54 dB/cm/MHz; P < 0.001).This study demonstrates that US ATI combined with grayscale imaging is an effective way of assessing the degree of steatosis in patients with moderate to severe NAFLD.
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Hepatopatia Gordurosa não Alcoólica , Humanos , Hepatopatia Gordurosa não Alcoólica/complicações , Hepatopatia Gordurosa não Alcoólica/diagnóstico por imagem , Hepatopatia Gordurosa não Alcoólica/patologia , Prótons , Estudos Prospectivos , Fígado/diagnóstico por imagem , Fígado/patologia , Imageamento por Ressonância Magnética/métodos , Ultrassonografia/métodosRESUMO
PURPOSE: To use magnetization tagged magnetic resonance imaging (MRI) (tag-MRI) to quantify cardiac induced liver strain and compare strain of cirrhotic and normal livers. MATERIALS AND METHODS: Tag-MRI was performed at 1.5T on eight subjects with no history of liver disease and 10 patients with liver cirrhosis. A breath-hold peripheral pulse-gated (PPG) conventional tag-MRI cine sequence was performed with planes to include the left lobe of the liver and the inferior wall of the heart. Commercially available software HARP (Diagnosoft, Palo Alto, CA) was used for image analysis and strain calculation. Three regions-of-interest (ROIs) were selected: segment II of the liver near the heart (A), right liver lobe far from the heart (B), and the left ventricular wall (C). The average and maximal (max) strain were measured in A, B, and C. The maximum strains were used to generate a cardiac-corrected strain gradient: (maxA-maxB)/maxC. Results were compared with Student's t-test (SPSS, Chicago, IL). RESULTS: In subjects with no history of liver disease vs. cirrhotic patients, the average strain was 22% ± 7% vs. 4% ± 3% (P < 0.001), the max strain was 63% ± 15% vs. 17% ± 5% (P < 0.001), and the corrected strain gradient was 0.52 ± 0.16 vs. 0.11% ± 0.08%. CONCLUSION: There is a significant difference in liver strain measured with tag-MRI between subjects with no history of liver disease and patients with cirrhosis.
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Algoritmos , Técnicas de Imagem por Elasticidade/métodos , Interpretação de Imagem Assistida por Computador/métodos , Cirrose Hepática/patologia , Cirrose Hepática/fisiopatologia , Fígado/patologia , Fígado/fisiopatologia , Adulto , Idoso , Módulo de Elasticidade , Feminino , Humanos , Aumento da Imagem/métodos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Sensibilidade e EspecificidadeRESUMO
Various disorders of sex development (DSD) result in abnormal development of genitalia, which may be recognized at prenatal ultrasonography, immediately after birth, or later in life. Current methods for diagnosing DSD include a thorough physical examination, laboratory tests to determine hormone levels and identify chromosomal abnormalities, and radiologic imaging of the genitourinary tract and adjacent organs. Because of the complex nature of DSD, the participation of a multidisciplinary team is required to address the patient's medical needs as well as any psychosocial issues that the patient or the family may encounter after the diagnosis. The first step in the management of DSD is sex assignment, which is based on factors such as the genotype; the presence, location, and appearance of reproductive organs; the potential for fertility; and the cultural background and beliefs of the patient's family. The primary goal of sex assignment is to achieve the greatest possible consistency between the patient's assigned sex and his or her gender identity. Once the sex is assigned, the next step in management might be surgery, hormone therapy, or no intervention at all. Patients with ovotesticular DSD and gonadal dysgenesis may require a gonadectomy, followed by reconstructive surgery. Some patients may need hormone replacement therapy during puberty. An understanding of the immediacy of families' need for sex assignment and clinicians' need for reliable diagnostic imaging results will help radiologists participate effectively in the prenatal and postnatal assessment of patients with DSD.