Ultrasound Attenuation Imaging vs MRI-PDFF, Echogenicity and Liver Function for Assessing Degree of Steatosis in NAFLD and Non-NAFLD Patients.

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.

Variation in Fetal Weight Percentile Estimates.

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.

Magnetic Resonance Prediction of Lung Maturity in Fetuses With Congenital Diaphragmatic Hernia.

ABSTRACT: To determine if lung to liver MR T2 signal ratio is predictive of neonatal outcome in fetuses with congenital diaphragmatic hernia (CDH).After Interal Review Board approval, the PACS systems at the University of Washington and University of Utah were searched for cases having an in utero fetal MR examination diagnostic of CDH. Inclusion criteria were at least 1 prior ultrasound demonstrating a CDH and an MR obtained within 1 week of that prior ultrasound.A total of 69 patients from the University of Utah and 13 from the University of Washington satisfied the inclusion criteria for a total of 82. After adjusting for gestational age and contralateral lung volume, there was little apparent association between contralateral lung to liver MR T2 signal and 5-minute Apgar score and neonatal mortality When considering neonatal Apgar and mortality, increasing contralateral lung volume was significantly associated with lower risk (hazard ratio, 0.40 per doubling; 95% confidence interval, 0.24-0.69; P = 0.001) as expected.Our data demonstrate that the lung to liver MR signal ratio was not predictive of outcome. The measurement of contralateral lung area, and gestational age at the time of the examination (time of diagnosis) are still the best predictors of poor neonatal outcome.

Role of portable ultrasound during a short-term medical service trip to rural Guatemala: a collaborative mission of trainees and physicians.

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.

The heart as a spring, the measurement of myocardial bounce to assess left ventricular function on cardiac MR.

Little has been reported on the left ventricular myocardial distension (bounce) and its utility to assess cardiac function. The purpose of this study is to determine whether myocardial bounce at end diastole is reproducibly visualized by blinded observers and to determine whether it corresponds to systolic and diastolic function. 144 Consecutive cardiac MR exams between September and December 2017 were selected for analysis. The bounce was graded by two blinded observers, and the change in LV diameter pre and post bounce was measured. The bounce was defined as the rapid change in LV volume that occurs at the end of diastole during atrial contraction just prior to systolic ejection. Inter-reader agreement was summarized using Cohen's kappa. Spearman's rank correlation coefficient was used to evaluate associations between bounce grade and cardiac physiology parameters. Overall agreement was good with unweighted kappa = 0.69 (95% CI 0.60-0.79). Bounce grade was significantly correlated with the average change in LV diameter before and after the bounce (Spearman's rho = 0.76, p < 0.001). Median diameter changes were 0.0, 1.9, and 4.2 mm in grades 0 (no bounce), 1 (small bounce), and 2 (normal), respectively. The bounce lasted 8 to 12 ms in all patients. Bounce grade was significantly correlated with LV EF (Spearman's rho = 0.43, p < 0.001). Median EF was 44%, 51%, and 58% in grades 0, 1, and 2, respectively. Of the 87 patients who had E/A ratio or E/e' ratio measured, bounce grade was also significantly correlated with E/A ratio (r = - 0.24, p = 0.034) and E/e' ratio (r = - 0.24, p = 0.022), with lower grades having higher ratio values on average (Table 4). Of the 15 patients with a bounce grade of 0 by one or both readers and EF ≥ 50%, 8 had E/A ratio measurements and 7 had E/e' ratio measurements. The E/A ratio values ranged from 1 to 2.7 (median 1.5). The E/e' ratio values ranged from 4.8 to 9.6 (median 7.7). The simple observation of a normal myocardial bounce during cine loop review of cardiac MR exams was predictive of normal diastolic and systolic cardiac function. Lack of myocardial bounce was highly associated with both systolic and diastolic dysfunction. The subpopulation of patients with loss of myocardial bounce and normal ejection fraction appear to represent patients with early diastolic dysfunction. Further studies with more diastolic dysfunction MRs are needed to examine this relationship. This study suggests changes to the myocardial bounce seen on cardiac MR may be a simple useful tool for detecting cardiac dysfunction. This study is not to replace, but rather aid the clinical diagnosis and management of both diastolic and systolic dysfunction.

Double Trouble: Complications in Twin Pregnancies.

With the increasing rate of twin pregnancies due to increase in maternal age and use of assisted reproduction, it is important to be aware of unique diseases which occur specifically to twin pregnancies, especially in monochorionic twin pregnancies. These entities include twin to twin transfusion syndrome, twin anemia polycythemia sequence, twin reversed arterial perfusion, cotwin demise, and conjoined twins. Early evaluation and documentation are imperative to guide management which ultimately leads to better patient outcomes.