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American Institute of Ultrasound in Medicine <strong>Proceedings</strong> J Ultrasound Med 32(suppl):S1–S134, 2013Methods—Twelve patients with Gleason grade 4 prostate cancerwere prospectively scanned with a GE Voluson E9 unit employing alinear 18-MHz probe with conventional 3D/4D imaging using 3D angioand glass body power Doppler image reconstruction. All patients wereimaged by DCE-MRI with a 1.5-T Siemens unit within 1 week of thesonogram. All lesions were followed by serial vascular imaging for 5years. Six recurrences were found and biopsy proven. Three were retreatedby microwave, remaining stable, and 3 were retreated with MRI-guidedlaser ablation in 2012.Results—3D-PDS and DCE-MRI showed the tumor vascularrecurrence in 6 of 12 patients who were retreated and followed without recurrencemeasured either by a vascularity increase or prostate-specificantigen rise.Conclusions—Vascular imaging appears useful in preoperativeplanning and follow-up of microwave thermal treatments.1505306 Multiplanar Mapping of CelluliteRobert Bard Biofoundation, New York, New York USAObjectives—To compare the accuracy of 3D sonographic mappingof cellulite with high-resolution small-field 3-T magnetic resonanceimaging (MRI).Methods—Over a 2-year period, 99 consecutive patients withpalpable lower extremity subcutaneous nodules were preoperativelyscanned with a GE Voluson E9 unit employing a linear 18-MHz probewith 3D angio and glass body power Doppler image reconstruction and a3.0-T MRI small field of view within 1 week. All images were comparedwith histologic sections. During the last year of the study, access to 22–70-MHz linear probes permitted the concomitant study of 53 patients withcellulite. Cellulite was studied with A- and B-mode ultrasound, color,power, and angio Doppler, and 3D histogram analysis of the regional bloodsupply and small-field 3-T MRI. Treatment used laser and antioxidanttherapies.Results—With the use of 22–70-MHz probes, areas of cellulitewere imaged as part of a study using antioxidant therapies to reduce disfiguringareas. MRI had no diagnostic value in cellulite evaluation, althoughit accurately depicted fat compartments. Additionally, Dopplerultrasound blood flow analysis showed abnormal flows in the regions ofgreatest cellulite architectural distortion. The depth of the subcutaneousfat may be measured and the penetration of the cellulite may be assessedwith 3D volumetric dermal/subdermal imaging.Conclusions—3D multiplanar ultrasound imaging appears tobe significantly more accurate than MRI in diagnosing cellulite and mayfacilitate laser ultrasound-guided treatments. Previsual treatment improvementmay be noted by a decrease in inflammatory neovascularity.1506560 Prostate Cancer Neovascular Responses to AntioxidantsRobert Bard Biofoundation, New York, New York USAObjectives—To show Doppler sonographic vessel density imagingresponses to antioxidant therapies.Methods—One hundred eleven patients with prostate cancertreated with antioxidant supplement therapies composed of beta-sitosterol,resveratrol, and herbal antioxidants and followed over a 4-year periodwere prospectively scanned with a GE Voluson E9 unit employing an endorectal18-MHz probe with conventional 3D/4D imaging using 3D angioand glass body power Doppler image reconstruction. Eighty-seven patientshad Gleason 3, and 23 had Gleason 4. Follow-up at 6, 12, 18, 24, 30,and 36 months was obtained. The vessel index was assessed on sonographyby 3D histogram analysis and by dynamic contrast enhanced magneticresonance imaging (DCE-MRI). Follow-up biopsies were obtained shortlyafter imaging studies, which occurred on a 6-month basis.Results—Gleason grade 3 (low grade): 72 of 87 patients haddecreased vascular indices, indicating a positive response to the protocol.Prostate-specific antigen (PSA) lowering was noted. Gleason grade 4 (highgrade): 10 of 23 patients had decreased vascular indices, indicating a positiveresponse to the protocol. PSA lowering was noted. Five patients werestable. Eight patients showed disease progression and a PSA rise, indicatinga negative response to the protocol. DCE-MRI confirmed all sonographictumor vascular findings. Biopsy correlation was good.Conclusions—Vessel density sonographic indexing and DCE-MRI analysis correlated well with a positive biochemical response to antioxidanttherapies. Twenty-one percent of patients with aggressive tumorswho were nonresponders to this protocol were referred for alternative treatmentsin a timely manner.1506561 Prostate Cancer 3-Dimensional Capsular Erosion Alert forBone Metastases and Lymphadenopathy EvaluationsRobert Bard Biofoundation, New York, New York USAObjectives—To show capsular erosion as an alert to bonemetastases.Methods—Eighty-one patients with capsular erosion evidenton 3D imaging were prospectively scanned with a GE Voluson E9 unitemploying an endorectal 18-MHz probe with conventional 3D/4D imagingusing 3D angio and glass body power Doppler image reconstructionand dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI).Results—Sixty-seven of 81 patients had boney metastasesidentified on MRI and bone scans. Two hundred forty patients withoutcapsular erosion on 3D imaging showed bone metastases in 3 of 240cases. Capsular erosion was associated with perirectal adenopathy in 40of 81 patients.Conclusions—Patients with capsular erosion demonstrated a3× incidence of bone metastases and a 2× incidence of perirectal lymphadenopathy.Since bone metastases are difficult to image on some standardMRI protocols, DCE-MRI may be requested to highlight abnormalneovascularity.1507806 Evaluation of a Small Abdominal Circumference by Ultrasoundas a Predictor of Increased Doppler ResistancePedro Roca, 1 * Allen Kunselman, 2 Gabor Mezei, 1 Kari Whitley,1 Serdar Ural, 1 John Repke 1 1 Obstetrics and Gynecology,2Public Health Sciences, Penn State Hershey Medical Center,Hershey, Pennsylvania USAObjectives—Ultrasonographic fetal evaluation has been usedto diagnose intrauterine growth restriction (IUGR). A measurement thathas shown to be predictor of IUGR is the fetal abdominal circumference(AC). The use of Doppler of the umbilical arteries is helpful in followingfetuses previously diagnosed with IUGR. However, Doppler evaluation ofumbilical arteries has failed to be diagnostic for IUGR. To date, no studyhas specifically examined the relationship if any between AC measurementsby ultrasound and umbilical artery Doppler values. The objective ofthis study was to determine if findings of decreased AC during ultrasoundcan be used as an independent predictor of increased umbilical arteryDoppler resistance in fetuses.Methods—After Institutional Review Board approval, we conducteda retrospective cohort study of all ultrasound studies performed atthe maternal-fetal medicine Unit in our center from July to November2009. We obtained the fetal AC expressed as a percentile of gestational ageand measured the umbilical artery Doppler. The association between ACand elevated umbilical artery Doppler was evaluated.Results—A total of 299 patients were evaluated. We used theSAS 9.2 system to evaluate the 2 main variables, AC percentile and umbilicalartery Doppler. We found a linear association between AC percentilesand umbilical artery Doppler percentiles. The Pearsoncorrelation coefficient was –0.03 (95% confidence interval, –0.40, –0.19). The R2 value was only 0.09, which means that only 9% of theumbilical artery Doppler percentile variability is explained by the ACpercentile.S85
American Institute of Ultrasound in Medicine <strong>Proceedings</strong> J Ultrasound Med 32(suppl):S1–S134, 2013Conclusions—The AC percentile is a weak predictor of abnormalumbilical artery Dopplers. Further research may help in determiningif ultrasound evaluations other than the AC percentile may stronglycorrelate with IUGR.1508173 Persistence of Placenta Previa in Twin Pregnancies Diagnosedin the Second Trimester by the Degree of CervicalOverlapSimi Gupta, 1 * Nathan Fox, 1,2,3 Andrei Rebarber, 1,2,3 DanielSaltzman, 1,2,3 Chad Klauser, 1,2,3 Ashley Roman 1,2,3 1 Obstetricsand Gynecology, New York University School of Medicine,New York, New York USA; 2 Maternal-Fetal Medicine, CarnegieImaging for Women, New York, New York USA; 3 Obstetrics andGynecology, Mount Sinai School of Medicine, New York, NewYork USAObjectives—Several studies in singleton gestations with completeprevia have determined that the degree of placental overlap correlateswith the likelihood of persistence of previa at the time of delivery. However,no studies have correlated these findings in twin gestations. The objectiveof this study was to determine if the measurement of placentaloverlap in twin pregnancies diagnosed with complete previa during thesecond trimester will predict persistence of placenta previa at the time ofdelivery.Methods—This was a retrospective cohort study of twin pregnancieswith complete placenta previa diagnosed at 15 to 19 and 20 to 23weeks’ gestation from 2005 to 2011. All patients underwent transvaginalultrasound using GE Voluson or Medison equipment. The degree ofplacental overlap was measured from the internal os to the edge of theplacenta and was correlated with the risk of persistence at the time of delivery.Groups were compared using the Mann-Whitney U test and Fisherexact test as appropriate with P < .05 as significance.Results—Of 532 twin gestations, 41 patients (7.7%) wereidentified as having complete previa at 15 to 19 weeks’ gestation, and 9of 41 patients (22%) had persistence of placenta previa at the time ofdelivery. At 15 to 19 weeks, there was no significant difference in medianoverlap between patients who had persistence of previa or resolutionof previa at delivery (17 vs 12 mm; P = .26) . A subset of 14 patients(2.6%) were identified as having complete previa at 20 to 23 weeks’ gestation,and 8 of 14 patients (57%) had persistence at the time of delivery.At 20 to 23 weeks, there was no significant difference in medianoverlap between patients who had persistence of previa or resolution ofprevia at delivery (12.5 vs 14 mm; P = .85). Using thresholds of 5, 10,15, 20, and 25 mm overlap at either 15 to 19 or 20 to 23 weeks, there wasno significant difference in the risk of persistence at the time of delivery.Conclusions—In our population of twin gestations, the degreeof overlap of complete previa during the second trimester did not correlatewith the likelihood of resolution by the time of delivery.1509891 Sonographic Morphologic Score as a Predictor of the Outcomein Fetal Sacrococcygeal TeratomaMarjan Bolouri, 1 * Eveline Shue, 2 Douglas Miniati, 2 VickyFeldstein 1 1 Radiology and Biomedical Imaging, 2 Surgery,University of California San Francisco Medical Center, SanFrancisco, California USAS86Objectives—Sacrococcygeal teratoma (SCT) is the most commontumor of the neonate. Ultrasound (US) is critical in the prenatal evaluationof fetuses with SCT, for whom outcomes vary widely. The purposeof this study was to develop a morphologic scoring scheme to use as apredictor of the outcome in fetuses with SCT.Methods—The records of all patients carrying fetuses diagnosedwith SCT between 1986 and 2011 at our fetal treatment center werereviewed; those with available outcome data and US examinations wereincluded in the study (n = 40). Two radiologists, blinded to the outcome,retrospectively reviewed the obstetric sonograms performed at presentation.Tumor sonographic morphology was classified as predominantlycystic (>60%), predominantly solid (>60%), or mixed (40%–60% solidand cystic). Tumor volume measurements and volume/estimated fetalweight ratios were calculated. Good outcomes were defined as survival tohospital discharge, whereas poor outcomes were defined as intrauterinefetal demise, termination for hydrops or maternal mirror syndrome, perinataldeath, or need for fetal intervention. Sensitivity, specificity, and thepositive predictive value (PPV) of morphology as a predictor of outcomewas calculated.Results—A predominantly solid (>60%) sonographic appearancewas associated with a poor outcome. Of 40 cases in this series, 10SCTs were predominantly cystic, and 29 were predominantly solid on initialUS. One mass appeared 50% cystic and 50% solid. The mean gestationalage at presentation was 23 weeks. No significant difference in meantumor volume was seen between those with a poor outcome and those witha good outcome (347 versus 183 cm 3 ; P = .124). Mixed to predominantlysolid US morphology was associated with poor outcomes (sensitivity,100%; specificity, 67%; PPV, 83%). None of the SCT cases presenting withpredominantly cystic sonographic morphology had a poor outcome.Conclusions—A predominantly solid SCT appearance by USis a highly sensitive predictor of a poor outcome. Therefore, sonographicmorphologic assessment is a useful predictor of the postnatal outcome inthe prenatal evaluation of fetal SCT. This may be useful for prognosis andguiding obstetric management.1511819 Retrospective Review of Fetal Body LymphangiomaIncluding Postnatal OutcomeKari Thomas, Karen Oh, Roya Sohaey* Diagnostic Radiology,Oregon Health and Science University, Portland, Oregon USAObjectives—The purpose of this retrospective review is to studya series of 8 fetal body lymphangiomas (a type of lymphatic malformation)detected on prenatal ultrasound and to assess how findings on fetal magneticresonance imaging (MRI) and/or postnatal MRI or computed tomography(CT) differed from the prenatal ultrasound, primarily withregard to the overall anatomic extent of the malformation. Accuratedetermination of the overall extent of these malformations is critical indelivery and postnatal treatment planning.Methods—We reviewed each patient’s prenatal ultrasound andthen compared these findings with subsequent fetal MRI and/or postnatalimaging. Postnatal imaging included MRI and/or CT. Maternal and neonatalelectronic records were reviewed.Results—In each of the 8t cases in our series, fetal MRI (4/8)and postnatal imaging provided clinically relevant information for deliveryplanning (with fetal MRI) and treatment options (with both fetal MRIand postnatal imaging). This information, regarding the size of the malformationand involvement of adjacent organs, was not fully disclosed byprenatal ultrasound findings alone.Conclusions—The extent of fetal body lymphangiomas is routinelyunderestimated by prenatal ultrasound. Fetal MRI and/or postnatalcross-sectional imaging provided additive diagnostic benefit in every case.These imaging modalities should be offered to patients when fetal lymphangiomais diagnosed on prenatal ultrasound.1513506 Effect of Targeted Ultrasound Contrast Agent Attachmenton Nonlinear Frequency EmissionsJohn Eisenbrey, 1 * Valgerdur Halldorsdottir, 1,2 Anush Sridharan,1,3 Joshua Rychak, 4 Flemming Forsberg 1 1 Radiology,Thomas Jefferson University, Philadelphia, Pennsylvania USA;2School of Biomedical Engineering and Health Systems, 3 Electricaland Computer Engineering, Drexel University, Philadelphia,Pennsylvania USA; 4 Targeson Inc, San Diego, California USAObjectives—Current strategies for differentiating attached fromunattached targeted ultrasound contrast agents (UCAs) rely on using motiontracking or signal changes after destructive pulses, both of which in-
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2013Journal ofUltrasoundin Medicine
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Small-Animal Preclinical High-Frequ
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2013 AIUM Award WinnersJoseph H. Ho
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2013 AIUM Award WinnersDistinguishe
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Endowment for Education andResearch
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Rosa De Vermette, MD, RDCS,RDMS, RO
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Kee-Hak Lim, MDG. Sharat Lin, PhDTo
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