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American Institute of Ultrasound in Medicine <strong>Proceedings</strong> J Ultrasound Med 32(suppl):S1–S134, 2013and Dandy-Walker complex could not be calculated, as there were nopregnancies where MRI was accurate but ultrasound alone was not.Conclusions—There is a variable cost per additional diagnosiscorrectly secured that should be weighed when considering a pregnancyfor adjunct fetal MRI. Further study should be directed at assessing theglobal cost-benefit of fetal MRI, as well as considering the value of MRIfor prognostication and surgical planning purposes.1530478 Transcranial Sonography and 123 I-FP-CIT Single-PhotonEmssion Computed Tomography in Movement DisordersDavid Školoudík, 1,3 * Petra Bartova, 1 Tana Fadrna, 1 OtakarKraft, 2 Martin Havel 2 1 Neurology, 2 Nuclear Medicine,University Hospital Ostrava, Ostrava, Czech Republic;3Neurology, Palacký University Medical School and UniversityHospital Olomouc, Olomouc, Czech RepublicTable 1MRI StudiesNeeded for 1 Cost perAdditional Accurate AdditionalDiagnosis Diagnosis Accurate DiagnosisMeningomyelocele 3 $6,466.20Multiple anomalies 6 $12,932.40Brochopulmonary sequestration 9 $19,398.60Congenital cystic adenomatoid malformation 12 $25,864.80Ventriculomegaly 14 $31,175.601530454 Comparison of Brain Vessel Imaging From Transtemporaland Subcondylar Approaches Using Contrast-EnhancedTranscranial Color-Coded Duplex Sonography and a VirtualNavigatorDavid Školoudík, 1,3 * Martin Roubec, 1 Martin Kuliha, 1Jaroslav Havelka, 2 Katerina Langova, 4 Roman Herzig 31Neurology, 2 Radiology, University Hospital Ostrava, Ostrava,Czech Republic; 3 Neurology, Palacký University MedicalSchool and University Hospital Olomouc, Olomouc, Czech Republic;4 Biophysics, Faculty of Medicine and Dentistry, Instituteof Molecular and Translational Medicine, Palacký UniversityOlomouc, Olomouc, Czech RepublicObjectives—The transcondylar approach is a new approachused for detection of chronic cerebrospinal venous insufficiency and intracranialvenous reflux in patients with multiple sclerosis. The aim of thestudy was to assess the capability of native and contrast-enhanced (CE-)transcranial color-coded duplex sonography (TCCS) to detect flow andreflux in deep cerebral veins and intracranial venous sinuses fromtranscondylar and transtemporal approaches.Methods—Brain magnetic resonance imaging and TCCS fromtranstemporal and transcondylar approaches using the new technology,fusion imaging, were performed in 8 volunteers and 5 patients with multiplesclerosis.Results—Root mean square error .05) subjectsusing CE-TCCS, respectively. Intracranial venous reflux was not detectedin any subject. A bidirectional Doppler signal from the region of the cavernoussinus detected in 3 subjects was evaluated as a breathing artifact.Conclusions—The study results showed that the TCCStranscondylar approach has serious limitations for standard detection of intracranialvenous reflux.S91Objectives—Diagnosis of Parkinson’s disease (PD) and otherParkinsonian syndromes (PS) could be difficult in early stages of the disease.Transcranial sonography (TCS) is able to detect structural changes inthe substantia nigra and basal ganglia in PD and PS patients, and fluoropropyl-carbomethoxy-iodophenyl-tropane(FP-CIT) single-photon emissioncomputed tomography (SPECT) could detect presynaptic dysfunctionin several neurodegenerative diseases, including PD and PS. The aim ofour study was to assess correlation between TCS and SPECT findings anddiagnosis of PD, other PS, essential tremor (ET), and psychogenic movementdisorder (PMD).Methods—A total of 49 (32 male; age range, 26–73 years;mean age, 56.1 ± 9.1 years) out of 53 screened patients were enrolled inthe study: 29 PD patients, 7 PS patients, 11 patients with ET, and 2 PMDpatients. Substantial nigra (SN) echogenicity and SN area were measuredusing TCS. SPECT evaluation of basal ganglia was performed using adopamine active transporter ligand ( 123 I-ioflupane). Both examinationswere performed within 2 months after clinical examination. The sensitivity,specificity, positive predictive value (PPV), and negative predictivevalue (NPV) for TCS and SPECT were evaluated.Results—TCS and SPECT findings correlated in 84% patients(κ = 0.62; 95% confidence interval [CI], 0.38–0.86; ACE1 = 0.61; P =.00002). TCS/SPECT sensitivity, specificity, PPV, and NPV for diagnosisof PD were 89.7%/96.6%, 60.0%/70.0%, 76.5%/82.4% and 80.0%/93.3%,respectively. Both positive TCS and SPECT findings correlated significantlywith diagnosis of PD (κ = 0.52; 95% CI, 0.27–0.76; ACE1 = 0.59;P = .0002; and κ = 0.69; 95% CI, 0.49–0.90; ACE1 = 0.74; P = .000001,respectively).Conclusions—TCS and SPECT are helpful in early diagnosisof PD with high correlation. The sensitivity, specificity, PPV, and NPVwere similar for both methods. (Supported by a grant from the Moravian-Silesian Region).1535936 Cell-Free Fetal DNA Testing for Aneuploidy: Initial ExperienceKisti Fuller, 1,2 * Adam Borgida 2 1 Maternal-Fetal Medicine,University of Connecticut, West Hartford, Connecticut USA;2Maternal-Fetal Medicine, Hartford Hospital, Hartford, ConnecticutUSAObjectives—Cell-free fetal DNA (cffDNA) tesing is nowwidely available from commercial labs. We evaluated our initial experienceof patients choosing cffDNA testing for fetal aneuploidy.Methods—Since January 2012, we have been routinely offeringcffDNA testing as an alternative to invasive testing for fetal aneuploidy.We reviewed our database of patients undergoing cffDNA testing.Data collected included maternal age, indication for testing, gestationalage at time of testing, type of cffDNA test, length of time for results, andout-of-pocket costs when known.Results—There were 106 patients who met with a geneticcounselor for possible cffDNA testing. Of these 14 of 106 (13%) declinedtesting, and 1 of 106 (1%) chose to undergo invasive testing. Of the 91 remainingpatients, 24 (26.4%) chose directed DNA (dDNA) testing, and 67(73.6%) chose massive parallel shotgun sequencing (MPSS). After theinitial draw, 3 of 24 (12.5%) samples for dDNA failed to produce a result,and a repeat sample was required. The average patient age was 36 years.The average gestational age at the time of testing was 16.5 weeks. Theaverage time from serum sample until initial results were received was 10days. Testing indications were: advanced maternal age, 67%; abnormal
American Institute of Ultrasound in Medicine <strong>Proceedings</strong> J Ultrasound Med 32(suppl):S1–S134, 2013serum screen, 46.2%; ultrasound anomaly, 28.6%; and/or family history,4.4%. Patients that chose dDNA were not billed up front, and no informationon their out-of-pocket costs was available. Patients that choseMPSS testing required some prepayment. Of the 53 patients with a knownup-front charge, it was $235 for 26 and $475 for 27 patients.Conclusions—The most common indication for cffDNA testingwas advanced maternal age. The testing was most commonly done inthe early second trimester, and it took an average of 10 days for results.There was a higher rate of test failure in the dDNA group (12%). The outof-pocketcost prior to testing may affect the patient’s desire for testing.1536107 Hospital-Wide Survey of Bacterial Contamination of Pointof-CareUltrasound ProbesMatthew Lawrence, 1 * James Blanks, 2 Ruben Ayala, 2 JoelSchofer, 1 Diana Macian, 1 Douglas Talk, 3 Jessie Glasser 41Emergency Department, Naval Medical Center Portsmouth,Chesapeake, Virginia USA; 2 Laboratory Services, MicrobiologyDivision, 3 Obstetrics and Gynecology, 4 Internal Medicine,Infectious Disease Division, Naval Medical Center Portsmouth,Portsmouth, Virginia USAObjectives—With the increasing use of point-of-care ultrasoundin many areas of medicine, there is a concern that ultrasound equipmentcan facilitate transmission of infection to patients, especially methicillinresistantStaphylococcus aureus (MRSA). The primary objective of thisstudy is to determine the prevalence of bacterial colonization on hospitalwidepoint-of-care ultrasound probes by performing cultures of the probes.Our hypothesis is that bacterial contamination is not a significant problem,and that our current ultrasound probe cleaning protocols are sufficientto protect patients against such nosocomial spread of infection.Methods—The study was conducted at a single military hospitalon 43 point-of-care ultrasound machines (87 probes) located within 9 departmentsover an 8-week period. Every probe was cultured 4 times duringthe study period, at 2-week intervals. Intracavitary probes were excludedfrom the study due to high-level disinfection protocols at our institution.Positive cultures underwent species identification in the microbiology lab.Results—At the time of this submission, the first half of datacollection was complete (2 culture sets performed on each machine, 2 culturesets remaining). Of the 174 probe cultures, 13 resulted in positivegrowth (7.5%). Three cultures (1.7%) identified Micrococcus species, and8 cultures (4.6%) identified coagulase-negative Staphylococcus, both ofwhich are common human skin flora. Three cultures (1.7%) identifiedBacillus species, not B anthracis or B cereus. Finally, 3 cultures (1.7%)identified Pseudomonas species, which was not P aeruginosa. No culturesidentified MRSA.Conclusions—As hypothesized, bacterial contamination ofpoint-of-care ultrasound probes is low and primarily involves organismscommon to normal skin flora and the environment. MRSA contaminationwas not identified at our institution. Antibacterial wipes after each useseem to prevent significant bacterial growth on ultrasound probe surfaces.(The views expressed in this article are those of the authors and do notnecessarily reflect the official policy or position of the Department of theNavy, Department of Defense, or the United States Government.)1536431 A Novel Approach to Visualizing the Vasculature Architectureof the Placenta Using 3-Dimensional Slicer Software:A Pilot StudyRie Oyama, 1 * Chizuko Isurugi, 1 Tomonobu Kanasugi, 1 AkihikoKikuchi, 1 Toru Sugiyama, 1 Sonia Pujol, 2 Ron Kikinis 21Obstetrics and Gynecology, Iwate Medical University,Morioka, Japan; 2 Radiology, Brigham and Women’s Hospital,Boston, Massachusetts USAObjectives—The aim of this pilot study presents a novel approachto visualize the vasculature architecture of the placenta usinggrayscale to acquire volume data of the villous tree from the 3D ultrasoundmachine, and then these data restructure the placental vasculatureusing 3D Slicer software, which is an open-source medical visualizationand analysis software package for medical image computing.Methods—We used a Voluson E6 (GE Healthcare) system witha RAB4-8-D/OB 3D/4D 8-MHz transabdominal wideband convex volumetransducer. The 3D volume image was adjusted to include the entireplacenta. The volume data set was stored in the DICOM format for restructuringon the 3D Slicer software. This study included 2 women withsingleton pregnancies seen at 16 and 20 weeks at Iwate Medical UniversityHospital. Informed consent was obtained from each patient. The InstitutionalReview Board approved this study. The raw volume data wereimported into the Slicer software, which was loaded to display on the 2Dviewer (axial, sagittal, and coronal), and then the 3D image was displayedon the 3D viewer. The 3D volume image restructured the placental vasculatureusing volume rendering, and the manual segmentation moduleand label statistical analysis were used. (1) Volume-rendering module: Wedetermined region of interest of the placenta. Parameter set: The presetchosen was CT-AAA, and the rendering used VTK CPU casting. (2) Manualsegmentation module: Threshold Paint was used to create a region ofinterest of the placenta and an umbilical cord image, which was based onthe grayscale volume of original raw data. (3) Label statistical analysis:This module counted the number of voxels, which was the 3D volumeimage of the placenta displayed using the manual segmentation.Results—This study showed the placental vasculature of theultrasound image using 2 module methods. The number of voxels (10 ×3) at 16 weeks was 60.519 and at 20 weeks was 193.934.Conclusions—The 3D Slicer visualized the vasculature architectureof the placenta, which came from raw ultrasound data. Also, it willbe able to impact the filed of obstetric ultrasound and elucidation of theplacenta.1536710 Efficacy of Ultrasound-Guided Tibial Nerve PerineuralInjections at the Posterior Tarsal TunnelOliver Joseph,* Oleg Uryasev, John McNamara, ApostolosDallas Virginia Tech Carilion School of Medicine, Roanoke,Virginia USAObjectives—Compression of the tibial nerve (TN) within thetarsal tunnel results in posterior tarsal tunnel syndrome. Like other nervecompression syndromes, corticosteroid injections are a potential therapeuticmodality. We hypothesize that one can effectively inject the TNperineural space immediately proximal to the tarsal tunnel.Methods—This research is a pilot study to investigate the efficacyof TN perineural injections bilaterally on 4 cadaveric models.A 10–5-MHz small linear array transducer was placed along the medialmalleolus and Achilles tendon to visualize the neurovascular bundle. TheTN appeared spindle shaped with alternating hypoechoic and hyperechoicbands superficial and anterior to the flexor hallucis longus tendon. Anteriorlong-axis injections of 0.35 mL of 0.5% methylene blue with subsequentanatomic dissection were confirmatory. Injections were designatedaccurate (nerve stained) and precise (no damage to adjacent anatomy).Results—Five of 8 (63%) injections were accurate and 6 of 8(75%) precise. Initial attempts were unsuccessful, while later injections wereaccurate and precise. The most apparent source of error was from 1 cadaver’spronounced musculoskeletal deformity, which precluded successful injectionsbilaterally. Of the 3 cadavers unaffected by musculoskeletal deformity,accuracy was 5 of 6 (83%), and precision was 6 of 6 (100%).Conclusions—While surgery is the definitive treatment for refractoryposterior tarsal tunnel syndrome, corticosteroid injections couldlikely provide symptomatic relief and postpone surgical intervention. Thisstudy suggests that ultrasound guidance can increase accuracy and precisionand is a potential adjunct to treatment. Future study will expand theinitial data set and allow for a consistent protocol, while later studies of patientoutcomes will demonstrate clinical relevance.S92
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Small-Animal Preclinical High-Frequ
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2013 AIUM Award WinnersJoseph H. Ho
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