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American Institute of Ultrasound in Medicine <strong>Proceedings</strong> J Ultrasound Med 32(suppl):S1–S134, 2013done. In 130 cases, ultrasound showed nodular lesions, and these patientshad a percutaneous biopsy performed under the control of ultrasound.Results—The authors have demonstrated that, in rare cases, ultrasoundexamination may be useful to illustrate nodular lesions located atthe chest wall. It is true that it is not possible to prepare an initial diagnosisof a lung tumor on this basis; to obtain such a diagnosis, a CT examinationwas used, but a precise collection of samples from a lesion locatedperipherally makes its display on real-time ultrasonography very easy.Conclusions—(1) It is possible to display 90.9% of lesions locatedperipherally in a traditional ultrasound examination. (2) In mostcases, as part of that procedure, it is necessary to establish the location ofthe tumor and the depth of the CT-guided biopsy. (3) Displaying lesionson ultrasonography makes it possible to collect material for histopathologicexamination accurately in 88.7%.Table 1. Number of Studies Carried out Under the Control of Ultrasound (out of2572 Cases)Inability of fiber-optic bronchoscopy 143Tumors located peripherally 130 (90.9%)Ultrasound-controlled biopsy 130 (90.9%)Histopathologic diagnosis 127 (88.8%)1539837 Sonoelastographic Qualitative Analysis in the Managementof Salivary Gland MassesHasan Yerli, 1 * Erkan Eski, 2 Ekrem Korucuk, 3 A. MuhtesemAgildere 4 1 Radiology, 2 Otolaryngology, Baskent UniversityZubeyde Hanim, Practice and Research Center, Izmir, Turkey;3Otolaryngology, Karsiyaka State Hospital, Izmir, Turkey;4Radiology, Baskent University Faculty of Medicine, Izmir, TurkeyObjectives—Our aim was to investigate whether the use of aqualitative elasticity scoring method by sonoelastography is useful for themanagement of salivary gland masses.Methods—Forty-six patients with salivary gland masses (38parotid and 8 submandibular) were prospectively included in this study.For each lesion, B-mode sonographic and sonoelastographic images wereobtained. Elasticity scores were determined with a 4-point scoring method.Differences among scores for benign and malignant salivary gland masseswere assessed using the Mann-Whitney U test. Qualitative variables werecompared using the Pearson χ 2 test. The findings were compared withhistopathology.Results—The score values of 37 benign masses ranged from 1to 4, while the score values of 9 malignant masses ranged from 2 to 4. Themean scores were 2.28 ± 0.94 for benign lesions and 3.1 ± 0.72 for malignantlesions (P < .05). When we considered scores 1 and 2 benign andscores 3 and 4 malignant, 12 false-positives were determined by the 4-point scoring method, and 62% of benign masses were diagnosed.Conclusions—Sonoelastography might be regarded as anotherultrasound parameter in the management of salivary gland masses in termsof detecting benign masses.1539862 Peripubertal Ovarian and Uterine Volumes: Are HistoricalValues Still Valid Today?Steven Kraus, 1,2 Sara O’Hara, 1,2 * Janet Adams, 1 Rachel Mistur 21Radiology, Cincinnati Children’s Hospital Medical Center,Cincinnati, Ohio USA; 2 Radiology, University of CincinnatiCollege of Medicine, Cincinnati, Ohio USAObjectives—With increasing reports of precocious puberty andconcerns of environmental exposures to young girls, we wondered if publishedreference values for normal peripubertal ovarian and uterine volumesdating back to the 1990s were still applicable today. Previous samplesizes were small, and accurate values are needed for diagnosis of peripubertaldisorders.Methods—We retrospectively reviewed pelvic ultrasoundexams performed on girls aged 7 to 12 years over a 29-month period, regardlessof indication for the scan. Ovarian and uterine dimensions wererecorded along with age at the time of the scan, menstrual status, and clinicalhistory. We excluded patients with precocious puberty and clear pelvicabnormalities including: masses, cysts >2.5 cm in diameter, ovarian torsion,incomplete exams, postsurgical pelvis, polycystic ovarian syndrome,and nonvisualized organs. In patients with multiple exams, we used onlythe most recent exam. The volume of the ovary was calculated using theellipsoid formula: volume = (longitudinal × transverse × anteroposterior)× 0.5233.Results—Searching radiology records revealed 600 patients.After exclusions, 476 patients formed our data set. Three hundred thirtyeightpatients had not started their menses, while 138 had experienced atleast 1 menstrual cycle. Ovarian and uterine volumes with SD by age aretabulated below.Conclusions—The normative values obtained represent thecurrent peripubertal population and reflect changes in pubertal developmentthat have evolved over the past 20 years. Our study results highlightthe importance of age and menstrual status classification when assessingovarian volume; therefore, reference values for ovarian and uterine volumesshould be revised to include age and menstrual status categorization.These data provide reassurance when evaluating patients withpremature puberty.Table 1. Ovarian Volume by AgePremenarchalPostmenarchalMean Volume,Mean Volume,Age, y mL (SD) n mL (SD) n7 1.47 (1.14) 34 3.80 (0.00) 18 1.65 (0.84) 44 2.01 (0.83) 29 2.17 (1.66) 54 6.33 (3.23) 410 2.67 (1.78) 72 6.02 (3.59) 1311 3.32 (1.90) 74 4.65 (2.99) 2112 4.68 (2.54) 60 5.89 (2.71) 971539863 @EDUltrasoundQA: An Updated Twitter CurriculumDavid Bahner, 1 Saad Raginwala, 1,2 Nilesh Patel, 1 * CreaghBoulger, 1 Eric Adkins, 1 Eric Cortez 1 1 Emergency Medicine,Ohio State University, Columbus, Ohio USA; 2 Grand RapidsMedical Education Partners, Grand Rapids, Michigan USAObjectives—To demonstrate an updated Twitter-based ultrasoundcurriculum designed to provide educational pearls in a questionanswer–basedformat.Methods—A curriculum consisting of high-yield ultrasoundconcepts in a question-answer format was developed and posted to a Twitterpage every morning at 9 AM and evening at 5 PM beginning on July1, 2012. As with the previous curriculum, each post or “tweet” was limitedto 140 characters. Each month covers a separate ultrasound topic, includingfocused assessment with sonography for trauma, ultrasoundphysics, and cardiac scanning. The curriculum is supplemented by normaland pathologic images.Results—As of September 26, 2012, there were 106 followers;153 tweets have been published with an average length of 46 charactersper question and 94 characters per answer. Followers of @EDUltrasoundQAcome from a variety of backgrounds and levels of training, includingemergency medicine attendings and residents, sonographers,midlevel providers, medical students, and educators. Several followers arecontributors in various areas of social media, including podcasts, blogs,and medicine-related Twitter feeds. The feed has been mentioned 11 timesby other accounts and has been ranked in the FOAMed (Free Open AccessMeducation) top 25 Twitter feeds.S103
American Institute of Ultrasound in Medicine <strong>Proceedings</strong> J Ultrasound Med 32(suppl):S1–S134, 2013Conclusions—Twitter provides an excellent means to delivereducational content to learners at all levels of training. This project hasdemonstrated another novel type of curriculum that has the potential to beused in many educational endeavors. Future goals include increasing interactivitybetween the curriculum designers and participants, further categorizingfollowers, and better characterizing its impact on education.Finally, given its broad applicability, additional efforts are being made toenable other educators to easily implement this technology.1539867 Ultrasound of Arteriovenous Malformations of the GenitourinarySystemVijayanadh Ojili, 1 * Gowthaman Gunabushanam, 2 RaviVassa, 1 Nagar Arpit, 3 Kedar Chintapalli, 1 Leslie Scoutt 21Radiology, University of Texas Health Science Center, SanAntonio, Texas USA; 2 Diagnostic Radiology, Yale UniversitySchool of Medicine, New Haven, Connecticut USA; 3 Radiology,Ohio State University Medical Center, Columbus, Ohio USAObjectives—To describe the sonographic findings of arteriovenousmalformations (AVMs) of the genitourinary system and correlatethese with computed tomographic (CT) and angiographic findings whereavailable.Methods—A brief review of the AVMs of the genitourinarysystem (including renal and uterine AVMs) will be presented. The sonographicfindings will be described and correlated with CT and angiographicfindings. Pertinent management issues, including angiographyand embolization procedures, will be briefly discussed.Results—Not applicable as this is a pictorial review.Conclusions—AVMs of the genitourinary tract are potentiallylife-threatening conditions that require aggressive image-guided or surgicalmanagement. Therefore, it is important for the radiologist to accuratelydiagnose these conditions in a timely fashion. Although multidetector CTand digital subtraction angiography are the imaging modalities of choicefor comprehensive evaluation, ultrasound is often the initial imaging testperformed in the diagnostic workup of these patients and will provide a diagnosisin most cases.1539898 Prenatal Diagnosis of Recurrent AtelosteogenesisJanice Byrne, 1,2 * Anne Kennedy, 3 Paula Woodward, 3 DeborahKrakow, 4 John Carey 2 1 Obstetrics and Gynecology, 2 Pediatrics,3 Radiology, University of Utah, Salt Lake City, UtahUSA; 4 Human Genetics, University of California, Los Angeles,California USAObjectives—Document the prenatal ultrasound and postnatalclinical findings in a rare condition.Methods—Prospective identification of recurrence of a veryrare lethal skeletal dysplasia by prenatal imaging and comparison withpostnatal findings from the previous affected pregnancy.Results—A 28-year-old G2P1001 married Caucasian womanwas referred at 35 weeks’ gestation for findings concerning for a skeletaldysplasia, possibly type 1 atelosteogenesis. Micromelia with severely affectedfibulae and humeri, mild long bone curvature, clubfeet, a smallchest, and polyhydramnios were noted. At 38 weeks, the patient deliveredvaginally a live-born infant with obvious skeletal dysplasia. In addition tothe findings noted by ultrasound, severely abducted (“hitchhiker”) thumbsand great toes were seen. Characteristic radiographic findings including taperedhypoplastic humeri confirmed the suspicion of type 2 atelosteogenesis.DTDST mutation analysis was sent, but prior to the results beingavailable, the patient again became pregnant. Ultrasound at 11 weeksshowed a cystic hygroma, and 2 weeks later, short curved long bones and“hitchhiker” thumbs and great toes could be seen. The patient terminatedthe pregnancy. Gross examination confirmed the ultrasound findings.Conclusions—These cases illustrate the critical importance ofpostnatal correlation of ultrasound findings in rare conditions, especiallywhen multiple types of a disorder are known. Types 1 (original proposeddiagnosis) and 3 atelosteogenesis are autosomal dominant and would confera negligible recurrence risk given the unaffected parents. Type 2, on theother hand, is autosomal recessive with a 25% recurrence risk. Identificationof a mutation in the DTDST sulfate transporter gene will allow preimplantationgenetic diagnosis in a future pregnancy.1539948 Association Between First-Trimester Ultrasonographic TwinCrown-Rump Length Discrepancies and Neonatal OutcomesPedro Roca, 1 * Allen Kunselman, 2 Gabor Mezei, 1 Kari Whitley, 1Dennis Mujsce, 3 Ian Paul, 3 Serdar Ural 1 1 Obstetrics andGynecology, 2 Public Health Sciences, 3 Pediatrics, Penn StateHershey, Hershey, Pennsylvania USAObjectives—Determine the association between increased fetalsize discrepancies in crown-rump length (CRL) during first-trimester ultrasoundand poor perinatal outcomes.Methods—Retrospective study, all twin pregnancies deliveredat our institution before December 2009. We excluded pregnancies thatcommenced with higher-order multiples as well as those with major fetalcongenital anomalies.Results—Forty-six pregnancies were included. The firsttrimesterultrasound was performed on average at 10 3/7 weeks (SD, 2weeks). The median percent discrepancy in CRL relative to the smaller twinin each pregnancy was 7.2% (25th percentile, 2.8%; 75th percentile, 10.8%).Generalized estimating equations with a logit link were used to assess the associationof 4 predictors (ie, CRL during the first trimester [11–14 weeks’gestation] ultrasound of each twin, the deviation [ie, difference] from themean CRL for each twin set per delivery, the week of the first-trimester ultrasound,and the twin birth order) with each early neonatal outcome. Thisis an extension of logistic regression that accounts for the clustering of twinsper delivery. Similarly for continuous outcomes, mixed-effects models thataccount for twin clustering were fit using the same 4 predictors. Table 1 reportsthe adjusted odds ratios (AORs), 95% confidence intervals (CIs), andP values for 4 early neonatal outcomes. There was no evidence of an associationof CRL or the deviation from the mean CRL for twins with respiratorydistress syndrome (RDS), need for mechanical ventilation (MV), needfor total parenteral nutrition (TPN), or need for a nasogastric tube (NGT).Conclusions—The difference of CRL during first-trimester ultrasoundis a poor predictor for early neonatal complications. This studysuggests little relationship between the difference in size of twins as assessedby CRL during routine first-trimester ultrasound and early neonataloutcomes targeted above.Table 1. Predictor of OutcomesAOR (95% CI) [P]RDS MV TPN NGTCRL 0.94 1.18 0.97 0.95(0.85–1.03) (0.95–1.48) (0.90–1.05) (0.87–1.04)[.17] [.14] [.45] [.28]Deviation from 1.12 1.00 1.18 1.05mean CRL of twins (0.93–1.35) (0.73–1.38) (0.95–1.47) (0.90–1.23)[.23] [.99] [.14] [.53]S104
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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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David Stark, MDA. Thomas Stavros, M
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