Official Proceedings - AIUM

American Institute of Ultrasound in Medicine Proceedings 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