American Institute of Ultrasound in Medicine <strong>Proceedings</strong> J Ultrasound Med 32(suppl):S1–S134, 2013surgery (MRgFUS) is a noninvasive treatment for symptomatic uterinefibroids. Patient selection is the most important step to achieve good results.The purpose of this study was to assess the initial efficacy of scaledsignal intensity (SSI) of uterine fibroids on T2-weighted MR images as anew objective parameter to determine the suitability for MRgFUS.Methods—Twenty-four uterine fibroids in 20 premenopausalwomen were treated using MRgFUS. Treatments were performed fromOctober 2008 to January 2010, and the mean age of the patients was 37.9± 5.9 years. SSI was measured on T2-weighted MR images by standardizingits mean pixel intensity to a 0 to 100 scale, using reference intensitiesof muscle (0) and fat (100), respectively. SSI in each fibroid was retrospectivelyanalyzed according to the nonperfusion volume (NPV) ratio.Results—The mean NPV ratio in uterine fibroids with SSI 10 (n= 18), the mean NPV ratio was 51.8% ± 21.0%. Uterine fibroids with SSI10.Conclusions—SSI of uterine fibroids on T2-weighted MR imagescan be suggested as an objective parameter for patient selection inMRgFUS. Uterine fibroids with
American Institute of Ultrasound in Medicine <strong>Proceedings</strong> J Ultrasound Med 32(suppl):S1–S134, 20131540840 Spectrum of Ultrasound Findings in Patients With AnorectalMalformationSteven Kraus, 1,2 * Sara O’Hara, 1,2 Janet Adams 1 1 Radiology,Cincinnati Children’s Hospital Medical Center, Cincinnati,Ohio USA; 2 Radiology, University of Cincinnati College ofMedicine, Cincinnati, Ohio USAObjectives—There are many secondary and associated malformationsof multiple organ systems that can be discovered by ultrasound(US) and are important to detect in the clinical management of patientswith anorectal malformation (ARM). The objective of this poster is to reviewthe most common and important findings that can change the clinicalmanagement of these patients.Methods—Our radiology database was searched for patientswith ARM and US exams performed on these patients. The exams werereviewed, and both still images and US clips were collected and presentedpictorially, some with selective, radiographic, fluoroscopic, magnetic resonance(MR), and/or clinical images for correlation.Results—The most common associated malformations in patientswith ARM detected by US are genitourinary (GU) and spinal in etiology.Vesicoureteral reflux, absent kidney, multicystic dysplastic kidney,crossed fused ectopia, and horseshoe kidney are common renal anomaliesdetected. Ectopic ureter insertion in the urethra with resultant hydroureterand hydronephrosis is also seen and must be detected early to avoid asignificant effect on long-term renal function. In females with cloaca, hydrocolposis seen in about 50% of patients at birth due to vaginal obstructionand is extremely important to detect since these patientsinvariably have urinary obstruction, which can cause permanent renal sequelae,vaginitis, and even vaginal perforation if not treated in the postnatalperiod. Other various anomalies of the female genital tract were seen, andexamples are shown. Males can present with multiple episodes of epidydymitisif they have high-pressure voiding due to a neurogenic bladder(bladder-sphincter incoordination), resulting in reflux of urine into the vasdeferens. Neonatal spine US is an excellent screening exam to detect spinalcord tethering, filar thickening or a mass, evidence of caudal regression,and a presacral mass (important to detect prior to definitive repair).Conclusions—Examples of the most important US findings ofthe GU tract and spine in patients with ARM are reviewed and presentedpictorially, some with radiographic, fluoroscopic, MR, and/or clinical correlation.1540916 Doppler Echocardiographic Estimates of Right VentricularPressure Are Inaccurate in Children With ElevatedRight Heart PressureGeorgeann Groh, 1 * Mark Holland, 2 Joshua Murphy, 1 TimothySekarski, 1 Philip Levy, 1 Craig Myers, 1 Diana Hartman, 1Gautam Singh 1 1 Pediatrics, 2 Physics, Washington UniversitySchool of Medicine, St Louis, Missouri USAObjectives—Doppler echocardiography (DE)-estimated rightventricular systolic pressure (RVp) is widely used as a surrogate for RVpmeasured by right heart catheterization (RHC), the gold standard. However,its accuracy has not been prospectively validated in children. Ourobjective was to prospectively validate the accuracy of DE-estimated RVpin children.Methods—Simultaneous pressure gradients between the rightventricle and right atrium were prospectively assessed by RHC and DEusing tricuspid valve regurgitation in 94 consecutive children (age 0–18years; median, 5.7 years) with 2-ventricle physiology. Subjects were classifiedinto 2 groups based on RHC-measured RVp: group 1 (n = 53) withnormal RVp (RVp 1/2 SBP). Correlation and agreementbetween the 2 methods were assessed using linear regression and Bland-Altman analysis, respectively. Accuracy was predefined as 95% limits ofagreement (LOA) ± 10 mm Hg for DE RVp estimates.Results—The correlation between DE- and RHC-measuredRVp was strong in both groups (group 1, r = 0.8; P < .001; group 2,r = 0.77; P < .001). The agreement between the 2 methods was good ingroup 1 (bias, 2.5 mm Hg; 95% LOA, +9.7 to –4.8 mm Hg) but poor ingroup 2 (bias, 0.89 mm Hg; 95% LOA, +25.1 to –25.1 mm Hg). DEestimatedRVp was inaccurate, with both overestimation and underestimation,in 2% of subjects in group 1 vs 34% in group 2.Conclusions—DE estimates of RVp are frequently inaccuratein children with elevated RVp. They should not be solely relied on in themanagement of children with elevated RVp.1540920 Cranial Ultrasound Findings in Preterm Infants WithGerminal Matrix and Periventricular LeukomalaciaArash Anvari, 1 * Anthony Samir, 1 Michael Gee 2 Radiology,1Abdominal Imaging and Intervention, 2 Pediatrics Division,Massachusetts General Hospital, Boston, Massachusetts USAObjectives—This educational poster will review germinal matrixand periventricular leukomalacia (PVL) in preterm infants and therole of cranial ultrasound in the diagnosis and characterization.Methods—Content Organization: (1) Introduction of germinalmatrix hemorrhage: epidemiology, pathophysiology, its complications likehydrocephalus and periventricular leukomalacia, and clinical outcomes.(2) Cranial ultrasound technique: transducer, standard views, supplementalacoustic windows, timing, advantages, and limitations. (3) Ultrasoundfindings in different classes (I–IV) of germinal matrix hemorrhage andPVL.Results—Not applicable because it is an educational e-poster.Conclusions—This e-poster emphasizes the clinical applicationof cranial ultrasound in early diagnosis of germinal matrix hemorrhageand PVL and its important role in clinical management.1540927 Focal Lesions in the Transplanted Liver: Differential DiagnosisRonald Wachsberg New Jersey Medical School , Newark,New Jersey USAObjectives—To illustrate the spectrum of focal lesions andpseudolesions that can be seen in liver transplant recipients.Methods—Cases are presented of various focal lesions andpseudolesions detected in liver transplant recipients at a busy transplantcenter.Results—A focal lesion in a liver graft can be an infarct, abscess,biloma, hematoma, steatosis, recurrent or de novo malignancy, preexistingincidental lesion in the donor liver, and arteriovenous fistula.Several pseudolesions, eg, loculated intrafissural fluid, thrombus withinthe donor inferior vena cava, and others, can mimic a liver lesion.Conclusions—Awareness of the spectrum and features of focallesions and pseudolesions that can be detected in a liver graft is essentialto arrive at the correct diagnosis.1540949 First-Trimester 3-Dimensional Placental Volume and ItsAssociation With Gestational DiabetesNwamaka Obi,* Karenrose Contreras, Andre Bieniarz, JeanGoodman, Paula Melone, Roberta Karlman Maternal-FetalMedicine, Loyola University Medical Center, Maywood, IllinoisUSAObjectives—Gestational diabetes mellitus (GDM) a commonmetabolic disorder in pregnancy and complicates about 3% to 10% ofpregnancies worldwide. The goal of predicting GDM has not beenreached, and its impact extends beyond just perinatal outcomes. The objectiveof the study was to determine if first-trimester 3D placental volumeis predictive of GDM.Methods—This was a prospective cohort study that included140 women aged ≥18 years with singleton pregnancies. At the time ofS114
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