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American Institute of Ultrasound in Medicine <strong>Proceedings</strong> J Ultrasound Med 32(suppl):S1–S134, 2013nuchal translucency ultrasound, 3D images of the placenta were obtainedand volumes measured using the multiplanar volume method with PhilipsQLAB. The development of GDM and other pregnancy outcomes wererecorded. Continuous and categorical variables were compared using theStudent t test and χ 2 test. Logistic regression analysis was performed to determinethe association of first-trimester placental volume with gestationaldiabetes while controlling for confounders.Results—A total of 140 women were included in the study.There were complete pregnancy outcomes recorded for 98 (70%), 8 (8%)of which had GDM. Mean first-trimester 3D placental volumes (57.6 ± 2.2vs 51.6 ± 2.65 mL) and infant birth weights (3312.2 ± 61.2 vs 3629.6 ±186.3g) were similar between the non GDM and GDM groups. In logisticregression analysis, first-trimester placental volume was not statisticallysignificant while controlling for age, race, and body mass index(BMI) between the groups. Women with a higher BMI were at significantlyincreased risk of GDM. 3D placental volume was predictive of birthweight regardless of the presence of gestational diabetes.Conclusions—First-trimester 3D placental volume was similarin women with and without gestational diabetes. A high BMI is a wellknownrisk factor for the development of GDM, which was also seen inthis study. Larger studies are needed to confirm our findings.Table 1. Logistic Regression AnalysisAdjusted ORPAge 1.127 .160Race 0.859 .85BMI 1.133 .021Placental volume 0.968 .228OR indicates odds ratio.1540968 Role of Bedside 3/4-Dimensional Ultrasonography in theDiagnosis of Acute AppendicitisTimothy Mooney,* Kevin O’Rourke, Gerardo ChiricoloEmergency, New York Methodist Hospital, Brooklyn, New YorkUSAObjectives—Abdominal ultrasonography (US) is commonlyused in diagnosing acute appendicitis (AA).Traditional 2D US is both safeand quickly performed. Diagnostic accuracy can be limited, and equivocalstudies are common. 3D/4D US technology could improve diagnosticaccuracy by enhancing visualization of anatomy and spatial relationships.Our objective was to evaluate the performance and accuracy of bedside3D/4D US in patients with suspected AA.Methods—All adult and pediatric patients with suspected AAwere eligible for enrollment. We excluded patients who underwent computedtomographic scanning prior to enrollment and those with a prearrivaldiagnosis of AA. Patients were enrolled when there was an emergencysonographer available. These emergency department physician sonographershad a 4-hour tutorial by an experienced application specialist on3D/4D image acquisition. The same sonographer scanned each patient’sright lower quadrant first using both 2D and 3D/4D multiplanar and surface-renderingUS. All clips and images were deindentified and interpretedby another sonographer who recorded an impression separately. The US interpretationswere then compared to surgical pathology or phone follow-up.Results—A total of 30 patients met inclusion criteria and wereenrolled. Twenty-one patients (70%) were ultimately diagnosed withAA. Of the 30 total patients, 13 (43%) were diagnosed with AA usingconventional 2D US, with the other 17 diagnosed with a nonvisualizedappendix, inconclusive US of the right lower quadrant. Two patients(6%) were diagnosed with AA from 3D/4D US images and clips (bothhad a diagnosis of AA from 2D US examination also). Sensitivity for2D US was 62% (95% confidence interval [CI], 48%–62%); specificitywas 100% (95% CI, 65%–100%); positive predictive value was 100%(95% CI, 78%–100%); and negative predictive value was 53% (95%CI, 36%–53%), with overall accuracy of 72%. 3D/4D US had sensitivityof 10% (95% CI, 2%–10%); specificity was 100% (95% CI, 82%–100%); positive predictive value was 100% (95% CI, 21%–100%); andnegative predictive value was 32% (95% CI, 27%–32%), with overallaccuracy of 36%.Conclusions—3D/4D US fails to increase the diagnostic accuracyof US in AA and has little utility in AA’s staged diagnostic workup.1540972 Reliability of Linear Measurements of the Thoracic ParaspinalMuscles Using Ultrasound ImagingNancy Talbott,* Dexter Witt Rehabilitation Sciences, Universityof Cincinnati, Cincinnati, Ohio USAObjectives—Ultrasound imaging (USI) has become more commonin the rehabilitation area. Muscles critical to the stabilization of thespine have been assessed to assist in guiding interventions. In the shoulder,function relies on scapular muscles, which work most effectivelywhen the thoracic spine is stabilized. To assist in understanding the role ofthe thoracic paraspinal muscles (TPSM) during arm elevation and in usingthat information in determining effective rehabilitation treatment, realtimemonitoring of the changes in the TPSM would be of benefit. The objectiveof this study was to determine if USI can reliably measure theTPSM during arm movements.Methods—USI of 18 healthy subjects was performed with subjectsprone and the arm elevated fully in the scapular plane. The spinousprocess and lamina of T7 were imaged as the subject rested the arm on astable surface, actively contracted, and held a weight. After resting, testingwas repeated twice on one arm and 3 times on the opposite arm. Ninesubjects returned to have the testing performed again by the original examiner.TPSM linear measurements were recorded in 2 locations: (1) betweenthe superior hyperechoic line of the laminae and the inferiorhyperechoic line of the lower trapezius muscle; and (2) between the superiorhyperechoic line of the transverse process and the inferior hyperechoicline of the lower trapezius.Results—Intrasession correlation values were strong. Within asession, intra-tester reliability ranged from 0.882 to 0.960. Inter-tester reliabilitywithin a session was also good, with intraclass correlation coefficients(ICCs) ranging from 0.706 to 0.906. Agreement between sessionswas also acceptable, with ICCs ranging from 0.733 to 0.885.Conclusions—The USI methodology used in this studyachieved TPSM measurements with high intra-rater reliability and goodinter-rater reliability at rest and during active contractions. Changes in theTPSM thickness occurring during active contraction of the shoulder andscapula can be reliably monitored by USI. As small but significant changesoccur during arm activities, USI of these muscles may be useful for guidinginterventions.1540981 Reliability of Ultrasound Measurements of the LowerTrapezius Muscle During Active and Resisted MovementsDexter Witt,* Nancy Talbott Rehabilitation Sciences, Universityof Cincinnati, Cincinnati, Ohio USAObjectives—Ultrasound imaging (USI) to assess patients withshoulder pain often emphasizes structural changes of the tendons. Pain,however, may be related to alterations in the scapular muscles, includingabnormal activation of the lower trapezius (LT). The ability to make reliablemeasurements of the LT during active contraction using USI wouldbe of benefit in determining firing patterns, identifying muscle atrophy,and designing interventions. While previous USI studies have establishedthe reliability of USI measurements of the LT at rest, the objective of thisstudy was to determine if USI could be used to reliably measure the thicknessof the LT muscle during LT contraction.S115
American Institute of Ultrasound in Medicine <strong>Proceedings</strong> J Ultrasound Med 32(suppl):S1–S134, 2013Methods—USI images of the LT were captured bilaterally in 20normal subjects at the T7 level. With the arm in 120° of abduction, imageswere taken in the prone position with the subject’s arm at rest, activelyholding the position and while holding a weight. This process was repeated3 times on both shoulders by a single examiner. Within 7 days, 10 of thesubjects returned. The same testing sequence was repeated on the dominantarm by the original examiner and by a second examiner. Images werestored electronically and analyzed offline. Reliability was assessed via intraclasscorrelation coefficients (ICCs).Results—Intersession intra-rater reliability agreement wasgood, with ICC values of 0.835, 0.871, and 0.909 at rest, during an activehold, and holding the weight, respectively. Same-session inter-rater reliabilitywas also good, with ICC values of 0.864, 0.881, and 0.891 in the respectivestates of rest, active hold, and holding the weight.Conclusions—The USI methodology used in this studyachieved LT measurements with high inter-rater and intra-rater reliabilityat rest and with the addition of active contraction and resistance. Benefitsfor having this reliability method include: (1) identification of percentchanges of thickness between rest and contraction; (2) an adjunct to electromyographyin the determination of muscle changes during activities; (3)a viable tool for clinical facilitation of LT activation; and (4) documentingatrophy of the LT.1540998 Evaluation of Acquisition and Interpretation of FocusedAssessment With Sonography for Trauma Scans in anUrban Level 1 Trauma CenterZachary Robinson, 1 * Lem Smith, 1 Eliza Beal, 1 Brian Abbott, 2Creagh Boulger, 2 Daniel Eiferman, 3 David Bahner 21College of Medicine, 2 Emergency Medicine, 3 Critical Care,Trauma, and Burn Surgery, Wexner Medical Center, Ohio StateUniversity, Columbus, Ohio USAObjectives—Focused assessment with sonography for trauma(FAST) has become the standard of care in the evaluation of traumapatients. A review of recent literature showed sensitivity of 84% to 94%,specificity of 96% to 98%, a positive predictive value of 61% to 87%, anda negative predictive value of 98% to 100%. A formalized ultrasound trainingprogram has been introduced at our institution for surgical residents toensure proper acquisition and interpretation of ultrasound images. A qualityreview process was initiated to evaluate accuracy in using FAST intrauma patients.Methods—Trauma FAST exams are wirelessly saved to a picturearchiving and communication system, and generated reports are savedto an electronic medical record. Patients who presented as a level 1 or level2 trauma between January and March 2012 and received a FAST scan aspart of their assessment were included in the quality review. The results ofthe FAST scan and any other imaging performed during the same encounterwere recorded and reviewed. The results of FAST were comparedto confirmatory testing of abdominal computed tomography (CT), chestCT, or operative reports. The results of FAST were then determined to betrue-positive, true-negative, false-positive, or false-negative.Results—There were 200 trauma alerts during the study period.One hundred twenty-one patients were eligible for review with bothsaved images and a generated report in the chart. Fifteen patients were excludedbecause the FAST scan results were not available; the FAST scanwas indeterminate; or the patient died prior to confirmatory imaging. Therewere 94 true-negatives, 2 false-negatives, 7 true-positives, and 3 falsepositivesin the remaining 106 patients reviewed, yielding sensitivity of78% and specificity of 97%. The positive predictive value was 70%; thenegative predictive value was 98%; and the accuracy was 95%.Conclusions—Our results confirm that FAST has a high negativepredictive value for abdominal injury in patients experiencingtrauma. These quality results, collected after a focused training program,show the training to be effective in educating surgical residents on theproper acquisition and interpretation of FAST in trauma patients.1541009 An Educational Model for Teaching Focused AssessmentWith Sonography for Trauma to Surgical ResidentsEliza Beal, 1 * Ashley Zielinski, 1 Creagh Boulger, 2 SereanaDresbach, 3 David Bahner, 2 Daniel Eiferman 4 1 College ofMedicine, 2 Emergency Medicine, 3 Pulmonary, Allergy, CriticalCare, and Sleep, 4 Critical Care, Burn, and Trauma Surgery, WexnerMedical Center, Ohio State University, Columbus, Ohio USAObjectives—Focused assessment with sonography for traumahas become indispensable in the evaluation of trauma patients. Few surgicaltraining programs have specific courses to teach the FAST exam.The Wexner Medical Center at Ohio State University has established apilot program with hands-on teaching sessions and self-directed learningto teach surgery residents the skills needed to accurately obtain and interpretFAST scan images.Methods—Thirteen postgraduate year 1 (PGY-1)-level residentsparticipated in an initial evaluation session, which included 10 confidencequestions, 12 ultrasound knowledge questions, and a practicalexam where they were asked to perform both the FAST exam and thelong-axis rescue cardiac view. Participants answered confidence questionson a spectrum from 1 to 8 with 1 being strongly disagree, 7 being stronglyagree, and 8 indicating that the individual had no experience with the skill.The practical exam was evaluated by 2 attending physicians with significantexperience with the FAST exam and ultrasound education. The imageswere graded on a 1 to 5 scale (1 = no image obtained and 5 = imageperfectly obtained with proper settings and labeling). The 13 PGY-1 residentswill undergo 2-hour hands-on training and will be reevaluated forknowledge and skill acquisition.Results—With little formalized training in focused ultrasound,PGY-1 residents responded with fairly low overall confidence in skills(mean = 2.08). When asked about confidence in acquiring specific views,participants generally rated their views in the “disagree” portion of thecontinuum, but the means on the 9 confidence questions ranged fromslightly to strongly disagree (3.94–1.92). No resident answered “no experience”for any question. Skills assessed by the proctors showed a generaltendency of not being able to attain the image or missing relevant anatomy,with the means ranging from 1.38 to 2.46 for the 5 images obtained.Conclusions—Preliminary data show that confidence andknowledge are low, and practical scores show an inability to performFAST scans among PGY-1 level surgical residents. The initial results suggestthat training in the FAST exam is necessary for PGY-1 surgical residentsto adequately obtain images used for clinical decision making.1541032 Cervical Length Assessment by Transabdominal and Endo -vaginal UltrasoundJennifer Thompson,* Michael Smrtka, Geeta Swamy, ChadGrotegut, Brita Boyd, Amy Murtha Duke University,Durham, North Carolina USAObjectives—Endovaginal (EV) cervical length identifies womenat risk for preterm birth (PTB) and thus eligibility for vaginal progesterone.Our objective was to compare transabdominal (TA) with EV cervicallengths to determine the degree of correlation, the capability of TA to predictan EV-detected short cervix, and the rate of cervical change over time.Methods—Retrospective review of singleton pregnancies havingTA and EV ultrasound (US) for cervical length between 16 and 28 weeks’gestation at Duke University from January to December 2011. TA measurementsare routinely obtained on midtrimester exams with EV measurementfor high PTB risk, TA
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Small-Animal Preclinical High-Frequ
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2013 AIUM Award WinnersJoseph H. Ho
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