American Institute of Ultrasound in Medicine <strong>Proceedings</strong> J Ultrasound Med 32(suppl):S1–S134, 20131541264 The Natural History of Vasa Previa Across GestationAndrei Rebarber, 1,2,3 * Cara Dolin, 2 Nathan Fox, 1,2,3 ChadKlauser, 1,2,3 Daniel Saltzman, 1,2,3 Ashley Roman 1,2 1 CarnegieImaging for Women, New York, New York USA; 2 Obstetrics andGynecology, New York University School of Medicine, NewYork, New York USA; 3 Obstetrics and Gynecology, Mount SinaiSchool of Medicine, New York, New York USAObjectives—To estimate the prevalence and persistence of vasaprevia in at-risk pregnancies using a standardized screening protocol.Methods—A descriptive study of patients from 1 ultrasoundpractice from June 2005 to May 2012. Cases were identified by ICD-9code and content search analysis of the 2 ultrasound reporting systems,Sonultra and AS Ob/Gyn using the key words “vasa previa.” Vasa previawas defined as any velamentous fetal vessel (arterial or venous) noted tobe within 2 cm of the internal cervical os. Screening for vasa previa usingtransvaginal ultrasound with color flow mapping was performed routinelyin the following situations: resolved placenta previa, history of vasa previain a prior pregnancy, velamentous insertion of the cord in the loweruterine segment, placenta succenturiata with implantation in the loweruterine segment, and twin gestations.Results—A total of 27,573 patients were referred to our unitfor fetal anatomic surveys over the study period. Thirty-two cases of vasaprevia were identified. Twenty-nine cases were available for analysis: 6 patientshad migration and resolution of the vasa previa. When the initial diagnosisof vasa previa was made during the second trimester (34to
American Institute of Ultrasound in Medicine <strong>Proceedings</strong> J Ultrasound Med 32(suppl):S1–S134, 2013of the cervix might be helpful for detection of the ripening process andpossibly predicting PTL.Table 1. AUC, Sensitivity, Specificity, PPV, and NPV for 3D Ultrasound Parameters of theCervixSensi- Speci-SignificantCutoff tivity, ficity, PPV, NPV, Level 95%AUC Point % % % % AUC P CICL by 2D TVS, mm 0.643 29 72 68 20 95 .055 0.54–0.73CL by TUI, mm 0.649 32 73 63 19 95 .049 0.54–0.74Cervical volume, cm 3 0.501 44.6 64 55 14 93 .987 0.40–0.60FI 0.822 46.2 82 82 36 98 .0002 0.73–0.89CI indicates confidence interval.Pediatrics and Fetal EchocardiographyModerator: Gary Satou, MD1522495 Is Fetal Echocardiography Necessary in In Vitro Fertilization/IntracytoplasmicSperm Injection Pregnancies Afteran Anatomic Survey?Oluyemi Aderibigbe, 1 * Angela Ranzini, 1 Sumekala Nadaraj 21Obstetrics and Gynecology, Saint Peters University Hospital,New Brunswick, New Jersey USA; 2 Pediatric Cardiology, Children’sHospital of Philadelphia, Philadelphia, PennsylvaniaUSAObjectives—In vitro fertilization/intracytoplasmic sperm injection(IVF/ICSI) is one of the indications for fetal echocardiography(ECHO) due to a reported increased risk for cardiac anomalies. In thisstudy, we evaluated the utility of ECHO after an anatomic survey (AS) inan experienced center. At the time of the AS, cardiac evaluation includedviews of the 4-chamber heart and attempts at outflow tracts and archviews.Methods—Records of patients seen in our hospital’s AntenatalTesting Unit with the indication of IVF/ICSI for an AS and ECHO betweenJanuary 1996 and October 2010 and who delivered at our institutionwere evaluated.Results—Eighty-five patients carrying 110 fetuses were identified.Six cardiac anomalies (4 ventricular septal defects [VSDs], 1 pulmonaryartery [PA]-aortic disproportion, and 1 postvalvular PA dilatation)were suspected on the AS. At ECHO, 2 VSDs were confirmed, 2 werenot, and 2 additional VSDs were seen; 1 aberrant right subclavian artery(ARSA) and 1 right aortic arch (RAA) were found, and PA dilatation wasconfirmed. On neonatal ECHO, only 2 of the 7 VSDs seen at either the ASor ECHO were present; the postvalvular PA dilatation and RAA were confirmed.Second-trimester ECHO, however, identified only 2 additionalanomalies confirmed at birth: an RAA in a fetus with a known VSD andan additional fetus with a VSD. Neonatally, 3 patients with a normal ASand ECHO were found to have VSDs. The most common cardiac abnormalityin IVF/ICSI fetuses is a VSD, which is identified in 4.5% of allcases in the neonatal period. VSDs identified in the antenatal period resolvedin 82% of cases. A RAA and an ARSA should be identified on thetranstracheal view (3-vessel view [3VV]) of the heart.Conclusions—In IVF/ICSI pregnancies, VSDs are commonbut likely to resolve or be seen only at birth. In expert centers, fetal ECHOmay not be necessary if the 3VV of the heart is evaluated and the heart isevaluated for VSDs.1538566 Application of Acoustic Radiation Force Impulse Imagingin Quantitative Evaluation of Neonatal Brain DevelopmentSu Yijin,* Du Lianfang, Xia Jin, Wu Ying, Jia Xiao, CaiYingyu, Li Yunhua, Zhao Jing, Liu Qian, Zhang JuanSchool of Medicine, Shanghai Jiaotong University, Shanghai,ChinaObjectives—To quantitatively evaluate the effect of acousticradiation force impulse imaging (ARFI) in neonatal brain development.Methods—we used ARFI on a Siemens S2000 system to quantitativeevaluate white and gray matter of neonatal different tissues in brainwith different gestational ages. We used a new technical index, Virtual TouchTissue Quantification (VTQ) to evaluate elastic changes of brain tissues.Results—Different tissues in the brain had different elastic numericalvalues. Neonates with different gestational ages had different elasticnumerical values. Elastic numerical values of full-term infants werehigher than preterm infants.Conclusions—ARFI provides a new quantitative index to evaluateneonatal brain development. It increases objectivity and reliability ofclinical analysis. Ultrasound is an examination method that is noninvasive,safe, simple, and convenient, so it has more usefulness with ARFI inquantitative evaluation of neonatal brain development.Table 1. Comparison of VTQ Values for Preterm and Full-Term NeonatesNeonates Cases, n Mean, m/s SD, m/sPreterm 23 1.89 1.07Full-term 35 2.35 1.24Compared with full-term neonates, the VTQ value for preterm neonates was lower(P < .001).1538283 Is Follow-up Sonography Necessary in Babies With MorphologicallyNormal but Unstable Hips?Christine Iseman, Bokyung Han, Henrietta Kotlus Rosenberg*Radiology, Mount Sinai Medical Center, New York,New York USAObjectives—To determine if follow-up (FU) hip ultrasound(US) is necessary in babies with an unstable hip when the hip morphologyis normal (nl).Methods—This retrospective study included patients (pts) withat least 2 hip US examinations performed between January 1, 2008, andJanuary 31, 2012. Pt population: 342 pts, 42 excluded as FU US performedin a Pavlik harness, 15 excluded as both hips nl aligned on first and FU US,and 10 excluded due to poor technique. A total of 515 hips were analyzedin 285 pts. Of those, 68 hips were excluded as they were normal on the firststudy. In total, 480 hips were analyzed. All sonograms and associated reportswere reviewed by 1 attending and 1 resident radiologist. Degree ofsubluxation/dislocation assessed and graded: normal = 0; mild = 1; moderate= 2; severe = 3; and dislocation = 4.Results—A total of 447 hips were initially subluxed or dislocatedand resolved on FU (93%; group 1). Thirty-three hips were initiallysubluxed or dislocated and did not resolve (7%). Of hips that did not resolveon FU, 4% were morphologically nl (group 2), and 2% were initiallymorphologically abnormal (abnl) but became morphologically nl onFU (group 3). Four hundred six of 447 hips (91%) demonstrated normalα angles ≥ 60° at first US and nl alignment during all maneuvers on FU.Forty-one of 447 hips had abnl α angles ≤60° initially and nl alignmentduring all maneuvers on FU. Age range at time of initial US: 1 to 136days. Age range at time of FU US, which demonstrated resolution of subluxation/dislocation:23 to 362 days for group 1, 35 to 174 days for group2, and 23 to 174 days for group 3. One hundred fifty-one babies whosesubluxation/dislocation resolved had US performed within the first 30days of life; 21% resolved within 28 days; 52% in 29 to 56 days, 16% in56 to 84 days, and 21% in >84 days.S28
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