Achiron R.,The Chaim Sheba Medical Center |
Achiron R.,Tel Aviv University |
Kivilevitch Z.,Ultrasound Unit
Ultrasound in Obstetrics and Gynecology | Year: 2017
Objectives: To describe the fetal sonographic characteristics, in-utero natural history and postnatal outcome of choriovitelline placenta, in which the fetal umbilical vein is replaced by the extra-embryonic vitelline circulation. Methods: This was a retrospective study of pregnancies examined during the period 2010–2014. Fetuses which presented with sonographic criteria of a downward caudal course of an enlarged vein from the umbilical annulus to the hepatic hilum were followed prospectively. Two-dimensional and three-dimensional color Doppler with high-definition flow were used in order to investigate the extra- and intrahepatic venous system. Ultrasound images and volumes were stored digitally, clinical data were obtained from patients' medical files and telephone interviews were conducted regarding the course of the pregnancy, perinatal data and developmental milestones. Results: Four cases were identified during the study period. The mean ± SD gestational age at diagnosis was 19.5 ± 4.3 (range, 13–23) weeks. The characteristic downward course of the persistent vitelline vein was associated with aneurysmal dilatation and anomalous anatomical configuration of the intrahepatic venous system. One case ended with antepartum death at 28 weeks. The mean gestational age at delivery was 34.6 (±5.0) weeks and the birth weight corresponded to the 57.2nd (± 16.8 SD) centile. In two cases, a thrombotic mass was detected in the portal venous system after birth. One necessitated antithrombotic treatment for 6 months; in the other case, spontaneous resolution occurred 7 days after birth. In the three surviving infants, the persistent extrahepatic vitelline vein regressed gradually within 6 months after birth. Neurodevelopment was normal at follow-up aged 1 year and 7 months, 3 years and 6 months and 5 years and 5 months. Conclusion: The main clinical importance of choriovitelline placentation derives from the possible formation of thrombus in the portal venous system. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.
Kivilevitch Z.,Ultrasound Unit |
Achiron R.,Ultrasound Unit |
Achiron R.,Tel Aviv University
Journal of Ultrasound in Medicine | Year: 2010
The differential diagnosis of fetal upper abdominal vascular dilatation is usually ascribed to an umbilical vein (UV) varix by most examiners. The possible prenatal differential diagnosis of an extrahepatic vitelline (portal) system origin has only been anecdotally reported. 1 To our knowledge, only 2 other cases of an intrahepatic portal vein system aneurysm (PVSA) have been reported in the prenatal period. 2,3 We present a rare case of a fetal extrahepatic PVSA, which substituted the UV as the blood carrier from the placenta. A PVSA is a rare abnormality, with reported incidence in adults of 0.43%. 4 Serious complications such as intra-abdominal hemorrhage and thrombosis can follow. 4-6The particular sonographic features that differentiate it from a UV varix and its short postnatal outcome are described. A review of the prenatal literature, its assumed embryologic basis, and possible serious clinical postnatal sequelae are discussed. © 2010 by the American Institute of Ultrasound in Medicine.
Sorrentino G.,Clinic Center |
Crispino P.,Ultrasound Unit |
Coppola D.,Ultrasound Unit |
De Stefano G.,Ultrasound Unit
Drugs in R and D | Year: 2015
Introduction: The prevalence of liver steatosis is particularly high in subjects with signs of the metabolic syndrome, and current therapeutic guidelines mostly rely on lifestyle changes alone, which rarely achieve significant objective improvements. In the present study, we evaluated the possibility of monitoring objective improvements in these subjects, before and after a dietary regimen.Methods: Overall, 78 subjects with metabolic syndrome and ultrasound confirmation of liver steatosis were included in an open, controlled study; all of these subjects were treated for 90 days with the standard regimen of diet and exercise. One group of 43 subjects (Group A) also received a Eurosil 85®-based nutraceutical (silymarin + vitamin E) as a dietary adjunct, whereas the remaining 35 subjects (Group B) represented the control group. Changes from baseline values were recorded in biometric, biochemical, and ultrasound data. For assessments and monitoring of liver steatosis, two indexes were utilised—Hepatic Steatosis Index (HSI) and Lipid Accumulation Product (LAP) index.Results: The absolute changes from baseline were significantly higher in Group A in biometric parameters (reduction of abdominal circumference, Body Mass Index, ultrasound measurement of right liver lobe) and in both the HSI and LAP indexes. Both treatments were well tolerated.Conclusion: The results observed suggest that the use of a Eurosil 85®-based nutraceutical as a dietary adjunct with antioxidant properties potentially favours the efficacy of the dietary regimen alone and may possibly improve the subjects’ motivation to sustain such lifestyle changes over time. © 2015, The Author(s).
Yagel S.,Hebrew University of Jerusalem |
Kivilevitch Z.,Ultrasound Unit |
Cohen S.M.,Hebrew University of Jerusalem |
Valsky D.V.,Hebrew University of Jerusalem |
And 3 more authors.
Ultrasound in Obstetrics and Gynecology | Year: 2010
The human fetal venous system is well-recognized as atarget for investigation in cases of circulatory compromise, and a broad spectrum of malformations affecting thissystem has been described. In Part I of this review, we described the normal embryology, anatomy andphysiology of this system, essential to the understandingof structural anomalies and the sequential changesencountered in intrauterine growth restriction and otherdevelopmental disorders. In Part II we review the etiologyand sonographic appearance of malformations of thehuman fetal venous system, discuss the pathophysiologyof the system and describe venous Doppler investigationin the fetus with circulatory compromise. Copyright © 2010 ISUOG. Published by John Wiley & Sons, Ltd.
Gargiulo M.,University of Bologna |
Gallitto E.,University of Bologna |
Serra C.,Ultrasound Unit |
Freyrie A.,University of Bologna |
And 5 more authors.
European Journal of Vascular and Endovascular Surgery | Year: 2014
Objective To evaluate four-dimensional contrast-enhanced ultrasound (4D-CEUS) as an alternative imaging method to computed tomography angiography (CTA) during follow up of fenestrated endovascular aneurysm repair (FEVAR) for juxta- and para-renal abdominal aortic aneurysms (AAA).Methods Between October 2011 and March 2012, all consecutive patients who underwent FEVAR follow up were included in the study and evaluated with both 4D-CEUS and CTA. The interval between the two examinations was always ≤30 days. Endpoints were the comparison of postoperative AAA diameter, AAA volume, presence of endoleaks, revascularized visceral vessel (RVV) visualization, and patency. Comparative analysis was performed using Bland-Altman plots and McNemar's Chi-square test. Results Twenty-two patients (96% male, 4% female; mean age 74 ± 7 years; American Society of Anesthesiologists grade III/IV 82%/18%) were enrolled. Seventy-eight RVV (fenestrations: 60; scallops: 17; branches: 1) were analyzed. The mean AAA diameter evaluated by 4D-CEUS and CTA was 45 ± 10 mm (range 30-69 mm) and 48 ± 9 mm (range 32-70 mm), respectively. The mean difference was 3 ± 3 mm. The mean AAA volume evaluated by 4D-CEUS and CTA was 150 ± 7 cc (range 88-300 cc) and 159 ± 68 cc (range 80-310 cc), respectively. The mean difference was 7 ± 4 cc; a Bland-Altman plot revealed agreement in AAA diameter and volume evaluation (p <.01) between 4D-CEUS and CTA. The observed agreement for the detection of endoleaks was 95%. McNemar's Chi-square test confirmed that 4D-CEUS and CTA were equivalent (p >.05) at detecting endoleaks. The first segment of six (8%) RVVs (four renal and two superior mesenteric arteries) was not directly visualized by 4D-CEUS owing to obesity, but the contrast enhancement into the distal part of vessel or into the relative parenchyma gave indirect information about their patency. McNemar's Chi-square test demonstrated the superiority of CTA (p =.031) in visualizing RVVs. The patency of 77/78 RVVs was confirmed with both techniques. McNemar's Chi-square test confirmed that 4D-CEUS and CTA were equivalent in their ability to detect visceral vessel patency.Conclusions The data suggest that 4D-CEUS is as accurate as CTA in the evaluation of postoperative AAA diameter and volume, endoleak detection, and RVV patency after FEVAR. Four-dimensional CEUS could provide hemodynamic information regarding RVVs, and reduce radiation exposure and renal impairment during follow up. Obesity limits the diagnostic accuracy of 4D-CEUS. © 2014 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.
Navve D.,Ultrasound Unit |
Hershkovitz R.,Soroka University Medical Center |
Zetounie E.,Ultrasound Unit |
Klein Z.,Meir Medical Center |
Tepper R.,Ultrasound Unit
Journal of Ultrasound in Medicine | Year: 2013
Objectives-The whirlpool sign is used as a sonographic marker for adnexal torsion. The aims of this study were to describe the location of the whirlpool sign (lateral or medial to the ovary) and to evaluate the clinical importance of the location. Methods-Thirty patients with a confirmed surgical diagnosis of torsion and a positive whirlpool sign on sonography before surgery were included. We examined the sonographic clips of these patients. Classic signs of adnexal torsion were determined: ovarian edema, the presence of a mass, pelvic free fluid, and ovarian ischemia on Doppler imaging. The whirlpool sign was detected on grayscale and color Doppler sonography by moving the transducer to and fro along the axis of suspected torsion. Results-Sixteen of 30 patients had right-sided torsion. Of these, 7 had a lateral whirlpool sign. All 7 of these patients had an ovarian or paraovarian mass. Nine of these 16 patients had a medial whirlpool sign. Of these, 7 had an ovarian or paraovarian mass, and 2 had no mass. Of the 14 patients with left-sided torsion, all had a medial whirlpool sign. Nine of 14 these patients had an ovarian or paraovarian mass, and 5 had no mass. The mean volume of the masses among cases with the lateral whirlpool sign was significantly greater compared to those with the medial whirlpool sign (304 versus 108 cm3; P = .035). In 25 of 30 cases, the torsed components included the ovary. Conclusions-The lateral whirlpool sign is associated with enlarged masses in comparison to the medial whirlpool sign. This finding indicates the need to search meticulously for the lateral whirlpool sign in cases with enlarged masses to decide whether to operate on these patients emergently. © 2013 by the American Institute of Ultrasound in Medicine.
Gonzalez R.,Ultrasound Unit |
Aedo S.,University of Chile |
Dezerega V.,Barros Luco Trudeau Hospital |
Sepulveda W.,Fetal Medicine Center
Journal of Ultrasound in Medicine | Year: 2013
Objectives-To report normative data for the fetal nasal bone length (NBL), frontonasal fold (FNF) thickness, and the FNF/NBL ratio and to study their performance in the sonographic screening of trisomy 21 in a normal, unselected Latin American population. Methods-Women undergoing a routine sonographic examination between 16 and 32 weeks' gestation at a primary health care center in Santiago, Chile, were prospectively recruited for NBL and FNF thickness measurements. Pregnancies with maternal/fetal complications were subsequently excluded from analysis. Correlations between NBL, FNF thickness, and FNF/NBL ratio and gestational age were assessed with the Spearman correlation coefficient (ρ). To generate reference percentiles for NBL and FNF thickness, adjusted regression models were derived using a statistical method for calculating reference percentiles of fetal biometric parameters. Results-A total of 1922 cases complied with entry criteria. Both the NBL and the FNF thickness increased with gestational age. However, the FNF/NBL ratio remained constant (ρ= 0.016; P=.95), with a mean value of 0.68 and 95th and 99th percentile values of 0.84 and 0.90, respectively. During the study period, all 4 fetuses with trisomy 21 diagnosed in this low-risk population had an FNF/NBL ratio above the 99th percentile, whereas only 3 had NBL below the fifth percentile, and 3 had FNF thickness above the 95th percentile. Conclusions-The FNF/NBL ratio is a promising marker for the sonographic screening of trisomy 21 in the low-risk population; however, further prospective studies including larger numbers of fetuses with trisomy 21 are warranted to determine the clinical value of this marker. As the NBL is dependent on the ethnicity of the population screened, determination of normative data for NBL and the FNF/NBL ratio in different ethnic populations is also recommended before including this method in the routine screening for aneuploidy. © 2013 by the American Institute of Ultrasound in Medicine.
Goldberg I.,Tel Aviv Sourasky Medical Center |
Sprecher E.,Tel Aviv Sourasky Medical Center |
Sprecher E.,Tel Aviv University |
Schwartz M.E.,Pachyonychia Congenita Project |
And 2 more authors.
Dermatology | Year: 2013
Background: High-variable-frequency ultrasound is used as an imaging tool for various cutaneous disorders. We utilized this tool in pachyonychia congenita (PC) patients, who typically present with plantar hyperkeratosis and often severely debilitating pain, compared to patients with epidermolytic palmoplantar keratoderma (EPPK) and mal de Meleda (MDM). Objective: To ascertain the feasibility of ultrasound technology for the diagnosis of PC. Methods: The study included a total of 16 patients, 7 with PC, 5 with EPPK and 4 with MDM, who underwent ultrasound examination of the plantar skin with high-resolution multifrequency ultrasound equipment. Results: Ultrasound scans performed over the proximal and distal plantar foot calluses in PC patients demonstrated hyperechoic dots and lines within the epidermis compatible with hyperkeratosis, engorged varicose veins in the dermis and an anechoic layer interposed between the epidermis and the dermis, corresponding to blister fluid below the calluses. In contrast to PC patients, patients with MDM and EPPK demonstrated no blisters. Conclusion: PC patients, as opposed to a group of patients with MDM and EPPK, displayed subepidermal blistering beneath their calluses. This finding may help in the diagnosis of PC and in partially explaining plantar pain as part of PC symptomatology. © 2013 S. Karger AG, Basel.
Yefet E.,Emek Medical Center |
Daniel-Spiegel E.,Emek Medical Center |
Daniel-Spiegel E.,Ultrasound Unit
Pediatrics | Year: 2016
OBJECTIVE: To investigate the short- and long-term outcomes of children from pregnancies complicated with polyhydramnios, defined as amniotic fluid index (AFI) >24 cm, and with a normal detailed ultrasound examination. METHODS: This retrospective cohort study examined 134 children aged 4 to 9 years with polyhydramnios and normal detailed ultrasound examination during pregnancy compared with 268 controls with normal AFI and normal detailed ultrasound examination matched for maternal age, year of delivery, gestational week at delivery, and presence or absence of diabetes. The primary outcome was the rate of malformations diagnosed postnatally. Additional outcomes were obstetrics outcomes, genetic syndromes, and neurodevelopment. RESULTS: Polyhydramnios was associated with increased risk for cesarean delivery (CD) and birth weight >90th percentile. This elevation in CD was attributed to increased rate of elective CD due to suspected macrosomia. Polyhydramnios was associated with increased risk for congenital malformations (n = 25 [19%] compared with 27 [10%], respectively; P = .016) without a statistically significant increase in the rate of major malformations (11 [8%] vs. 10 [4%]; P = .057). Genetic syndromes were more prevalent in the polyhydramnios group (5 [3.7%] vs. 2 [0.75%]; P = .043), as were neurologic disorders and developmental delay (9.7% vs. 3%; P = .004). CONCLUSIONS: Despite a normal detailed ultrasound examination, polyhydramnios is associated with increased rate of fetal malformations, genetic syndromes, neurologic disorders, and developmental delay, which may be diagnosed only after birth. Copyright © 2016 by the American Academy of Pediatrics.
Kivilevitch Z.,Ultrasound Unit |
Achiron R.,Chaim Sheba Medical Center Tel Hashomer |
Zalel Y.,Chaim Sheba Medical Center Tel Hashomer
American Journal of Obstetrics and Gynecology | Year: 2010
Objective: The objective of the study was to evaluate the magnitude of normal fetal brain asymmetry. Study Design: This was a prospective study. Normal fetuses between 19-28 weeks of gestation were studied. The cerebral atria, occipital cortex, and hemispheres in both sides were measured. The difference between each side was evaluated and was correlated with sex, head biometry, and estimated weight. Results: Four hundred six fetuses were studied. Mean atrial width was larger in the males and on the left side (5.2% and 6.5%, respectively). Mean cortical width was 2.6% larger in males but 5.5% thinner on the left side. Mean hemisphere width was larger in males and on the left side (2.3% and 1.5%, respectively). The atria and the cortex presented an inverse relationship regarding fetal growth parameters. Conclusion: Brain asymmetry represents normal fetal brain developmental phenomena. It is sex dependent and lateralized in most cases to the left. Lateralization was more accentuated in males. © 2010 Mosby, Inc. All rights reserved.