Multiple Pregnancies: Determining Chorionicity and Amnionicity

The determination of chorionicity and amnionicity in multiple gestations is one that confounds many in the medical field. The importance of diagnosing the type of multiple gestation cannot be overstated. This is intended to be an introductory primer and refresher to chorionicity and amnionicity. We will first examine what determines mono- versus dichorionic twinning including zygosity and cleavage of the zygote

Subharmonic and Endoscopic Contrast Imaging of Pancreatic Masses: A Pilot Study.

OBJECTIVES: To use subharmonic imaging (SHI) to depict the vascularity of pancreatic masses compared to contrast-enhanced endoscopic ultrasound (EUS) and pathologic results. METHODS: Sixteen patients scheduled for biopsy of a pancreatic mass were enrolled in an Institutional Review Board-approved study. Pulse-inversion SHI (transmitting/receiving at 2.5/1.25 MHz) was performed on a LOGIQ 9 system (GE Healthcare, Milwaukee, WI) with a 4C transducer, whereas contrast harmonic EUS (transmitting/receiving at 4.7/9.4 MHz) was performed with a radial endoscope (GF-UTC180; Olympus Corporation, Tokyo, Japan) connected to a ProSound SSD α-10 scanner (Hitachi Aloka, Tokyo, Japan). Two injections of the contrast agent Definity (Lantheus Medical Imaging, North Billerica, MA) were administrated (0.3-0.4 and 0.6-0.8 mL for EUS and SHI, respectively). Contrast-to-tissue ratios (CTRs) in the mass and an adjacent vessel were calculated. Four physicians independently scored the images (benign to malignant) for diagnostic accuracy and inter-reader agreement. RESULTS: One patient dropped out before imaging, leaving 11 adenocarcinomas, 1 gastrointestinal stromal tumor with pancreatic infiltration, and 3 benign masses. Marked subharmonic signals were obtained in all patients, with intratumoral blood flow clearly visualized with SHI. Significantly greater CTRs were obtained in the masses with SHI than with EUS (mean ± SD, 1.71 ± 1.63 versus 0.63 ± 0.89; P = .016). There were no differences in the CTR in the surrounding vessels or when grouped by pathologic results (P \u3e .60). The accuracies for contrast EUS and SHI were low (\u3c53%), albeit with a greater κ value for SHI (0.34) than for EUS (0.13). CONCLUSIONS: Diagnostic accuracy of contrast EUS and transabdominal SHI for assessment of pancreatic masses was quite low in this pilot study. However, SHI had improved tumoral CTRs relative to contrast EUS

Retro-Aortic Left Renal Vein

The term retro-aortic left renal vein (RLRV) is defined as the left renal vein coursing posterior to the abdominal aorta. RLRV is an uncommon condition in which the left renal vein passes posterior to the abdominal aorta and anterior to the vertebrae. RLRV may lead to left renal vein hypertension (LRVH) syndrome, which is also known as Nutcracker syndrome. Nutcracker syndrome (NCS) is a condition in which the left renal vein is compressed causing hypertension of the vessel. RLRV and Nutcracker syndrome are vascular anomalies considered to be of clinical importance especially during surgical procedures of the renal vasculature

Carotid Artery Aneurysm: A Case Study

A 60 year old male arrived at the emergency department after losing consciousness. CT showed he demonstrated a right hemispheric embolic stroke with a middle cerebral artery distribution. Upon further investigation, the patient was found to have a right common carotid artery aneurysm that extended about 1 cm from the carotid bifurcation into the internal carotid artery. The patient underwent carotid artery reconstruction with the use of his right great saphenous vein. This case demonstrates an unusual form of cerebral embolization due to a internal carotid artery aneurysm

Evaluating Bone Fracture Healing Utilizing Doppler Imaging Modes, Shear Wave Elastography, X-Ray and Dual-Energy X-Ray Absorptiometry in a Rabbit Model

Abstract The healing of a bone fracture is a complex, multistage process consisting of inflammation in the local tissue, angiogenesis, callus formation, and eventually, remodeling and restoration of the bone to its original morphology. It is estimated that 5-10% of fractures do not heal properly and exhibit non-union of the fractured bone segments, with long-term complications compared to properly healed fractures. There is great clinical benefit in the ability to have early detection of impending non-union fractures, and diagnostic ultrasound can be used to image formation of the callus in a healing fracture through the use of different imaging modes. Superb microvascular imaging (SMI) is a new microvascular flow imaging mode and represents this information as a color overlay image or as a grayscale map of flow, named cSMI and mSMI, respectively. Shear wave elastography (SWE) is a technique for measuring tissue stiffness noninvasively. X-ray imaging is the standard for imaging fractures, and dual-energy X-ray absorptiometry (DXA) measures bone mineral density. This study investigated methods of evaluating the bone fracture healing process using Doppler flow imaging, cSMI, mSMI, and SWE, relative to X-ray, DXA and CD-31 stains in a rabbit model. The standard of care for evaluation of fracture healing is based solely on callus formation, but ultrasound has the ability to document inflammation and angiogenesis to predict patients at risk for delayed or non-union healing

Evaluating Bone Fracture Healing Utilizing Novel Ultrasound Modes, X-Ray and Dual-Energy X-Ray Absorptiometry in a Rabbit Model

Background and Purpose Healing in bone fractures is a complex process involving local inflammation, angiogenesis (i.e., the creation of new blood vessels), and formation of a bone-building callus, all of which leads to returning the bone nearly to its pre-fracture state. This is the process in a bone where the fracture is clean and the fractured ends oppose each other. Five to 10 percent of fractures are described as non-union, which can lead to poor healing and long-term complications. The purpose of this study was to compare fracture healing in a rabbit model using x-ray, the traditional method for evaluating fracture healing, with ultrasound methods including color Doppler imaging (CDI) and power Doppler imaging (PDI), shear wave elastography (SWE), superb microvascular imaging (SMI), and Dual-Energy X-Ray Absorptiometry (DXA).https://jdc.jefferson.edu/radiologyposters/1012/thumbnail.jp