Fetal lumbar spine: measuring axial growth with US

Ultrasound (US) can be used to visualize vertebral segments, suggesting a quantitative means of studying vertebral column growth in utero and thus a means of detecting developmental abnormalities. US images of the lumbar spine were obtained in 128 clinically normal fetuses between the gestational age of 11 through 41 weeks. A large-aperture, dynamically focused US system capable of regional magnification was used. Average lumbar spacing was calculated from distance between centrums of at least four lumbar bodies. The average distance between lumbar centrums increased nearly linearly throughout the second and third trimesters (r2 = 0.98). Enhanced anatomic display implies new capabilities for recognizing developmental abnormalities antenatally.     

Ultrasonic fetal ophthalmology

The fetal eye is studied ultrasonically during the second and third trimesters with a large aperture, dynamically focused imaging system. The globe, lens, iris, pupil, and cornea can be resolved separately, and extraocular structures including muscles, retro-orbital fat, and optic nerve may be visualized. The hyaloid artery is seen before 20 weeks and regresses by 25 weeks gestational age. Average vitreous diameter in 157 normal cases exhibits acclerations between 12 and 20 weeks, between 28 and 32 weeks, and near term with decelerations intervening. Associations between limited ocular growth and delayed cerebral development are reaffirmed.     

Ultrasound guidance for selected dilatation and evacuation procedures

Intraoperative ultrasound was used as an adjunct in difficult dilatation and evacuation (D&E) procedures for first-trimester abortions. This technique was useful in eight technically difficult D&Es in the presence of acute retroflexion, acute anteflexion, cervical stenosis and lower uterine segment fibroids.     

Psoas abscess — Fact and mimicry

Seven patients with processes involving the psoas muscle are presented. These included psoas abscess (3), metastatic tumor and abscess (1), lymphoma (1), and psoas hematoma (2). The role of radiologic studies in the diagnosis and management of these patients is discussed with particular reference to ultrasound and computed tomography.     

Fetal movement patterns: a possible means of defining neurologic developmental milestones in utero.

Phased-array ultrasonography provides a means for continuous observation of moving structures. This method can be used for assessing fetal movements from the middle of the first trimester. Eleven separate spontaneous movement patterns were defined in 40 examinations of clinically normal women (6 weeks to term). A trend of increasingly complex movement with advancing gestational age was noted with indication that discrete developmental events such as isolated body extension, thumb sucking, or repetitive chest wall excursions can be recognized. Fetal movement responses to a simple pressure stimulus were noted.     

Pelvic ultrasonography and the management of gestational trophoblastic disease

Pelvic ultrasonography was performed in 33 patients with persistent gestational trophoblastic disease (GTD) and the sonographic findings were compared in all patients with laparoscopic findings and histologic material from endometrial curettage and/or hysterectomy. Ultrasonography indicated trophoblastic uterine involvement in 17 patients (51.5%) and the ultrasound interpretation was histologically confirmed in all 17 patients by endometrial curettage and/or hysterectomy. Among the 16 patients in whom the uterus appeared normal by ultrasound, endometrial curettings demonstrated scanty fragments of trophoblastic tumor in 6 patients (37.5%). Furthermore, in all 16 patients in whom the uterus appeared normal by ultrasound, laparoscopy also revealed no uterine abnormalities. Ultrasonography appears to be accurate in detecting extensive trophoblastic uterine involvement and helpful in identifying resistant uterine foci. Pelvic ultrasonography should be an integral part of the pretreatment assessment of patients with persistent GTD.