Clinical significance of focal echogenic liver lesions

During a 4-year period, 53 focal echogenic liver lesions were demonstrated by sonography in 41 patients, in whom there was no evidence of metastatic origin. Most of the lesions were hemangiomas.One of the purposes of this study was to determine the characteristic ultrasound features for liver hemangioma. Small (less than 2 cm), homogeneous, echogenic, well-circumscribed, subcapsular lesions almost prove their hemangiomatous nature. Lesions with a diameter of more than 2 cm are usually more lobulated and heterogeneous. They are located more centrally in the liver and nearly all show a close anatomical relation with 1 of the hepatic veins. Very large lesions (greater than 5 cm) with a heterogeneous and irregular aspect suggest focal nodular hyperplasia, which must be proven by a Tc-isotopic liver scan.     

胎儿心室内灶状强回声在胎儿结构畸形诊断中的临床价值

目的探讨胎儿心室内灶状强回声在胎儿结构畸形诊断的临床价值。方法对胎儿超声心动图诊断为心室内灶状强回声的1068例胎儿进行回顾性分析,重点分析心室内灶状强回声位置、数量与胎儿结构畸形的相关性。结果左心室内1个灶状强回声754例（70.6%）,2个灶状强回声221例（20.7%）,3个灶状强回声23例（2.1%）,数个灶状强回声7例;右心室内1个灶状强回声9例,数个灶状强回声2例;双心室内灶状强回声52例（4.9%）。合并其他部位畸形7例（0.66%）。结论胎儿心室内灶状强回声位置、数量与胎儿结构畸形相关性不大。     

Prenatal diagnosis of 47,XXX

We report 2 cases of 47,XXX that were diagnosed prenatally and were screened positive for trisomy 21 by biochemical and ultrasound markers. These cases underline the importance of discussing the sex chromosome abnormalities during the genetic counseling after an abnormal triple screen test or ultrasound examination.     

声学微气泡在治疗和递送系统的应用

根据国外声振含气微泡最新研究进展．综述了声振含气微泡在治疗方面和作为药物或基因的递送系统方面的应用。     

染色体微阵列分析技术在超声筛查心室强光点胎儿产前诊断中的应用

【摘要】 目的 探讨染色体微阵列分析技术（chromosomal microarry analysis, CMA）在超声筛查心室强光点胎儿产前诊断中的临床应用价值。方法 采用美国Affymetrix公司CytoScan 750K芯片对医院183例超声筛查提示心室强光点的胎儿羊水标本进行检测,并用Chas v31软件对结果进行分析。结果 183例心室强光点胎儿羊水标本中,CMA共检出染色体异常胎儿9例,异常检出率为492%,其中非整倍体3例（21三体1例、XXY 1例、XYY 1例）,占总例数的164%;具有临床意义拷贝数变异（pathogenic copy number variation, pCNV）6例（其中1例为16p1311复发性微缺失）,占总例数的328%。 结论 与传统染色体核型分析及其他快速产前诊断方法相比,CMA针对全染色体,可有效地额外检出具有临床意义的微缺失/微重复,从而显著提高心室强光点胎儿染色体异常的检出率,可有效降低胎儿出生缺陷的发生。     

The association of maternal BMI with fetal echogenic intracardiac foci and echogenic bowel

Objectives.?To evaluate the impact of maternal body mass index (BMI) as well as maternal ethnicity on the detection of either echogenic intra-cardiac focus (EIF) or echogenic bowel (EB).

Methods.?This prospective study identified 74 uncomplicated singleton fetuses in which EIF and/or EB were detected between 18 and 21 weeks of gestation (i.e. study group). Seventy four consecutively scanned fetuses without EIF or EB, at the same gestational age, were selected as controls. The differences in maternal BMI and maternal ethnicity were compared between the two groups using the χ² test, Fisher's exact test, and the Student t-test. A multivariable logistic regression model was constructed to control for confounders. Odds ratios (OR) and their 95% confidence interval (CI) were computed.

Results.?The mean maternal BMI was significantly lower in the study group as compared to controls (22.9?±?3.1 vs. 28.0?±?7.5?kg/m², respectively; p?<?0.0001). Patients with fetal EIF and/or EB were significantly more likely to be Asians (20.3% vs. 5.4%, OR?=?4.5; 95% CI 1.3–16.9). Using a multivariable analysis, controlling for ethnicity, the association between maternal BMI and fetal EIF or EB remained significant (OR?=?0.83; 95% CI 0.76–0.91). However, based on this model Asian ethnicity was not an independent risk factor for the detection of EIF and/or EB (OR?=?2.6; 95% CI 0.8–8.9).

Conclusions.?Our data suggests an inverse relationship between the maternal BMI and the detection of fetal EIF and/or EB. Moreover, it appears that low maternal BMI, and not Asian ethnicity, is an independent risk factor for the detection of these echogenic fetal findings.     

Neonatal outcomes associated with intestinal abnormalities diagnosed by fetal ultrasound

Purpose

Intestinal abnormalities are sometimes seen during antenatal testing; however, the postnatal importance of these findings has not been well established. We evaluated whether abnormal intestinal appearance on fetal ultrasound (US) was ultimately related to neonatal outcome.

Methods

Fetal US examinations from 2003 to 2006 were evaluated. Hyperechogenic bowel was defined as having the echogenicity comparable to bone, and dilated bowel was identified based on the sonographer's assessment. Persistence or resolution of US findings on subsequent US examinations and eventual outcomes were assessed. Cases were categorized as hyperechogenic or dilated and then subgrouped based on whether the US finding resolved.

Results

Sixty-eight fetuses had either hyperechogenic (n = 48) or dilated bowel (n = 20) on antenatal US. In 56 cases, complete data were available for analysis. Of 44 liveborn infants, 11 (25.0%) had an abdominal abnormality, and 33 (75.0%) were normal at birth. Compared to those with dilated bowel, fetuses with hyperechogenic bowel had a higher rate of prenatal demise (20.8% vs 10%) but a lower rate of abnormality at birth (10.3% vs 53.3%). Hyperechogenic bowel resolved on subsequent US more frequently than dilated bowel (65.5% vs 20.0%). In both groups, all fetuses with sonographic resolution were normal at birth. Of 9 fetuses that had persistently hyperechogenic bowel, 3 (33.3%) were born with an abnormality, and all were found to have meconium peritonitis or meconium ileus. In the 12 cases where dilated bowel did not resolve, 8 (66.7%) were eventually born with an abnormality, most commonly intestinal atresia.

Conclusions

Hyperechogenic and dilated bowel are associated with a significant rate of fetal demise. Hyperechogenicity is more common than dilation and is more likely to be transient. Dilated bowel is more often associated with neonatal abnormality than hyperechogenic bowel. Persistence of fetal US findings predicts a higher likelihood of abnormality in the neonate.     

Ultrasound-facilitated thrombolysis using tissue-plasminogen activator-loaded echogenic liposomes

INTRODUCTION: Targeted delivery of thrombolytics to the site of occlusion is an attractive concept, with implications for the treatment of many thrombo-occlusive diseases. Ultrasound enhances thrombolysis, which can be augmented by the addition of a contrast agent. We have previously reported development of echogenic liposomes (ELIP) for targeted highlighting of structures with potential for drug and gene delivery. This study evaluated the potential of ELIP for thrombolytic loading, and the effect of ultrasound exposure of thrombolytic-loaded ELIP on thrombolytic efficacy. MATERIALS AND METHODS: Tissue-plasminogen activator (tPA) was loaded into ELIP. Echogenicity was assessed and reported as mean grayscale values. Whole porcine clots were treated with plasma, free tPA, tPA+Optison (echocontrast agent), or tPA-loaded ELIP, with and without ultrasound (1 MHz, continuous wave, 2 W/cm(2), for 2 min). Clots were weighed before and after a 30-min treatment period, and results reported as percent clot mass loss. RESULTS: tPA entrapment into ELIP was feasible with 50% entrapment, and retention of echogenicity. Treatment with tPA-loaded ELIP resulted in effective clot lysis with an effect similar to treatment with free tPA. Ultrasound exposure of tPA-loaded ELIP resulted in enhanced thrombolysis (49.5% relative improvement vs. no ultrasound). Much of the ultrasound effect appeared to be related to drug release from the tPA-ELIP complex. CONCLUSIONS: We have demonstrated entrapment of tPA into ELIP with effective clot lysis and drug release using ultrasound. Our tPA-loaded ELIP has potential for specific highlighting of clots to confirm agent delivery and help focus ultrasound therapy for targeted ultrasound-facilitated thrombolysis.     

Burned-out tumor of the testis presenting as supraclavicular lymphadenopathy

Burned-out tumor of the testis is a rare clinical entity. It generally presents with metastases and is nonpalpable in testicular palpation. We present a case of testicular burned-out tumor having supraclavicular and retroperitoneal lymph node metastases. Imaging findings of such tumors have insufficiently been documented in radiology literature. Scrotal sonography is crucial in detecting the regressed tumors especially in patients with extragonadal metastasis of a testicular primary.     

Echogenic fluid: a pitfall in the ultrasonographic diagnosis of cystic lesions.

Although it is well known that biliary sludge can produce fine diffuse echoes within the gallbladder, it is less commonly appreciated that other cystic structures may contain echogenic fluid and therefore be mistaken sonographically for solid lesions. In this article three cases of splenic cysts and one case each of pyrometrocolpos, hydroureter, and pyonephrosis presented with diffuse fine echoes in the fluid. Three of these cases were misinterpreted as a result of this echogenic appearance. These cases serve to emphasize the need for awareness of the echogenicity of some types of fluid and the value of other signs of cystic lesions besides absence of internal echoes.