PowerPoint Presentation - Scott Memorial...
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4/5/2019
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FUTURE TRENDS IN OBSTETRICAL SONOGRAPHY: LATEST MARKERS & MODALITIES
Reem S. Abu-Rustum, MD, FACOG, FACS, FAIUMDept. of Ob/Gyn, Division of MFM, University of Florida
DISCLOSURES
• I have no disclosures
LECTURE OBJECTIVES
By the end of this lecture the viewer should be able to:
• Describe the latest sonographic markers in the second trimester
• Describe the utility and limiations of various technological modalities
Present Advances in Obstetrcial Ultrasound
Latest Markers
Technological Modalities
12W2D
OBJECTIVES
Conus Medullaris
TT Ratio CSP
BCV
Prefrontal Thickness
Talipes
Placental Thickness
Conus Medullaris
TT Ratio CSP
BCV
Prefrontal Thickness
Talipes
Placental Thickness
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TETHERED SPINAL CORDCLOSED SPINA BIFIDA
www.thenextdds.com/clinicalimages.aspx?catid=612&id=4294970994
CONUS MEDULLARIS
CONUS MEDULLARIS
CM
Hypoechogenic
Traingular In Shape
Shifts cephalad with advancing gestation
Dysraphisms in 2-4/1000
Abnormal in NTD
CONUS MEDULLARIS
CM
CONUS MEDULLARIS CONUS MEDULLARIS
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Hoopman et al. Ultrasound Obstet Gynecol 2011; 38:548-552
Conus Distance (mm) = Femur Length (mm) - 8
CONUS MEDULLARIS
Conus Medullaris
TT Ratio CSP
BCV
Prefrontal Thickness
Talipes
Placental Thickness
DIGEORGE SYNDROMEANEUPLOIDIES
http://static.memrise.com/uploads/mems/output/1171765-140423151007.png
THYMUS
THYMUS AT 3VV THYMIC THORACIC RATIO
Thymus
Ao
PA
SVC
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MEAN IN DIGEORGE 0.25 TRISOMY 18 0.38, TRISOMY 21 0.40
THYMIC THORACIC RATIO 0.44THYMIC THORACIC RATIO:
TRISOMY 21 Ratio 0.45
THYMIC THORACIC RATIO:TRISOMY 18 Ratio 0.38
PA
AO SVC
THYMUS
THYMIC THORACIC RATIO
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THYMIC THORACIC RATIO:MASS
THYMIC THORACIC RATIO:MEGA THYMUS 0.57
THYMIC THORACIC RATIO:MEGA THYMUS
XRAY COURTESY of LINDA DAOU, MD
RECENTLY…
Chaoui et al. Prenatal Diagnosis 2016; 36: 1-5
Chaoui et al. Prenatal Diagnosis 2016; 36: 1-5
FETUS WITH DiGEORGE
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FETUS WITH DiGEORGE
Thymic/Thoracic Ratio 16.3/33.4=0.49
FETUS WITH DiGEORGE
*
Chaoui et al. Prenatal Diagnosis 2016; 36: 1-5
Conus Medullaris
TT Ratio CSP
BCV
Prefrontal Thickness
Talipes
Placental Thickness
TOTAL ANOMALOUSPULMONARY VENOUS RETURN
Wikipedia.org
PULMONARY VEINS LEFT BRACHIOCEPHALIC VEIN
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LBCV 21W6D
BCV
BCV
BCV
LBCV 21W6D
Sinkovskaya et al, Ultrasound Obstet Gynecol 2012; 40: 542-548
LBCV 21W6D
CV
pv
pv
pvpv
*
L
R
L
R
4 CHAMBER VIEW26W3D
Images adapted from Mahmoud et al. ePoster AIUM Annual Convention 2016.Schematics adapted from Abuhamad & Chaoui. A Practical Guide to Fetal Echocardiography: Normal and Abnormal Hearts. 3rd Edition
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L
R
AoLA
Images adapted from Mahmoud et al. ePoster AIUM Annual Convention 2016.
4 CHAMBER VIEW26W3D
*LBCV
LBCV26W3D
Images adapted from Mahmoud et al. ePoster AIUM Annual Convention 2016.Sinkovskaya et al. Ultrasound Obstet Gynecol 2012; 40: 542-548
Conus Medullaris
TT Ratio CSP
BCV
Prefrontal Thickness
Talipes
Placental Thickness
NORMAL PROFILE 26W2Dd2/d1 0.97 Vs 0.2 FOR TRISOMY 21
d1 D2
D1 Leading edge of skull to skin
D2 Skin to MM Line
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MM
NORMAL & ABNORMAL PROFILE
Normal FetusTrisomy 21
d1
d2
ABNORMAL PROFILECOURTESY OF NABIL HELOU, MD
26w6d
ABNORMAL PROFILELYMPHEDEMA
21w5d
ABNORMAL PROFILE
21w2d Trisomy 21
Conus Medullaris
TT Ratio CSP
BCV
Prefrontal Thickness
Talipes
Placental Thickness
CLUB FEET
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FOOT
Normal Foot Talipes
FOOT
58
Adapted from ‘A Practical Guide to 3D Ultrasound’. RS Abu-Rustum. CRC Press 2015
FEET
Conus Medullaris
TT Ratio CSP
BCV
Prefrontal Thickness
Talipes
Placental Thickness
PLACENTAL THICKNESS
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LATESTTECHNOLOGICAL MODALITIES
8W3D
TV 6-12 MHz
Linear 9L
3DVascular Modes
Automation
TV 6-12 MHz
Linear 9L
3DVascular Modes
Automation
LATESTTECHNOLOGICAL MODALITIES
TV RIC 6-12: ADVANTAGES
Resolution3D Capabilities
TV AT 11W3D USING RIC 6-12
TV RIC 6-12: LIMITATIONS
TV RouteIn Need of Technical SkillCost
TV 6-12 MHz
Linear 9L
3DVascular Modes
Automation
LATESTTECHNOLOGICAL MODALITIES
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TA LINEAR 9 MHz: ADVANTAGES
ResolutionAbdominalLow CostVirtual Convex Available
LINEAR 9 MHz PROBEKIDNEY: WITHOUT AND WITH
31w1d
33w3d
LINEAR 9 MHz PROBESPINE: WITHOUT AND WITH
31w0d
LINEAR 9 MHz PROBECEREVELLUM: WITHOUT AND WITH
LINEAR 9 MHz PROBE13W1D HEART
LINEAR 9 MHz PROBE32W1D ORBITS
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LINEAR 9 MHz PROBE32W1D HEART
TA LINEAR 9 MHz: LIMITATIONS
PenetrationProbe Width
TV 6-12 MHz
Linear 9L
3DVascular Modes
Automation
LATESTTECHNOLOGICAL MODALITIES
76
SURFACE MODE
77
Adapted from ‘A Practical Guide to 3D Ultrasound’. RS Abu-Rustum. CRC Press 2015
SURFACE MODE
HDlive 7W2D HDlive 8W3D HDlive 8W3D
SURFACE MODE
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Adapted from ‘A Practical Guide to 3D Ultrasound’. RS Abu-Rustum. CRC Press 2015
SURFACE MODE
Adapted from ‘A Practical Guide to 3D Ultrasound’. RS Abu-Rustum. CRC Press 2015
SURFACE MODE
SURFACE MODE SURFACE MODE
Adapted from ‘A Practical Guide to 3D Ultrasound’. RS Abu-Rustum. CRC Press 2015
SURFACE MODE
Adapted from ‘A Practical Guide to 3D Ultrasound’. RS Abu-Rustum. CRC Press 2015
SURFACE MODE
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85
Adapted from ‘A Practical Guide to 3D Ultrasound’. RS Abu-Rustum. CRC Press 2015
SURFACE MODE
86
Adapted from ‘A Practical Guide to 3D Ultrasound’. RS Abu-Rustum. CRC Press 2015
SURFACE MODE
87
Adapted from ‘A Practical Guide to 3D Ultrasound’. RS Abu-Rustum. CRC Press 2015
SURFACE MODE
88
Adapted from ‘A Practical Guide to 3D Ultrasound’. RS Abu-Rustum. CRC Press 2015
89
SKELETAL MODE
90
Adapted from ‘A Practical Guide to 3D Ultrasound’. RS Abu-Rustum. CRC Press 2015
SKELETAL MODE
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91
Adapted from ‘A Practical Guide to 3D Ultrasound’. RS Abu-Rustum. CRC Press 2015
SKELETAL MODE
92
Adapted from ‘A Practical Guide to 3D Ultrasound’. RS Abu-Rustum. CRC Press 2015
SKELETAL MODE
93
OMNI VIEW
94
Adapted from ‘A Practical Guide to 3D Ultrasound’. RS Abu-Rustum. CRC Press 2015
OMNI VIEW
95
INVERSION VERSION
96
*
*
**
*
Adapted from ‘A Practical Guide to 3D Ultrasound’. RS Abu-Rustum. CRC Press 2015
INVERSION VERSION
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97
Adapted from ‘A Practical Guide to 3D Ultrasound’. RS Abu-Rustum. CRC Press 2015
INVERSION VERSION
98
COMBINATION: FETAL HEART
99
HDlive/VCI
Ao
MBTV
MV
Ao
MB
MV
TV
Adapted from ‘A Practical Guide to 3D Ultrasound’. RS Abu-Rustum. CRC Press 2015
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INVERSION MODE
RVLV
LVOT
Adapted from ‘A Practical Guide to 3D Ultrasound’. RS Abu-Rustum. CRC Press 2015
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AoA
*
Adapted from ‘A Practical Guide to 3D Ultrasound’. RS Abu-Rustum. CRC Press 2015
INVERSION MODE
102
Adapted from ‘A Practical Guide to 3D Ultrasound’. RS Abu-Rustum. CRC Press 2015
INVERSION MODE
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103
Adapted from ‘A Practical Guide to 3D Ultrasound’. RS Abu-Rustum. CRC Press 2015
INVERSION MODE SURFACE/TUI/VCI
Loss of normal off-setASD and VSD and HRV
CAT
Left Right
HRV
Adapted from ‘A Practical Guide to 3D Ultrasound’. RS Abu-Rustum. CRC Press 2015
Loss of normal off-setASD and VSD seen
Adapted from ‘A Practical Guide to 3D Ultrasound’. RS Abu-Rustum. CRC Press 2015
SURFACE/TUI/VCI LATESTTECHNOLOGICAL MODALITIES
TV 6-12 MHz
Linear 9L
3DVascular Modes
Automation
107
MINIMAL MODE
Adapted from ‘A Practical Guide to 3D Ultrasound’. RS Abu-Rustum. CRC Press 2015
108
Adapted from ‘A Practical Guide to 3D Ultrasound’. RS Abu-Rustum. CRC Press 2015
MINIMAL MODE
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109
MCA
MCA
Adapted from ‘A Practical Guide to 3D Ultrasound’. RS Abu-Rustum. CRC Press 2015
MINIMAL MODE
RARA
UAUA
MINIMAL MODE
111
Adapted from ‘A Practical Guide to 3D Ultrasound’. RS Abu-Rustum. CRC Press 2015
MINIMAL MODE
112
Adapted from ‘A Practical Guide to 3D Ultrasound’. RS Abu-Rustum. CRC Press 2015
MINIMAL MODE
RECENTLY… SILOHUETTE
Adapted from B. Benoit ISUOG World Congress 2016
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HDlive STUDIO
Adapted from B. Benoit ISUOG World Congress 2016
AMBIGUOUS GENITALIA
Abu-Rustum, Chaaban J Ultrasound Med 2009 28: 95
Technique of Glanc J Ultrasound Med 2007 26: 563
LIMITATIONS 3D LIMITATIONS 3D
LIMITATIONS 3D
Abu-Rustums, Daou
LIMITATIONS 3D
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Cost/ReimbursementSteep Learning CurveMay Provide False ReassuranceGood 2D Remains the Gold Standard
LIMITATIONS 3D
TV 6-12 MHz
Linear 9L
3DVascular Modes
Automation
LATESTTECHNOLOGICAL MODALITIES
AUTOMATION IN 2D SONOGRAPHY
1- FT Automation: NT, IT
2- Automated Biometry: BPD, HC, AC and FL
•Automation1- Fetal Heart
2- Volume NT
3- EFW from Fractional Limb Volume
4- Progress in Labor
5- Future: FT Anatomic/biometric evaluation
•Automation
AUTOMATION IN 2D SONOGRAPHY
ABUHAMAD’S AUTOMATION
• Acquired volume of a structure contains all the anatomical 2D planes for a complete evaluation of this structure
• For every organ, 2D anatomical planes that are needed for a complete evaluation are organized in a constant anatomic relationship to each other.
J Ultrasound Med 2005 24: 397 J Ultrasound Med 2007 26: 501UOG 2008 31: 30
125
MAIN CONCEPT
Computerized program to automatically display all2D planes that are required for a complete evaluation
of this particular organ
Obtain a volume of an organ
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AUTOMATION: FETAL HEARTVCAD ACTIVATION
Adapted from ‘A Practical Guide to 3D Ultrasound’. RS Abu-Rustum. CRC Press 2015
AUTOMATION: FETAL HEARTVCAD ALIGNMENT
Adapted from ‘A Practical Guide to 3D Ultrasound’. RS Abu-Rustum. CRC Press 2015
AUTOMATION: FETAL HEARTVCAD ALIGNMENT
Adapted from ‘A Practical Guide to 3D Ultrasound’. RS Abu-Rustum. CRC Press 2015
130
LVOT
AUTOMATION: FETAL HEARTCARDIAC 1
Adapted from ‘A Practical Guide to 3D Ultrasound’. RS Abu-Rustum. CRC Press 2015
RVOT
Adapted from ‘A Practical Guide to 3D Ultrasound’. RS Abu-Rustum. CRC Press 2015
AUTOMATION: FETAL HEARTCARDIAC 2
Stomach
Adapted from ‘A Practical Guide to 3D Ultrasound’. RS Abu-Rustum. CRC Press 2015
AUTOMATION: FETAL HEARTCARDIAC 3
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RA
SVCIVC
Adapted from ‘A Practical Guide to 3D Ultrasound’. RS Abu-Rustum. CRC Press 2015
AUTOMATION: FETAL HEARTCARDIAC 4
DAo
DA
Adapted from ‘A Practical Guide to 3D Ultrasound’. RS Abu-Rustum. CRC Press 2015
AUTOMATION: FETAL HEARTCARDIAC 5
135
S
DAo
AoA
Adapted from ‘A Practical Guide to 3D Ultrasound’. RS Abu-Rustum. CRC Press 2015
AUTOMATION: FETAL HEARTCARDIAC 6
AUTOMATION: LIMITATIONS
Machine DependentSteep Learning CurveLimited by Fetal Size, Position and Maternal BMIIntroduces a 3rd Dimension of Error
CONCLUSIONS
We are at a most exciting time in prenatal diagnosis
This is a direct result of all the technological advances
Enables us to diagnose earlier and with more certainty
There is so much to learn and stay abreast with
Tremendous need for in-depth provider and patient education
Great caution must be exercised with the introduction of allthese new modalities
THANK YOU!
Adapted from ‘A Practical Guide to 3D Ultrasound’. RS Abu-Rustum. CRC Press 2015
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I THANK YOU FOR YOUR ATTENTION…