Journal of Diagnostic Medical Sonography

A review is provided of the literature that has been published on image segmentation relative to sonography. Manual and automatic techniques for partitioning a sonogram are highlighted. In addition, a preliminary set of results is provided on the interrater reliability of the manual segmentation of axillary lymph nodes that have been sonographically imaged. A correlation between sonographers conducting manual segmentation is very high (r = 0.9 with P < .00 at the .01 alpha level). This work is set to provide additional information on lymph node cubic volume and the agreement between manual and automatic segmentation of axillary lymph nodes.

Sonographic imaging of the shoulder in an infant is a challenge for pediatric physicians, radiologists, and sonographers. At the Texas Scottish Rite Hospital for Children, sonographic techniques have been used to examine the posterior aspect of the glenohumeral joint in patients with brachial plexus palsy. Between 1999 and 2006 146 patients were evaluated by sonography, including 124 patients who were assessed both before and after therapeutic intervention. The sonographic findings were accurate and reliable in providing diagnostic information. The advantages are that ultrasonic energy involves no ionizing radiation and is noninvasive, examination times are shorter than computed tomography (CT) or magnetic resonance imaging (MRI), costs are lower, and no sedation is needed in preparation. Results showed that when properly performed, sonography is a diagnostic tool preferable over plain x-ray, CT, MRI, and arthrography in evaluating the shoulder in infants.

The standard for performing an antepartum obstetrical sonogram primarily involves the examination of the fetus; however, both the American Institute of Ultrasound in Medicine (AIUM) and American College of Radiology (ACR) guidelines suggest the evaluation of maternal structures as well. The authors present 35 incidental findings that were discovered on routine antepartum obstetrical sonography. These include abdominal wall, gastrointestinal, reproductive, urinary, and vascular anomalies in the maternal structures. A review of the literature demonstrates that many of these findings have clinical significance, which highlights the wisdom of the AIUM and ACR guidelines, and it also stresses the importance of seeking and reporting them.

This study investigated the relationship between fetal liver volume (FLV) and gestational age (GA) in Nigerian subjects using 2D sonography. Fetal liver volume measurements were obtained from 900 normal singleton fetuses between 15 and 41 weeks GA (mean = 28 weeks). The FLV was computed from anterior-posterior, sagittal, and transverse dimensions of the fetal liver by assuming the liver to be a pyramidal structure. The mean FLV obtained ranged from 4.14 ± 0 cm ³ at 15 weeks to 76.88 ± 7.58 cm³ at 40 weeks and 79.45 ± 9.32 cm³ at 41 weeks. A simple regression analysis showed a positive linear relationship between GA and FLV (r = 0.98), which is described by the equation FLV = 53.53 + 3.246 GA. A strong positive correlation was also noted between FLV and biparietal diameter (BPD; r = 0.968), FLV and head circumference (r = 0.960), FLV and abdominal circumference (r = 0.901), and FLV and fetal weight (r = 0.979). Z test analysis showed no significant difference between GA estimated by FLV and GA estimated by BPD or femur length (α = 0.01). The use of FLV determined by 2D sonography has been shown to be accurate in dating pregnancy, and its use in a multiparameter biometry should improve the precision in predicting the expected date of delivery.

Blue rubber bleb nevus syndrome (BRBNS) is a rare disease characterized by the presence of cutaneous and gastrointestinal (GI) hemangiomas. These BRBNS-associated hemangiomas, possibly numbering into the hundreds, may also be identified in multiple visceral locations.

Although the presence of benign cutaneous lesions is of small concern, GI lesions are cause for bleeding. Heavy visceral organ involvement can lead to intravascular coagulation, consumptive coagulathopy, and organ failure. Therefore, GI-related complaints, anemia, the visual identification of a cutaneous blue-colored lesion located on the upper extremity or trunk, and multiple visceral hemangiomas involving a large portion of the organ may indicate the presence of BRBNS. It is important that this unusual combination of patient signs, symptoms, and sonographic findings be presented to the interpreting physician to facilitate inclusion of this rare condition as a possible differential diagnosis to be considered.

Hyperreactio luteinalis is a rare, benign ovarian finding during pregnancy, but its sonographic appearance can imitate a malignant process, and the ovarian enlargement predisposes a woman carrying this anomaly to other complications. The management of hyperreactio luteinalis during pregnancy is preferably conservative, and surgical treatment is reserved for the cases with associated complications. This article reviews maternal ovarian hyperreactio luteinalis in pregnancy and demonstrates an example. Proper assessment of the maternal hyperreactio luteinalis helps to prevent its unnecessary surgical treatment.

Interstitial ectopic pregnancy, also referred to as a cornual ectopic pregnancy, is a rare form of ectopic pregnancy. The sonographic appearance of interstitial ectopic pregnancy is complex and varied, making an accurate diagnosis difficult and thorough clinical correlation necessary. Interstitial ectopic pregnancies carry an elevated risk of maternal mortality compared with other ectopic pregnancies, making expedient diagnosis and treatment important.

In 2001, the National Aeronautics and Space Administration (NASA) integrated a sonography machine into the Health Research Facility on the International Space Station. With longer missions in space and a possible trip to Mars, NASA decided the International Space Station needed more diagnostic capabilities. A ground-to-space two-way communication system was set up between the astronauts and the radiologists at Mission Control. A series of studies was conducted to ensure the operating astronauts could produce diagnostic images under remote guidance. Some of the remotely guided studies included ocular examinations, the Focused Assessment with Sonography for Trauma scan, and musculoskeletal examinations.