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1032: Prenatal Diagnosis of Amyoplasia Congenita by 3D and 4D Ultrasound
S106
Ultrasound in Medicine and Biology
Our case series includes three diverticula of the urethra, an urethral nephrogenic adenoma, a metastasis of a cervical malignancy, four cases of pelvic floor instability, and two cases of mobile urethra. The great advantage of volumetric transvaginal imaging in the assessment of the female urethra is to be able to obtain reformatted axial scan planes, that cannot be obtained by ultrasound imaging in any other way. 1028 3D Ultrasound in Gynaecologics Luca M Sconfienza, IRCCS Policlinico San Donato, Italy Francesca Lacelli, ASL 2 - Ospedale Santa Corona, Pietra Ligure, Italy Giovanni Serafini, ASL 2 - Ospedale Santa Corona, Pietra Ligure, Italy Purpose: The aim of this work was to review the technical aspects and clinical applications in our daily practice of three- (3D) and fourdimensional (4D) ultrasonography (US) in gynecologic imaging. Material and Methods: we used three different techniques to obtain 3D and 4D US images: freehand technique with a transvaginal (TV) approach, mechanical and matrix technique with transabdominal (TA) approach. We reviewed our own clinical experience of 159 patients in several clinical situations over the past 3 years. Results: In most situations, volume US adds high diagnostic value to standard two-dimensional (2D) US. In particular, volume US is very helpful in the assessment of uterine malformations, in performing sonohysterography, in detecting the origin of adnexal lesions and in the guidance of interventional procedures, including abscess drainage in pelvis and abdomen. 3D US also provides accurate measurements in 3 planes with acceptable interobserver reliability, even in post-processing elaboration. Conclusions: 3D US has proved to be a useful imaging tool for clinical problem solving in gynecology, especially in imaging the uterus and uterine cavity. However, it remains difficult to compare 2D and 3D because 2D imaging always precedes the 3D volume acquisition. 1029 The 3D Color Doppler Study of Angiogenesis in Breast Cancers Ming-Kwang Shyu, Dept. Obstetrics & Gynecology, National Taiwan Univesity Hospital, Taiwan Wen-Hung Kuo, Dept. Surgery, National Taiwan Univesity Hospital, Taiwan King-Jen Chang, Dept. Surgery, National Taiwan Univesity Hospital, Taiwan Fon-Jou Hsieh, Dept. Obstetrics & Gynecology, National Taiwan Univesity Hospital, Taiwan Objects: To evaluate the efficacy of 3D color Doppler for detecting breast cancers through angiogenesis study. Materials and Methods: Over one hundred cases of palpable mass were scanned by 3D Doppler ultrasound, recorded the computerized vascularization index (VI),flow index (FI) and vascularization flow index (VFI), and clarified the angiogenesis characteristics of malignant and metastatic breast cancers. Results: Over one hundred cases of palpable mass were enrolled. Both cancer and benign patients were equal in number. The cancer patient group showed higher age but similar tumor size. The VI, FI and VFI were significantly elevated in cancer patient group and some indices showed higher possibility of occurrence of lymph node metastasis. Conclusion: 3 dimensional color Doppler study of angiogenesis in breast diseases can offer important messages for the nature of tumor and occurrence of lymph node metastasis.
Volume 35, Number 8S, 2009 1030 To Evaluate 3D Multislice Ultrasound-A Novel Approach on the Visualization of the Fetal Secondary Palate Xinlin Chen, Hubei Women and Children Hospital, China Yan Li, China Peiwen Chen, Department of Ultrasound, Hubei Maternal and Child Health Hospital, Wuhan, China Yangqing Xu, Department of Ultrasound, Hubei Maternal and Child Health Hospital, Wuhan, China Objective: To evaluate the value of three-dimensional (3D) Multislices View (MSV)mod on the each-lay visualization of the secondary palate in normal fetus and fetus with cleft lip and/or palate. Methods: Sonographic examinations were performed in 20 normal fetus and 10 fetus with cleft lip and/or palate. The acquired volume images were analyzed by Multislices View (MSV)mod. The normal fetus were divided into two groups as follows: in 10 fetus the secondary palate was scanned in the middlemost sagittal plane; while the other 10 fetus were scanned at a 30°⬃50° angle back-up the sagittal plane. Results: The secondary palate successfully visualized in 18 of 20 normal fetuses, in both axial and coronal planes. The most clear images of the secondary palate are obtained at an angle of 30°⬃50° back-up in the sagittal plane. In the fetus with cleft lip and palate, the lesion of the secondary palate was clearly demonstrated in the restructured axial and coronal planes by three-dimensional(3D) Multislices View (MSV)mod, including the position,the rang and the depth. Conclusions: 3D MSV mod allows clear visualization of normal and cleft secondary palate, and is a new approach for the prenatal diagnosis of cleft palate, especially useful for it’s position and degree. 1031 SonoScape Portable Color Doppler Ultrasound System S8 Randy Hwan, SonoScape, China SonoScape is a Chinese leader specializing in developing and manufacturing cutting-edge color Doppler ultrasound systems and ultrasound transducers. As the only China Top Brand in the medical ultrasound industry recognized by General Administration of Quality Supervision, Inspection and Quarantine of the People’s Republic of China, SonoScape is continuing providing the highest quality ultrasound systems and services at the most competitive prices for our customers worldwide. The new product S8 is incorporated with the cutting-edge ultrasound technology like High Q Noise Filter Technology (HQNF), Native-Resolution-Scan-Converter Technology (NRSC), Multi-beams Process Technology (MBP), MicroScan Imaging Technology, Automatic Tissue Optimization Technology (ATO), highlighting a wide range selection of HD probes not only capable of rendering superior quality 4D images but also excellent for cardiac applications with the advanced imaging techniques including Tissue Doppler Imaging. This ground-breaking product incorporating 4D imaging is once again effectively demonstrating SonoScape’s progress on continuing setting new standards in leading-edge performance as a major global company. 1032 Prenatal Diagnosis of Amyoplasia Congenita by 3D and 4D Ultrasound Frances E Miceli, Sydney West Area Health Service, Australia Amyoplasia Congenita is a rare muscular condition within the spectrum of Arthrogryposis Multiplex Congenita. It is usually considered to be sporadic in nature. It is mainly characterized by maldevelopment of the skeletal muscles in which the muscle tissue is replaced by fibrous and fatty tissue. This can be seen to varying degrees although the severity
Abstracts tends to increase distally with the hands and feet being the worst affected. The decreased muscle mass results in contractures and little or no movement of the limbs. There may also be associated scoliosis, micrognathia, abdominal wall defects, hypoplasia of the labial fold in females and inguinal hernia in males. We present a case in which limb contractures were seen at the nuchal translucency scan at 12w3d and all four limbs remained in the same fixed and flexed position throughout the pregnancy. Multiple scans were performed by 2D, 3D and 4D ultrasound and there was no movement of the fetal limbs seen at any time during the pregnancy. The only movement seen was limited to gross body movements of the trunk alone. 1033 Contribution of 3D Ultrasound in the Diagnosis of Alobar Holoprosencephaly Lay Kieng Ng, Singapore General Hospital, Singapore Sook-Ling Lee, Singapore General Hospital, Singapore LK Tan, Singapore General Hospital, Singapore HK Tan, Singapore General Hospital, Singapore Case Report: Patient was a 27 year old Malay woman, G2P1. Her first pregnancy was uneventful. She presented in our department at 11 weeks amenorrhoea, ultrasound dating concurred with 8 weeks gestation. Her fetal anomaly screening scan was performed at 23.3 weeks amenorrhoea, ultrasound biometry concurred with 19.7 weeks. The following anomalies were demonstrated in the fetal head on two and three-dimensional ultrasound: (i) a single large horse-shoe shaped ventricle (ii) thin and poorly developed cortex (iii) fused thalami (iv) corpus callosum, inter-hemispheric fissure and third ventricle appeared absent (v) hard palate area equal 0.27 sq cm, which is below 2.5th centile; this is strongly suggestive of maxillary hypoplasia (vi) hypotelorism, interocular distance measured 5.5 mm (vii) Large anterior fontanelle Findings are suggestive of alobar holoprosencephaly. Amniocentesis was performed. Results: 46, XY. The couple was counseled for poor prognosis of holoprosencephaly and the risks of intrauterine death, neonatal death and associated disabilities including severe mental retardation, quadriplegia and recurrent seixures The couple decided to keep the pregnancy. Growth scan at 29.1 weeks noted macrocephaly. Patient presented at 36.6 weeks with leaking liquor. She went into spontaneous labour and a male fetus was delivered by normal vaginal delivery. A cranial ultrasound was performed and confirmed all the antenatal ultrasound findings. In addition the baby was noted to have microphthalmia, left eye smaller than right, and a single nostril. Baby passed away on day 1 of life. Conclusion: The application of 3-dimensional ultrasound had facilitated improved demonstration of antenatal anomalies. 1034 Virtual Embryoscopy in First Trimester Abnormal Fetal Development Frederique M van Dunne, Erasmus Medical Center, Rotterdam, The Netherlands, The Netherlands Melek Rousian, Erasmus Medical Center, Rotterdam, The Netherlands, The Netherlands Anton H Koning, Erasmus Medical Center, Rotterdam, The Netherlands, The Netherlands Niek Exalto, Erasmus Medical Center, Rotterdam, The Netherlands, The Netherlands Eric A Steegers, Erasmus Medical Center, Rotterdam, The Netherlands, The Netherlands
S107
Objective: 3D/4D virtual reality in the Barco I-Space named virtual embryoscopy is used to assess the human embryonic development accurately and specifically for structural anomalies in the first trimester of pregnancy. Methods: 3D ultrasound sweeps were preformed between 6 and 13 weeks gestation using a vaginal ultrasound probe. Datasets of various embryos with structural defects were collected. The ultrasound data were transferred to a Barco I-Space setting: a four walled room using eight different projectors making it possible to view in real 3D. The datasets were projected as so called ‘holograms’ allowing depth perception and interaction with the rendered objects. This virtual reality system immerses the viewer(s) in a three-dimensional virtual environment that allows the users to perceive and interact with the volume rendered data in an intuitive manner. Results: First trimester embryos with various structural defects were analysed with virtual embryoscopy. For instance abdominal wall defects, anencephaly and 3 stets of conjoined twins are demonstrated. The virtual reality images offered easy to interpret images with depth perception providing additional value to conventional 2D and 3D ultrasound examination. Using virtual embryoscopy first trimester embryos can be analysed relatively effortlessly and with great accuracy leading to earlier diagnosis of the defects. Conclusion: Virtual embryoscopy is a promising non-invasive method where 3D ultrasound images give a natural and accurate view of various abnormal fetal structures in first trimester pregnancy. Virtual reality can help to make an earlier and accurate diagnosis of fetal anomalies in first trimester providing additional value. 1035 3D/4D Ultrasound Examinations in the First Trimester of Pregnancy with Minimal Exposition Time Sergey M Voevodin, Scientific Centre of Obstet. Gynae and Perinatalogy, Russia Objective: Ultrasound examinations in first trimester of pregnancy with minimal exposition time. Methods: 534 pregnant women with intrauterine pregnancies were examined by 3D/4D ultrasound equipment. Dates of gestation varied from 5 to 13 weeks. The examination included several 3D/4D scans with a summery exposition time of no more than 20 seconds followed by a virtual examination via special software (Medison 3DXI). Results: As a result, abnormal pregnancies were detected in 22 cases (intrauterine hematoma, the absence of heartbeat, anembryonia, increased nuhal translucency space, anomalies of embryo and fetus). In 512 cases normal pregnancies were revealed. All parts of gestational sacs and fetuses anatomy were clearly visible in all cases. In 2 cases of 17 multiple pregnancies a mistake was made. The results of these examinations were verified by dynamic ultrasound exams during following weeks of gestation. Conclusions: The use of 3D/4D ultrasound virtual scan in first trimester gave us satisfactory results with a very limited exposition of scanning. This examination type can be called “ecological ultrasound” as it greatly reduces the possibility of unfavourable ultrasound influence on the fetuses. 1036 Treacher Collins Syndrome-The Diagnosis and Monitoring of an Affected Fetus Alison L Webb, Christopher Kohlenberg Dept. of Perinatal Ultrasound, Nepean Hospital, Penrith NSW, Australia Treacher Collins Syndrome, or Mandibulofacial Dystostosis is a rare autosomal dominant genetic disorder characterised by distinc-
Ultrasound in Medicine and Biology
Our case series includes three diverticula of the urethra, an urethral nephrogenic adenoma, a metastasis of a cervical malignancy, four cases of pelvic floor instability, and two cases of mobile urethra. The great advantage of volumetric transvaginal imaging in the assessment of the female urethra is to be able to obtain reformatted axial scan planes, that cannot be obtained by ultrasound imaging in any other way. 1028 3D Ultrasound in Gynaecologics Luca M Sconfienza, IRCCS Policlinico San Donato, Italy Francesca Lacelli, ASL 2 - Ospedale Santa Corona, Pietra Ligure, Italy Giovanni Serafini, ASL 2 - Ospedale Santa Corona, Pietra Ligure, Italy Purpose: The aim of this work was to review the technical aspects and clinical applications in our daily practice of three- (3D) and fourdimensional (4D) ultrasonography (US) in gynecologic imaging. Material and Methods: we used three different techniques to obtain 3D and 4D US images: freehand technique with a transvaginal (TV) approach, mechanical and matrix technique with transabdominal (TA) approach. We reviewed our own clinical experience of 159 patients in several clinical situations over the past 3 years. Results: In most situations, volume US adds high diagnostic value to standard two-dimensional (2D) US. In particular, volume US is very helpful in the assessment of uterine malformations, in performing sonohysterography, in detecting the origin of adnexal lesions and in the guidance of interventional procedures, including abscess drainage in pelvis and abdomen. 3D US also provides accurate measurements in 3 planes with acceptable interobserver reliability, even in post-processing elaboration. Conclusions: 3D US has proved to be a useful imaging tool for clinical problem solving in gynecology, especially in imaging the uterus and uterine cavity. However, it remains difficult to compare 2D and 3D because 2D imaging always precedes the 3D volume acquisition. 1029 The 3D Color Doppler Study of Angiogenesis in Breast Cancers Ming-Kwang Shyu, Dept. Obstetrics & Gynecology, National Taiwan Univesity Hospital, Taiwan Wen-Hung Kuo, Dept. Surgery, National Taiwan Univesity Hospital, Taiwan King-Jen Chang, Dept. Surgery, National Taiwan Univesity Hospital, Taiwan Fon-Jou Hsieh, Dept. Obstetrics & Gynecology, National Taiwan Univesity Hospital, Taiwan Objects: To evaluate the efficacy of 3D color Doppler for detecting breast cancers through angiogenesis study. Materials and Methods: Over one hundred cases of palpable mass were scanned by 3D Doppler ultrasound, recorded the computerized vascularization index (VI),flow index (FI) and vascularization flow index (VFI), and clarified the angiogenesis characteristics of malignant and metastatic breast cancers. Results: Over one hundred cases of palpable mass were enrolled. Both cancer and benign patients were equal in number. The cancer patient group showed higher age but similar tumor size. The VI, FI and VFI were significantly elevated in cancer patient group and some indices showed higher possibility of occurrence of lymph node metastasis. Conclusion: 3 dimensional color Doppler study of angiogenesis in breast diseases can offer important messages for the nature of tumor and occurrence of lymph node metastasis.
Volume 35, Number 8S, 2009 1030 To Evaluate 3D Multislice Ultrasound-A Novel Approach on the Visualization of the Fetal Secondary Palate Xinlin Chen, Hubei Women and Children Hospital, China Yan Li, China Peiwen Chen, Department of Ultrasound, Hubei Maternal and Child Health Hospital, Wuhan, China Yangqing Xu, Department of Ultrasound, Hubei Maternal and Child Health Hospital, Wuhan, China Objective: To evaluate the value of three-dimensional (3D) Multislices View (MSV)mod on the each-lay visualization of the secondary palate in normal fetus and fetus with cleft lip and/or palate. Methods: Sonographic examinations were performed in 20 normal fetus and 10 fetus with cleft lip and/or palate. The acquired volume images were analyzed by Multislices View (MSV)mod. The normal fetus were divided into two groups as follows: in 10 fetus the secondary palate was scanned in the middlemost sagittal plane; while the other 10 fetus were scanned at a 30°⬃50° angle back-up the sagittal plane. Results: The secondary palate successfully visualized in 18 of 20 normal fetuses, in both axial and coronal planes. The most clear images of the secondary palate are obtained at an angle of 30°⬃50° back-up in the sagittal plane. In the fetus with cleft lip and palate, the lesion of the secondary palate was clearly demonstrated in the restructured axial and coronal planes by three-dimensional(3D) Multislices View (MSV)mod, including the position,the rang and the depth. Conclusions: 3D MSV mod allows clear visualization of normal and cleft secondary palate, and is a new approach for the prenatal diagnosis of cleft palate, especially useful for it’s position and degree. 1031 SonoScape Portable Color Doppler Ultrasound System S8 Randy Hwan, SonoScape, China SonoScape is a Chinese leader specializing in developing and manufacturing cutting-edge color Doppler ultrasound systems and ultrasound transducers. As the only China Top Brand in the medical ultrasound industry recognized by General Administration of Quality Supervision, Inspection and Quarantine of the People’s Republic of China, SonoScape is continuing providing the highest quality ultrasound systems and services at the most competitive prices for our customers worldwide. The new product S8 is incorporated with the cutting-edge ultrasound technology like High Q Noise Filter Technology (HQNF), Native-Resolution-Scan-Converter Technology (NRSC), Multi-beams Process Technology (MBP), MicroScan Imaging Technology, Automatic Tissue Optimization Technology (ATO), highlighting a wide range selection of HD probes not only capable of rendering superior quality 4D images but also excellent for cardiac applications with the advanced imaging techniques including Tissue Doppler Imaging. This ground-breaking product incorporating 4D imaging is once again effectively demonstrating SonoScape’s progress on continuing setting new standards in leading-edge performance as a major global company. 1032 Prenatal Diagnosis of Amyoplasia Congenita by 3D and 4D Ultrasound Frances E Miceli, Sydney West Area Health Service, Australia Amyoplasia Congenita is a rare muscular condition within the spectrum of Arthrogryposis Multiplex Congenita. It is usually considered to be sporadic in nature. It is mainly characterized by maldevelopment of the skeletal muscles in which the muscle tissue is replaced by fibrous and fatty tissue. This can be seen to varying degrees although the severity
Abstracts tends to increase distally with the hands and feet being the worst affected. The decreased muscle mass results in contractures and little or no movement of the limbs. There may also be associated scoliosis, micrognathia, abdominal wall defects, hypoplasia of the labial fold in females and inguinal hernia in males. We present a case in which limb contractures were seen at the nuchal translucency scan at 12w3d and all four limbs remained in the same fixed and flexed position throughout the pregnancy. Multiple scans were performed by 2D, 3D and 4D ultrasound and there was no movement of the fetal limbs seen at any time during the pregnancy. The only movement seen was limited to gross body movements of the trunk alone. 1033 Contribution of 3D Ultrasound in the Diagnosis of Alobar Holoprosencephaly Lay Kieng Ng, Singapore General Hospital, Singapore Sook-Ling Lee, Singapore General Hospital, Singapore LK Tan, Singapore General Hospital, Singapore HK Tan, Singapore General Hospital, Singapore Case Report: Patient was a 27 year old Malay woman, G2P1. Her first pregnancy was uneventful. She presented in our department at 11 weeks amenorrhoea, ultrasound dating concurred with 8 weeks gestation. Her fetal anomaly screening scan was performed at 23.3 weeks amenorrhoea, ultrasound biometry concurred with 19.7 weeks. The following anomalies were demonstrated in the fetal head on two and three-dimensional ultrasound: (i) a single large horse-shoe shaped ventricle (ii) thin and poorly developed cortex (iii) fused thalami (iv) corpus callosum, inter-hemispheric fissure and third ventricle appeared absent (v) hard palate area equal 0.27 sq cm, which is below 2.5th centile; this is strongly suggestive of maxillary hypoplasia (vi) hypotelorism, interocular distance measured 5.5 mm (vii) Large anterior fontanelle Findings are suggestive of alobar holoprosencephaly. Amniocentesis was performed. Results: 46, XY. The couple was counseled for poor prognosis of holoprosencephaly and the risks of intrauterine death, neonatal death and associated disabilities including severe mental retardation, quadriplegia and recurrent seixures The couple decided to keep the pregnancy. Growth scan at 29.1 weeks noted macrocephaly. Patient presented at 36.6 weeks with leaking liquor. She went into spontaneous labour and a male fetus was delivered by normal vaginal delivery. A cranial ultrasound was performed and confirmed all the antenatal ultrasound findings. In addition the baby was noted to have microphthalmia, left eye smaller than right, and a single nostril. Baby passed away on day 1 of life. Conclusion: The application of 3-dimensional ultrasound had facilitated improved demonstration of antenatal anomalies. 1034 Virtual Embryoscopy in First Trimester Abnormal Fetal Development Frederique M van Dunne, Erasmus Medical Center, Rotterdam, The Netherlands, The Netherlands Melek Rousian, Erasmus Medical Center, Rotterdam, The Netherlands, The Netherlands Anton H Koning, Erasmus Medical Center, Rotterdam, The Netherlands, The Netherlands Niek Exalto, Erasmus Medical Center, Rotterdam, The Netherlands, The Netherlands Eric A Steegers, Erasmus Medical Center, Rotterdam, The Netherlands, The Netherlands
S107
Objective: 3D/4D virtual reality in the Barco I-Space named virtual embryoscopy is used to assess the human embryonic development accurately and specifically for structural anomalies in the first trimester of pregnancy. Methods: 3D ultrasound sweeps were preformed between 6 and 13 weeks gestation using a vaginal ultrasound probe. Datasets of various embryos with structural defects were collected. The ultrasound data were transferred to a Barco I-Space setting: a four walled room using eight different projectors making it possible to view in real 3D. The datasets were projected as so called ‘holograms’ allowing depth perception and interaction with the rendered objects. This virtual reality system immerses the viewer(s) in a three-dimensional virtual environment that allows the users to perceive and interact with the volume rendered data in an intuitive manner. Results: First trimester embryos with various structural defects were analysed with virtual embryoscopy. For instance abdominal wall defects, anencephaly and 3 stets of conjoined twins are demonstrated. The virtual reality images offered easy to interpret images with depth perception providing additional value to conventional 2D and 3D ultrasound examination. Using virtual embryoscopy first trimester embryos can be analysed relatively effortlessly and with great accuracy leading to earlier diagnosis of the defects. Conclusion: Virtual embryoscopy is a promising non-invasive method where 3D ultrasound images give a natural and accurate view of various abnormal fetal structures in first trimester pregnancy. Virtual reality can help to make an earlier and accurate diagnosis of fetal anomalies in first trimester providing additional value. 1035 3D/4D Ultrasound Examinations in the First Trimester of Pregnancy with Minimal Exposition Time Sergey M Voevodin, Scientific Centre of Obstet. Gynae and Perinatalogy, Russia Objective: Ultrasound examinations in first trimester of pregnancy with minimal exposition time. Methods: 534 pregnant women with intrauterine pregnancies were examined by 3D/4D ultrasound equipment. Dates of gestation varied from 5 to 13 weeks. The examination included several 3D/4D scans with a summery exposition time of no more than 20 seconds followed by a virtual examination via special software (Medison 3DXI). Results: As a result, abnormal pregnancies were detected in 22 cases (intrauterine hematoma, the absence of heartbeat, anembryonia, increased nuhal translucency space, anomalies of embryo and fetus). In 512 cases normal pregnancies were revealed. All parts of gestational sacs and fetuses anatomy were clearly visible in all cases. In 2 cases of 17 multiple pregnancies a mistake was made. The results of these examinations were verified by dynamic ultrasound exams during following weeks of gestation. Conclusions: The use of 3D/4D ultrasound virtual scan in first trimester gave us satisfactory results with a very limited exposition of scanning. This examination type can be called “ecological ultrasound” as it greatly reduces the possibility of unfavourable ultrasound influence on the fetuses. 1036 Treacher Collins Syndrome-The Diagnosis and Monitoring of an Affected Fetus Alison L Webb, Christopher Kohlenberg Dept. of Perinatal Ultrasound, Nepean Hospital, Penrith NSW, Australia Treacher Collins Syndrome, or Mandibulofacial Dystostosis is a rare autosomal dominant genetic disorder characterised by distinc-