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0286: Live Scanning Workshop: Basic Fetal Heart
Abstracts spleen and the heart. 3D acquisitions are usually performed by mechanical probe with a sector ranging from approximately 10 to 70 degrees, which allow appropriately covering of most organs. Companies now introduce specific contrast-modes on these probes, allowing evaluating a portion of or the whole organ vasculature at successive phases of enhancement. 4D acquisitions can be obtained by the repetition of 3D acquisitions, or directly by using matrix probes which work without any motion of elements and allow higher frame rates but with lower spatial resolution at the time. Post-treatment is an essential, often time-consuming phase to allow reconstruction in any plane, including those which could not be obtained from 2D modes. Quantitative studies include enhancement profiles analysis based on time-intensity curves and calculation of volume of focal lesions or any portion of an organ. Potential clinical applications include most of the indications that have already been developed with 2D imaging as a complement or potentially in the future as the contrast-enhanced ultrasound mode. Examples of lesions of the liver, kidney, spleen and pancreas will be shown to illustrate the potential of these techniques. 0284 Congenital Intrahepatic Portosystemic Venous Shunt Between Portal Vein and Hepatic Vein: Perinatal Ultrasonographic Detection and Follow-up Byoung Hee Han, Department of Radiology, Kwandong University College of Medicine, Cheil General Hospital & Women’s Healthcare Center, Korea Mi Jin Song, Department of Radiology, Kwandong University College of Medicine, Cheil General Hospital & Women’s Healthcare Center, Korea Min Hwan Moon, Department of Radiology, Kwandong University College of Medicine, Cheil General Hospital & Women’s Healthcare Center, Korea Young-Ho Lee, Department of Radiology, Kwandong University College of Medicine, Cheil General Hospital & Women’s Healthcare Center, Korea Jee Yeon Min, Department of Pediatrics, Kwandong University College of Medicine, Cheil General Hospital & Women’s Healthcare Center, Korea Kyung Ah Kim, Department of Pediatrics, Kwandong University College of Medicine, Cheil General Hospital & Women’s Healthcare Center, Korea Yeon Kyung Lee, Department of Pediatrics, Kwandong University College of Medicine, Cheil General Hospital & Women’s Healthcare Center, Korea Objective: To show variable fetal and neonatal ultrasonographic findings of IPVS and the results of follow-up. Methods: We detected and followed up 6 congenital IPVS by fetal and neonatal US. Results: On fetal US, IPVS were detected in 2. There were abnormal intrahepatic tubular structure in 1, prominent hepatic vein in 1 and congestive heart failure(CHF) in 1. Other findings were intrauterine growth retardation(IUGR) in 4, echogenic bowel in 2, placentomegally in 2, small amniotic fluid in 1, single umbilical artery in 1 and persistent right umbilical vein in 1. Neonatal US showed abnormal communication of a branch of Lt. portal vein with a hepatic vein in 5 and communication of two branches of Lt. portal vein with two hepatic veins in 1 There was coincidental shunt between hepatic artery and portal vein in 1. Four of the six congenital IPVS were spontaneously closed on follow-up US (211months), one of them was treated with coil embolization during neonatal period, and the last one is not closed until now. Conclusions: US demonstrated congenital IPVS in just two fetuses. However, we suggest that if the secondary findings such as abnormal tubular structure, prominent hepatic vein, and CHF are detected, IPVS
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should be suspected. IUGR is nonspecific but the most common associated finding. Neonatal US is useful for the confirmation, detection of prenatally undetected congenital IPVS, and classification. Clinical observation and follow-up with US until closure are the first choice for management of congenital IPVS. 0286 Live Scanning Workshop: Basic Fetal Heart Jo Lennox, Ultrasound Care Congenital heart disease is a major cause of perinatal morbidity and mortality. Antenatal diagnosis of CHD facilitates specialist prenatal care and optimizes post natal management. The fetal heart is recognized as one of the most difficult areas of a fetus to image. Good quality cardiac assessment is a vital part of the screening obstetric ultrasound at 19 weeks gestation. It requires a sound knowledge of normal fetal cardiac anatomy and congenital heart abnormalities. Familiarity with and reproduction of standard imaging techniques dramatically increases the ability of the sonographer to detect the abnormal fetal heart. In this session, we will discuss: 䡠 The normal fetal cardiac anatomy 䡠 The fetal circulation 䡠 The basic views required to complete a fetal cardiac screening examination 䡠 The importance of fetal position 䡠 Normal fetal heart rates and rhythms 䡠 Examples of fetal cardiac abnormalities. This will be followed by hands on scanning session and question time. 0290 Plenary Presentation: Molecular Imaging and Assessment of Angiogenesis with Contrast Ultrasound Jonathan R Lindner, Oregon Health & Science University, United States Contrast-enhanced ultrasound (CEU) relies on the acoustic detection of microbubble or gas-containing nano-scale contrast agents. It is possible to target ultrasound microbubble contrast agents to disease-related cellular and molecular processes that are amenable to pure-intravascular tracers. Targeting relies on conjugating specific ligands to the surface of the microbubbles. This talk will focus on some of the recent advances in molecular imaging with targeted ultrasound contrast agents in angiogenesis and how they can be paired with perfusion and vascular anatomic information available on CEU. A popular strategy for molecular imaging of adaptive or pathologic angiogenesis has been to target endothelial integrins that participate in vasculogenesis or remodeling. Molecular imaging probes have been targeted to matrix-binding integrins that signal endothelial cell migration, proliferation and survival such as av- and a5-integrins. These agents have been used to examine temporal development of tumor angiogenesis, and endogenous and therapeutic angiogenesis in models of chronic limb ischemia. CEU molecular imaging has also been able to detect key growth factor receptors, such as VEGFR-2, that play a key role in tumor and ischemia-mediated vascular remodeling. The immune response plays a critical role in angiogenesis and arteriogenesis, in part by providing a source for pro-angiogenic growth factors, cytokines, and proteases. Targeted contrast ultrasound imaging of monocyte recruitment and endothelial cell adhesion molecule expression has recently been shown to herald vasculogenesis and vascular remodeling in limb ischemia prior to any significant flow recovery. This strategy also has been used to detect immune response dysfunction associated with impaired arteriogenesis, such as in diabetes mellitus.
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should be suspected. IUGR is nonspecific but the most common associated finding. Neonatal US is useful for the confirmation, detection of prenatally undetected congenital IPVS, and classification. Clinical observation and follow-up with US until closure are the first choice for management of congenital IPVS. 0286 Live Scanning Workshop: Basic Fetal Heart Jo Lennox, Ultrasound Care Congenital heart disease is a major cause of perinatal morbidity and mortality. Antenatal diagnosis of CHD facilitates specialist prenatal care and optimizes post natal management. The fetal heart is recognized as one of the most difficult areas of a fetus to image. Good quality cardiac assessment is a vital part of the screening obstetric ultrasound at 19 weeks gestation. It requires a sound knowledge of normal fetal cardiac anatomy and congenital heart abnormalities. Familiarity with and reproduction of standard imaging techniques dramatically increases the ability of the sonographer to detect the abnormal fetal heart. In this session, we will discuss: 䡠 The normal fetal cardiac anatomy 䡠 The fetal circulation 䡠 The basic views required to complete a fetal cardiac screening examination 䡠 The importance of fetal position 䡠 Normal fetal heart rates and rhythms 䡠 Examples of fetal cardiac abnormalities. This will be followed by hands on scanning session and question time. 0290 Plenary Presentation: Molecular Imaging and Assessment of Angiogenesis with Contrast Ultrasound Jonathan R Lindner, Oregon Health & Science University, United States Contrast-enhanced ultrasound (CEU) relies on the acoustic detection of microbubble or gas-containing nano-scale contrast agents. It is possible to target ultrasound microbubble contrast agents to disease-related cellular and molecular processes that are amenable to pure-intravascular tracers. Targeting relies on conjugating specific ligands to the surface of the microbubbles. This talk will focus on some of the recent advances in molecular imaging with targeted ultrasound contrast agents in angiogenesis and how they can be paired with perfusion and vascular anatomic information available on CEU. A popular strategy for molecular imaging of adaptive or pathologic angiogenesis has been to target endothelial integrins that participate in vasculogenesis or remodeling. Molecular imaging probes have been targeted to matrix-binding integrins that signal endothelial cell migration, proliferation and survival such as av- and a5-integrins. These agents have been used to examine temporal development of tumor angiogenesis, and endogenous and therapeutic angiogenesis in models of chronic limb ischemia. CEU molecular imaging has also been able to detect key growth factor receptors, such as VEGFR-2, that play a key role in tumor and ischemia-mediated vascular remodeling. The immune response plays a critical role in angiogenesis and arteriogenesis, in part by providing a source for pro-angiogenic growth factors, cytokines, and proteases. Targeted contrast ultrasound imaging of monocyte recruitment and endothelial cell adhesion molecule expression has recently been shown to herald vasculogenesis and vascular remodeling in limb ischemia prior to any significant flow recovery. This strategy also has been used to detect immune response dysfunction associated with impaired arteriogenesis, such as in diabetes mellitus.