P087: Volume contrast imaging: a new approach to identify fetal lungs in cases with thoracic malformations

Abstract

Objective:The most common indication for neonatal renal ultrasound is the antenatal finding of pyelectasis followed by suspected renal anomaly. Some of the latter have a characteristic appearance suggesting the diagnosis. This 5-year audit of 778 neonates reviewed the outcome of those with persisting pyelectasis and renal anomalies and suggested protocols for investigation. Method: The Mercy Hospital for Women is a tertiary referral obstetric and gynaecology hospital with a level-3 neonatal intensive care unit and approximately 5000 deliveries a year. A computer search of neonatal renal scans for the years 1996-2000 was made.Neonates with persisting pyelectasis and renal anomalies were reviewed. A micturating cystourethrogram (MCU) was requested in a number of infants. Vesicoureteric reflux (VUR) was classified according to the International Classification of Reflux. The results of investigations and outcome are reported. Results: In the 5 years, 25,204 babies were born at the Mercy Hospital for Women, 778 neonates (3%) were referred for renal ultrasound. The results were classified according to the postnatal diagnosis. Of 592 (76%) with normal postnatal scans, 49 had an MCU and 19 had VUR. There were 120 (15%) with persisting pyelectasis, 15 (13%) with VUR, not always ipsilateral. There were 7 with unilateral renal obstruction. There were 59 (8%) with structural anomalies including multicystic dysplastic kidney (MCDK), anatomic variants, ureterocoeles, reflux nephropathy, polycystic kidney disease and urethral obstruction. Conclusion: In this consecutive series, there were 100 (13%) neonates with significant abnormalities, structural anomalies, unilateral renal obstruction and VUR affecting clinical management. Protocols for investigation of neonates with persisting pyelectasis, severe hydronephrosis and renal anomalies are suggested. P086 Hôpital Necker-Enfants Malades, Paris, FranceObjective: The aim of this study is to present the three-dimensional Doppler-ultrasound contribution to the prenatal diagnosis of lung sequestration. Methods: Prenatal three-dimensional angiosonography was used to image pulmonary blood supply in 20 normal controls and to screen for an abnormal pulmonary blood supply in 6 fetuses with hyperechogenic lung lesions. Post natally (n = 5) or post mortem (n = 1), these lesions turned to be an isolated lung sequestration (n = 2), a type III congenital adenomatoid malformation (n = 2), a type I + III congenital adenomatoid malformation (n = 1), or a complex malformation in which a left congenital diaphragmatic hernia was associated with both lung sequestration and type III adenomatoid malformation (n = 1, termination of pregnancy). Results: Three-dimensional angiosonography demonstrated clearly an abnormal blood supply before 20 weeks of gestation in the three cases that turned to be lung sequestrations, and in none of the other cases. In 2 of the three cases with pulmonary sequestration, 2D ultrasound initially failed to identify the feeding vessel. Conclusion: Three-dimensional ultrasoun...

Transfrontal three‐dimensional visualization of midline cerebral structures

“…Manipulation of the image and the use of some rendering modes enable anatomical views to be investigated that were not demonstrated in the original acquisition plane14. The use of post‐processing filters, such as in VCI in the static plane, can provide images with no speckled pattern and with improved tissue contrast15, 16. In addition, the use of TUI allows a variable number of reconstructed 2D parallel sections to be displayed on a single panel, as in computed tomography or magnetic resonance imaging17.…”

“…Moreover, offline analysis of the volume allowed us to improve tissue contrast using static VCI. We have noticed that the application of this filter frequently leads to greater precision in the definition of the landmarks of structures such as the cerebellar vermis and the fourth ventricle15, 16.…”

Role of 3-D Ultrasound in Clinical Obstetric Practice: Evolution Over 20 Years

“…VCI-C is a new approach that improves the contrast and resolution of the tissue compared with 2-DUS. It is able to yield measurements, margins and internal aspects of structures/tissues that are more precise (Ruano et al 2004a) (Fig. 3).…”

Évaluation du poumon fœtal en imagerie

“…17) et de manière beaucoup plus difficile le retour veineux. L'utilisation du mode Doppler couleur en 3D est décrit par certains auteurs comme un outil complémentaire pour affiner le diagnostic entre MAK microkystique et séquestration pulmonaire en permettant de mieux visualiser le vaisseau nourricier systémique des séquestrations [39,40].…”