PubMed Health⌕ Search

Biomedical subjects

Beryl R Benacerraf

Publications and source records attributed to Beryl R Benacerraf.

At least 19 recordsLinked to original sources
PubMed2006

Three-dimensional US of the fetus: volume imaging.

PURPOSE: To retrospectively compare the rapidity, efficiency, and accuracy of three-dimensional (3D) and two-dimensional (2D) ultrasonography (US) for complete anatomic survey in fetuses at 17-21 weeks of gestation. MATERIALS AND METHODS: Institutional review board approval was obtained, informed consent was waived, and the study was HIPAA compliant. Fifty consecutive women undergoing fetal anatomic survey at 17-21 weeks of gestation formed the study cohort. After standard 2D US was performed by one of eight sonographers, the same sonographer also obtained five 3D volumes to encompass the entire fetal anatomy. Three physicians interpreting the scans independently evaluated the completeness of the examination and time needed to read the scans, comparing the standard 2D method with the 3D volume reconstruction technique. The paired t test was used to compare biparietal diameter (BPD), femur length, and performance times between the 3D measurements and the 2D measurement. The t test was used to compare fetal anatomy according to volume angle. Differences were significant when P < .05. RESULTS: Mean time to perform 2D US was 19.6 minutes per examination, whereas mean time to perform complete 3D volume acquisition was 1.8 minutes. Mean times needed to interpret 3D images and measure the BPD and femur were 5.53, 4.79, and 5.34 minutes for the three interpreting physicians. Compared with complete fetal surveys performed with 2D US, individual fetal anatomic landmarks (except for fetal arms and cavum septum pellucidum) were identified more than 94% of the time by using 3D US. Grouping anatomic views by region, the heart, head, extremities, and abdominal views were completely seen in 88%, 90%, 90%, and 95% of patients, respectively. No significant difference was seen between the three physicians regarding completeness of the 3D examinations (P = .7). One fetus had multiple anomalies, with 3D volumes identified as abnormal by all three physicians. Overall, 74% of 3D BPD measurements were within 1 mm of the 2D measurements, and 64% of 3D femur measurements were within 1 mm of the 2D measurements. CONCLUSION: The standard fetal anatomic survey can be performed in less than 2 minutes with 3D volume US, and the volumes can be interpreted in 6-7 minutes, compared with a mean of 19.6 minutes to perform standard 2D US.

Adult↗
PubMed2006

Inversion mode display of 3D sonography: applications in obstetric and gynecologic imaging.

OBJECTIVE: Three-dimensional sonography involves volume acquisitions of sonographic data that can be displayed in a variety of ways, including surface rendering and multiplanar reconstruction. A new method of displaying sonographic volumes is called the inversion mode, which displays the cystic portions within the entire volume as echogenic areas. The gray-scale portion of the image becomes transparent, and the cystic areas become brightly visible in three dimensions. CONCLUSION: This article shows the applications for this method of volume sonography display and shows the importance of being able to visualize all of the cystic areas concurrently within a volume.

Female↗
PubMed2006

Improving the efficiency of gynecologic sonography with 3-dimensional volumes: a pilot study.

OBJECTIVE: The purpose of this study was to determine whether 3-dimensional (3D) sonography can provide a rapid, efficient, and accurate way to do a transvaginal gynecologic scan compared with traditional 2-dimensional (2D) sonography. METHODS: Thirty-five consecutive patients who underwent gynecologic sonography formed the study cohort. After a standard 2D transvaginal scan was done, including measurements of the endometrium and abnormalities, 4 volume acquisitions were obtained, encompassing the uterus (2 volumes) and the ovaries. These volumes were reviewed offline without any patient information. Endometrium and other measurements were performed on the volumes. The 2D and 3D results were compared by paired t tests. RESULTS: The mean time needed for the standard 2D scan was 2.6 minutes compared with 1.07 minutes for the 3D volume acquisitions. The mean time for the reconstruction, measurement, and interpretation of the volumes offline was 1.19 minutes. The mean time for the entire 3D examination (both parts) was 2.26 minutes (P = .047, comparing 2D with total 3D). There was no significant difference between the measurements of the endometrium, fibroids, and ovarian cysts when comparing 2D and reconstructed 3D images. Two-dimensional and 3D sonography differed little in their ability to identify the organs and the abnormalities on the scans. CONCLUSIONS: This study shows that a complete transvaginal gynecologic examination can be done in 1.07 minutes of scan time and interpreted offline in an additional 1.19 minutes. The 35 cases were scanned and interpreted with the use of 3D sonography in 79.17 minutes total compared with 91.46 minutes of 2D scan time (P = .047). The accuracy of the scan was similar for both techniques.

Adult↗
PubMed2005

The role of the second trimester genetic sonogram in screening for fetal Down syndrome.

The Genetic Sonogram is an ultrasound examination done on second trimester fetuses that not only evaluates the fetus for structural malformations, but also searches for the sonographic markers of fetal Down syndrome. The main markers that comprise the genetic sonogram include the nuchal fold, short femur and humerus, pyelectasis, hyperechoic bowel, echogenic intracardiac focus, and any major abnormality. The absence of any marker on a second trimester scan conveys a 60-80% reduction in prior risk of Down syndrome based on advanced maternal age or serum screen risk. The presence of sonographic markers, either singly or in combination, will raise the baseline risk of Down syndrome using likelihood ratios calculated for each individual marker. Using this approach, approximately 75% of fetuses with Down syndrome can be identified by modifying the patient's baseline risk according to the results of the ultrasound. The second trimester scan will likely continue to play an important role in the future in the detection of aneuploidy.

Down Syndrome↗
PubMed2005

Three- and 4-dimensional ultrasound in obstetrics and gynecology: proceedings of the American Institute of Ultrasound in Medicine Consensus Conference.

The American Institute of Ultrasound in Medicine convened a panel of physicians and scientists with interest and expertise in 3-dimensional (3D) ultrasound in obstetrics and gynecology to discuss the current diagnostic benefits and technical limitations in obstetrics and gynecology and consider the utility and role of this type of imaging in clinical practice now and in the future. This conference was held in Orlando, Florida, June 16 and 17, 2005. Discussions considered state-of-the-art applications of 3D ultrasound, specific clinical situations in which it has been found to be helpful, the role of 3D volume acquisition for improving diagnostic efficiency and patient throughput, and recommendations for future investigations related to the utility of volume sonography in obstetrics and gynecology.

Female↗
PubMed2005

How sonographic tomography will change the face of obstetric sonography: a pilot study.

OBJECTIVE: This study was undertaken to determine whether 3-dimensional (3D) volume sonography (sonographic tomography) can yield a far quicker and equally accurate anatomic examination of the second-trimester fetus compared with traditional 2-dimensional (2D) scanning. METHODS: Twenty-five consecutive second-trimester fetuses with normal structural surveys on standard 2D imaging underwent 5 standard 3D volume acquisitions each (in the regions of the head, chest, abdomen, face, and lower extremities) immediately after the 2D scan. The 2D and 3D images were subsequently compared in relation to the completeness of the fetal survey, measurements of the biparietal diameter and femur length, and time required to obtain the fetal survey. RESULTS: The structural surveys were complete in 20 of 25 cases using 3D reconstructed volumes. One fetus had an incomplete evaluation of the face on 3D volumes (and limited on 2D imaging because of the prone position of the fetus). The other 4 fetuses with incomplete surveys done on 3D volumes had missing images of a hand or foot. Three-dimensional reconstructions slightly overmeasured the biparietal diameter compared with the 2D reference standard (mean difference, 1.1 mm; P < .001). For femur length, the mean difference was not statistically significant. It took a mean time of 1.1 minutes to obtain the 3D volumes and 5.5 minutes to reconstruct the complete surveys by the 3D volume method. With the standard 2D technique, the structural surveys were done in a mean time of 13.9 minutes. The mean time difference between both methods was 7.3 minutes (P = 2.4 x 10(-9)). CONCLUSIONS: Using 3D volume acquisition, it is feasible to perform and interpret a structural survey in half the time in which a 2D survey is performed. Further research is necessary to standardize the acquisition of volumes to minimize artifacts and produce uniform images.

Female↗
PubMed2004

The accreditation of ultrasound practices: impact on compliance with minimum performance guidelines.

OBJECTIVE: To determine the effectiveness of the American Institute of Ultrasound in Medicine (AIUM) accreditation program in improving compliance with standards and guidelines for the performance of obstetric and gynecologic ultrasound examinations. METHODS: Scores of case studies of accreditation applications were compared with their respective scores at the time of reaccreditation 3 years later. To account for the element of time, scores of applications that recently completed first-time accreditation were also compared as a control group. RESULTS: Individual obstetric case studies, as well as the average of all obstetric and gynecologic case studies, showed highly significant improvement with the reaccreditation application when compared with the initial accreditation application 3 years earlier (all P <.001). The proportion of practices successfully meeting obstetric and gynecologic AIUM accreditation requirements improved significantly with reaccreditation (obstetric, 57.3% for accreditation compared with 86.6% for reaccreditation; gynecologic, 60% for accreditation compared with 91.9% for reaccreditation; P <.001). Furthermore, reaccreditation scores were significantly higher than scores of recent first-time applications for obstetric case studies as well as scores of the average of obstetric and gynecologic case studies (all P <.05). CONCLUSIONS: Our study confirms that practices that sought and received ultrasound accreditation were able to improve the scores of case studies and compliance with published minimum standards and guidelines for the performance of obstetric and gynecologic ultrasound examinations when reevaluated 3 years after the initial application scores. This improvement should translate into an enhancement of the quality of ultrasound practice.

Accreditation↗
PubMed2003

The Genetic Sonogram Scoring Index.

This article describes the individual sonographic markers used in the Genetic Sonogram Scoring Index. The importance of the clustering of markers forms the basis of the scoring index, such that individual markers are assigned point values based on their sensitivity and specificity in the detection of Down syndrome. The points acquired by each fetus are tabulated into a final "score." The performance of the scoring index in the detection of aneuploidy is presented. The clinical application of the scoring index for the detection of chromosomally abnormal fetuses in patients both at high- and low-risk for aneuploidy is discussed.

Adult↗
PubMed2003

An 8-center study to evaluate the utility of mid-term genetic sonograms among high-risk pregnancies.

OBJECTIVE: A multicenter study was undertaken to evaluate the diagnostic efficacy of a genetic sonogram. METHODS: Eight centers provided data on 176 pregnancies complicated by fetal Down syndrome. One hundred thirty-four pregnancies were considered high risk because of advanced maternal age (> 35 years), and 42 were considered high risk for having "abnormal" triple-screen results (risk > 1:250). Each center provided fetal biometric data, information regarding the presence or absence of major structural abnormalities, and between 3 and 6 additional ultrasonographic markers for trisomy 21. The heterogeneity of our 8 independent "sensitivity estimates" was evaluated by Poisson regression, and a single combined estimate of the sensitivity was calculated. RESULTS: Of the total 176 cases of trisomy 21, 125 fetuses (71.0%) had either an abnormal long bone length (femur length, humerus length, or both), a major structural abnormality, or a Down syndrome marker. The combined diagnostic sensitivity was 71.6%, with a range of 63.6% (7 of 11) to 80% (8 of 10). Five centers had sensitivity estimates falling between 64% and 76%. The sensitivity of individual markers varied between 3% (sandal gap) and 46.5% (nuchal skin fold thickness). A condensed regimen of nuchal skin fold thickness, femur length, and a standard anatomic survey would screen in 56.8% of fetuses with Down syndrome. CONCLUSIONS: This 8-center study that included many fetuses with Down syndrome validates the concept that the genetic sonogram can be used to better adjust the Down syndrome risk for high-risk patients.

Biometry↗
PubMed2002

Second trimester ultrasound screening for chromosomal abnormalities.

The use of prenatal ultrasound has proven efficacious for the prenatal diagnosis of chromosomal abnormalities. The first sonographic sign of Down syndrome, the thickened nuchal fold, was first described in 1985. Since that time, multiple sonographically-identified markers have been described as associated with Down syndrome. The genetic sonogram, involving a detailed search for sonographic signs of aneuploidy, can be used to both identify fetuses at high risk for aneuploidy and, when normal, can be used to decrease the risk for aneuploidy for a pregnancy when no sonographic markers are identified. Combining the genetic sonogram with maternal serum screening may be the best method of assessing aneuploidy risk for women who desire such an assessment in the second trimester. Trisomy 18, Trisomy 13, and triploidy are typically associated with sonographically identified abnormalities and have a high prenatal detection rate. The use of the described sonographic signs in low-risk women requires further investigation, however, patients at increased risk for aneuploidy due to advanced maternal age or abnormal serum screening can benefit from a genetic sonogram screening for sonographic signs of aneuploidy to adjust their baseline risk of an affected fetus.

Aneuploidy↗
PubMed2002

Hypoechogenicity of fetal long bones: a new ultrasound marker for arthrogryposis.

OBJECTIVE: To demonstrate osteopenia associated with arthrogryposis. METHODS & RESULTS: We describe 3 cases of fetal arthrogryposis seen prenatally with the sonographic feature of severe hypoechogenicity of the long bones. This manifestation of presumed osteopenia is thought to represent osteoporosis secondary with absent fetal movement. CONCLUSION: We describe hypoechogenicity of the fetal bones as a new sonographic feature of arthrogryposis.

Abnormalities, Multiple↗
PubMed2002

The genetic sonogram: a method of risk assessment for Down syndrome in the second trimester.

OBJECTIVE: To determine the risk of Down syndrome in fetuses with sonographic markers using the Bayes theorem and likelihood ratios. METHODS: We prospectively evaluated the midtrimester sonographic features of fetuses with Down syndrome and compared them with euploid fetuses. Patients were referred for an increased risk of aneuploidy and evaluated for the presence of structural defects, a nuchal fold, short long bones, pyelectasis, an echogenic intracardiac focus, and hyperechoic bowel. All fetuses underwent amniocentesis at the time of sonographic assessment. The sensitivity, specificity, and likelihood ratios for markers were calculated both as nonisolated and isolated findings. RESULT: There were 164 fetuses with Down syndrome and 656 euploid fetuses. The presence of any marker resulted in sensitivity for the detection of Down syndrome of 80.5% with a false-positive rate of 12.4%. The absence of any markers conferred a likelihood ratio of 0.2, decreasing the risk of Down syndrome by 80%. As an isolated marker, the nuchal fold had an "infinite" likelihood ratio for Down syndrome; a short humerus had a likelihood ratio of 5.8, whereas structural anomalies had a likelihood ratio of 3.3. Other isolated markers had low likelihood ratios because of the higher prevalence in the unaffected population. The likelihood ratios for the presence of 1, 2, and 3 of any of the markers were 1.9, 6.2, and 80, respectively. CONCLUSIONS: Although an isolated marker with a low likelihood ratio may not increase a patient's risk of Down syndrome, the presence of such a marker precludes reducing the risk of aneuploidy. Clusters of markers appear to confer a higher risk.

Aneuploidy↗