Abstract
This study from Boston found that over a two-year period, nearly 12% of low-risk pregnant women were recalled for a further anomaly scan due to suboptimal views on the first. Of these recalls, only one fetus (0.49%) was identified as having an anomaly thus making the cost of finding one anomaly in all the repeat scans $55,000. The researchers suggest that repeat scans may not be warranted. It would be interesting to see how findings from a UK study compare.
This large study from Connecticut, of over 16,000 women, showed similar results to the study above. Approximately 13% required a rescan due to suboptimal views at the first anomaly scan. Of those, 0.5% had an anomaly. As a pessimist though, I feel that repeat scans are here to stay whether they are cost effective or not.
Once again, cost is the focus of this obstetric screening paper – a sign of the rising importance of healthcare economics perhaps? This team found that fetal cell-free DNA testing in the second trimester was cost equivalent to the traditional ‘QUAD’ test, more than halved the number of invasive procedures and reduced steps in the patient pathway.
Despite the accuracy of fetal cell-free DNA testing, this team reminds us that first trimester ultrasound continues to have a place in screening due to all the additional clinical things it can detect including, of course, maternal problems.
Damaged Achilles tendons in 85 rats were treated with either a placebo ointment or topical fish oil or therapeutic ultrasound or therapeutic ultrasound using fish oil as the coupling agent. After four weeks of treatment, the Achilles tendons in rats from the last group had improved structural stiffness and ultimate tensile strength compared to those in the other groups.
The researchers studied 286 people with type 1 diabetes over five years. Of these, 150 had non-alcoholic fatty liver disease (NAFLD) diagnosed by ultrasound. NAFLD is associated with a higher prevalence of cardiovascular disease in type 1 diabetic adults, but this study showed there was also an increased risk of incident cardiovascular disease in those with NAFLD compared to those without (17.3% vs. 1.5%).
Some recent studies and guidelines have concluded that ultrasound is more sensitive than MRI when it comes to detecting placenta accreta. Those findings have bothered me, particularly in cases of posterior accreta. However, this study of 45 women concludes that MRI is indeed more effective at evaluating posterior placentae suspicious for accreta and is essential when percreta is suspected.
A total of 1208 patients who underwent laparoscopic inguinal hernia repair were followed up after at least five years by way of a clinical examination, ultrasound investigation and questionnaire. Intraoperative and early postoperative complications were rare. Hernia recurrence was low (0.4%) as was the rate of severe chronic pain (0.59%). This is interesting since these are two of the most common reasons for requesting another groin scan post-up.
There were nearly 24,000 Korean participants in this study and almost 10% had gallbladder polyps. There was an association between chronic hepatitis B and polyps. Also, Helicobacter pylori infection was a significant risk factor for the presence of polyps with stones.
From this project involving nearly 190,000 women, it seems the larger you are the more likely first trimester ultrasound measurements to determine your estimated date of delivery will postpone the day compared to the known LMP. Interestingly, underweight women (BMI < 18.5) also had a higher chance of having their due date postponed by seven days or more. Reasons offered include erroneous measurements due to poor visibility, irregular cycles and anovulation.
Here is an international collaboration looking at the aetiology of pancreatic lesions of 15 mm or less in 394 patients. Contrast enhanced ultrasound played a valuable role in the differential diagnosis of pancreatic ductal adenocarcinoma (PDAC) and non-PDAC. The clinical benefit is that those with non-PDAC lesions may be spared unnecessary radical surgery.
Ultrasound is cheaper and less invasive than video otoscopy and CT or MR imaging when it comes to investigating doggy ear infections. However, this study involving 32 dogs showed that it just doesn’t have the sensitivity for diagnosing otitis media and therefore cannot yet replace cross-sectional imaging.