Physical Address

304 North Cardinal St.
Dorchester Center, MA 02124

The Fetal Musculoskeletal System

Summary of Key Points Two-dimensional ultrasound is the primary imaging modality for the majority of musculoskeletal disorders. When a fetal musculoskeletal dysplasia is suspected on ultrasound, referral to a center with expertise may be helpful. A main role of ultrasound is to determine if the condition is likely lethal; it is important to use multiple parameters to make this determination. After delivery or pregnancy termination, a…

The Fetal Urogenital Tract

Summary of Key Points Evaluation of amniotic fluid volume (subjective assessment combined with semiquantitative methods such as maximum vertical pocket or amniotic fluid index) provides important information about some maternal and fetal conditions, as well as placental function. Sonographic findings suspicious of renal cystic disease include cysts, renal hyperechogenicity, and/or large kidneys. Whenever renal cystic disease is suspected, it is useful to perform a renal ultrasound…

The Fetal Gastrointestinal Tract and Abdominal Wall

Summary of Key Points The gastrointestinal (GI) tract and abdominal wall anomalies are diverse. Although they may occur in isolation, many are associated with syndromic or karyotype abnormalities; thus it is important to search for associated anomalies. Familiarity with normal development is needed to recognize the varying appearances during gestation of structures such as the abdominal wall with physiologic midgut herniation, the identification of the gallbladder…

The Fetal Heart

Summary of Key Points Moderate to severe congenital heart disease (CHD) occurs in approximately 6 per 1000 live births. The incidence of CHD is much higher in the fetal population, estimated to be at least 15 per 1000. The incidence of CHD is higher with positive family history, monochorionic twins, and in vitro fertilization. Most fetuses with CHD have no known risk factors. Fetal echocardiography is…

The Fetal Chest

Summary of Key Points Normal fetal lungs appear homogeneously echogenic on ultrasound surrounding the heart with a cardiothoracic ratio that remains constant through the second and third trimesters. Pulmonary hypoplasia can be primary or secondary and unilateral or bilateral. Congenital pulmonary airway malformations (CPAMs) are a spectrum of disorders that include bronchopulmonary malformation, hybrid lesions (CPAM and sequestration), and congenital lobar overinflation/bronchial atresia. A large fetal…

The Fetal Spine

Summary of Key Points Neural tube defects (NTDs) are a common congenital anomaly with clinically important associated morbidity and mortality rates. Most open NTDs will have associated intracranial abnormalities, most commonly Chiari II malformation, detected by sonography. Although much less common, closed NTDs are less likely to have associated intracranial abnormalities and require careful examination of the spine for detection. Other spinal abnormalities such as scoliosis,…

The Fetal Brain

Summary of Key Points Protocol-based ultrasound carefully performed by a knowledgeable and experienced examiner following established guidelines is very sensitive in evaluating the central nervous system (CNS). Ventriculomegaly can be due to many underlying conditions, including obstruction, destruction, and dysmorphism, or a combination. In cases of brain abnormalities in which additional morphologic or functional information is needed beyond that available with ultrasound, magnetic resonance imaging can…

The Fetal Face and Neck

Summary Key Points Ear and eye anomalies often accompany abnormalities of the skull and face. Abnormalities of fetal head size and shape may be associated with various syndromes and chromosomal anomalies. Hypoplastic or absent nasal bone may be seen in fetuses with trisomy 21. Cleft lip may be associated with cleft palate, and detailed description of the cleft is important to accurately counsel parents, predict postnatal…

Multifetal Pregnancy

Summary of Key Points Multifetal pregnancies have higher rates of perinatal morbidity and mortality than singletons. Chorionicity is the major determining feature for the inherent unique complications faced by multiple gestations. Fetal growth differences and congenital malformations are increased in all types of multiple gestations. In monochorionic twins with a single demise, there is a high risk of severe cerebral and other injuries in the survivor.…

Chromosomal Abnormalities

Summary of Key Points Screening for aneuploidy using the nuchal translucency (NT) measurement should be performed by a credentialed provider participating in an ongoing quality-monitoring program. In chromosomally normal fetuses with an increased NT, normal anatomy and no identifiable genetic syndromes, there does not appear to be a higher risk of developmental delay than in the general population. A “marker” identified during a second-trimester sonogram should…

The First Trimester

Summary of Key Points First-trimester development follows a predictable pattern on first-trimester ultrasound. Some ultrasound findings are definitive for early pregnancy failure, whereas others are suggestive and require follow-up. Ultrasound is vital in the diagnosis of ectopic pregnancy in typical and atypical locations. Gestational trophoblastic disease is composed of four entities, and ultrasound is helpful in their diagnosis and management. The first trimester of pregnancy is…

Bioeffects and Safety of Ultrasound in Obstetrics

Summary of Key Points Obstetric ultrasound should only be performed with a clear indication, with calibrated machines, and by proficient professionals. Know the specific machine being used (what causes increase in output power). Keep the examination as short as possible and use the lowest possible output power but compatible with arriving at the correct diagnosis (as low as reasonably achievable [ALARA] principle). Keep track of the…

Overview of Obstetric Imaging

Summary of Key Points Ultrasound allows for accurate prediction of gestational age. The appropriate training and skills are necessary for safely performing and accurately interpreting obstetric ultrasound There are many options for screening pregnant women, most of which include ultrasound. Routine obstetric ultrasound has specific recommended views that allow for depiction of many, but not all, fetal anomalies. Three-dimensional ultrasound, fetal Doppler examinations, and fetal magnetic…

Peripheral Vessels

Summary of Key Points Key aspects of vascular Doppler imaging include knowledge of anatomy and waveform morphology, scanning technique, and attention to detail. Spectral Doppler velocity criteria can characterize stenosis detected by gray-scale and color Doppler. Doppler evaluation of peripheral artery disease can provide diagnostic information and enable surgical planning and evaluation of bypass grafts. Extremity aneurysm and pseudoaneurysm have typical Doppler findings similar to other…

The Extracranial Cerebral Vessels

Summary of Key Points The combination of gray-scale, color-flow Doppler, and Doppler spectral analysis is highly accurate in determining plaque characterization and degree of carotid stenosis. Accurate diagnosis of carotid stenosis is critical for patients who would benefit from surgical and interventional treatment. Clinicians can accurately follow changes in noncritical carotid stenosis or plaque using ultrasound. The assessment of the vertebral arteries is an integral component…

Musculoskeletal Interventions

Summary of Key Points Choose transducer geometry and entry site to visualize the needle as a specular reflector. Orient transducer to maximize tendon echogenicity (anisotropy). Injected corticosteroid/anesthetic suspension often displays a contrast effect, which can help localize injected mixture. Patients with diabetes should be cautioned that they may develop a transient hyperglycemia that may last up to 5 days following therapeutic injection. Most small joints and…

The Shoulder

Summary of Key Points In the diagnosis of full-thickness rotator cuff tears, ultrasound is of comparable accuracy to magnetic resonance imaging, although it may be less accurate in the diagnosis of partial-thickness tears. The key to scanning the shoulder is meticulous technique using a protocol that systematically evaluates the entirety of the shoulder. Understanding of optimal patient positioning, probe orientation, and shoulder anatomy is critical to…

Overview of Musculoskeletal Ultrasound Techniques and Applications

Summary of Key Points A wide variety of inflammatory, degenerative, traumatic, and neoplastic conditions can be imaged accurately and cost-effectively with ultrasound. Understanding optimal imaging techniques and recognizing and avoiding common artifacts is essential to musculoskeletal ultrasound. Ultrasound can provide higher-resolution imaging of nerves and tendons compared with standard clinical magnetic resonance imaging examinations. Dynamic imaging may be performed with ultrasound, which can assist in the…

The Scrotum

Summary of Key Points Diagnostic ultrasound is an accurate means of evaluating most scrotal processes and can supplement the physical examination. Solid intratesticular lesions have a high likelihood of malignancy, whereas cystic extratesticular intrascrotal lesions are almost certainly benign. Doppler sonography is the most useful and most rapid technique to assess the patient with acute scrotal pain. Ultrasound can establish the diagnosis of testicular ischemia and…

The Breast

Summary of Key Points Breast ultrasound plays a key role in supplemental breast cancer screening, diagnostic imaging, and interventional breast procedures. All images should be annotated with the following: the side (left or right), clock face position, distance from the nipple in centimeters, and transducer orientation. All lesions should be scanned and measured in two orthogonal planes to assess the size, surface, internal characteristics, and shape.…