Power and Color Doppler Ultrasound Settings for Inflammatory Flow: Impact on Scoring of Disease Activity in Patients With Rheumatoid Arthritis

Authors: Søren Torp-Pedersen, Robin Christensen, Marcin Szkudlarek, Karen Ellegaard, Maria Antonietta D’Agostino, Annamaria Iagnocco, Esperanza Naredo, Peter Balint, Richard J. Wakefield, Arendse Torp-Pedersen, and Lene Terslev

Published in: ARTHRITIS & RHEUMATOLOGY, Vol. 67, No. 2, February 2015, pp 386–395
DOI 10.1002/art.38940

Objective. To determine how settings for power and color Doppler ultrasound sensitivity vary on different high- and intermediate-range ultrasound machines and to evaluate the impact of these changes on Doppler scoring of inflamed joints.

Methods. Six different types of ultrasound machines were used. On each machine, the factory setting for superficial musculoskeletal scanning was used unchanged for both color and power Doppler modalities. The settings were then adjusted for increased Doppler sensitivity, and these settings were designated study settings. Eleven patients with rheumatoid arthritis (RA) with wrist involvement were scanned on the 6 machines, each with 4 settings, generating 264 Doppler images for scoring and color quantification. Doppler sensitivity was measured with a quantitative assessment of Doppler activity: color fraction. Higher color fraction indicated higher sensitivity.

Results. Power Doppler was more sensitive on half of the machines, whereas color Doppler was more sensitive on the other half, using both factory settings and study settings. There was an average increase in Doppler sensitivity, despite modality, of 78% when study settings were applied. Over the 6 machines, 2 Doppler modalities, and 2 settings, the grades for each of 7 of the patients varied between 0 and 3, while the grades for each of the other 4 patients varied between 0 and 2.

Conclusion. The effect of using different machines, Doppler modalities, and settings has a considerable influence on the quantification of inflammation.

Read the Complete Article:Power and Color Doppler settings for Inflammatory Flow

Shear-Wave Elastography: Basic Physics and Musculoskeletal Applications

Authors: Mihra S. Taljanovic, MD, PhD, Lana H. Gimber, MD, MPH, Giles W. Becker, MD, L. Daniel Latt, MD, PhD, Andrea S. Klauser, MD, David M. Melville, MD, Liang Gao, PhD, Russell S. Witte, PhD

In the past 2 decades, sonoelastography has been progressively used as a tool to help evaluate soft-tissue elasticity and add to information obtained with conventional gray-scale and Doppler ultrasonographic techniques. Recently introduced on clinical scanners, shearwave elastography (SWE) is considered to be more objective, quantitative,
and reproducible than compression sonoelastography with increasing applications to the musculoskeletal system. SWE uses an acoustic radiation force pulse sequence to generate shear waves, which propagate perpendicular to the ultrasound beam, causing transient displacements. The distribution of shear-wave velocities at each pixel is directly related to the shear modulus, an absolute measure of the tissue’s elastic properties. Shear-wave images are automatically coregistered with standard B-mode images to provide quantitative color elastograms with anatomic specificity. Shear waves propagate faster through stiffer contracted tissue, as well as along the long axis of tendon and muscle. SWE has a promising role in determining the severity of disease and treatment followup of various musculoskeletal tissues including tendons, muscles, nerves, and ligaments. This article describes the basic ultrasound physics of SWE and its applications in the evaluation of various traumatic and pathologic conditions of the musculoskeletal system.

RadioGraphics 2017; 37:855–870
Published online 10.1148/rg.2017160116

READ THE ARTICLE:  Shear Wave Elastography Physics Applications

 

IRIA Kerala:Subspecialty Expert Committee Formation

Dear Members,
Pleased to announce that, as discussed and decided in the state executive meeting on 22nd April, 2018, the following subspeciality expert committee formation is being planned.
Those who are interested to join subspeciality committees may please send your cv to rijomc@gmail.com
1. Neuroradiology
2.Head & Neck Radiology.
3. MSK Radiology
4. Chest Radiology.
5. Breast Imaging
6. Fetal Radiology
7. Interventional Radiology.
8. Abdominal Radiology(Gastrointestinal, Hepatobiliary and Urogenital Radiology).
9. Conventional Radiology.
10 Women’s Health & Gynec imaging.
11. Pediatric Radiology
12. Cardiac Radiology.

The objectives and guidelines for the committees include, but are not limited, to
1. To create, support and nurture a pool of subspeciality experts from Kerala.
2. To help organising committees IRIA conferences in Kerala to decide the subspeciality topics and provide state level, national and international experts as speakers.
3. To provide e- brochures and information on radiological tests in the respective specialities for patients and referring consultants.
4. To create imaging protocols in subspeciality diseases as guidelines for referring doctors after necessary discussions and consensus.
5. To design “conditions of reporting”format stating the limitations, sensitivity and specificity of tests supported by literature and statistics.
6. To promote the culture of care iniatitives and design programs that increases positive, problem solving and caring attitude between IRIA members. ToC increase awareness programs on culture of care amongst IRIA members for better patient communication and interactions.
7. To contribute and support articles to journal club of IRIA Kerala website.

Dr. Rijo Mathew, Secretary
IRIA, Kerala State

Greetings!
I have a dream to work, as a team, towards a vision for IRIA Kerala. We should aim to develop IRIA Kerala to be at par with the best of Global Radiology in Clinical, Diagnostic and Interventional Care, leading the way on relevant research and evidence based decision making, which translates to optimal patient care. We should aim to reach all radiologists in Kerala providing every radiologist with continuous opportunities for skill enhancement. We should also aim to develop a team of subspecialty experts that will lead the way for IRIA Kerala.
There are 3 C’s every organization has to address:
1. Confront the issues faced by the profession: The National Leadership of IRIA with Dr. K. Mohanan, President Elect Dr. Hemant Patel and Secretary General Dr. C. Amarnath have actively taken up PC-PNDT issues.
2. Creative: Contributing to the continuous educational and training opportunities for Radiologists in various subspecialties. The First National Fetal Radiology Conference was organized at Kochi in September 2018 with several experts sharing their knowledge and experience
3. Compassion. The RAKSHA initiative of IRIA has taken up several projects in Kerala. Radiologists in various districts celebrated the International Girl Child on October 11.
Over the past 6 months, a team of committed radiologists has taken the lead for several activities including
1. Membership Campaign Target 1000 initiated
2. Fetal Imaging Conference at Kollam by Trivandrum City Chapter & Kollam Radiology Club on April 22, 2018
3. Kottayam Radiology Club & Thrissur Radiology Club reactivated
4. National Fetal Radiology Conference at Kochi, September 22, 23, 2018
5. Breast Imaging Workshop by MARK & Calicut Radiology Club
6. KREST Physics program at Kochi on August 11, 12 2018
7. Kochi IRIA public awareness programs at General Hospital & Girls School, Pachalam- Dr Amel Anthony, Dr Manjusha and Dr Anusha Varghese led the event
8. Celebrating the International Day of the Girl Child by National IRIA at Trivandrum organized by IRIA Kerala and Trivandrum City Chapter. Hon. Health Minister Shailaja Teacher Inaugurated. Govt Secretary Social Justice Biju Prabhakaran, IAS, SP of Police, Ms. Merlin Joseph, IPS gave messages. National President Dr Mohanan K Presided. RAKSHA National Coordinator Dr. Sona Pungaokar gave the RAKSHA message.
9. Dr. Gomathy, IRIA Kerala RAKSA State Co-ordinator has led the way commendably organizing state wide programs.
10. A special call out to the district coordinators of IRIA Kerala RAKSHA for leading the way in an exemplary manner: Dr Anusha Varghese, Dr. Manjusha, Dr. Sushama, Dr Judy Mary Kurian, Dr. Maggie Xavier, Dr. Rethika, Dr. Della, Dr Shiba, Dr. Usha and Dr. Sini
11. Reactivated the Journal Club on the IRIA Kerala Website: Two articles have been posted. We aim to post an article every fortnight covering all subspecialties of Radiology and Imaging.
This is a humble beginning. Together, with your support, participation and encouragement, we aim to make giant strides forward!

Dr. Rijo Mathew Choorakuttil
Member, Scientific Advisory Committee, IRIA
Member in Charge of Ultrasound, Career Assurance Program, IRIA
In Charge, National Fetal Radiology CME Programmes of IRIA
Fetal Radiology, Subspecialty Head, Indian College of Radiology & Imaging

 

IRIA KERALA STATE CHAPTER ACTIVITIES REPORT 2019

The activities of IRIA Kerala state Chapter were directed towards 5 “C”s.

  1. Central IRIA activities
  2. Confront – the issues faced by the Radiologists in the state.
  3. Creative – Skill Enhancement programs focused on subspecialty training and Turf expansion.
  4. Compassion – Programs to promote and nurture the social responsibility of Radiologists towards larger causes.
  5. City chapters & Radiology clubs -To promote and support activities of IRIA at different parts of the state.

CENTRAL (NATIONAL) IRIA ACTIVITIES

The following members of IRIA Kerala were actively involved as office bearers and members of various National committees under the able leadership of President Dr. Hemant Patel in the year 2019.

  • Amel Antony as Senior Vice president
  • K. Mohanan as Immediate Past president
  • Ramesh S. Shenoy as In charge of E-newsletter and IRIA Digitization Committee
  • Rijo Mathew as National Coordinator for IRIA Samrakshan Project
  • C. Kesavadas, Member, Scientific Advisory Committee
  • Manoj Pillai as Member, National PC – PNDT Committee
  • P. C. Shaji, Member, Conference Guidelines Committee
  • G. S. Harikumaran Nair as Member, Constitution Advisory Committee
  • T. Kesavan as Member, Legal & Ethical Committee
  • Gomathy Subramaniam as Member, Raksha & Samrakshan Committee
  • Binoj Varghese, Member Samrakshan Committee and
  • M. R. Balachandran Nair as South Zone representative of Trade Relations Committee

 

Central council meetings: There were four  central council meetings in 2019. Two central council meetings at Chandigarh in January 2019, one at Chennai in June 2019 and another at IRIA House, New Delhi in November. Dr. K. Mohanan, Dr. Amel Antony & Dr. Rijo Mathew attended all the four meetings.

  1. a) Membership Campaign & PLM to Life Member Conversion– 80 new members were enrolled. A significant number of PLM to LM conversion took place in the year 2019, for IRIA Kerala has 673 life members,276PLM and12 Emeritus Members.
  2. b) PC-PNDT seminar at IRIA House on May 5th– Dr.Amel Antony & Dr.Rijo Mathew attended the seminar.
  3. c) IREP-IRIA Kochi hosted the IRIA sponsored ICRI conducted Resident Education Programme with the participation of 150 delegates on August 17,18 at IMA House, Kochi.IRIA Senior Vice President Dr.Amel Antony inaugurated the programme. ICRI Chairman Dr.Lalendra Upreti gave the keynote address.Dr.Srinivas Desai, IRIA Resident Education Coordinator and the faculty did an exemplary training program which was well appreciated.
  4. d) International Women’s day– was celebrated in different parts of the state. IRIA Kochi organized a major event with interactive sessions with women celebrities of different fields.
  5. e) IRIA Outreach Program-IRIA Kerala organized two Outreach programs in Breast Imaging at Kochi and Kozhikode.Two Reach out programs in Interventional Radiology were conducted at Kochi and Kozhikode.
  6. f) Tree plantation drive – On August 4th,Tree plantation drive was organized at Kochi and Malappuram.200 Mahagony saplings were distributed to the delegates of Amrita Breast Imaging Conclave, an IRIA Outreach program conducted on the same day at IMA House, Kochi.
  7. g) Raksha – National IRIA program of Raksha had continuous activities as in the last year at different parts of the state under the able leadership of State Coordinator, Dr. GomathySubramaniam.
  8. h) Samrakshan – A novel initiative launched by IRIA in 2019 to reduce the perinatal mortality had several sessions of lectures in all the city chapters of the state. Several Radiologists in the state are actively involved in the academic committees of Samrakshan with Dr. Rijo Mathew as it’s National Coordinator, Dr. Ramesh S. Shenoy as IT and social media campaign In charge, Dr. Jithin, Dr. Saneej K. & Dr. Shaheer in the academic subcommittees.
  9. i) International Day of Radiology Nov 8 – was celebrated by all city chapters and Radiology departments throughout the state. IRIA Kerala and Kochi organized a seminar on Sports Imaging with Prof.Dr. P. M. Venkatasai giving the key note address and Dr. Pallavi Panchu a talk on Push & Pull of Musculoskeletal system at IMA House, Kochi.
  10. j) Sonosummit at Chennai – A large number of delegates and faculties from Kerala actively participated in the first ever largest sonography conference of Asia organized at Chennai Trade Centre on June 27-30th.

CONFRONT THE ISSUES FACED BY THE MEMBERS IN THE STATE:

  1. PC – PNDT: Members of Thrissur, Pathanamthitta, Idukki and Trivandrum district had issues from AA’s regarding the PC PNDT amendment which restricted practice in more than two centres in a district. The members and the state leadership were able to convince the authorities with the stay orders from more than 10 different high courts on this issue, except in Trivandrum where the AA denied registration renewal of our member Dr. Vijayaretnam which was duly challenged in the High court of Kerala and a favourable stay order obtained.
  2. DEFAMATION ON SOCIAL MEDIA: There was an attempt to defame the reputation of an IRIA member in the social media regarding the reports issued. IRIA Kochi under the able leadership of Dr.Amel Antony, Dr.Balachandran Nair, Dr. Ramesh S. Shenoy, Dr. Rijo Mathew, Dr. K. Mohanan and IMA Kochi immediately constituted an expert committee to verify the facts and issued a statement to the press. In a landmark verdict from Kerala High court, Dr. Ambily Chandran received a favourable verdict directing CERT to remove all defamatory posts in the social media. The Honorable High court has favourably considered the opinion of the expert panel constituted by IRIA & IMA in this case. Dr. Amel Antony conducted a press conference and explained the court verdict immediately after the landmark judgement was issued.
  3. PCPNDT LIASONING: All city chapters are encouraged to effectively coordinate with PC – PNDT officials who can sort out many issues in the initial stages itself. IRIA is committed to the goal to save the girl child.
  4. MEETING WITH HEALTH MINISTER, HEALTH SECRETARY & DME: State leadership of IRIA met the Health Minister, Health secretary and DME and submitted the petition on various issues faced by the Radiologists. We have been assured positively by the Health authorities.
  5. Blacklisting of M/s Philips Company: The issue of IRIA member Dr.Govindan Nair v/s Philips at various civil and criminal courts were discussed in detail in the GBM held at Kumarakom.It was decided to blacklist M/s Philips till the issue has been amicably settled.IRIA Kerala and National leadership under Dr. Hemant Patel, Dr. K. Mohanan, Dr.Amel Antony & Trade committee South zone representative Dr.Balachandran Nair have made several attempts to sort out the issues in this period.

CREATIVE -SKILL ENHANCEMENT PROGRAMS FOCUSED ON POST GRADUATE TRAINING, SUBSPECIALITYPROMOTION&TURF EXPANSION

  1. POST GRADUATE TRAINING – KREST Kochi conducted the post graduate training program in February with 80 delegates.
  2. IREP at Kochi – The IRIA funded Resident Education Program was conducted successfully at IMA House, Kochi on August 17,18 with 150 delegates.
  3. KREST Physics program was conducted in 6th and 7th July 2019 at Kochi by Prof.Paneer Selvam and team.
  4. SUBSPECIALITY CME’S & TRAINING PROGRAMMES – The topics of Annual state Conference CME held at Kumarakom, Kottayam on March 16th& 17th were based on Head & Neck imaging & pediatric Radiology. More than 250 delegates participated.
  5. CME on Neuroimaging was organized by Alleppey Radiology Club on 9th June 2019.
  6. MSK Radiology Workshops, CME programmes and lectures were conducted at Trivandrum, Thiruvalla, Kochi and Thrissur. Since the theme of International Radiology day was Sports Imaging, lectures on MSK & Sports Imaging were organized at different institutions.
  7. Fetal Radiology- Kozhikode Medical College organized fetal radiology courses in December. Several lectures on Samrakshan, the flagship program of National IRIA with focus on dopplers in obstetrics were organized at all city chapters. Midterm CME at Kollam had fetaldoppler& Radiology as a core theme apart from Women’s Imaging.
  8. Breast Imaging – IRIA Kochi organized the Amrita Breast conclave, an IRIA Reach out program in association with Breast Imaging society of India on 4th August 2019 with the participation of 20 delegates. Calicut Radiology Club organized an IRIA outreach program at MVR cancer centre on 20th October 2019.0
  9. Interventional Radiology – IRIA Kerala, KMCT Calicut Radiology club & Dept.of Radiodiagnosis, Kozhikode organized an IRIA outreach program on Interventional Radiology on 14th July 2019 at Kozhikode.150 delegates attended. Another Outreach program on Interventional Radiology was conducted at Grand Hyatt, Kochi by Dept. of Radiology, Aster Medcity in June.
  10. 10. Thoracic Imaging – KMCT Medical College in association of CRC organized a CME on Thoracic Imaging on 3rd November 2019
  11. 11. Abdominal Radiology – IRIA Kochi leadership was actively involved to organize the 3rd National Conference ISGAR at Le Meridien, Kochi with Dr. Rijo Mathew as Organizing Chairman on 27th – 29th September 2019.
  12. 12. Interdisciplinary meetings were organized by IRIA Kochi, Calicut Radiology Club & IRIA Thiruvalla.
  13. E-NEWSLETTER KOCHI – IRIA Kochi launched an e-newsletter for the first time by any city chapter in the country under the leadership of President Dr. Balachandran Nair and Secretary, Dr.Ramesh S. Shenoy.
  14. 14. JFR (Journal of Fetal Radiology) – Dr.K.Mohanan,Vice Chancellor, Kerala University of Health Sciences launched the Journal of Fetal Radiology on 16th November 2019 with Dr. Rijo Mathew Choorakuttil as it’s Editor in chief.

COMPASSION -TO INITIATE & EXECUTE PROGRAMS THAT NURTURES THE SOCIAL RESPONSIBILITY OF THE RADIOLOGISTS:

Raksha – The national IRIA program initiated in 2018 has continued to organize several efforts to support the girl child under the able leadership of the State Coordinator Dr. Gomathy Subramaniam. IRIA Kerala allotted Rs.20,000/ towards Raksha in the midterm executive committee meeting. Kollam chapter has allotted Rs.15000/- towards Raksha. Calicut Radiology club and IRIA Kochi chapter have contributed towards Raksha.

  1. a) Aqua filter was donated to The Girls orphanage in Kozhikode.
  2. b) Aqua filter was donated to the Centre of Psychotherapy, Mental health action Trust, MAHAT an institution for mentally challenged children, Chalappuram, Calicut.
  3. c) Health education seminar on menstrual hygiene, adolescent awareness program was conducted Girl’s Polytechnic College.
  4. d) Donated school bags and stationery to the Girls orphanage in Calicut.
  5. e) Stationery items, books, bags, pencils etc. were donated to the Govt. Girl’s School.
  6. f) Sports kits were distributed to the disabled girls on International Day of Girl child.
  7. g) On the New Year Eve, Trampoline for children was installed in the Prashanthi School for Children with special needs, Pantheerankkavu, Calicut.

Samrakshan – A novel initiative launched by IRIA in 2019 to reduce the perinatal mortality had several sessions of lectures in all the city chapters of the state. Several Radiologists in the state are actively involved in the academic committees of Samrakshan with Dr.Rijo Mathew as it’s National Coordinator, Dr. Ramesh S. Shenoy as IT and social media campaign in charge, Dr.Jithin, Dr.Saneej K & Dr.Shaheer in the academic subcommittees. IRIA Kerala & Kochi acts as the major nodal centre for the Samrakshan activities all over India.

Stem Cell Registry: Kochi chapter IRIA started a registry for stem cell transplantation to help a Radiologist from  Kozhikode, suffering from Leukaemia with rare translocation defect with the help of NGO DATHRI. Our National Vice President Dr. Amel Antony inaugurated this movement and subjected himself for buccal swab sampling. 30 members registered on the occasion.

CITY SUBCHAPTERS & RADIOLOGY CLUBS

We have five city subchapters and three Radiology clubs. All of them had monthly meetings with vibrant academic activities and member participation which have taken the IRIA activities all over the state in the last two years.

Dr.S.Pradeep from Trivandrum was elected as National Vice President for the year 2020. Dr. S. Pradeep was past president of IRIA Kerala and past President of Trivandrum City Chapter. We congratulate him for his success and wish him all the best for this tenure at National IRIA.

I wish to thank all the office bearers of the City chapters and Radiology Clubs for their active participation and proactive involvement in the IRIA activities of the Kerala state in terms of member ship drive, academics and Raksha activities.

We had a satisfactory year of IRIA activities, wide and far reaching in terms of membership, academics, social activities and member involvement. We are extremely thankful to the National IRIA le0.0.d by President Dr.Hemant Patel whose visionary and dynamic leadership for the wholehearted support throughout this year. We wish to express our sincere gratitude to the guiding forces from our own state in the National Leadership,the senior Vice President Dr. Amel Antony, and IPP Dr. K. Mohanan for their support in all our endeavours. We sincerely thank Secretary General Dr. Rajeev Singh, Treasurer, Dr. Pushparaj Bhatele, ICRI Chairman, Dr. Lalendra Upreti, and ICRI Secretary.Dr.Shailesh Lunawat, National Resident Education Coordinator Dr.Shrinivas Desai and all the office-bearers of IRIA & ICRI for the support and timely advice.

I wish to thank all the office bearers and members of the state executive committee for the assistance and guidance. I express my sincere gratitude to all the members of IRIA Kerala for the support extended to me for these two years.

Long Live IRIA

Dr. Rijo Mathew

Secretary, IRIA Kerala

 

 

 

 

Announcement

Dear members,                                                                                                                                                                                                                  05/10/2018

The General Body Meeting of Indian Radiological & Imaging Association, Kerala State Branch is scheduled at 5 pm on 28th October, 2018 at IMA House after our midterm CME. All members are requested to attend the same. The agenda of the GBM will be informed soon.

Dr. Rijo Mathew, Secretary,
IRIA, Kerala State

X-ray phase contrast imaging of the breast-advances towards clinical implementation

Citation: Auweter SD, Herzen J, Willner M, Grandl S, Scherer K, Bamberg F, et al. X-ray phase-contrast imaging of the breast—advances towards clinical implementation. Br J Radiol 2014;87:20130606.

ABSTRACT
Breast cancer constitutes about one-quarter of all cancers and is the leading cause of cancer death in women. To reduce breast cancer mortality, mammographic screening programmes have been implemented in many Western countries. However, these programmes remain controversial because of the associated radiation exposure and the need for improvement in terms of diagnostic accuracy. Phase-contrast imaging is a new X-ray-based technology that has been shown to provide enhanced soft-tissue contrast and improved visualization of cancerous structures. Furthermore, there is some indication that these improvements of image quality can be maintained at reduced radiation doses. Thus, X-ray phase-contrast mammography may significantly contribute to advancements in early breast cancer diagnosis. Feasibility studies of X-ray phase-contrast breast CT have provided images that allow resolution of the fine structure of tissue that can otherwise only be obtained by histology. This implies that X-ray phase-contrast imaging may also lead to the development of entirely new (micro-) radiological applications. This review provides a brief overview of the physical characteristics of this new technology and describes recent developments towards clinical implementation of X-ray phase-contrast imaging of the breast.

Read the Complete Article: Breast Cancer Imaging

Placental Insufficiency in Fetuses That Slow in Growth but Are Born Appropriate for Gestational Age: A Prospective Longitudinal Study

Authors: Nadia Bardien1,5, Clare L. Whitehead1,3, Stephen Tong1,3, Antony Ugoni4, Susan McDonald5, Susan P. Walker1,2*

1 Department of Perinatal Medicine, Mercy Hospital for Women, Melbourne, Australia, 2 Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Australia, 3 Translational Obstetrics Group, University of Melbourne, Melbourne, Australia, 4 School of Physiotherapy, University of Melbourne, Melbourne, Victoria, Australia, 5 La Trobe University, Mercy Hospital for Women, Melbourne, Australia

Abstract

Objectives

To determine whether fetuses that slow in growth but are then born appropriate for gestational age (AGA, birthweight >10th centile) demonstrate ultrasound and clinical evidence of placental insufficiency.

Methods

Prospective longitudinal study of 48 pregnancies reaching term and a birthweight >10th cen-tile. We estimated fetal weight by ultrasound at 28 and 36 weeks, and recorded birthweight to determine the relative change in customised weight across two time points: 28–36 weeks and 28 weeks-birth. The relative change in weight centiles were correlated with fetoplacental Doppler findings performed at 36 weeks. We also examined whether a decline in growth trajectory in fetuses born AGA was associated with operative deliveries performed for suspected intrapartum compromise.

Results

The middle cerebral artery pulsatility index (MCA-PI) showed a linear association with fetal growth trajectory. Lower MCA-PI readings (reflecting greater diversion of blood supply to the brain) were significantly associated with a decline in fetal growth, both between 28–36 weeks (p = 0.02), and 28 weeks-birth (p = 0.0002). The MCA-PI at 36 weeks was significantly higher among those with a relative weight centile fall <20%, compared to those with a moderate centile fall of 20–30% (mean MCA-PI 1.94 vs 1.61; p<0.05), or severe centile fall of >30% (mean MCA-PI 1.94 vs 1.56; p<0.01). Of 43 who labored, operative delivery for suspected intrapartum fetal compromise was required in 12 cases; 9/18 (50%) cases where growth slowed, and 3/25 (12%) where growth trajectory was maintained (p = 0.01).

Conclusions

Slowing in growth across the third trimester among fetuses subsequently born AGA was associated with ultrasound and clinical features of placental insufficiency. Such fetuses may represent an under-recognised cohort at increased risk of stillbirth.

Published in PLOS One:  DOI:10.1371/journal.pone.0142788

READ THE COMPLETE ARTICLE:Placental Insufficiency in Fetuses That Slow in Growth but Are Born Appropriate for Gestational Age: A Prospective Longitudinal Study