Older athletes have risk of AA.

By Theresa Pablos, AuntMinnie staff writer

February 28, 2020 -- Older endurance athletes may be prone to heart conditions with a relatively high risk of death. Echocardiographic imaging helped identify an enlarged aorta in 25% of older athletes in a new study, published on February 26 in JAMA Cardiology.

Dilation of the aorta is a risk factor for a group of related conditions tied to an in-hospital mortality rate of more than 25%, with age, male sex, and hypertension established as some risk factors for aortic dilation.

The new research suggests long-term endurance exercise may be a risk factor, too.

"Findings from this study fill an important gap in our understanding of how long-term participation in endurance sport affects the cardiovascular system," wrote the authors, led by Dr. Timothy Churchill from the cardiovascular performance program at Massachusetts General Hospital in Boston.

Previous research has found that intense exercise can contribute to aortic dilation, but no studies had looked at the impact of this phenomenon on older endurance athletes. For their study, the authors recruited 442 male and female runners and rowers who participated in competitive athletic activities, including the Boston Marathon and U.S. national-level rowing competitions.

All athletes were between the ages of 50 and 75 and had at least 10 years of endurance training after the age of 40. The authors screened out participants with a personal or family history of relevant heart conditions, including aortopathy and connective tissue disorders.

Transthoracic echocardiographic imaging was performed on the athletes to measure their myocardial structure and function. The authors took aortic measurements in triplicate over three cardiac cycles.

Out of the male athletes, almost one-third had at least one aortic dimension of 40 mm or larger; however, the findings varied by sport. Male rowers accounted for 61% of athletes with an enlarged aorta. The rowers also had a significantly larger raw aortic size and ascending aorta than male runners.

The difference in aortic dilation between male rowers and runners could be explained by the cardiovascular activity requirements of each sport, the authors noted. For instance, running requires sustained, even cardiovascular activity, whereas rowing requires different levels of strain during the stroke motion.

"While speculative, these findings suggest that the pressure stress uniquely present in rowing may represent an important hemodynamic driver of aortic dilation, particularly at the level of the aortic sinuses," the authors wrote.

For female athletes, the findings were much less pronounced. Only 6% of women had aorta measurements of 40 mm or larger, and there was no significant difference between runners and rowers. However, 38% of female athletes would meet the criteria for enlarged aorta if the threshold was lowered to 34 mm, another standard measurement.

Finally, aortic dilation was also linked to elite athlete status, defined as rowers who participated in the Olympics or world championships and marathon runners who completed races in under two hours and 45 minutes. Elite competitors and those with more cumulative years of athletic training had significantly larger aortic dimensions, the authors found.

"To our knowledge, this study presents the first detailed characterization of the prevalence of clinically relevant ascending aortic dilation among aging competitive athletes," the authors wrote.

What these findings mean for clinical outcomes has yet to be ascertained, the authors noted. They theorized the changes in aorta size could be a previously unrecognized but benign adaption to endurance sports. However, the changes could also mean that long-term training could result in overuse pathology with potentially deadly complications.

"Future studies aimed at defining the natural history of aortic dilation in this population with an emphasis on clinical outcomes ... will be required to resolve this fundamental uncertainty," the authors wrote. "In the absence of such data, clinical implications of our findings remain uncertain and will require individualized assessment."

ARFI predicts Prognosis of HCC post RF.

U S performance mixed in breast cancer survivors.

By Kate Madden Yee, AuntMinnie.com staff writer.

February 27, 2020 -- Supplemental screening ultrasound shows a mixed performance in women with a personal history of breast cancer, with lower sensitivity and a higher interval cancer rate. But the modality also had higher specificity, according to a study published online February 25 in Radiology

The findings suggest that the quest for effective ways to follow breast cancer survivors continues, wrote a team led by Dr. Soo-Yeon Kim, PhD, of Seoul National University Hospital in South Korea.

"Further research is needed to more accurately identify women who will benefit from supplemental ultrasound screening," the group wrote.

Breast cancer survivors are more vulnerable to developing second cancers, and they are tracked carefully with regular imaging. But mammography has shown lower sensitivity and higher interval cancer rates in women with a history of the disease compared with those without, Kim and colleagues noted.

Breast MRI is recommended for screening women at high risk of breast cancer, but it has its downsides, including high cost and the need for a contrast agent. Because screening breast ultrasound is readily available, doesn't require contrast, and is cost-effective, interest in using it to track breast cancer survivors has increased.

Kim and colleagues compared the performance of screening breast ultrasound between women with and without personal history of breast cancer. Their study included 3,226 breast cancer survivors and 3,226 women without history of the disease, all of whom underwent supplemental breast ultrasound and mammography between January and December 2013. The women were matched by age and breast density.

Fourteen cancers were identified among the breast cancer survivors (six on screening, eight interval) and 13 among the women with no personal history of the disease (12 on screening, one interval). Supplemental ultrasound's performance among the two groups of women varied.

Performance of supplemental screening ultrasound
Performance measure	Women with no personal history of breast cancer	Breast cancer survivors	p-value
Abnormal interpretation rate	11%	7.3%	< 0.001
Biopsy rate	1.8%	1.2%	0.04
Interval cancer rate per 1,000 women	0.3	2.5	0.02
Sensitivity	92%	43%	0.03
Specificity	89.3%	92.8%	< 0.001

"The low sensitivity and high interval cancer rate in women with a personal history of breast cancer imply that limited sensitivity of mammography in these women might have not been fully overcome by supplemental ultrasound," Kim and colleagues wrote. But, "regarding false-positive findings, supplemental ultrasound in women with a personal history of breast cancer showed lower abnormal interpretation rates, lower biopsy rates, and higher specificity than in women without a personal history of breast cancer."

It's clear that more research is necessary to determine how best to track breast cancer survivors, wrote Drs. Christoph Lee and Janie Lee, both of the University of Washington in Seattle, in an accompanying editorial.

"Additional studies are needed in larger and more diverse settings to better define the benefits and harms of supplemental screening among women with a previous history of breast cancer," they wrote.

Which US method is best for DVT.

By  Theresa Pablos, AuntMinnie Staff writer

February 17, 2020 -- Three different compression ultrasound methods all performed well for imaging deep vein thrombosis (DVT) in a study published online on February 11 by PLOS One. The failure rates for single limited, serial limited, and whole-leg ultrasound ranged from 1% to 2%.

While the three methods are regularly used in clinical practice to help identify DVT, there is no consensus about which one works best. The authors reviewed dozens of studies with thousands of patients and found that no one ultrasound method stood above the rest.

"In the present meta-analysis, more recent studies using clinical follow-up as the reference method showed very comparable failure rates of the three strategies," wrote the authors, led by Dr. Noémie Kraaijpoel from the department of vascular medicine at the University of Amsterdam. "This could imply that there may not be a preferred strategy when taking only safety into account."

The authors searched the scientific literature for compression ultrasound studies from on January 1, 1989, the year the first high-quality research on the modality was published, through July 2019. They included studies using three methods of imaging adults with suspected DVT:

1. Single limited compression ultrasound -- a single examination of the proximal deep veins
2. Serial limited compression ultrasound -- two examinations about five to 10 days apart of proximal deep veins
3. Whole-leg compression ultrasound -- a single examination of both distal and proximal deep veins

Six studies with 2,079 patients assessed single limited compression ultrasound. The analysis showed the modality had a 1.4% failure rate and 6.4% proportion of positive results, although the findings varied among the included individual studies.

For serial limited compression ultrasound, the authors included 11 studies with 3,360 patients. The modality had a 1.9% failure rate and 25% proportion of positive results.

Finally, seven studies with 3,159 evaluated whole-leg compression ultrasound. The findings showed a failure rate of 1% and 25% proportion of positive results.

While all included studies had comparable failure rates (p = 0.36), the proportion of confirmed DVT was significantly higher for serial limited and whole-leg compression ultrasound than for single limited compression ultrasound. The authors noted the difference in prevalence could be the result of patient selection.

Notably, single limited compression ultrasound had a lower DVT prevalence -- likely due to the selection of patients with a lower DVT risk. As a result, the modality could theoretically have a higher failure rate if more DVTs had been found in the group.

Nevertheless, the compression ultrasound methods produced similar results and may be considered equivalent for clinical practice.

"The failure rates of single limited, serial limited, and whole-leg [compression ultrasound] for DVT were found to be quite comparable in patients selected as per the individual study diagnostic algorithms," the authors wrote. "Preference for one of the strategies should be based on probability assessment, feasibility, and expertise."

Penile Ultrasound Integral to Diagnosing Erectile Dysfunction Cause

Ultrasound of the penis can play a vital role in determining the underlying cause of erectile dysfunction in men who don’t respond to medication.

Although prescription drugs have significantly – and successfully – changed how providers treat erectile dysfunction (ED), for those men who don’t see improvement, relying on ultrasound can be the key to identifying next steps and possible treatments, according to an article published in the American Journal of Roentgenology.

“Radiologists must be familiar with the imaging protocol, the limitations of the technique, and the interpretations of its findings, to warrant an accurate diagnosis and appropriate patient management,” said lead study author Cristian Gómez Varela, from the radiology department in Complejo Hospitalario Universitario de Pontevedra in Spain. “It is essential to differentiating between the vascular and nonvascular causes of the ED and, therefore, determining appropriate management of the patient.”

The Conditions

When used correctly – with a high-frequency linear array (7.5-12 MHz) and full-length images of the penis in both flaccid and erect states – ultrasound can contribute to successfully diagnosing three vascular-related causes of ED, Varela said.

Peyronie’s Disease (PD): This penile deformity caused by scar tissue that develops after repeated injury results in painful erections. In most cases, MRI is the preferred modality to assess PD. But, gray-scale ultrasound can be very helpful in diagnosis and follow-up, assessing size and location of plaques, detecting small non-palpable lesions or the involvement of the penile septum, or evaluating disease progression. In addition, sonoelastography can estimate tissue stiffness, as well as identify plaques that go undetected on gray-scale ultrasound.

Penile Fracture: Caused by trauma to the penis, usually during sexual intercourse, fracture can cause a rupture in the membrane responsible for trapping blood in the penis to sustain an erection. Ultrasound can make pinpointing any ruptures easier, as fractures are seen as dark breaches in the membrane.

Priapism: This condition can occur in two forms – both high-flow and low-flow. Low-flow priapism is considered a medical emergency as it can cause tissue death and, if left untreated, permanent ED. Ultrasound can identify tissue thickening and scarring in the arteries of the penis, and Doppler ultrasound can also pinpoint inadequate blood retention.
Given its effectiveness is identifying these vascular-related conditions behind ED, according to Varela and colleagues, ultrasound is the preferred method for initially evaluating the penile anatomy and blood flow. Not only is it readily available, but it is minimally invasive and can be well tolerated by patients.

AI helps characterize breast masses on ultrasound

By Erik L. Ridley, AuntMinnie staff writer

February 4, 2020 -- A breast ultrasound artificial intelligence (AI) algorithm was able to differentiate breast masses at a high level of accuracy by combining analysis of B-mode and color Doppler images, according to research published online January 31 in European Radiology. It even yielded comparable performance to experienced radiologists.

A research team led by Xuejun Qian, PhD, of the University of Southern California and Bo Zhang, PhD, of Central South University in Hunan, China, found that their deep-learning algorithm had substantial agreement with radiologists for providing BI-RADS categorization. It also yielded high sensitivity and specificity.

"The decisions determined by the model and quantitative measurements of each descriptive category can potentially help radiologists to optimize clinical decision-making," the authors wrote.

Breast ultrasound interpretation has been characterized by variable inter- and intrareader reproducibility, with higher false positives than other imaging tests, according to the researchers. Seeking to develop an automated breast classification system that could improve consistency and performance, they gathered a training set of 103,212 breast masses and a validation set of 2,748 independent breast masses at two Chinese hospitals between August 2014 and March 2017. They also assembled a test set of biopsy-proven 605 breast masses classified as BI-RADS 2 to 5 from March 2017 to September 2017.

Next, the researchers trained two convolutional neural networks: one based just on B-mode images and the other based on both B-mode and color Doppler images. On the validation cases, the model based on both B-mode and color Doppler image analysis had a higher level of agreement (kappa = 0.73) with the original interpreting radiologists for BI-RADS categorization than the network based only on B-mode images (kappa = 0.58). The difference was statistically significant (p < 0.001).

They then evaluated the performance of both models on the test set of 605 masses.

Performance of neural networks for classifying breast masses on test set
	Model based on B-mode images	Model based on both B-mode and color Doppler images
Sensitivity	96.8%	97.1%
Specificity	75.5%	88.7%
Accuracy	85.3%	92.6%
Area under the curve (AUC)	0.956	0.982

The researchers noted that the addition of color Doppler information improved the algorithm's specificity and accuracy on a statistically significant basis (p < 0.001). The small increase in sensitivity was not statistically significant, however.

"Overall, Doppler information should be incorporated into breast [ultrasound] examination protocols for breast masses, and the use of such a dual-modal system may improve cancer diagnostics," the authors wrote.

The researchers also had 10 radiologists with three to 20 years of breast imaging experience assess the 605 masses in the test set. Nine of the 10 radiologists had a sensitivity that ranged from 87.8% to 94.6%, while the last radiologist had 64.7% sensitivity. That same radiologist had the highest specificity (98.5%), with the remaining participants producing sensitivity ranging from 84.1% to 91.7%. Overall, the 10 readers produced an AUC of 0.948.

"These results indicate that the performance of model 2 reached the levels of the human experts," the authors concluded.

 

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ULTRASOUND, CT, MRI Offer Options for Diagnosing Appendicitis.

By AuntMinnie.com staff writers

June 22, 2018 -- Ultrasound, CT, and MRI are all viable supplemental imaging modalities for assessing acute appendicitis after initial ultrasound, according to a study published online June 19 in Radiology.

The team led by Dr. Kevin Eng conducted a literature search on Medline and Embase, identifying studies that used surgery or histopathologic exam information alone or in combination with clinical follow-up or chart review to assess the diagnostic accuracy of supplemental imaging modalities for appendicitis.

Studies included the following:

• For children -- ultrasound: six studies and 548 patients; CT: nine studies and 1,498 patients; MRI: five studies and 287 patients
• For adults -- ultrasound: three studies and 169 patients; CT: 11 studies and 1,027 patients; MRI: six studies and 427 patients

All three modalities had comparable, high accuracy for diagnosing the disease, both in children and adults, the researchers found.

Pooled sensitivities and specificities of second-line imaging for diagnosing appendicitis
Measure	Ultrasound	CT	MRI
Sensitivity: Adults	83.1%	89.9%	97.4%
Sensitivity: Children	91.3%	96.2%	89.9%
Specificity: Adults	90.9%	93.6%	97.1%
Specificity: Children	95.2%	94.6%	93.6%

"All three modalities may be valid as second-line imaging in a clinical imaging pathway for diagnosis and management of appendicitis," they concluded.

Elastography shows high reproducibility in breast lesions.

By Theresa Pablos, AuntMinnie staff writer

January 24, 2020 -- Two different ultrasound elastography techniques -- strain elastography (SE) and shear-wave elastography (SWE) -- showed high interoperator reproducibility when scanning breast lesions in a new study, published on January 21 in Ultrasound in Medicine and Biology.

Repeatability is critical to test the clinical effectiveness of imaging technologies. In the study, two experienced operators used the same probe on the same ultrasound system to test how reliably SE and SWE showed the same result when imaging breast lesions.

While SE performed slightly better for malignant lesions, both ultrasound elastography techniques demonstrated good to excellent agreement.

"Under the same operating conditions, our results indicated the excellent reproducibility of SE and SWE in assessing breast neoplasms among well-trained operators," wrote the authors, led by Dr. Lu Zhang from the Shanghai Jiaotong University School of Medicine.

Clinicians use SE and SWE to assess the stiffness of masses or tissue, but the two techniques use different methods to acquire images. While SE acquires an image by compressing or pulsing to displace tissue, SWE uses acoustic pressure to create an image of tissue stiffness. The researchers wondered whether these differences would affect interoperator reliability for benign and malignant lesions.

To find out, two blinded radiologists with more than three years of clinical experience performed breast ultrasound examinations on 91 women with pathologically confirmed breast lesions. The researchers excluded women with cystic or mixed lesions, lesions with coarse calcifications, and tumors that exceeded elastography's region of interest.

The radiologists acquired two SE images (nodule outline drawn and not drawn) and three SWE images (quality control, nodule outline drawn, and nodule outline not drawn) using the Resona 7 ultrasound system (Mindray Medical) with an L11-3 probe. An image was deemed satisfactory when the quality control scale at the bottom of the image reached a stable stage.

Diagnostic performance of SE and SWE
	Sensitivity		Specificity
	Operator 1	Operator 2	Operator 1	Operator 2
Elastic score (SE)	58%	59%	95%	88%
Strain ratio (SE)	71%	57%	78%	92%
Mean elastic modulus (SWE)	58%	45%	78%	93%
Max elastic modulus (SWE)	71%	52%	88%	100%
Minimum elastic modulus (SWE)	48%	19%	80%	95%
Standard deviation of elastic modulus (SWE)	65%	74%	87%	73%

Both SE and SWE showed satisfactory repeatability, the researchers found. For SE, operators' evaluation results showed no significant difference. For SWE, all scores except for minimum elastic modulus showed promising repeatability.

In addition, specificities were higher than sensitivities for both types of ultrasound, and both SE and SWE performed well on all types of lesions.

"It is generally believed that the reproducibility of SE is lower than that of SWE," the authors wrote. "However, our study found that the reproducibility of both SE and SWE breast lesions is very satisfactory except for [minimum elastic modulus of SWE], which may explain the very similar diagnostic performance of SE and SWE by the two operators."

One limitation of the study was its small sample size, and the researchers urged future, larger studies to confirm their findings. In addition, SE and SWE should still be considered adjunct modalities to B-mode ultrasound because of the high specificity and low sensitivity findings.

"In our study, SE and SWE had high specificity but relatively low sensitivity, which reminds us not to overestimate the value of elastography in the diagnosis of breast nodules," they wrote.
"We still need to rely on B-mode ultrasound with elastography as an auxiliary model."

2 US features predict cancer recurrence risk.

By Theresa Pablos, AuntMinnie staff writer

January 23, 2020 -- Machine learning might one day be able to tell which breast cancer patients will benefit from additional genetic testing. In a recent study, researchers used natural language processing to identify key features from ultrasound reports associated with cancer recurrence risk.

The study included hundreds of women with breast cancer who had previously undergone genetic tests, also known as transcriptomic tests, to determine their risk of cancer recurrence. After using a script to parse the women's BI-RADS ultrasound findings, the researchers found two key features that may identify when a patient could benefit from additional testing.

"Ultrasound findings, notably the 'retrotumoral' and 'margins' features, if abnormal, may help provide justification to obtain one of the transcriptomic tests," wrote the authors, led by Dr. Neema Jamshidi, PhD, a diagnostic radiologist from the University of California, Los Angeles (UCLA) David Geffen School of Medicine (Plos One, January 10, 2020). "Future multi-institutional prospective studies will be important in determining if these observations persist in larger cohorts."

The researchers acquired data from the electronic health records of 219 patients with breast cancer at the Harbor-UCLA Medical Center between April 2008 and January 2013. All patients had an ultrasound scan performed when they were first diagnosed with breast cancer. They also all had either an Oncotype DX or MammaPrint test to identify their risk of cancer recurrence.

The researchers coded a custom script to analyze the BI-RADS findings from the descriptive terminology from the women's initial ultrasound scans. Their program searched the terminology and attempted to find words or phrases associated with cancer reoccurrence risk.

In particular, three sonographic features -- "margins," "retrotumoral," and "internal echoes" -- were correlated with the genetic test results. The features "margins" and "retrotumoral" appeared in both the MammaPrint and Oncotype DX classification trees, while "internal echoes" only appeared in the MammaPrint classification tree.

...

The researchers hope future studies use more patients to determine whether atypical findings related to "margins" and "retrotumoral" features can truly help determine which patients would benefit from genetic testing. They also hope studies will evaluate other types of genetic tests.

US and HCC on Obese Patients.

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Pulsed US shows promise as cancer therapy.

By AuntMinnie.com staff writers

January 8, 2020 -- A new form of low-intensity pulsed ultrasound therapy shows promise for destroying cancerous tumors without harming nearby healthy cells, according to research published online January 7 in Applied Physics Letters.

The therapy works by tuning the ultrasound frequency to match that of specific cancer cells -- similar to how an opera singer can shatter a wine glass by loudly singing a precise note. As a result, the researchers can use lower-intensity ultrasound beams.

In the study, researchers from the California Institute of Technology and City of Hope Beckman Research Institute used the technique to disrupt breast, colon, and leukemia cancer cell models in suspension without harming healthy immune or red blood cells.

"This project shows that ultrasound can be used to target cancer cells based on their mechanical properties," stated David Mittelstein, an MD/PhD candidate at CalTech and lead author on the paper, in a press release. "This is an exciting proof of concept for a new kind of cancer therapy that doesn't require the cancer to have unique molecular markers or to be located separately from healthy cells to be targeted."

US detects astronaut's blood clot in space

By Abraham Kim, AuntMinnie.com staff writer

January 7, 2020 -- An astronaut on the International Space Station using an onboard ultrasound scanner to research the effects of space flight instead detected their own venous thrombosis, according to an article published in the January 2 issue of the New England Journal of Medicine.

Two months into a six-months-long mission on the International Space Station, the astronaut identified a potential blood clot while performing a self-directed ultrasound exam as part of a vascular research study. A follow-up ultrasound exam performed by the astronaut with guidance from two radiologists on Earth confirmed that the blood clot was a deep vein thrombosis (DVT) in the jugular vein of the neck (NEJM, January 2, 2020, Vol. 382:1, pp. 89-90).

Treatment of the condition typically entails taking blood-thinning medication for several months to prevent the clot from growing and moving to a different part of the body, noted co-author Dr. Stephen Moll in a statement released by the University of North Carolina School of Medicine. Moll is a professor of medicine at the university and a member of its Blood Research Center.

"There is some risk when taking blood thinners that if an injury occurs, it could cause internal bleeding that is difficult to stop. ... Knowing there are no emergency rooms in space, we had to weigh our options very carefully," he said.

Moll discussed treatment options with a team of NASA physicians and finally advised the astronaut to take a blood thinner for approximately 90 days, with regular ultrasound exams guided by radiologists to monitor the blood clot. The medical team also advised the astronaut to stop taking the blood thinner four days before the journey back home to Earth due to the high physical demands involved in the reentry process.

The International Space Station. Image courtesy of NASA.

After landing on Earth, the astronaut underwent a point-of-care ultrasound exam that indicated the astronaut no longer required further treatment for DVT. The astronaut remained asymptomatic on a follow-up exam six months after returning to Earth, the authors found.

The case of DVT in spaceflight underscores the complexities of space medicine, which, for this astronaut, included patient-performed, radiologist-guided ultrasonography, Moll and colleagues noted. The case revealed gaps in current understanding of circulatory and hemostatic physiology in space, as well as the need for more research on how blood and blood clots behave in space.

"How do you minimize risk for DVT?" Moll said. "Should there be more medications for it kept on the International Space Station? All of these questions need answering, especially with the plan that astronauts will embark on longer missions to the moon and Mars."

US of Infants exposed to Zika predicts long-term risk

By Theresa Pablos, AuntMinnie.com contributing writer

January 6, 2020 -- Some infants who were exposed to the Zika virus in utero but who appeared normal at birth later demonstrated delays in development as toddlers, according to a study published online January 6 in JAMA Pediatrics. But imaging tools such as ultrasound and MRI can help indicate which children might be at increased risk.

Researchers found that infants whose postnatal ultrasound images showed nonspecific findings, such as lenticulostriate vasculopathy, were significantly more likely to experience impaired social cognition development as toddlers than the other infants who were exposed to the Zika virus in utero.

"Although many of the infants in this cohort study had normal neurodevelopmental scores through 18 months of age, scores in multiple areas of development for some infants decreased from normative mean scores over time," wrote the authors, led by Dr. Sarah Mulkey, PhD, from Children's National Hospital in Washington, DC.

Exposure to the Zika virus before birth can cause brain abnormalities, as well as eye and vision problems. While some infants exposed in utero to Zika develop symptoms detectable through ultrasound and other imaging modalities, most newborns do not have any clinical manifestations of congenital Zika syndrome (CZS). However, these apparently healthy infants are still at risk for long-term negative health effects, including neurodevelopmental delay.

The researchers performed neurodevelopmental assessments on 70 children from Colombia who were exposed to the Zika virus in utero but had no signs of congenital Zika syndrome before or at birth. They administered the tests when the children were 4 months to 8 months old and/or 9 months to 18 months old.

In one of the clinical tests, the children showed a consistent and moderate neurodevelopmental decline. Their scores for mobility, communication, and social cognition decreased throughout the assessment period compared with the standard scores for children in their age ranges.

"The infants included in the present cohort were well characterized, with laboratory-confirmed in utero exposure to [Zika virus], normal fetal MRI and ultrasonography findings, and no evidence of CZS or microcephaly at birth," the authors wrote. "Thus, these infants were expected to have low risk for subsequent neurodevelopmental deficits, yet these deficits emerged in the first year of life and without a reduction in head circumference."

About 60 of the children in the study had also received cranial ultrasound as infants. One-third of the children showed mild, nonspecific findings, including lenticulostriate vasculopathy, subependymal or germinolytic cyst, choroid plexus cyst, and isolated calcification.

The children with these ultrasound findings were more likely than those with normal findings to experience a decline in social cognition, the researchers found. They noted that this could be a risk factor for worse early neurodevelopmental outcomes.

"To our knowledge, this study is the first to show that these nonspecific imaging findings may indicate subtle brain injury potentially associated with impaired neurological development," the authors wrote.

They cautioned that their study included a relatively small sample size, and no concurrent control group was used. Nevertheless, the findings suggest the importance of pre- and postnatal imaging for infants exposed to the Zika virus, as noted in an editorial letter from experts at the U.S. Centers for Disease Control and Prevention (CDC).

"In the cohort followed by Mulkey et al, nonspecific findings on postnatal imaging ... were associated with lower scores in the social cognition domain," wrote Margaret Honein, PhD, and her CDC colleagues. "Although the clinical significance of these nonspecific findings is not yet clear, the importance of postnatal neuroimaging for all children with Zika virus exposure in utero was made extremely clear."

Patients prefer Ultrasound first.

By AuntMinnie.com staff writers

December 23, 2019 -- About 40% of patients want their primary care doctors to have access to handheld ultrasound devices for quick use when needed during appointments, according to a consumer survey commissioned by GE Healthcare.

However, another survey commissioned by the company revealed general practitioners didn't feel strongly about integrating new technologies into their practices, proving that the two groups aren't seeing eye-to-eye when it comes to new innovations.

One survey included 500 general practitioners from New York, Florida, California, Illinois, and Texas who completed a six-question survey over the phone. The consumer study included 1,000 adults in the U.S. who answered questions online.

On a positive note, about 37% of doctors currently were using the tools or were interested in using them.

Those who used them said the devices made a difference at their practices. About 60% of handheld ultrasound users felt it positively impacted their practices, and 85% of doctors who use the tool feel it will impact the healthcare industry.

Technology use appealed to most patients. About 50% of consumers think their doctors should make use of the latest medical technology, such as handheld ultrasound, if it is affordable, according to the consumer survey.