Intertwin Membrane Placental Cord Insertions in a Dichorionic Diamniotic Twin Pregnancy: Case Report.

Introduction: Intertwin membrane cord insertion (IMCI) is a rare variation of velamentous cord insertion (VCI) that can be seen in dichorionic twin pregnancies. This condition exposes fetal vessels to risks such as compression and rupture, which can lead to complications including fetal growth restriction (FGR) and preterm delivery.

Clinical Presentation: A 30-year-old woman, gravida 1 para 0, was referred at 19+5 weeks for evaluation of a dichorionic diamniotic twin pregnancy due to an abdominal cyst in Twin A, transposition of the great arteries in Twin B, and suspected abnormal cord insertions.

Rapid, high-resolution and distortion-free mapping of fetal brain using multi-echo radial FLASH and model-based reconstruction.

Purpose: To develop a rapid, high-resolution, and distortion-free technique for simultaneous water-fat separation, and mapping of the fetal brain at 3 T.

Methods: A 2D multi-echo radial FLASH sequence with blip gradients is adapted for data acquisition during maternal free breathing. A calibrationless model-based reconstruction with sparsity constraints is developed to jointly estimate water, fat, and field maps directly from k-space.

Prenatal Aspiration of Fetal Ovarian Cysts: When to Intervene? A Case Report and Review of the Literature.

Fetal adnexal cysts present unique challenges during pregnancy, requiring careful management strategies to mitigate risks throughout gestation and delivery. We present the case of a 35-year-old G4P2 patient, referred to our center for a large adnexal cyst confirmed by ultrasound (US) and fetal MRI, with a calculated volume of 210 mL. Given the cyst's size and the family's strong preference for vaginal delivery (VD), US-guided aspiration was performed at 35 weeks, followed by an uncomplicated spontaneous VD at 37 weeks.

Fetal MRI: Radiofrequency Safety Assessment at 3 Tesla.

Background: 3-T MRI can improve image quality of fetal imaging compared to 1.5-T MRI. However, concerns exist regarding increased local tissue heating at 3-T.

Towards automatic US-MR fetal brain image registration with learning-based methods.

Fetal brain imaging is essential for prenatal care, with ultrasound (US) and magnetic resonance imaging (MRI) providing complementary strengths. While MRI has superior soft tissue contrast, US offers portable and inexpensive screening of neurological abnormalities. Despite the great potential synergy of combined fetal brain US and MR imaging to enhance diagnostic accuracy, little effort has been made to integrate these modalities.

Rapid, High-resolution and Distortion-free Mapping of Fetal Brain using Multi-echo Radial FLASH and Model-based Reconstruction.

Purpose: To develop a rapid, high-resolution and distortion-free technique for simultaneous water-fat separation, and mapping of the fetal brain at 3T.

Methods: A 2D multi-echo radial FLASH sequence with blip gradients is adapted for data acquisition during maternal free breathing. A calibrationless model-based reconstruction with sparsity constraints is developed to jointly estimate water, fat, and field maps directly from k-space.

Unique model of chronic hypoxia in fetal lambs demonstrates abnormal contrast-enhanced ultrasound brain perfusion.

Background: Children with congenital heart disease (CHD) demonstrate long-term neurodevelopmental impairments. We investigated contrast-enhanced ultrasound (CEUS) cerebral perfusion in a fetal animal model exposed to sub-physiologic oxygen at equivalent levels observed in human fetuses with CHD.

Methods: Fifteen fetal lambs [hypoxic animals (n = 9) and normoxic controls (n = 6)] maintained in an extrauterine environment underwent periodic brain CEUS.

Contrast-enhanced subharmonic aided pressure estimation for assessment of intracranial pressure in vivo.

Background: Intracranial pressure (ICP) monitoring in children currently requires invasive techniques. Subharmonic aided pressure estimation (SHAPE) uses contrast-enhanced ultrasound (CEUS) to measure intravascular and interstitial pressure, but utility in ICP measurements has yet to be explored.

Objective: The objective of this study was to investigate SHAPE as a novel tool for noninvasive ICP measurements in fetal lambs.

Risks of Single Fetal Demise after Laser for Twin-Twin Transfusion Syndrome.

Introduction: The aim of the study was to determine if markers of donor placental insufficiency and recipient cardiac dysfunction increase the risk for single fetal demise (SFD) after laser for twin-twin transfusion syndrome (TTTS).

Methods: Single-center retrospective review of patients who had laser for TTTS. Risk factors for donor and recipient demise within 1 week were compared in pregnancies with SFD and pregnancies with dual survival using χ2 or Fisher's exact test.

The fetal lamb model of congenital diaphragmatic hernia shows altered cerebral perfusion using contrast enhanced ultrasound.

Background: Neurodevelopmental impairment is common in survivors of congenital diaphragmatic hernia (CDH). Altered cerebral perfusion in utero may contribute to abnormal brain development in CDH patients.

Methods: 5 fetal lambs with surgical left-CDH and 5 controls underwent transuterine cranial Doppler and contrast enhanced ultrasound (CEUS).

Neonatal gastrointestinal emergencies: a radiological review.

Background: Abdominal emergencies in neonates require surgical management in almost all cases and complications may include bowel perforation, sepsis, shock, and even death. Radiological imaging has become a very important aid in the clinical setting as it shortens time to diagnosis.

Objective: The objective of this review is to discuss the more prevalent neonatal gastrointestinal emergencies, review appropriate imaging options, and illustrate common radiological presentations of these entities.

Contrast-enhanced ultrasound: a comprehensive review of safety in children.

Contrast-enhanced ultrasound (CEUS) has been increasingly used in pediatric radiology practice worldwide. For nearly two decades, CEUS applications have been performed with the off-label use of gas-containing second-generation ultrasound contrast agents (UCAs). Since 2016, the United States Food and Drug Administration (FDA) has approved the UCA Lumason for three pediatric indications: the evaluation of focal liver lesions and echocardiography via intravenous administration and the assessment of vesicoureteral reflux via intravesical application (contrast-enhanced voiding urosonography, ceVUS).

Translational research in pediatric contrast-enhanced ultrasound.

The role of contrast-enhanced ultrasound (CEUS) imaging is being widely explored by various groups for its use in the pediatric population. Clinical implementation of new diagnostic or therapeutic techniques requires extensive and meticulous preclinical testing and evaluation. The impact of CEUS will be determined in part by the extent to which studies are oriented specifically toward a pediatric population.

Emerging contrast-enhanced ultrasound applications in children.

Ultrasound contrast agent (UCA) use in radiology is expanding beyond traditional applications such as evaluation of liver lesions, vesicoureteral reflux and echocardiography. Among emerging techniques, 3-D and 4-D contrast-enhanced ultrasound (CEUS) imaging have demonstrated potential in enhancing the accuracy of voiding urosonography and are ready for wider clinical adoption. US contrast-based lymphatic imaging has been implemented for guiding needle placement in MR lymphangiography in children.

Contrast-enhanced ultrasound of the pediatric brain.

Brain contrast-enhanced ultrasound (CEUS) is an emerging application that can complement gray-scale US and yield additional insights into cerebral flow dynamics. CEUS uses intravenous injection of ultrasound contrast agents (UCAs) to highlight tissue perfusion and thus more clearly delineate cerebral pathologies including stroke, hypoxic-ischemic injury and focal lesions such as tumors and vascular malformations. It can be applied not only in infants with open fontanelles but also in older children and adults via a transtemporal window or surgically created acoustic window.

Contrast-Enhanced Brain Ultrasound Perfusion Metrics in the EXTra-Uterine Environment for Neonatal Development (EXTEND): Correlation With Hemodynamic Parameters.

Objectives: Contrast-enhanced ultrasound (CEUS) can provide quantitative perfusion metrics and may be useful to detect cerebral pathology in neonates and premature infants, particularly in extrauterine environments. The effect of hemodynamics on cerebral perfusion metrics is unknown, which limits the clinical application of this technology. We aimed to determine associations between systemic hemodynamics and concurrently measured brain perfusion parameters in an animal model of extrauterine support.

Fetoscopic insufflation modeled in the extrauterine environment for neonatal development (EXTEND): Fetoscopic insufflation is safe for the fetus.

Background: Minimally invasive fetal surgery, or fetoscopy, is an alternative to open fetal surgery to repair common birth defects like myelomeningocele. Although this hysterotomy-sparing approach reduces maternal morbidity, the effects of in utero insufflation on the fetus are poorly understood. Our purpose was to determine the optimal fetal insufflation conditions.

Pediatric contrast-enhanced ultrasound: optimization of techniques and dosing.

When performing contrast-enhanced ultrasound (CEUS), ultrasound (US) scanner settings, examination technique, and contrast agent dose and administration must be optimized to ensure that high-quality, diagnostic and reproducible images are acquired for qualitative and quantitative interpretations. When carrying out CEUS in children, examination settings should be tailored to their body size and specific indications, similar to B-mode US. This review article details the basic background knowledge that is needed to perform CEUS optimally in children, including considerations related to US scanner settings and US contrast agent dose selection and administration techniques.

Two's Company: Multiple Thoracic Lesions on Prenatal US and MRI.

Background: Congenital pulmonary airway malformations (CPAM), bronchopulmonary sequestrations (BPS), and CPAM-BPS hybrid lesions are most commonly solitary; however, >1 lung congenital lung lesion may occur.

Objectives: To assess the frequency of multiple congenital thoracic anomalies at a high-volume referral center; determine prenatal ultrasound (US) and magnetic resonance imaging (MRI) features of these multifocal congenital lung lesions that may allow prenatal detection; and determine the most common distribution or site of origin.

Methods: Database searches were performed from August 2008 to May 2019 for prenatally evaluated cases that had a final postnatal surgical diagnosis of >1 congenital lung lesion or a lung lesion associated with foregut duplication cyst (FDC).