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Microcephaly (small head) is clinically important only if there is concomitant micrencephaly (small brain). Extensive studies on patients in mental institutions have shown that there is close correlation among microcephaly, micrencephaly, and mental retardation when the head is more than three standard deviations below the norm. If the small head is less than two standard deviations below the norm, no strong correlation exists with eigher small brain or mental retardation. High-resolution ultrasound permits imaging of the fetal head in utero, allowing accurate evaluation of head size and detection of intracranial anomalies. The microcephalics detected in utero over a 2-year period form the basis of this series, showing close correlation with the known clinical data on children with microcephaly. An approach to ultrasound detection and evaluation of fetal microcephaly is proposed.

A retrospective study of ultrasound images of the liver in patients with hepatitis was undertaken. Two distinct ultrasound patterns were detected. In acute hepatitis, the predominant findings were accentuated brightness and more extensive demonstration of the portal vein radicle walls and overall decreased echogenicity of the liver. Chronic hepatitis primarily revealed decreased brightness and number of portal vein radicle walls and verall increased liver echogenicity. In addition, the pathological severity closely paralleled these ultrasound patterns. A prospective study confirmed the same acute hepatitis ultrasound findings with close correlation to the clinical severity. These distinct ultrasound patterns will help to evaluate patients with suspected acute and chronic hepatitis and more accurately define intrahepatic causes of jaundice.

Ultrasound has been suggested as a lower risk alternative to mammography for detecting breast abnormalities. Mammograms and ultrasonograms of 32 women patients were compared, revealing three distinct ultrasonic parenchymal patterns which corresponded to previously reported mammographic patterns: fatty (N1), ductal (P1 or P2), and dysplastic (DY). These constitute a new system of parenchymal classification, to our knowledge.

Computed tomography has assumed an important role in evaluating renal disorders. It is especially suited to the study of masses suspected of containing fat, parapelvic masses, displacement or malposition of the urinary tract and kidneys which are poorly visualized by other means. The need for correlation with clinical findings and other imaging methods is stressed.

The evaluation of 1,003 sonomammographic examinations on a predominantly symptomatic population using a prototype real-time dedicated breast scanner is presented. Interpretations were initially made by one of four experienced radiologists without knowledge of clinical data (i.e., symptoms, age, physical findings, or other imaging modality interpretations). A second interpretation was subsequently made with this information. Pathologic confirmation was available on 262 lesions, including 71 carcinomas and 191 benign biopsies. Of the carcinomas, 19 were smaller than 2.0 cm in diameter. The sensitivity of sonographic detection of breast cancer on initial readings was 0.76 and on second readings with clinical data was 0.85. The specificity for a benign reading on sonography was 0.80 on initial interpretation and 0.81 on the second interpretation.

The inferior vena cava is frequently involved in diseases of the abdomen and retroperitoneum. Critical evaluation of this vessel's course can greatly help in determining the origin of an adjacent mass. Ultrasound was used to divide the inferior vena cava into three parts. A vector type principle was applied to masses anteriorly displacing the vena cava, and the location of the mass was compared to the particular portion of the cava most affected. With this approach, it was often possible to determine what structures a mass may have originated from.

A new technique is described for delineating pelvic structures by using a distended bladder in combination with a water enema. The distended urinary bladder, which acts as a sonic window to the pelvis, fully defines only the portion of structures that abut against the surface. With fluid in both the bladder and rectosigmoid colon, and occasionally the cecum, a ‘sandwich effect’ can be obtained, resulting in a more complete definition of interposed structures. Questionable masses that might be feces in the bowel can be easily distinguished from significant pathology. This new technique has the potential for increasing accuracy of diagnosis of pelvic masses and delineating tumor extension of masses arising in such pelvic organs as the bladder, prostate, and uterus.

In vitro and in vivo experience with a real-time aspiration-biopsy transducer indicates that the advantage of this instrument is that it permits the examiner to monitor the movement of the structure being aspirated or biopsied, as well as the movements of adjacent organs, while the needle tip is being inserted into the structure. When the needle tip is inserted into the skin, a strong acoustic shadow is produced along the path of the needle, indicating the optimum position for aspiration and biopsy. Within fluid-filled areas the needle tip is imaged consistently. For solid-organ biopsies, the movement of the structure of interest as well as the acoustic-shadow path of the needle can be consistently observed, but the needle tip is recorded with more difficulty.

The results of 1,029 ultrasound B-scan examinations of the breast using two automated water-path scanners were correlated with histopathology data in 278 patients who had undergone biopsy. Of the 1,029 patients, a subgroup of 709 patients had both ultrasound mammograms (USM) and radiographic mammograms (XRM) obtained. A sensitivity for breast cancer of 69% was found for USM and 74% for XRM on initial independent readings when there was no knowledge of clinical data. These are not statistically different using the McNemar test for paired comparisons. When the USM were reinterpreted with the knowledge of the patient's age, history, physical examination, and, when available, the XRM interpretation, the USM sensitivity for breast cancer was 79%.

Ultrasonic evaluation of a soft tissue mass of the thigh was performed and suggested the diagnosis of myositis ossificans. Correlation with routine radiographic studies is made, as well as with the follow-up radiographic examination.

A technique utilizing abdominal compression during CT scanning with resultant improvement in image quality is described. Advantages included decrease or elimination of streak artifacts; differentiation of nonopacified bowel from other soft tissue densities; and better delineation of tissue planes.

ULTRASOUND in renal transplantation studies may be used for (1) initial pretransplant evaluation in both the donor and the recipient, (2) immediate postsurgical examination, and (3) long-term serial follow-up. The ability of ultrasound to analyze soft tissue, both within and surrounding the kidney, makes it an important complementary examination to the functional information provided by an excretory urogram. An understanding of the ultrasound characteristics of the kidney are important, since changes in these echo patterns are suggestive of disease. The kidney has strong echoes that arise from the outer surface—the capsule. Strong echoes are also produced from the midportion of the kidney and are caused by numerous reflecting interfaces from the renal hilus, defined as the central collecting system, which includes the blood vessels, the fatty fibrous tissue, and the pelvicalyceal system. While any of these structures may become prominent, a separation of the central collecting system usually implies hydronephrosis.