Sonographic diagnosis of partial hydatidiform mole.

We undertook a study to determine whether partial hydatidiform mole could be distinguished from other cases of first-trimester missed abortion using ultrasound. Scans from 22 cases of pathologically proved partial hydatidiform mole and 33 cases of first-trimester missed abortion were independently reviewed by three radiologists, each unaware of the final pathologic diagnosis. Using a standard data form, each radiologist recorded the dimensions, shape, and contents of the gestational sac, the sonographic appearance of the decidual reaction/placenta and myometrium, and the presence or absence of adnexal cysts. The following two criteria were found to be significantly associated (P less than .05) with the diagnosis of partial mole: 1) ratio of transverse to anteroposterior dimension of the gestational sac greater than 1.5, and 2) cystic changes, irregularity, or increased echogenicity in the decidual reaction/placenta or myometrium. There was high interobserver correlation for both criteria, as measured by the kappa statistic. In 50% of the cases, either both or neither of these criteria were met. When both criteria were met, the frequency of partial mole was 87%; when neither criterion was met, the frequency of missed abortion was 90%. These results indicate that ultrasound can be of value in predicting a high likelihood of partial mole prior to curettage.

Improved prediction of intrauterine growth retardation with use of multiple parameters.

Several sonographic parameters have been proposed for predicting intrauterine growth retardation (IUGR), but each has been shown to have a low positive predictive value. To predict IUGR more reliably, the authors developed a multiparameter approach based on sonographic and clinical data from 62 fetuses with IUGR and 91 normal fetuses. Logistic regression analysis revealed that the combination of sonographically estimated fetal weight, amniotic fluid volume, and maternal blood pressure status best correlates with the presence or absence of IUGR and produced an IUGR scoring system based on these three parameters. The scoring system, which has a range of 0-100, was tested on a second set of fetuses (47 with IUGR, 81 normal) to determine its performance characteristics. An IUGR score below 50 virtually excludes the diagnosis of IUGR (0.9% likelihood of IUGR, or negative predictive value of 99.1%). A score above 75 allows confident diagnosis of IUGR (positive predictive value, 82%). A score of 50-75 is equivocal, in that it is associated with an intermediate (24%) likelihood of IUGR. The IUGR score is a practical tool that can be easily used in any ultrasound facility.

Radiology work-load measurements reflecting variables specific to hospital, patient, and examination: results of a collaborative study.

The authors coordinated the efforts of 44 hospitals in the United States to develop average times required for technologists to perform each of 19 radiologic examinations. When applicable, the overall average times were compared with extant Canadian work-load statistics. In six of the 14 examinations for which Canadian standards exist, the average times differed by 25% or more. The data were further analyzed to adjust time estimates for the effects of different hospital characteristics (e.g., number of beds, teaching status), patient characteristics (e.g., ambulation, outpatient status), and examination characteristics (e.g., number of views, resident involvement). The key factors and the magnitude of their effects varied from examination to examination, but the effects were generally large enough to have managerial significance. The factors can be evaluated by individual hospitals to produce customized estimates of average examination times. The data presented in this report can be used in management control systems by radiology departments in hospitals of varying sizes and teaching characteristics.