Erika Rubesova

All Publications

• MR Imaging of the Fetal Gastrointestinal Anomalies. Magnetic resonance imaging clinics of North America Rubesova, E., Moeremans, M. 2024; 32 (3): 489-496

  Abstract

  Fetal MR imaging has been shown to be a useful tool for the diagnosis of fetal gastro-intestinal pathologies. To recognize the various pathologies, it is, however, essential to know the normal MR imaging appearance of the fetal bowel at various gestational ages. By providing additional information to ultrasound in case of a fetal gastrointestinal anomaly, MR imaging helps to improve planning for the delivery, postnatal management, and improves parental counseling.

  View details for DOI 10.1016/j.mric.2024.03.005

  View details for PubMedID 38944436

• Development of Autoimmune Diseases Among Children With Pediatric Acute-Onset Neuropsychiatric Syndrome JAMA network open Ma, M., Masterson, E. E., Gao, J., Karpel, H., Chan, A., Pooni, R., Sandberg, J., Rubesova, E., Farhadian, B., Willet, T., Xie, Y., Tran, P., Silverman, M., Thienemann, M., Mellins, E., Frankovich, J. 2024; 7 (7)

  View details for DOI 10.1001/jamanetworkopen.2024.21688

• Imaging of Vesicoureteral Reflux: AJR Expert Panel Narrative Review. AJR. American journal of roentgenology Cajigas-Loyola, S. C., Chow, J. S., Hayatghaibi, S., Iyer, R. S., Kwon, J., Rubesova, E., Sanchez-Jacob, R., Wyers, M., Otero, H. J. 2023

  Abstract

  Vesicoureteral reflux (VUR) is a common congenital anomaly of the urinary tract that can present with collecting system dilation or as a febrile infection. VUR can lead to permanent renal sequela requiring surgery but can also spontaneously resolve without complication. Therefore, it is important to recognize those patient populations who warrant imaging for screening, confirmation, or ongoing surveillance for VUR, while avoiding overdiagnosis. In the appropriate patient populations, an accurate diagnosis of VUR allows early treatment and prevention of pyelonephritis and scarring. Various imaging modalities are available to diagnose and grade VUR, including voiding cystourethrogram (VCUG), radionucleotide cystography (RNC), and contrast-enhanced voiding urosonography (ceVUS). The objective of this article is to summarize the current understanding of VUR diagnosis and management and to discuss these imaging modalities' strengths and pitfalls. Considerations include indications for VUR imaging, patient preparation, conduct of the examination, issues related to radiologic reporting, and cost-effectiveness. An emphasis is placed on ceVUS, which is the most recently introduced of the three imaging modalities and is receiving growing support among pediatric radiologists.

  View details for DOI 10.2214/AJR.23.29741

  View details for PubMedID 37672329

• Real-time ultrasound-derived fat fraction in pediatric population: feasibility validation with MR-PDFF. Pediatric radiology Zalcman, M., Barth, R. A., Rubesova, E. 2023

  Abstract

  Nonalcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease in children. To avoid limitations of liver biopsy and MRI, quantitative ultrasound has become a research focus. Ultrasound-derived fat fraction (UDFF) is based on a combination of backscatter coefficient and attenuation parameter.The objectives of the study were to determine (1) agreement between UDFF/MRI proton density fat fraction (MR-PDFF) and (2) whether BMI and age are predictive for UDFF.This cross-sectional prospective study included a convenience sample of 46 children referred for clinically indicated abdominal MRI. MR-PDFF and five acquisitions of UDFF were collected. Intraclass correlation coefficient (ICC) and Bland-Altman analysis were used to assess agreement between MR-PDFF and UDFF. Receiver operating characteristic curves were calculated for UDFF prediction of liver steatosis (MR-PDFF ≥ 6%). Multivariable regression was performed to assess BMI and age as predictors for UDFF.Twenty-two participants were male, 24 were female, and the mean age was 14 ± 3 (range: 7-18) years. Thirty-six out of 46 participants had normal liver fat fraction <6%, and 10/46 had liver steatosis. UDFF was positively associated with MR-PDFF (ICC 0.92 (95% CI, 0.89-0.96). The mean bias between UDFF and MR-PDFF was 0.64% (95% LOA, -5.3-6.6%). AUROC of UDFF for steatosis was of 0.95 (95% CI, 0.89-0.99). UDFF cutoff of 6% had a sensitivity of 90% (95% CI, 55-99%) and a specificity of 94% (95% CI, 81-0.99%). BMI was an independent predictor of UDFF (correlation: 0.55 (95% CI, 0.35-0.95)).UDFF shows strong agreement with MR-PDFF in children. A UDFF cutoff of 6% provides good sensitivity and specificity for detection of MR-PDFF of ≥ 6%.

  View details for DOI 10.1007/s00247-023-05752-0

  View details for PubMedID 37667050

  View details for PubMedCentralID 5413933

• Reproducibility of 2D versus 3D radiomics for quantitative assessment of fetal lung development: a retrospective fetal MRI study. Insights into imaging Watzenboeck, M. L., Heidinger, B. H., Rainer, J., Schmidbauer, V., Ulm, B., Rubesova, E., Prayer, D., Kasprian, G., Prayer, F. 2023; 14 (1): 31

  Abstract

  PURPOSE: To investigate the reproducibility of radiomics features extracted from two-dimensional regions of interest (2D ROIs) versus whole lung (3D) ROIs in repeated in-vivo fetal magnetic resonance imaging (MRI) acquisitions.METHODS: Thirty fetal MRI scans including two axial T2-weighted acquisitions of the lungs were analysed. 2D (lung at the level of the carina) and 3D (whole lung) ROIs were manually segmented using ITK-Snap. Ninety-five radiomics features were extracted from 2 and 3D ROIs in initial and repeat acquisitions using Pyradiomics. Radiomics feature intra-class correlation coefficients (ICC) were calculated between 2 and 3D ROIs in the initial acquisition, and between 2 and 3D ROIs in repeated acquisitions, respectively.RESULTS: MRI data of 11 (36.7%) female and 19 (63.3%) male fetuses acquired at a median 25+0 gestational weeks plus days (GW) (interquartile range [IQR] 23+4-27+0 GW) were assessed. Median radiomics feature ICC between 2 and 3D ROIs in the initial MRI acquisition was 0.733 (IQR 0.313-0.814, range 0.018-0.970). ICCs between radiomics features extracted using 3D ROIs in initial and repeat acquisitions (median 0.908 [IQR 0.824-0.929, range 0.335-0.996]) were significantly higher compared to 2D ROIs (0.771 [0.699-0.835, 0.048-0.965]) (p<0.001).CONCLUSION: Fetal MRI radiomics features extracted from 3D whole lung segmentation masks showed significantly higher reproducibility across repeat acquisitions compared to 2D ROIs. Therefore, fetal MRI whole lung radiomics features are robust diagnostic and potentially prognostic tools in the image-based in-vivo quantitative assessment of lung development.

  View details for DOI 10.1186/s13244-023-01376-y

  View details for PubMedID 36752863

• Fetal MRI radiomics: non-invasive and reproducible quantification of human lung maturity. European radiology Prayer, F., Watzenbock, M. L., Heidinger, B. H., Rainer, J., Schmidbauer, V., Prosch, H., Ulm, B., Rubesova, E., Prayer, D., Kasprian, G. 2023

  Abstract

  OBJECTIVES: To assess the reproducibility of radiomics features extracted from the developing lung in repeated in-vivo fetal MRI acquisitions.METHODS: In-vivo MRI (1.5 Tesla) scans of 30 fetuses, each including two axial and one coronal T2-weighted sequences of the whole lung with all other acquisition parameters kept constant, were retrospectively identified. Manual segmentation of the lungs was performed using ITK-Snap. One hundred radiomics features were extracted from fetal lung MRI data using Pyradiomics, resulting in 90 datasets. Intra-class correlation coefficients (ICC) of radiomics features were calculated between baseline and repeat axial acquisitions and between baseline axial and coronal acquisitions.RESULTS: MRI data of 30 fetuses (12 [40%] females, 18 [60%] males) at a median gestational age of 24 + 5 gestational weeks plus days (GW) (interquartile range [IQR] 3 + 3 GW, range 21 + 1 to 32 + 6 GW) were included. Median ICC of radiomics features between baseline and repeat axial MR acquisitions was 0.92 (IQR 0.13, range 0.33 to 1), with 60 features exhibiting excellent (ICC > 0.9), 27 good (> 0.75-0.9), twelve moderate (0.5-0.75), and one poor (ICC < 0.5) reproducibility. Median ICC of radiomics features between baseline axial and coronal MR acquisitions was 0.79 (IQR 0.15, range 0.2 to 1), with 20 features exhibiting excellent, 47 good, 29 moderate, and four poor reproducibility.CONCLUSION: Standardized in-vivo fetal MRI allows reproducible extraction of lung radiomics features. In the future, radiomics analysis may improve diagnostic and prognostic yield of fetal MRI in normal and pathologic lung development.KEY POINTS: Non-invasive fetal MRI acquired using a standardized protocol allows reproducible extraction of radiomics features from the developing lung for objective tissue characterization. Alteration of imaging plane between fetal MRI acquisitions has a negative impact on lung radiomics feature reproducibility. Fetal MRI radiomics features reflecting the microstructure and shape of the fetal lung could complement observed-to-expected lung volume in the prediction of postnatal outcome and optimal treatment of fetuses with abnormal lung development in the future.

  View details for DOI 10.1007/s00330-022-09367-1

  View details for PubMedID 36604329

• A novel fetal MRI lung volume nomogram stratified by estimated fetal weight Gershnabel, S., Jayapal, P., Zalcman, M., Barth, R. A., Rubesova, E., Hintz, S., Zhang, J., Leonard, S. A., El-Sayed, Y. Y., Blumenfeld, Y. J. MOSBY-ELSEVIER. 2023: S577

  View details for Web of Science ID 000909337401449

• Superior Mesenteric Artery Syndrome in an Adolescent With Anorexia and Suspected Pancreatitis. JPGN reports Hsu, D., Zhang, K. Y., Rubesova, E., Bruzoni, M., Khavari, N., Goyal, A. 2022; 3 (2): e194

  View details for DOI 10.1097/PG9.0000000000000194

  View details for PubMedID 37168901

  View details for PubMedCentralID PMC10158292

• Gender-based salary differences in academic medicine: a retrospective review of data from six public medical centers in the Western USA. BMJ open Miller, H., Seckel, E., White, C. L., Sanchez, D., Rubesova, E., Mueller, C., Bianco, K. 2022; 12 (4): e059216

  Abstract

  OBJECTIVES: We assessed the effect of gender, rank and research productivity on compensation for faculty at academic medical centres.DESIGN: A web-based retrospective review of salary for professors in 2016.SETTING: Faculty from six state-run, publicly funded academic medical centres in the Western USA.PARTICIPANTS: 799 faculty members, 225 assistant (51%women), 200 associate (40%women) and 374 full professors (32%women) from general surgery (26%women), obstetrics and gynaecology (70%women) and radiology (34%women).METHODS: Archived online faculty profiles were reviewed for gender, rank and compensation (total, baseline and supplemental). Total compensation was defined as baseline compensation plus supplemental income. Baseline compensation was defined as base salary minus reductions due to participation in the voluntary Employee Reduction in Time and phased retirement programmes. Supplemental income was defined as additional salary for clinical care and research (eg, grants). Elsevier's Scopus was used to collect data on h-index, a measure of research productivity. Linear regression models were estimated to determine the relationship between these factors and salary.RESULTS: Total compensation was significantly higher for men across all professorial ranks in both general surgery [Formula: see text] and obstetrics and gynaecology [Formula: see text]. Women faculty members within these departments earned almost US$75000 less than their men colleagues. The disparity in salary originates from gaps in supplemental income, as baseline compensation was not significantly different between men and women. No significant gender difference in total compensation for radiology was found [Formula: see text]. Higher h-index was associated with higher baseline compensation across all departments as well as with supplemental income for general surgery. Higher h-index was related to lower supplemental income for radiology and was not related to supplemental income for obstetrics and gynaecology.CONCLUSIONS: Further investigations should focus on discrepancies in supplemental income, which may preferentially benefit men.

  View details for DOI 10.1136/bmjopen-2021-059216

  View details for PubMedID 35393330

• Reply to "Comment on 'Liver Fat Quantification by Ultrasound in Children: A Prospective Study'". AJR. American journal of roentgenology D'Hondt, A., Rubesova, E. 2021: W1

  View details for DOI 10.2214/AJR.21.26022

  View details for PubMedID 34232686

• Contrast-enhanced ultrasound of the pediatric bowel. Pediatric radiology Gokli, A., Dillman, J. R., Humphries, P. D., Kljucevsek, D., Mentzel, H., Rubesova, E., Takahashi, M. S., Anupindi, S. A. 2021

  Abstract

  Contrast-enhanced ultrasound (CEUS) has emerged as a valuable modality for bowel imaging in adults and children. CEUS enables visualization of the perfusion of the bowel wall and of the associated mesentery in healthy and disease states. In addition, CEUS images can be used to make quantitative measurements of contrast kinetics, allowing for objective assessment of bowel wall enhancement. Bowel CEUS is commonly applied to evaluate inflammatory bowel disease and to monitor treatment response. It has also been applied to evaluate necrotizing enterocolitis, intussusception, appendicitis and epiploic appendagitis, although experience with these applications is more limited. In this review article, we present the current experience using CEUS to evaluate the pediatric bowel with emphasis on inflammatory bowel disease, extrapolating the established experience from adult studies. We also discuss emerging applications of CEUS as an adjunct or problem-solving tool for evaluating bowel perfusion.

  View details for DOI 10.1007/s00247-020-04868-x

  View details for PubMedID 33978797

• Blood Flow Imaging in the Neonatal Brain Using Angular Coherence Power Doppler IEEE TRANSACTIONS ON ULTRASONICS FERROELECTRICS AND FREQUENCY CONTROL Jakovljevic, M., Yoon, B., Abou-Elkacem, L., Hyun, D., Li, Y., Rubesova, E., Dahl, J. J. 2021; 68 (1): 92–106

  Abstract

  Using ultrasound to image small vessels in the neonatal brain can be difficult in the presence of strong clutter from the surrounding tissue and with a neonate motion during the scan. We propose a coherence-based beamforming method, namely the short-lag angular coherence (SLAC) beamforming that suppresses incoherent noise and motion artifacts in Ultrafast data, and we demonstrate its applicability to improve detection of blood flow in the neonatal brain. Instead of estimating spatial coherence across the receive elements, SLAC utilizes the principle of acoustic reciprocity to estimate angular coherence from the beamsummed signals from different plane-wave transmits, which makes it computationally efficient and amenable to advanced beamforming techniques, such as f-k migration. The SLAC images of a simulated speckle phantom show similar edge resolution and texture size as the matching B-mode images, and reduced random noise in the background. We apply SLAC power Doppler (PD) to free-hand imaging of neonatal brain vasculature with long Doppler ensembles and show that: 1) it improves visualization of small vessels in the cortex compared to conventional PD and 2) it can be used for tracking of blood flow in the brain over time, meaning it could potentially improve the quality of free-hand functional ultrasound.

  View details for DOI 10.1109/TUFFC.2020.3010341

  View details for Web of Science ID 000602706700010

  View details for PubMedID 32746214

• Ultrasound shear wave elastography: does it add value to gray-scale ultrasound imaging in differentiating biliary atresia from other causes of neonatal jaundice? Pediatric radiology Sandberg, J. K., Sun, Y. n., Ju, Z. n., Liu, S. n., Jiang, J. n., Koci, M. n., Rosenberg, J. n., Rubesova, E. n., Barth, R. A. 2021

  Abstract

  Neonatal/infantile jaundice is relatively common, and most cases resolve spontaneously. However, in the setting of unresolved neonatal cholestasis, a prompt and accurate assessment for biliary atresia is vital to prevent poor outcomes.To determine whether shear wave elastography (SWE) alone or combined with gray-scale imaging improves the diagnostic performance of US in discriminating biliary atresia from other causes of neonatal jaundice over that of gray-scale imaging alone.Infants referred for cholestatic jaundice were assessed with SWE and gray-scale US. On gray-scale US, two radiology readers assessed liver heterogeneity, presence of the triangular cord sign, hepatic artery size, presence/absence of common bile duct and gallbladder, and gallbladder shape; associated interobserver correlation coefficients (ICC) were calculated. SWE speeds were performed on a Siemens S3000 using 6C2 and 9 L4 transducers with both point and two-dimensional (2-D) SWE US. Both univariable and multivariable analyses were performed, as were receiver operating characteristic curves (ROC) and statistical significance tests (chi-squared, analysis of variance, t-test and Wilcoxon rank sum) when appropriate.There were 212 infants with biliary atresia and 106 without biliary atresia. The median shear wave speed (SWS) for biliary atresia cases was significantly higher (P<0.001) than for non-biliary-atresia cases for all acquisition modes. For reference, the median L9 point SWS was 2.1 m/s (interquartile range [IQR] 1.7-2.4 m/s) in infants with biliary atresia and 1.5 m/s (IQR 1.3-1.9 m/s) in infants without biliary atresia (P<0.001). All gray-scale US findings were significantly different between biliary-atresia and non-biliary-atresia cohorts (P<0.001), intraclass correlation coefficient (ICC) range 0.7-1.0. Triangular cord sign was most predictive of biliary atresia independent of other gray-scale findings or SWS - 96% specific and 88% sensitive. Multistep univariable/multivariable analysis of both gray-scale findings and SWE resulted in three groups being predictive of biliary atresia likelihood. Abnormal common bile duct/gallbladder and enlarged hepatic artery were highly predictive of biliary atresia independent of SWS (100% for girls and 95-100% for boys). Presence of both the common bile duct and the gallbladder along with a normal hepatic artery usually excluded biliary atresia independent of SWS. Other gray-scale combinations were equivocal, and including SWE improved discrimination between biliary-atresia and non-biliary-atresia cases.Shear wave elastography independent of gray-scale US significantly differentiated biliary-atresia from non-biliary-atresia cases. However, gray-scale findings were more predictive of biliary atresia than elastography. SWE was useful for differentiating biliary-atresia from non-biliary-atresia cases in the setting of equivocal gray-scale findings.

  View details for DOI 10.1007/s00247-021-05024-9

  View details for PubMedID 33772640

• Liver Fat Quantification by Ultrasound in Children: A Prospective Study. AJR. American journal of roentgenology D'Hondt, A. n., Rubesova, E. n., Xie, H. n., Shamdasani, V. n., Barth, R. A. 2021

  Abstract

  Background: Nonalcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease in children in certain regions and is rising in prevalence with increasing obesity. Accurate noninvasive imaging methods for diagnosing and quantifying liver fat are needed to guide NAFLD management. Objective: To evaluate four ultrasound technologies for quantitative assessment of liver fat content in children, using MRI proton density fat fraction (PDFF) as reference standard. Methods: This prospective study enrolled children who underwent clinical abdominal MRI without general anesthesia between November 2018 and July 2019. Patients underwent investigational liver ultrasound within a day of 1.5 or 3T MRI. Acquired ultrasound radiofrequency data were processed offline to compute acoustic attenuation coefficient, hepatorenal index (HRI), Nakagami parameter, and shear wave elastography (SWE) parameters (elasticity, viscosity and dispersion). Ultrasound parameters were compared to MRI PDFF obtained using a multi-echo sequence. A second observer independently performed offline attenuation coefficient and HRI measurements in all patients. Results: A total of 48 patients were enrolled: 22 girls, 26 boys; mean age 13 years (range, 7-17 years); mean body mass index 22.25 kg/m2 (range, 14.5-48.1 kg/m2). A total of 21% (10/48) had steatosis (PDFF >5%). PDFF was correlated with attenuation coefficient (r=0.76, 95% CI 0.60-0.86, p<.001), HRI (r=0.84, 95% CI 0.74-0.91, p<.001), and Nakagami parameter (r=0.55, 95% CI, 0.32-0.72, p<.001), but not SWE parameters (r=0.05-0.25; p>.05). In patients with no, mild, moderate, and severe steatosis based on PDFF, mean±SD attenuation coefficient was 0.48±0.08, 0.54±0.03, 0.57±0.04, and 0.86±0.07 dB/cm/MHz, and mean±SD HRI was 1.28±0.30, 1.59±0.23, 2.25±0.04, and 3.06±0.49. For attenuation coefficient, threshold of 0.54 dB/cm/MHz achieved sensitivity 80% and specificity 82% for steatosis, and of 0.60 dB/cm/MHz achieved sensitivity 80% and specificity 98% for moderate steatosis. For HRI, threshold of 1.48 achieved sensitivity 90% and specificity 76% for steatosis, and of 2.11 achieved sensitivity 100% and specificity 100% for moderate steatosis. Inter-observer concordance coefficient was 0.92 for attenuation coefficient and 0.91 for HRI. Conclusion: Attenuation coefficient and HRI accurately detected and quantified liver fat in this small sample of children. Clinical Impact: Quantitative ultrasound parameters may guide NAFLD diagnosis and management in children.

  View details for DOI 10.2214/AJR.20.24874

  View details for PubMedID 33438457

• Contrast enhanced ultrasound: comparing a novel modality to MRI to assess for bowel disease in pediatric Crohn's patients TRANSLATIONAL GASTROENTEROLOGY AND HEPATOLOGY Mudambi, K., Sandberg, J., Bass, D., Rubesova, E. 2020; 5

  View details for DOI 10.21037/tgh.2019.11.02

  View details for Web of Science ID 000506650100001

• Contrast-enhanced US in Pediatric Patients: Overview of Bowel Applications. Radiographics : a review publication of the Radiological Society of North America, Inc Gokli, A. n., Acord, M. R., Hwang, M. n., Medellin-Kowalewski, A. n., Rubesova, E. n., Anupindi, S. A. 2020; 40 (6): 1743–62

  Abstract

  Contrast material-enhanced US is a technique that is approved by the U.S. Food and Drug Administration for the characterization of liver lesions and intravesicular applications in children; however, contrast-enhanced US has several other pediatric applications in clinical practice. The most common application is for patients with inflammatory bowel disease (IBD). Contrast-enhanced US can be used to diagnose IBD, distinguish regions of active or chronic inflammation of the bowel wall, and evaluate associated complications such as abscesses, fistulas, and strictures. Dynamic contrast material evaluation provides qualitative and quantitative information about mural and mesenteric blood flow, which is essential in the determination of disease activity in these patients. It also has the potential to provide a means of monitoring the response to therapy beyond endoscopy or MR enterography. In addition to its use for IBD, contrast-enhanced US can be used to assess for bowel perfusion when problem solving in patients with necrotizing enterocolitis, neonatal bowel infarction, or intussusception. It is a useful imaging technique to fortify diagnoses that may otherwise be indeterminate, such as appendicitis, epiploic appendagitis, intraluminal bowel masses, and complex cysts. Finally, innovative applications such as shear-wave elastography have the potential to provide information about the stiffness of the bowel wall. Online supplemental material is available for this article.©RSNA, 2020 See discussion on this article by Watson and Humphries.

  View details for DOI 10.1148/rg.2020200019

  View details for PubMedID 33001781

• In fetuses with congenital lung masses, decreased ventricular and atrioventricular valve dimensions are associated with lesion size and clinical outcome. Prenatal diagnosis Mardy, C., Blumenfeld, Y. J., Arunamata, A. A., Girsen, A. I., Sylvester, K. G., Halabi, S., Rubesova, E., Hintz, S. R., Tacy, T. A., Maskatia, S. A. 2019

  Abstract

  INTRODUCTION: The clinical importance of mass effect from congenital lung masses on the fetal heart is unknown. We aimed to report cardiac measurements in fetuses with congenital lung masses, and correlate lung mass severity/size with cardiac dimensions and clinical outcomes.METHODS: Cases were identified from our institutional database between 2009 and 2016. We recorded: atrioventricular valve (AVVz) annulus dimensions and ventricular widths (VWz) converted into z-scores, ratio of aortic to total cardiac output (AoCO), lesion side, and congenital pulmonary airway malformation volume ratio (CVR). Respiratory intervention (RI) was defined as: intubation, ECMO use or surgical intervention prior to discharge.RESULTS: Fifty-two fetuses comprised the study cohort. Mean AVVz and VWz were below expected for gestational age. CVR correlated with ipsilateral AVVz (RS =-0.59, p<0.001) and ipsilateral VWz (-0.59, p<0.001). Lower AVVz, AoCO, and higher CVR were associated with RI. No patient had significant structural heart disease identified postnatally.CONCLUSION: In fetuses with left-sided lung masses, ipsilateral cardiac structures tend to be smaller, but in our cohort there were no patients with structural heart disease. However, smaller left-sided structures may contribute to the need for RI that affects a portion of these fetuses.

  View details for DOI 10.1002/pd.5612

  View details for PubMedID 31742724

• Prenatally diagnosed omphalocele: characteristics associated with adverse neonatal outcomes. Journal of perinatology : official journal of the California Perinatal Association Chock, V. Y., Davis, A. S., Cho, S., Bax, C., Fluharty, E., Weigel, N., Homeyer, M., Hudgins, L., Jones, R., Rubesova, E., Sylvester, K. G., Blumenfeld, Y. J., Hintz, S. R. 2019

  Abstract

  OBJECTIVE: To characterize factors associated with adverse neonatal outcomes in prenatally diagnosed omphalocele cases.STUDY DESIGN: Prenatally diagnosed omphalocele cases at a single referral center from 1 January 2009 to 31 December 2017 were retrospectively reviewed. Clinical variables and antenatal imaging measurements were collected. Associations between prenatal and neonatal characteristics and the adverse outcome of death or prolonged length of stay (LOS) were analyzed.RESULTS: Out of 63 fetal cases, 33 were live-born, >50% had other anomalies, and neonatal mortality was 12%. Adverse outcomes were associated with neonatal variables, including lower median 1-min Apgar score, initial mechanical ventilation, and late-onset sepsis, but not approach toomphalocele closure. With multivariate analysis, death or prolonged LOS was associated only with low lung volumes by fetal MRI (OR 34 (3-422), p=0.006).CONCLUSION: Low lung volumes by fetal MRI were associated with death or prolonged LOS in neonates with prenatally diagnosed omphalocele and may guide clinicians with counseling families.

  View details for DOI 10.1038/s41372-019-0410-1

  View details for PubMedID 31227786

• The learning curve of contrast-enhanced 'microbubble' voiding urosonography-validation study. Journal of pediatric urology Velasquez, M., Emerson, M. G., Diaz, E., Kennedy, W., Rubesova, E., Barth, R. A. 2019

  Abstract

  INTRODUCTION: Vesicoureteral reflux (VUR) is a common pediatric urologic condition associated with urinary tract infection and pyelonephritis. It can be diagnosed via fluoroscopic voiding cystourethrogram (VCUG) and, more recently, contrast-enhanced voiding ultrasonography (ceVUS), which does not expose the patient to ionizing radiation. Voiding urosonography contrast agents used for the diagnosis of VUR have been widely available in Europe but were approved by the Food and Drug Administration for use in the United States only in 2016.OBJECTIVE: The objective was to optimize a protocol and compare the diagnostic performance of ceVUS to fluoroscopic VCUG in an academic medical center naive to previous use of contrast-enhanced voiding urosonography.STUDY DESIGN: Thirty-nine patients referred for clinically indicated evaluation of VUR were enrolled between September 2016 and March 2017. Patients underwent contrast-enhanced ultrasonography with prediluted Lumason and under the same catheterization underwent fluoroscopic VCUG. Comparative grading was performed by pediatric radiologists on-site at the time of examination.RESULTS: Reflux was observed in 16 of 39 patients (20 of 64 renal units) ranging from grades 1 through 5. VCUG and ceVUS were concordant for detecting reflux in 10 of 39 patients (14 of 84 renal units) and excluding reflux in 23 of 39 patients (64 of 84 renal units) (Fig.1). Using contrast enhanced voiding urosonography, 1 of 20 renal units had high-grade and 2 of 20 renal units had low-grade reflux that was not found on fluoroscopy. Using fluoroscopy, 1 of 20 renal units had high-grade and 2 of 20 renal units had low-grade reflux that had not been found on ceVUS. Two of 20 renal units were upgraded from low-grade on ceVUS to high-grade on fluoroscopy. This corresponds to a Cohen's kappa of 0.72 (confidence interval [CI] 0.54-0.91) or 'moderate.'DISCUSSION: During our investigation, we noted that there was a technical learning curve related to poor contrast mixing and the need to titrate the concentration of Lumason. However, over the course of the study, we were able to correct the technical aspects. Ultimately, our results showed good correlation between VCUG and Lumason ceVUS and only slightly less correlation than published studies by experienced centers. Future studies with voiding should allow for improved urethral visualization.CONCLUSION: While there is a considerable learning curve to the implementation of ceVUS for the diagnosis of pediatric VUR, these technical aspects can be corrected. Even a center previously naive to contrast-enhanced ultrasound technology can, over a short period of time, demonstrate good correlation between VCUG and ceVUS in the diagnosis of VUR. Translation of ceVUS into clinical practice is an alternative to VCUG for diagnosis of reflux, is feasible, and can eliminate the radiation exposure associated with a VCUG.

  View details for DOI 10.1016/j.jpurol.2019.04.015

  View details for PubMedID 31133505

• Normal values of the resistivity index of the pericallosal artery with and without compression of the anterior fontanelle. Pediatric radiology Elmfors, A. F., Sandgren, T., Ford, K., Rosenberg, J., Ringertz, H., Barth, R. A., Rubesova, E. 2019

  Abstract

  BACKGROUND: Resistivity index (RI) of the pericallosal artery as is commonly measured during head ultrasound (US) examination in neonates. Some studies have shown that RI measured with gentle compression of the fontanelle provides additional information in cases of neonatal brain anomalies.OBJECTIVE: The purpose of this study was to establish normal RI values with and without compression in a large population of neonates with normal cranial ultrasound as a function of gestational age.MATERIALS AND METHODS: The authors of this retrospective study reviewed the RI of 323 infants with normal gray-scale cranial US and with a gestational age ranging 26-42weeks. We conducted the exams both with and without compression of the anterior fontanelle and we studied changes in RI depending on gestational age, gender and type of delivery.RESULTS: Infants with a gestational age of more than 35weeks tended to have a lower RI (P=0.011). The compression of the anterior fontanelle emphasized the change in RI with increasing gestational age, with higher gestational ages having a lower RI (P<0.001). The results concerning the percentage change between baseline RI and RI with compression showed that infants with higher gestational ages have a smaller percentage change in RI (P=0.002).CONCLUSION: We established the normal values for RI from 26weeks to 42weeks of gestation. The results of the study show the importance of taking the gestational age into consideration when evaluating the RI.

  View details for PubMedID 30712160

• Tracking Blood Flow Changes in the Brains of Neonates using Angular-coherence-based Power Doppler Jakovljevic, M., Yoon, B., Abou-Elkacem, L., Rubesova, E., Dahl, J., Byram, B. C., Ruiter, N. V. SPIE-INT SOC OPTICAL ENGINEERING. 2019

  View details for DOI 10.1117/12.2513554

  View details for Web of Science ID 000471826100014

• The role of imaging in the management of necrotising enterocolitis: a multispecialist survey and a review of the literature EUROPEAN RADIOLOGY Ahle, M., Ringertz, H. G., Rubesova, E. 2018; 28 (9): 3621–31

  Abstract

  To investigate current practices and perceptions of imaging in necrotising enterocolitis (NEC) according to involved specialists, put them in the context of current literature, and identify needs for further investigation.Two hundred two neonatologists, paediatric surgeons, and radiologists answered a web-based questionnaire about imaging in NEC at their hospitals. The results were descriptively analysed, using proportion estimates with 95% confidence intervals.There was over 90% agreement on the value of imaging for confirmation of the diagnosis, surveillance, and guidance in decisions on surgery as well as on abdominal radiography as the first-choice modality and the most important radiographic signs. More variation was observed regarding some indications for surgery and the use of some ultrasonographic signs. Fifty-eight per cent stated that ultrasound was used for NEC at their hospital. Examination frequency, often once daily or more but with considerable variations, and projections used in AR were usually decided individually rather than according to fixed schedules. Predicting the need of surgery was regarded more important than formal staging.Despite great agreement on the purposes of imaging in NEC and the most important radiographic signs of the disease, there was considerable diversity in routines, especially regarding examination frequency and the use of ultrasound. Apart from continuing validation of ultrasound, important objectives for future studies include definition of the supplementary roles of both imaging modalities in relation to other diagnostic parameters and evaluation of various imaging routines in relation to timing of surgery, complications, and mortality rate.• Imaging is an indispensable tool in the management of necrotising enterocolitis • Predicting the need of surgery is regarded more important than formal staging • There is great consensus on important signs of NEC on abdominal radiography • There is more uncertainty regarding the role of ultrasound • Individualised management is preferred over standardised diagnostic algorithms.

  View details for PubMedID 29582131

• Utility of prenatal MRI in the evaluation and management of fetal ventriculomegaly. Journal of perinatology : official journal of the California Perinatal Association Katz, J. A., Chock, V. Y., Davis, A. S., Blumenfeld, Y. J., Hahn, J. S., Barnes, P., Barth, R. A., Rubesova, E., Hintz, S. R. 2018

  Abstract

  OBJECTIVE: Fetal ventriculomegaly may occur in isolation or as part of a broader syndrome. We aimed to determine the added value of magnetic resonance imaging (MRI) for informing the pre-natal and postnatal care of pregnancies complicated by ventriculomegaly (VM).STUDY DESIGN: Retrospective analysis of all cases of prenatally diagnosed VM referred to the fetal center at Lucile Packard Children's Hospital Stanford 1/1/2009-6/1/2014 were reviewed. Ultrasound (US) and MRI findings were reviewed, and the added yield of MRI evaluated.RESULTS: A total of 91 cases of fetal VM were identified and 74 (81%) underwent MRI. In 62/74 (84%) cases, additional CNS or non-CNS findings, not seen on US, were discovered on MRI, of which 58 were CNS-related. Forty-six (62%) of the additional findings were considered clinically relevant, of which 45 were CNS-related.CONCLUSION: Fetal MRI identifies additional, clinically relevant CNS and non-CNS findings in a majority of cases of VM following initial US.

  View details for PubMedID 30158676

• Normal values of the resistivity index of the pericallosal artery with and without compression of the anterior fontanelle PEDIATRIC RADIOLOGY Elmfors, A., Sandgren, T., Ford, K., Rosenberg, J., Ringertz, H., Barth, R. A., Rubesova, E. 2018; 49 (5): 646–51

  View details for DOI 10.1007/s00247-019-04347-y

  View details for Web of Science ID 000464910900010

• Prediction of neonatal respiratory distress in pregnancies complicated by fetal lung masses. Prenatal diagnosis Girsen, A. I., Hintz, S. R., Sammour, R., Naqvi, A., El-Sayed, Y. Y., Sherwin, K., Davis, A. S., Chock, V. Y., Barth, R. A., Rubesova, E., Sylvester, K. G., Chitkara, R., Blumenfeld, Y. J. 2017

  Abstract

  The objective of this article is to evaluate the utility of fetal lung mass imaging for predicting neonatal respiratory distress.Pregnancies with fetal lung masses between 2009 and 2014 at a single center were analyzed. Neonatal respiratory distress was defined as intubation and mechanical ventilation at birth, surgery before discharge, or extracorporeal membrane oxygenation (ECMO). The predictive utility of the initial as well as maximal lung mass volume and congenital pulmonary airway malformation volume ratio by ultrasound (US) and magnetic resonance imaging (MRI) was analyzed.Forty-seven fetal lung mass cases were included; of those, eight (17%) had respiratory distress. The initial US was performed at similar gestational ages in pregnancies with and without respiratory distress (26.4 ± 5.6 vs 22.3 ± 3 weeks, p = 0.09); however, those with respiratory distress had higher congenital volume ratio at that time (1.0 vs 0.3, p = 0.01). The strongest predictors of respiratory distress were maximal volume >24.0 cm(3) by MRI (100% sensitivity, 91% specificity, 60% positive predictive value, and 100% negative predictive value) and maximal volume >34.0 cm(3) by US (100% sensitivity, 85% specificity, 54% positive predictive value, and 100% negative predictive value).Ultrasound and MRI parameters can predict neonatal respiratory distress, even when obtained before 24 weeks. Third trimester parameters demonstrated the best positive predictive value. © 2017 John Wiley & Sons, Ltd.

  View details for DOI 10.1002/pd.5002

  View details for PubMedID 28061000

• HDlive imaging of a giant omphalocele. Ultrasound in obstetrics & gynecology Blumenfeld, Y. J., E Milan, K., Rubesova, E., Sylvester, K. G., DAVIS, A. S., Chock, V. Y., Hintz, S. R. 2016; 48 (3): 407-408

  View details for DOI 10.1002/uog.15993

  View details for PubMedID 27299988

• Role of imaging in the evaluation of inflammatory bowel disease: How much is too much? World journal of radiology Haas, K., Rubesova, E., Bass, D. 2016; 8 (2): 124-131

  Abstract

  Inflammatory bowel disease (IBD) is a lifelong condition with waxing and waning disease course that requires reassessment of disease status as well as screening for complications throughout a patient's lifetime. Laboratory testing, endoscopic assessment, and fecal biomarkers are often used in the initial diagnosis and ongoing monitoring of a patient with IBD. Imaging plays an integral role in the diagnosis and evaluation of IBD. Different imaging modalities can be used over the course of a patient's lifetime, from the initial screening and diagnosis of IBD, to determining the extent of intestinal involvement, monitoring for disease activity, and evaluating for complications of uncontrolled IBD. The various imaging modalities available to the provider each have a unique set of risks and benefits when considering cost, radiation exposure, need for anesthesia, and image quality. In this article we review the imaging techniques available for the evaluation of IBD including fluoroscopic small bowel follow-through, computed tomography enterography, magnetic resonance enterography, and transabdominal ultrasound with particular focus on the judicious use of imaging and the risks and benefits of each option. We also review the risks of ionizing radiation, strategies to reduce exposure to ionizing radiation, and current imaging guidelines among pediatric and adult patient with IBD.

  View details for DOI 10.4329/wjr.v8.i2.124

  View details for PubMedID 26981221

  View details for PubMedCentralID PMC4770174

• Fetal suprarenal masses - assessing the complementary role of magnetic resonance and ultrasound for diagnosis. Pediatric radiology Flanagan, S. M., Rubesova, E., Jaramillo, D., Barth, R. A. 2016; 46 (2): 246-254

  Abstract

  To assess the value and complementary roles of fetal MRI and US for characterization and diagnosis of suprarenal masses.We conducted a multi-institutional retrospective database search for prenatally diagnosed suprarenal masses between 1999 and 2012 and evaluated the roles of prenatal US and fetal MRI for characterization and diagnosis, using postnatal diagnosis or surgical pathology as the reference standard. Prenatal US and fetal MRI were assessed for unique findings of each modality.The database yielded 25 fetuses (gestational age 20-37 weeks) with suprarenal masses. Twenty-one fetuses had prenatal US, 22 had MRI, 17 had both. Postnatal diagnoses included nine subdiaphragmatic extralobar sequestrations, seven adrenal hemorrhages, five neuroblastomas (four metastatic), two lymphatic malformations, one duplex kidney with upper pole cystic dysplasia, and one adrenal hyperplasia. Ultrasound was concordant with MRI for diagnoses in 12/17 (70.6%) cases. Discordant diagnoses between US and MRI included three neuroblastomas and two adrenal hemorrhages. In the three neuroblastomas US was equivocal and MRI was definitive for neuroblastoma, demonstrating heterogeneous, intermediate-signal solid masses and liver metastases. In the two cases of adrenal hemorrhage US was equivocal and MRI was definitive with signal characteristics of hemorrhage. In 2/4 neuroblastomas, Doppler US demonstrated a systemic artery suggesting extralobar sequestration; however MRI signal characteristics correctly diagnosed neuroblastoma. All cases of extralobar sequestration were correctly diagnosed by US and MRI.US and MRI both accurately detect suprarenal masses. MRI complements US in equivocal diagnoses and detects additional findings such as liver metastases in neuroblastoma.

  View details for DOI 10.1007/s00247-015-3470-1

  View details for PubMedID 26589304

• Why do we need more data on MR volumetric measurements of the fetal lung? Pediatric radiology Rubesova, E. 2016; 46 (2): 167-171

  Abstract

  Fetal lung hypoplasia is associated with a series of congenital anomalies, particularly the congenital diaphragmatic hernia. Evaluation of the severity of the lung hypoplasia is important for parental counseling, assessment of prognosis and planning of postnatal management. Although a large number of studies have been performed to measure fetal lung volumes in order to predict outcome, there are little data on fetuses younger than 24 weeks of gestation, the age when parental counseling is crucial if termination is considered. Few studies have evaluated prognosis of lung hypoplasia in fetuses with congenital chest anomalies other than congenital diaphragmatic hernia. We review the studies on measurements of the fetal lung volumes by MRI.

  View details for DOI 10.1007/s00247-015-3521-7

  View details for PubMedID 26829947

• Added Value of Radiologist Consultation for Pediatric Ultrasound: Implementation and Survey Assessment. AJR. American journal of roentgenology Zucker, E. J., Newman, B., Larson, D. B., Rubesova, E., Barth, R. A. 2015; 205 (4): 822-826

  Abstract

  The purpose of this study was to determine whether radiologist-parent (guardian) consultation sessions for pediatric ultrasound with immediate disclosure of examination results if desired increases visit satisfaction, decreases anxiety, and increases understanding of the radiologist's role.Parents chaperoning any outpatient pediatric ultrasound were eligible and completed surveys before and after ultrasound examinations. Before the second survey, parents met with a pediatric radiologist on a randomized basis but could opt out and request or decline the consultation. Differences in anxiety and understanding of the radiologist's role before and after the examination were compared, and overall visit satisfaction measures were tabulated.Seventy-seven subjects participated, 71 (92%) of whom spoke to a radiologist, mostly on request. In the consultation group, the mean score (1, lowest; 4, highest) for overall experience was 3.8 ± 0.4 (SD), consultation benefit was 3.7 ± 0.6, and radiologist interaction was 3.7 ± 0.6. Demographics were not predictive of satisfaction with statistical significance in a multivariate model. Forty-six of 68 (68%) respondents correctly described the radiologist's role before consultation. The number increased to 60 (88%) after consultation, and the difference was statistically significant (p < 0.001). There was also a statistically significant decrease in mean anxiety score from 2.0 ± 1.0 to 1.5 ± 0.8 after consultation (p < 0.001). Sixty-four of 70 (91%) respondents indicated that they would prefer to speak with a radiologist during every visit.Radiologist consultation is well received among parents and associated with decreased anxiety and increased understanding of the radiologist's role. The results of this study support the value of routine radiologist-parent interaction for pediatric ultrasound.

  View details for DOI 10.2214/AJR.15.14542

  View details for PubMedID 26397331

• Meconium in Perinatal Imaging: Associations and Clinical Significance SEMINARS IN ULTRASOUND CT AND MRI Jerdee, T., Newman, B., Rubesova, E. 2015; 36 (2): 161-177

  Abstract

  An abnormal location, distribution, volume, or appearance of meconium is associated with a spectrum of bowel abnormalities, including atresia, obstruction, perforation, fistula, aganglionosis, immaturity, and absorptive dysfunction. This review discusses the fetal and perinatal imaging of these entities, their differential diagnoses, clinical significance, and appropriate imaging workup. Understanding the spectrum of normal and abnormal, specific and nonspecific appearances of meconium and its associated abnormalities on imaging will provide a practical, useful framework for performing and interpreting imaging studies and guiding clinical management.

  View details for DOI 10.1053/j.sult.2015.01.007

  View details for Web of Science ID 000355575300006

  View details for PubMedID 26001945

• Advances in fetal imaging. American journal of perinatology Rubesova, E., Barth, R. A. 2014; 31 (7): 567-576

  Abstract

  While ultrasound (US) has been a part of prenatal care for almost 40 years, technical progress over the last two decades has resulted in improved image quality and detection rate of congenital anomalies. The past 15 years have also seen the expansion of three-dimensional (3D) US, providing enhancements over with 2D US, and more realistic images of babies to parents and providers. Fetal magnetic resonance imaging (MRI) was first performed over 30 years ago, and has undergone major technical improvement over the past 15 to 20 years. Fetal MRI complements US by providing better visualization in the fetus when US is limited such as in oligohydramnios or severe maternal obesity. It offers a larger field of view and better tissue contrast than US and is not limited by shadowing from osseous structures. However, MRI has a limited resolution compared with US, is less readily available, and more expensive. While indications for fetal MRI have been clearly established for some abnormalities, such as neurological anomalies, other indications especially for fetal body imaging are not as clearly defined. In this article, we discuss recent developments in fetal MRI and 3D US and their common and newest indications.

  View details for DOI 10.1055/s-0034-1371712

  View details for PubMedID 24792771

• Fetal MRI correlates with postnatal CT angiogram assessment of pulmonary anatomy in tetralogy of Fallot with absent pulmonary valve. Congenital heart disease Sun, H. Y., Boe, J., Rubesova, E., Barth, R. A., Tacy, T. A. 2014; 9 (4): E105-9

  Abstract

  In tetralogy of Fallot with absent pulmonary valve, pulmonary stenosis and regurgitation results in significant pulmonary artery dilatation. Branch pulmonary artery dilatation often compresses the tracheobronchial tree, causing fluid trapping in fetal life and air trapping and/or atelectasis after birth. Prenatal diagnosis predicts poor prognosis, which depends on the degree of respiratory insufficiency from airway compromise and lung parenchymal disease after birth. Fetal magnetic resonance imaging (MRI) has been useful in evaluating the effects of congenital lung lesions on lung development and indicating severity of pulmonary hypoplasia. This report is the first demonstrating the utility of fetal MRI in tetralogy of Fallot/absent pulmonary valve patients, which predicted postnatal pulmonary artery size and visualized airway compression and lung parenchymal lesions. The distribution of lobar fluid trapping on fetal MRI correlated with air trapping on postnatal computed tomography angiogram.

  View details for DOI 10.1111/chd.12091

  View details for PubMedID 23701739

• Fetal MRI Correlates with Postnatal CT Angiogram Assessment of Pulmonary Anatomy in Tetralogy of Fallot with Absent Pulmonary Valve. Congenital heart disease Sun, H. Y., Boe, J., Rubesova, E., Barth, R. A., Tacy, T. A. 2014; 9 (4): E105-9

  View details for DOI 10.1111/chd.12091

  View details for PubMedID 23701739

• Advances in Fetal Imaging AMERICAN JOURNAL OF PERINATOLOGY Rubesova, E., Barth, R. A. 2014; 31 (7): 567-576

  Abstract

  While ultrasound (US) has been a part of prenatal care for almost 40 years, technical progress over the last two decades has resulted in improved image quality and detection rate of congenital anomalies. The past 15 years have also seen the expansion of three-dimensional (3D) US, providing enhancements over with 2D US, and more realistic images of babies to parents and providers. Fetal magnetic resonance imaging (MRI) was first performed over 30 years ago, and has undergone major technical improvement over the past 15 to 20 years. Fetal MRI complements US by providing better visualization in the fetus when US is limited such as in oligohydramnios or severe maternal obesity. It offers a larger field of view and better tissue contrast than US and is not limited by shadowing from osseous structures. However, MRI has a limited resolution compared with US, is less readily available, and more expensive. While indications for fetal MRI have been clearly established for some abnormalities, such as neurological anomalies, other indications especially for fetal body imaging are not as clearly defined. In this article, we discuss recent developments in fetal MRI and 3D US and their common and newest indications.

  View details for DOI 10.1055/s-0034-1371712

  View details for Web of Science ID 000337933200004

• Fetal magnetic resonance imaging: jumping from 1.5 to 3 tesla (preliminary experience) PEDIATRIC RADIOLOGY Victoria, T., Jaramillo, D., Roberts, T. P., Zarnow, D., Johnson, A. M., Delgado, J., Rubesova, E., Vossough, A. 2014; 44 (4): 376-386

  Abstract

  Several attempts have been made at imaging the fetus at 3 T as part of the continuous search for increased image signal and better anatomical delineation of the developing fetus. Until very recently, imaging of the fetus at 3 T has been disappointing, with numerous artifacts impeding image analysis. Better magnets and coils and improved technology now allow imaging of the fetus at greater magnetic strength, some hurdles in the shape of imaging artifacts notwithstanding. In this paper we present the preliminary experience of evaluating the developing fetus at 3 T and discuss several artifacts encountered and techniques to decrease them, as well as safety concerns associated with scanning the fetus at higher magnetic strength.

  View details for DOI 10.1007/s00247-013-2857-0

  View details for Web of Science ID 000333529100002

  View details for PubMedID 24671739

• Fetal bowel anomalies--US and MR assessment. Pediatric radiology Rubesova, E. 2012; 42: S101-6

  Abstract

  The technical quality of prenatal US and fetal MRI has significantly improved during the last decade and allows an accurate diagnosis of bowel pathology prenatally. Accurate diagnosis of bowel pathology in utero is important for parental counseling and postnatal management. It is essential to recognize the US presentation of bowel pathology in the fetus in order to refer the patient for further evaluation or follow-up. Fetal MRI has been shown to offer some advantages over US for specific bowel abnormalities. In this paper, we review the normal appearance of the fetal bowel on US and MRI as well as the typical presentations of bowel pathologies. We discuss more specifically the importance of recognizing on fetal MRI the abnormalities of size and T1-weighted signal of the meconium-filled distal bowel.

  View details for DOI 10.1007/s00247-011-2174-4

  View details for PubMedID 22395722

• Fetal bowel anomalies - US and MR assessment PEDIATRIC RADIOLOGY Rubesova, E. 2012; 42: 101-106

  View details for DOI 10.1007/s00247-011-2174-4

  View details for Web of Science ID 000301187100009

• Effectiveness of a Staged US and CT Protocol for the Diagnosis of Pediatric Appendicitis: Reducing Radiation Exposure in the Age of ALARA RADIOLOGY Krishnamoorthi, R., Ramarajan, N., Wang, N. E., Newman, B., Rubesova, E., Mueller, C. M., Barth, R. A. 2011; 259 (1): 231-239

  Abstract

  To evaluate the effectiveness of a staged ultrasonography (US) and computed tomography (CT) imaging protocol for the accurate diagnosis of suspected appendicitis in children and the opportunity for reducing the number of CT examinations and associated radiation exposure.This retrospective study was compliant with HIPAA, and a waiver of informed consent was approved by the institutional review board. This study is a review of all imaging studies obtained in children suspected of having appendicitis between 2003 and 2008 at a suburban pediatric emergency department. A multidisciplinary staged US and CT imaging protocol for the diagnosis of appendicitis was implemented in 2003. In the staged protocol, US was performed first in patients suspected of having appendicitis; follow-up CT was recommended when US findings were equivocal. Of 1228 pediatric patients who presented to the emergency department for suspected appendicitis, 631 (287 boys, 344 girls; age range, 2 months to 18 years; median age, 10 years) were compliant with the imaging pathway. The sensitivity, specificity, negative appendectomy rate (number of appendectomies with normal pathologic findings divided by the number of surgeries performed for suspected appendicitis), missed appendicitis rate, and number of CT examinations avoided by using the staged protocol were analyzed.The sensitivity and specificity of the staged protocol were 98.6% and 90.6%, respectively. The negative appendectomy rate was 8.1% (19 of 235 patients), and the missed appendicitis rate was less than 0.5% (one of 631 patients). CT was avoided in 333 of the 631 patients (53%) in whom the protocol was followed and in whom the US findings were definitive.A staged US and CT imaging protocol in which US is performed first in children suspected of having acute appendicitis is highly accurate and offers the opportunity to substantially reduce radiation.

  View details for DOI 10.1148/radiol.10100984

  View details for PubMedID 21324843

• Management of fetal mediastinal shift: A practical approach JOURNAL DE RADIOLOGIE Colombani, M., Rubesova, E., Potier, A., Quarello, E., Barth, R. A., Devred, P., Petit, P., Gorincour, G. 2011; 92 (2): 118-124

  Abstract

  The purpose of this article is to review the technique of fetal chest ultrasound screening evaluation, the diagnostic work-up in the presence of fetal mediastinal shift and which ultrasound imaging features to look for. The first step in evaluating the fetal thorax is to confirm situs. Then, a median sagittal line is drawn from a four-chamber view to assist in spatial orientation followed by echotexture analysis of the structures of the thorax in the presence of mediastinal shift. We propose a systematic approach based on the direction of the mediastinal shift and echogenicity of the compressing hemithorax. When the hemithorax contralateral to the mediastinal shift is enlarged, which is the most frequent situation, diaphragmatic hernia and macrocystic congenital cystic adenomatoid malformation are the most likely etiologies when the mass is heterogeneous. Microcystic congenital cystic adenomatoid malformation, sometimes associated with sequestration, is the most frequent etiology when the mass is homogeneous. When the hemithorax ipsilateral to the mediastinal shift is small, which is less frequent, and the contralateral hemithorax is homogeneously isoechoic, then a diagnosis of lung hypoplasia-agenesis-aplasia should be considered.

  View details for DOI 10.1016/j.jradio.2010.12.002

  View details for Web of Science ID 000288768400003

  View details for PubMedID 21352743

• A continuous heparin infusion does not prevent catheter-related thrombosis in infants after cardiac surgery PEDIATRIC CRITICAL CARE MEDICINE Schroeder, A. R., Axelrod, D. M., Silverman, N. H., Rubesova, E., Merkel, E., Roth, S. J. 2010; 11 (4): 489-495

  Abstract

  To determine whether a continuous infusion of heparin reduces the rate of catheter-related thrombosis in neonates and infants post cardiac surgery. Central venous and intracardiac catheters are used routinely in postoperative pediatric cardiac patients. Catheter-related thrombosis occurs in 8% to 45% of pediatric patients with central venous catheters.Single-center, randomized, placebo-controlled, double-blinded trial.Cardiovascular intensive care unit, university-affiliated children's hospital.Children <1 yr of age recovering from cardiac surgery.Patients were randomized to receive either continuous heparin at 10 units/kg/hr or placebo. The primary end point was catheter-related thrombosis as assessed by serial ultrasonography.Study enrollment was discontinued early based on results from an interim futility analysis. Ninety subjects were enrolled and received the study drug (heparin, 53; placebo, 37). The catheter-related thrombosis rate in the heparin group, compared with the placebo group, was 15% vs. 16% (p = .89). Subjects in the heparin group had a higher mean partial thromboplastin time (52 secs vs. 42 secs, p = .001), and this difference was greater for those aged <30 days (64 secs vs. 43 secs, p = .008). Catheters in place > or = 7 days had both a greater risk of thrombus formation (odds ratio, 4.3; p = .02) and catheter malfunction (odds ratio, 11.2; p = .008). We observed no significant differences in other outcome measures or in the frequency of adverse events.A continuous infusion of heparin at 10 units/kg/hr was safe but did not reduce catheter-related thrombus formation. Heparin at this dose caused an increase in partial thromboplastin time values, which, unexpectedly, was more pronounced in neonates.

  View details for DOI 10.1097/PCC.0b013e3181ce6e29

  View details for PubMedID 20101197

• Magnetic resonance imaging in the prenatal diagnosis of congenital diarrhea ULTRASOUND IN OBSTETRICS & GYNECOLOGY Colombani, M., Ferry, M., TOGA, C., Lacroze, V., Rubesova, E., Barth, R. A., Cassart, M., Gorincour, G. 2010; 35 (5): 560-565

  Abstract

  Congenital diarrhea is very rare, and postnatal diagnosis is often made once the condition has caused potentially lethal fluid loss and electrolyte disorders. Prenatal detection is important to improve the immediate neonatal prognosis. We aimed to describe the prenatal ultrasound and magnetic resonance (MRI) imaging findings in fetuses with congenital diarrhea.The study reports the pre- and postnatal findings in four fetuses that presented with generalized bowel dilatation and polyhydramnios. We analyzed the fetal ultrasound and MRI examinations jointly, then compared our provisional diagnosis with the amniotic fluid biochemistry and subsequently with the neonatal stool characteristics.In each of the four cases an ultrasound examination between 22 and 30 weeks' gestation showed moderate generalized bowel dilatation and polyhydramnios suggesting intestinal obstruction. MRI examinations performed between 24 and 32 weeks' gestation confirmed that the dilatation was of gastrointestinal (GI) origin, with a signal indicating intraluminal water visible throughout the small bowel and colon. The expected hypersignal on T1-weighted sequences characteristic of physiological meconium was absent in the colon and rectum. This suggested that the meconium had been completely diluted and flushed out by the water content of the bowel. The constellation of MRI findings enabled a prenatal diagnosis of congenital diarrhea. The perinatal lab test findings revealed two cases of chloride diarrhea and two of sodium diarrhea.Congenital diarrhea may be misdiagnosed as intestinal obstruction on prenatal ultrasound but has characteristic findings on prenatal MRI enabling accurate diagnosis; this is important for optimal neonatal management.

  View details for DOI 10.1002/uog.7509

  View details for Web of Science ID 000278210600010

  View details for PubMedID 20069658

• MR Assessment of Normal Fetal Lung Volumes: A Literature Review AMERICAN JOURNAL OF ROENTGENOLOGY Deshmukh, S., Rubesova, E., Barth, R. 2010; 194 (2): W212-W217

  Abstract

  Fetal lung volume can be assessed from MR images by planimetric measurement and comparison with normal values. We review 10 MRI articles that report normal fetal lung volumes based on gestational age to assess reproducibility and application of data.The articles were analyzed for differences in methodology and disparities in reported normal lung volumes by gestational age. Overall, there is substantial variability among studies regarding reported normal fetal lung volumes as measured on MRI.

  View details for DOI 10.2214/AJR.09.2469

  View details for Web of Science ID 000273951900053

  View details for PubMedID 20093576

• Performance of PROPELLER relative to standard FSE T2-weighted imaging in pediatric brain MRI PEDIATRIC RADIOLOGY Vertinsky, A. T., Rubesova, E., Krasnokutsky, M. V., Bammer, S., Rosenberg, J., White, A., Barnes, P. D., Bammer, R. 2009; 39 (10): 1038-1047

  Abstract

  T2-weighted fast spin-echo imaging (T2-W FSE) is frequently degraded by motion in pediatric patients. MR imaging with periodically rotated overlapping parallel lines with enhanced reconstruction (PROPELLER) employs alternate sampling of k-space to achieve motion reduction.To compare T2-W PROPELLER FSE (T2-W PROP) with conventional T2-W FSE for: (1) image quality; (2) presence of artefacts; and (3) ability to detect lesions.Ninety-five pediatric patients undergoing brain MRI (1.5 T) were evaluated with T2-W FSE and T2-W PROP. Three independent radiologists rated T2-W FSE and T2-W PROP, assessing image quality, presence of artefacts, and diagnostic confidence. Chi-square analysis and Wilcoxon signed rank test were used to assess the radiologists' responses.Compared with T2-W FSE, T2-W PROP demonstrated better image quality and reduced motion artefacts, with the greatest benefit in children younger than 6 months. Although detection rates were comparable for the two sequences, blood products were more conspicuous on T2-W FSE. Diagnostic confidence was higher using T2-W PROP in children younger than 6 months. Average inter-rater agreement was 87%.T2-W PROP showed reduced motion artefacts and improved diagnostic confidence in children younger than 6 months. Thus, use of T2-W PROP rather than T2-W FSE should be considered in routine imaging of this age group, with caution required in identifying blood products.

  View details for DOI 10.1007/s00247-009-1292-8

  View details for Web of Science ID 000269861000003

  View details for PubMedID 19669747

• Three-Dimensional MRI Volumetric Measurements of the Normal Fetal Colon AMERICAN JOURNAL OF ROENTGENOLOGY Rubesova, E., Vance, C. J., Ringertz, H. G., Barth, R. A. 2009; 192 (3): 761-765

  Abstract

  The use of fetal MRI markedly improves characterization of abdominal congenital anomalies. Accurate prenatal diagnosis of the level and cause of congenital intestinal obstruction is desired for optimal parental counseling and perinatal care. Because accurate diagnosis would be aided by nomograms of colonic volume, this study was conducted to determine normal colonic volumes at different gestational ages.This retrospective study consisted of a review of 83 fetal MRI examinations performed on fetuses with no gastrointestinal abnormalities. MRI was performed with a 1.5-T system. Axial, sagittal, and coronal T1-weighted fast gradient-refocused echo images were acquired at TR/TE, 165/2.6; flip angle, 90 degrees; matrix size, 384 x 192; slice thickness, 5 mm; field of view, 38 cm(2). Two investigators determined the region of interest in the colon by outlining areas of high signal intensity of meconium slice by slice. They then calculated colonic luminal volume in the regions of interest. Colonic luminal volumes were reported relative to gestational age and abdominal circumference. Normative curves were generated, and interobserver and intraobserver analyses were performed.Seventeen of the 83 fetuses (20%) were excluded because of movement artifacts on the images. Normal colonic luminal volume increased exponentially with gestational age and abdominal circumference. The range of colonic luminal volumes at 20-37 weeks' gestational age was 1.1-65 mL. Variation of volume was greater at advanced gestational age. Interobserver and intraobserver correlation was good.This study yielded preliminary volumetric measurements of the normal fetal colon at 20-37 weeks of gestational age that suggest the fetal colon grows exponentially.

  View details for DOI 10.2214/AJR.08.1504

  View details for Web of Science ID 000264005700032

  View details for PubMedID 19234275

• Accuracy of MDCT in predicting site of gastrointestinal tract perforation AMERICAN JOURNAL OF ROENTGENOLOGY Hainaux, B., Agneessens, E., Bertinotti, R., De Maertelaer, V., Rubesova, E., Capelluto, E., Moschopoulos, C. 2006; 187 (5): 1179-1183

  Abstract

  The purpose of this study was to prospectively evaluate the accuracy of MDCT for preoperative determination of the site of surgically proven gastrointestinal tract perforations and to determine the most predictive findings in this diagnosis.We prospectively studied 85 consecutive patients with extraluminal air on MDCT who had surgically proven gastrointestinal tract perforations. All patients underwent surgery within 12 hours after MDCT was performed. Two experienced radiologists, blinded to the surgical diagnosis, reached a consensus prediction of the site of the perforation using the following eight MDCT findings: concentration of extraluminal air bubbles adjacent to the bowel wall, free air in supramesocolic or inframesocolic compartments, extraluminal air in both abdomen and pelvis, focal defect in the bowel wall, segmental bowel-wall thickening, perivisceral fat stranding, abscess, and extraluminal fluid. MDCT imaging results were compared with surgical and pathologic findings. Logistic regression analyses were performed to assess the significance of the different radiologic criteria.Analysis of MDCT images was predictive of the site of gastrointestinal tract perforation in 73 (86%) of 85 patients. Logistic regression showed that concentration of extraluminal air bubbles (p < 0.001), segmental bowel wall thickening (p < 0.001), and focal defect of the bowel wall (p = 0.007) were strong predictors of the site of bowel perforation.MDCT is highly accurate for predicting the site of gastrointestinal tract perforations. Three of eight CT findings significantly correlate with surgical diagnosis.

  View details for DOI 10.2214/AJR.05.1179

  View details for Web of Science ID 000241510800010

  View details for PubMedID 17056902

• Quantitative diffusion imaging in breast cancer: A clinical prospective study JOURNAL OF MAGNETIC RESONANCE IMAGING Rubesova, E., Grell, A., De Maertelaer, V., Metens, T., Chao, S., Lemort, M. 2006; 24 (2): 319-324

  Abstract

  To study the correlation between apparent diffusion coefficient (ADC) and pathology in patients with undefined breast lesion, to validate how accurately ADC is related to histology, and to define a threshold value of ADC to distinguish malignant from benign lesions.Seventy-eight patients (110 lesions) were referred for positive or dubious findings. Three-dimensional fast low-angle shot (3D-FLASH) with contrast injection was applied. EPI diffusion-weighted imaging (DWI) with fat saturation was performed, and ROIs were selected on subtraction 3D-FLASH images before and after contrast injection, and copied on an ADC map. Inter- and intraobserver analyses were performed.At pathology 22 lesions were benign, 65 were malignant, and 23 were excluded. The ADCs of malignant and benign lesions were statistically different. In malignant tumors the ADC was (mean +/- SEM) 0.95 +/- 0.027 x 10(-3)mm(2)/second, and in benign tumors it was 1.51 +/- 0.068 x 10(-3)mm(2)/second. According to receiver operating characteristic (ROC) curves, we found a threshold between malignant and benign lesions for highest sensitivity and specificity (both 86%) around 1.13 +/- 0.10 x 10(-3)mm(2)/second. For a threshold of 0.95 +/- 0.10 x 10(-3)mm(2)/second, specificity was 100% but sensitivity was very low. Inter- and intraobserver studies showed good reproducibility.The ADC may help to differentiate benign and malignant lesions with good specificity, and may increase the overall specificity of breast MRI.

  View details for DOI 10.1002/jmri.20643

  View details for Web of Science ID 000239410300009

  View details for PubMedID 16786565

• Intragastric band erosion after laparoscopic adjustable gastric banding for morbid obesity: Imaging characteristics of an underreported complication AMERICAN JOURNAL OF ROENTGENOLOGY Hainaux, B., Agneessens, E., Rubesova, E., Muls, V., Gaudissart, Q., Moschopoulos, C., Cadiere, G. B. 2005; 184 (1): 109-112

  Abstract

  Our purpose was to describe the imaging findings of intragastric band erosion, an underreported complication after laparoscopic adjustable gastric banding for the treatment of morbid obesity. In this long-term complication, the gastric band fastened around the upper stomach to create a small proximal gastric pouch gradually erodes into the stomach wall and can extend into the gastric lumen. We present three cases of patients with band erosion in whom findings on an upper gastrointestinal series and CT established the diagnosis.Diagnosis of intragastric band erosion after gastric banding is usually made with endoscopy. However, the radiologic appearance of band erosion when visualized on an upper gastrointestinal series is pathognomonic and allows initial imaging diagnosis. In patients with extraluminal air or prosthesis infection, CT findings also are suggestive of this postoperative complication.

  View details for Web of Science ID 000226507900021

  View details for PubMedID 15615959

• Imaging of the articular cartilage in osteoarthritis of the knee joint: 3D spatial-spectral spoiled gradient-echo vs. fat-suppressed 3D spoiled gradient-echo MR imaging JOURNAL OF MAGNETIC RESONANCE IMAGING Yoshioka, H., Alley, M., Steines, D., Stevens, K., Rubesova, E., Genovese, M., Dillingham, M. F., Lang, P. 2003; 18 (1): 66-71

  Abstract

  To compare three-dimensional (3D) spatial-spectral (SS) spoiled gradient-recalled acquisition in the steady state (SPGR) imaging with fat-suppressed 3D SPGR sequences in MR imaging of articular cartilage of the knee joint in patients with osteoarthritis.MR images of six patients with osteoarthritis of the knee were prospectively examined with a 1.5T MR scanner. For quantitative analyses, the signal-to-noise ratios, contrast-to-noise ratios, and contrast of cartilage and adjacent structures including meniscus, synovial fluid, muscle, fat tissue, and bone marrow were measured.In patients with osteoarthritis, 3DSS-SPGR images demonstrated higher spatial resolution and higher mean signal-to-noise (S/N) ratios (cartilage, 24.9; synovial fluid, 12.3; muscle, 20.7; meniscus, 21.6), with shorter acquisition times (7 minutes 20 seconds), when compared to fat-suppressed 3D SPGR images (cartilage, 22.3; synovial fluid, 10.8; muscle, 16.7; meniscus, 13.4).3DSS-SPGR imaging is a promising method for evaluating cartilage pathology in patients with osteoarthritis of the knee and has the potential to replace fat-suppressed 3D SPGR imaging.

  View details for DOI 10.1002/jmri.10320

  View details for PubMedID 12815641

• Gd-labeled liposomes for monitoring liposome-encapsulated chemotherapy: Quantification of regional uptake in tumor and effect on drug delivery Contrast Media Research Conference Rubesova, E., Berger, F., Wendland, M. F., Hong, K. L., Stevens, K. J., Gooding, C. A., Lang, P. ELSEVIER SCIENCE INC. 2002: S525–S527

  View details for PubMedID 12188328

• Phase II and III studies with new drugs for non-small cell lung cancer: A systematic review of the literature with a methodology quality assessment ANTICANCER RESEARCH Meert, A. P., Berghmans, T., Branle, F., Lemaitre, F., Mascaux, C., Rubesova, E., Vermylen, P., Paesmans, M., Sculier, J. P. 1999; 19 (5C): 4379-4390

  Abstract

  We carried out a systematic review of new drugs active in non-small cell lung carcinoma (NSCLC). Fifty five phase II and III trials were reviewed (vinorelbine (19 trials), paclitaxel (15), gemcitabine (11), docetaxel (6), topotecan (2) or irinotecan (2)). The first four ones could be considered as active drugs when given as single agent. More information is required for the camptothecin derivatives. Four phase III randomised studies were available, all concerning vinorelbine. They showed that in combination with cisplatin, vinorelbine improved the response rate and perhaps survival, in comparison to vinorelbine alone and that vinorelbine was better than 5 fluorouracil and vindesine. A quantitative overview was impracticable, because of too few randomised trials. A qualitative overview was carried out using the European Lung Cancer Working Party score. The overall median quality score was 65.3%. There was no statistically significant difference between the drugs, but there was a positive correlation between the score and the number of patients. There was also an improvement of the quality score in favour of the randomised trials. Some important methodological aspects were often missing in the articles. In conclusion, gemcitabine, vinorelbine, paclitaxel and docetaxel are active against NSCLC but more good-quality data are required to define their exact role in the routine.

  View details for Web of Science ID 000084768200004

  View details for PubMedID 10650780