ULTRASOUND Messages for February, 2001: Re: ??????: Calculation of Risk for Down

Re: ??????: Calculation of Risk for Down
From: DuboseTerryJ@uams.edu
Mon Feb 26 09:46:37 2001

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Just be careful of the "echogenic bowel" when using one of the newer machines that use much higher frequencies. At high frequencies the normal bowel will take on a more echogenic appearance. Dr. Fougner addressed this here last year sometime. the discussion can probably be found with search.
Terry J. DuBose, M.S., RDMS, Assistant Professor Director, Diagnostic Medical Sonography Program CHRP, University of Arkansas for Medical Sciences Little Rock, Arkansas, USA 501-686-6510 http://www.io.com/~dubose/ http://www.uams.edu/CHRP/dmshome.htm http://www.obgyn.net/us/panel/panel.htm
-----Original Message----- From: zalel [mailto:zalel_y@netvision.net.il] Sent: Friday, February 23, 2001 11:01 AM To: Multiple recipients of list ULTRASOUND Subject: ??????: Calculation of Risk for Down
Dear Allen!
I think the combination of hyperechogenic bowel and borderline nuchal fold requires an amniocentesis, regardless the tripple test results .
Best regards
Yaron Zalel, MD

>----- Original Message -----
From: Allen Worrall <jworrall@alaska.net> To: Multiple recipients of list ULTRASOUND <ultrasound@mail.medispecialty.com> Sent: Friday, February 23, 2001 8:11 AM Subject: Calculation of Risk for Down
> I am aware that a negative ultrasound can reduce the risk assigned by a
> triple screen, by about 50%.
>
> What about a patient who has a very low risk Down Triple screen result,
> but one soft marker is found? Can the soft marker likelihood ratio be
> applied to alter the triple screen risk?
>
> Case in point: 35 year old with 4 previous C Sections, triple screen
> risk 1:7600. I found hyperechoic bowel (it seemed to me it was as
> echogenic as bone, but I find this a little subjective), 19weeks
> gestation, nuchal fold 5.4 mm, and a scan was not requested at 11-14
> weeks. On today's scan I found no other anomalies or "soft" markers. (I
> think Dr. Nyberg would consider a nuchal fold of 5 mm or greater as
> significant, Dr. Benacerraf 6 mm or greater).
>
> If we say the nuchal fold was normal (not yet 6 mm or greater):
> hyperechoic bowel has a likelihood ratio of 5.5. If we consider her age
> related a priori risk, it is ~ 1:302 at twenty weeks. Apply the
> likelihood ratio for the hyperechoic bowel and her risk is now ~ 1:56,
> clearly an indication for amniocentesis. Also if we use Dr.
> Benacerraf's scoring system, age 35 and score 1, amniocentesis should be
> recommended.
>
> Or should the 5.5 likelihood ratio be applied to her triple screen risk
> of 1:7600, which would increase her risk to 1:1382,and thus
> amniocentesis not indicated?
>
> I suspect the answer is that the patient should be offered
> amniocentesis, but I would like to see what others think about this.
>
> --
> Joseph A Worrall MD RDMS
> Fairbanks, Alaska
>

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