Re: ??????: Calculation of Risk for Down
From: Ph Coquel (philippe.coquel@wanadoo.fr)
Mon Feb 26 09:58:46 2001
And this is different if you use Acuson, ATL , Siemens or others
--
Ph Coquel, MD
>----- Original Message -----
From: DuboseTerryJ@uams.edu
To: "Multiple recipients of list ULTRASOUND"
<ultrasound@mail.medispecialty.com>
Sent: Monday, February 26, 2001 5:49 PM
Subject: Re: ??????: Calculation of Risk for Down
> 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
> >
