S54 Ultrasound in Medicine and Biology Volume 35, Number 8S, 2009

analysis performed with these 4 features yielded a RTE fibrosis value,and it highly correlated with the fibrosis stage(r�0.751).Conclusions: This quantitative technique would increase the confi-dence in the evaluation of fibrosis progression and will also reduceinterobsever variability. Thus RTE would greatly benefit in the study ofliver fibrosis progression.

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Acoustic Radiation Force Impulse Elastography for theEvaluation of Focal Solid Hepatic Lesions: Preliminary ResultsSeung Hyun Cho, Seoul National University Hospital, KoreaJae Young Lee, Seoul National University Hospital, KoreaSe Hyung Kim, Seoul National University Hospital, KoreaJeong-Min Lee, Seoul National University Hospital, KoreaJoon Koo Han, Seoul National University Hospital, KoreaByung Ihn Choi, Seoul National University Hospital, Korea

Purpose: To investigate usefulness of acoustic radiation force impulse(ARFI) elastography in the evaluation of focal solid hepatic lesions.Materials and Methods: 47 focal hepatic lesions of 41 patients un-derwent ARFI elastography; consisted of 15 hemangiomas, 15 HCCs,14 metastases, and three cholangiocarcinomas. The lesions were clas-sified into three groups: Group I, malignant lesions except HCC (livermetastases and cholangiocarcinomas); Group II, HCC; and group III,hemangiomas. The echogenicity and conspicuity of tumor on ARFIelastography and corresponding B-mode images were analyzed. In 29focal hepatic lesions, shear stiffness was obtained: 11 hemangiomas, 11HCCs, and other 7 malignant lesions.Results: Group 1 tumors (n�17) showed stiffer echogenicity in 13lesions (76%); identical stiffness in two; and softer echogenicity in two.In group 2 tumors (n�15), seven lesions (47%) were stiffer than theliver; the other seven lesions softer; and the remaining one equallystiffer. In group 3 tumors (n�15), six lesions appeared stiffer; the othersix lesions softer; and the remained three equally stiffer. Ten of 13lesions showing unclear margin on B-mode images displayed clearmargin on ARFI elastography. On lesion shear stiffness, in group 1,mean value � SD was 1.93 � 0.77; in group 2, 2.57 � 0.82; and ingroup 3, 1.5 � 0.7 (p�0.012). With a cut-off value of 2, positivepredictive value and specificity for malignancy was 83% and 91%.Conclusion: ARFI elastography showed promise in discriminatingmalignant from benign lesions and improving conspicuity of unclearlymarginated lesions on B mode image.

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Fetal GastroschisisAlan Cameron, Queen Mother’s Maternity Hospital, United Kingdom

Gastroschisis is a defect of the anterior abdominal wall with extrusionof fetal intestine into the amniotic cavity.The incidence of gastroschisis is approximately 1 in 2500-3000 livebirths but the incidence is increasing in many developed countries.The defect in the abdominal wall is usually to the right of the umbilicus.The condition is amenable to prenatal diagnosis as free loops of bowelare seen floating in the amniotic cavity on ultrasound examination.Gastroschisis has an approximate 80-90% detection rate. Gastroschisisis not commonly associated with abnormalities of other organ systemswith the exception of small bowel atresia , which may complicate up to30% cases.Neonatal surgery of the abdominal defect is required in the immediateneonatal period. Some neonates have primary closure but many infantshave a prolonged stay in hospital. The overall mortality is low and thelong term survival is 90%. However some neonates have significantmorbidity including surgical complications,need for total parenteral

nutrition, sepsis and short gut syndrome.

A number of ultrasound predictive factors for poor outcome have beendescribed - these include ultrasound evidence of a dilated stomach,dilatation of the small bowel, thickness of the bowel wall, fetal growthrestriction or increased or decreased amounts of amniotic fluid. Unfor-tunately none of these ultrasound parameters have consistently beencorrelated with adverse outcome.The evidence base for ultrasound risk factors, timing, mode and placeof delivery will be discussed and illustrated by case discussion.

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Meckel Gruber SyndromeMarcos Antonio Velasco, Instituto De Diagnostico Por ImagenMexico, Hospital General S.S.A., Acapulco, Mexico

Meckel gruber syndrome is an autosomal recessive syndrome. It wasfirst described by meckel in 1822 and later by gruber. Nowadays, theprenatal diagnosis is possible even in the first trimester by the identi-fication of an encephalocele and dysplastic enlarged kidneys. Othersabnormalities can be identified including:� Omphalocele� Cardiac anomalies� Agenesis of corpus callosum� Cerebellar hypoplasia� Dandy-walker cyst� Holoprosencephaly� Microcephaly� Mild ventriculomegaly� Spinal dysraphism� Hypotelorism� Microphthalmia or anophthalmia� Cleft lip and palate� Polydactyly� Intrauterine growth retardationMeckel syndromeDefinition: Meckel syndrome is a rare and lethal syndrome character-ized by occipital cephalocele, post-axial polydactyly and dysplasticcystic kidneys. It can be associated with many other conditions, andfibrotic lesion of the liver is one of the most common associations.Synonyms: Dysencephalia splanchnocystica, meckel syndrome.Incidence: Not precisely known, but authors agree that this is a veryrare condition. According to bergsma, the incidence of meckel syn-drome is 0.2: 10,000 live births. Salonen stated that the incidence ofmeckel syndrome at birth varies from 0.07-0.7: 10,000 births. Infinland, the disorder is unusually frequent and reaches 1.1:10,000births. [4] it is also estimated that this syndrome corresponds to 5% ofall neural tube defect s.Etiology: Autosomal recessive inheritance.Recurrence risk: A 25% recurrence risk is involved.

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Fetal Facial and Neck AnomaliesBeryl Benacerraf, WFUMB Councillor, United States

The examination of the face is an important part of the evaluation of theentire fetus although, until recently, images of the face were not part ofthe standard screening ultrasound examination of the fetus.The examination of the face includes the detection of cleft lip andpalate, looking at the upper lip as well as the hard and soft palates. Itis also possible to detect specific facial clefts, such as those associatedwith holoprosencephaly, amniotic band syndrome, and hemifacial mi-crosomia. Other facial defects that are detectable sonographically in-clude hypotelorism, hypertelorism, microopthalmia, micrognathia,maxillary hypoplasia, abnormalities of the fetal sutures and of the fetal

ears.