EFSUMB Newsletter
European Federation of Societies for Ultrasound in Medicine and Biology
How good are we at first-trimester prevention and prediction of early fetal growth restriction? A series of recent publications have shown that early preeclampsia can be successfully predicted in the first trimester using a combination of maternal, biophysical and biochemical factors [1 – 4], and administration of low-dose aspirin to women identified as high-risk can reduce the development of preterm preeclampsia by about 60 % [5]. Given that abnormal placentation and placental insufficiency are commons pathway to many cases of preeclampsia and fetal growth restriction (FGR), we intuitively use the same strategies to predict and prevent FGR. However, are we as successful in FGR as we are in preeclampsia?
A variety of definitions In contrast to preeclampsia, which is a clearly defined condition, multiple terms describe suboptimal fetal growth, and two of them, i. e. small for gestational age (SGA) and FGR, are often used interchangeably. This happens despite the two being two different conditions. SGA merely signifies a fetus (or a neonate) that is smaller than a given centile (usually the 10 th ), whereas FGR involves the failure of the fetus to reach its developmental potential, and it normally refers to a small fetus with some evidence of hypoxia. Therefore, one might say that FGR is a subset of SGA, and this is the case most of the times, but not always. A growth-restricted fetus can be non-SGA (i. e. > 10th centile for estimated weight or abdominal circumference) and still be FGR, if its growth potential was meant to be higher. This reality has been acknowledged by the recent consensus definition for FGR, which introduces the option of a fetus crossing centiles, even if its eventual centile is > 10 th [6]. Despite this development, different definitions have traditionally been used in the existing
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studies, even within the terms SGA and FGR (different cutoffs, Doppler parameters, pre- or postnatal weight etc), adding to the heterogeneity of the literature.
Targeting small fetuses Prediction of FGR (or SGA) has been pursued along that of preeclampsia, and it was early acknowledged that the yield of screening models is higher when FGR coexists with preeclampsia rather than when it is an isolated condition. Four years ago, the Fetal Medicine Foundation (FMF) developed a dedicated screening algorithm targeting SGA, and they reported that, by combining maternal, biochemical and biophysical factors, about 50 % of SGA can be predicted for a 10 % false positive rate [7]. However, is this the case?
Prediction of small fetuses through preeclampsiaoriented screening What happens in practice is that we screen for preeclampsia, we treat screen-positive cases aiming to prevent preeclampsia, and along the way we predict some of the FGR cases and prevent a subgroup of them. This is beautifully illustrated in a recent publication by the FMF, where data from the SPREE study (which is a screening study) were combined with data of the ASPRE trial (which is an interventional study) to show, among else, what happens with SGA when we screen and treat for preeclampsia. What this study found is that, by screening for preeclampsia, and using a cut-off of 1:100 for preeclampsia, we can predict 31 % of neonates with birth weight < 10 th centile requiring delivery
before 37 weeks, and 35 % of such babies requiring delivery before 32 weeks [1]. Of course, the prediction rates significantly increased for small neonates with coexisting preeclampsia, but this is a different group whatsoever. Focusing on even smaller neonates (birthweight < 3 rd centile) in the absence of preeclampsia, this screening strategy can predict about 40 % of those requiring delivery before 37 or 32 weeks [1]. So, in practice, screening for preeclampsia with a 10 % screen-positive rate (which is where 1:100 corresponds to) can predict about 35 – 40 % of the small and very small fetuses requiring early delivery.
Prevention of small fetuses through preeclampsiaoriented screening Administration of prophylactic aspirin to these screen-positive (for preeclampsia) cases, will significantly reduce the risk for small neonates with preeclampsia, but will only reduce the risk for the subgroup of such neonates without preeclampsia that require delivery before 32 weeks, by about 60 %. Of course this is quite an important group in terms of morbidity, but it only comprises about 0.25 % of the population [1].
A synopsis… It appears thus that combined first-trimester screening for preeclampsia can predict about 40 % of the subgroup of small fetuses who will need a preterm delivery. Prophylactic aspirin in screen-positive cases will reduce the risk for the small but clinically important group of very preterm (< 32 weeks) small fetuses by about 60 %.
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…and some more unanswered questions There are yet more unanswered questions, including the possible role of maternal hemodynamics as part of a combined screening, or the ability of the fetal fraction of cell-free DNA in the maternal blood to act as an independent predictor. And, of course, there is the issue with twins. There is an ongoing debate whether twin-specific growth charts should be used, or charts of singleton are applicable as well, so problems like this need to be solved before aiming at screening. Dr Alexandros Sotiriadis Dr Konstantinos Dinas Second Department of Obstetrics and Gynecology Faculty of Medicine, Aristotle University of Thessaloniki, Greece
References [1] Tan MY, Poon LC, Rolnik DL et al. Prediction and prevention of small-for-gestational-age neonates: evidence from SPREE and ASPRE. Ultrasound Obstet Gynecol 2018 [2] Tan MY, Wright D, Syngelaki A et al. Comparison of diagnostic accuracy of early screening for pre-eclampsia by NICE guidelines and a method combining maternal factors and biomarkers: results of SPREE. Ultrasound Obstet Gynecol 2018
[5] Rolnik DL, Wright D, Poon LC et al. Aspirin versus Placebo in Pregnancies at High Risk for Preterm Preeclampsia. N Engl J Med 2017 [6] Gordijn SJ, Beune IM, Thilaganathan B et al. Consensus definition of fetal growth restriction: a Delphi procedure. Ultrasound Obstet Gynecol 2016; 48: 333 – 339 [7] Poon LC, Syngelaki A, Akolekar R et al. Combined screening for preeclampsia and small for gestational age at 11–13 weeks. Fetal Diagn Ther 2013; 33: 16 – 27
[3] O’Gorman N, Wright D, Poon LC et al. Multicenter screening for preeclampsia by maternal factors and biomarkers at 11–13 weeks’ gestation: comparison to NICE guidelines and ACOG recommendations. Ultrasound Obstet Gynecol 2017 [4] O’Gorman N, Wright D, Poon LC et al. Accuracy of competing risks model in screening for pre-eclampsia by maternal factors and biomarkers at 11–13 weeks’ gestation. Ultrasound Obstet Gynecol 2017
EUROSON 2018 Poznan, Poland – a short overview On the occasion of the 30th EUROSON Congress in Poznan Poland the EFSUMB Past Presidents were invited to share in a history of ultrasound session. Not all were able to be present and it is with sadness that we report the recent death of Francis Weill who was not only EFSUMB President in 1984 – 1987 but also WFUMB President in 1988. We enjoyed presentations from PP 11 Harald Lutz on the History of US in Germany East and West, PP 10 Sturla Eik-Nes on the Scandinavian Perspective, PP 9 Luigi Bolondi who talked about 3 EFSUMB Presidents and 2 EUROSONs all from Bologna! PP 6 David Evans gave a very short history of the Doppler effect and PP 4 Christian Nolsoe talked about the Interventional Ultrasound Pioneers in Europe. PP 2 Christoph F Dietrich introduced the session with PP1 Odd Helge GIlja and plans are afoot to preserve this history. THe EUROSON Congress in Poznan, Poland was a great success of EFSUMB and Polish colleagues, especially Dr. Wojciech Kosiak, Polish and Congress Joint President. One of the most prominent features of the meeting was a young and active participant profile. Among them was a Turkish young man Hadi Ozer (aged 91), the founder of the
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Profs Dietrich, Bolondi, Jäger, Eik-Nes, Gilja, Evans, Lutz and Nolsoe (l to r).
Turkish Ultrasound Society, who lectured on the development of ultrasound in Turkey and the USA in a special history session. He had worked with some of the pioneers of ultrasound, during his fellowship in Philadelphia, in 1963, almost 55 years ago. The day he first used ultrasound was unforget-
table not only because of this event but by the coincidence of Kennedy assasination. Later, in 1970, he worked together with Dr. Edward H. Smith, as an assistant Prof. of Radiology, in Harvard and with Dr. Hans Henrik Holm from Herlev Hospital, Copenhagen, Denmark.
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Prof. Hadi Özer, founder of The Turkish US Society, is together with the current (Prof. Mustafa Seçil-on his right), and the past presidents (Prof. Adnan Kabaalioğlu and Prof. S. Süreyya Özbek-on his left side) of the Society. Prof. Suna Ö. Oktar (on the far left) is also a member of the Executive Committee of TUDS.
He founded theTurkish US Society in 1985, with his colleagues. The Society has long a tradition of a maximum of 4 years of Presidency. The EFSUMB Young Investigator Session was an exciting competition with diverse presentations. The EFSUMB Best Published Paper (500 euro) was won by Ben Stendberg (UK) for the paper published in Eur Radiol (2017) 27:4525 – 4531 entitled “The prevalence and significance of renal perfusion defects in early kidney transplants quantified using 3 D contrast enhanced ultrasound (CEUS).”
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(from left to right) Romania, Norway, Italy, Netherlands, UK and Turkey (the Polish student not photographed). The winner (with 3000 euro in prize money) in this close competition was Marcia Costa (UK) for her talk on ‘Combined focused ultrasound and radiotherapy for the treatment of hypoxic tumours, using photoacoustic imaging as planning tool.’
The Walter Kreinitz 500 euro prize for the best oncological abstract submitted to the EUROSON congress was won by Shaoshan Tang (China) with the abstract “Value of Contrast-enhanced Ultrasound in Diagnosis and Differential Diagnosis of Apophysis Lesions of the Gallbladder > 1 cm”
Congratulations to Prof Wojciech Kosiak and his team (and of course Dr Mateusz Kosiak for his entertaining review of medical dramas) for the vision and enthusiasm to create a memorable congress with 1400 participants from around the world. Visit the efsumb.org website to see more images.
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Please visit efsumb.org to view the Euroson School programmes
EFSUMB/WFUMB Webinar on Paediatric CEUS 30 October 2018 17.00 CET
Paul Humphries Chair Kasse Darge (USA): Paediatric CEUS Annamaria Deganello (UK): CEUS in Paediatric Trauma Doris Franke (Germany): CEUS in Paediatric Liver Indications
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EFSUMB Webinar – Ultimate Ultrasound Solution for Breast 8 November 2018 18.00 CET
D.A. Clevert Chair Karen Kinkel (Switzerland): New improvements in 2 D breast Imaging Richard Barr (USA): Comprehensive breast elastography Nicholas Bloch (USA): Anatomical Intelligence for Breast, a new assistant in confident breast scanning
EFSUMB’s next congress Registration fees
Important dates 15 October 2018 – Opening for abstract submission 28 November 2018 – Deadline for Very Early Registrations 5 March 2019 – Deadline for abstract submission 5 April 2019 – Notification to the authors 23 April 2019 – Deadline for registration of authors with accepted abstracts. Website www.euroson2019.com is now open.
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The 17th World Federation for Ultrasound in Medicine and Biology Congress 2019 hosted by the Australasian Society for Ultrasound in Medicine
6 – 9 September 2019 Melbourne Convention & Exhibition Centre Melbourne, Australia
Congress Information
CALL FOR ABSTRACTS Oral and poster abstracts are invited for the 17th World Federation for Ultrasound in Medicine and Biology Congress being held from the 6-9 September 2019 at the Melbourne Convention and Exhibition Centre, Melbourne, Australia. Abstracts must be submitted and completed online by Friday 1 March 2019. Abstracts are invited for the following sessions to be covered in the program: Breast Cardiac Critical Care Education Emergency Medicine General Gynaecology Musculoskeletal (MSK)
Obstetrics Physics Point of Care Ultrasound (PoCUS) Professional Practices Rheumatology Therapy Vascular
Abstracts will be reviewed by a Scientific Committee and submitters will receive a notification regarding the outcome of their submission by the end of April 2019.
ABSTRACT SUBMISSION PORTAL
Submission Guidelines • Whilst you can come back to your submission/s at any time (before the submission deadline ends), once you are finished with entering all details, please ensure you proceed all the way to the end to COMPLETE your submission. Otherwise your abstract will not be reviewed. • Amendments can be made to your abstract until the submission deadline. Simply log into your Currinda profile, select the abstract to amend and navigate through the top tabs to the sections you wish to change. • An automatic acknowledgement email will be sent once your abstract submission is complete. • Please note that the title must not be written in all caps, but in sentence case only. • Abstracts must: • Be typed straight into the text field in Currinda. It is recommended that authors have this text ready to copy and paste (ensuring that no formatting carries across) • Not exceed 400 words, excluding the title, authors and institutions • Sub-headings, e.g. Introduction, Method, Results, etc., may be included if required
Information for the contributors to the Scientific Program • All papers and posters require an abstract • Presentations will have electronic PowerPoint support • A 50 to 100 word curriculum vitae (CV) is required from each presenter to facilitate the chair’s introduction and to display on the Congress app • A headshot will be required from each presentation to display on the Congress app • The timing (presentation and discussion) of all papers is to be set at the discretion of the Convenor of each symposium. Notification of the timing of presentations will appear in correspondence sent to all successful authors
Information for the contributors to the Poster Program Posters will be displayed using a digital poster system throughout the meeting. Details on uploading posters will be distributed after authors have been notified of the outcome of their abstract.
• Show one presenting author only by ticking the appropriate box • Include the first name, surname and affiliation (institution) of all authors separately
Design of posters General
• Include superscript numbers for any references listed
• Keep it simple! Keep it clear!
• Have a title that is less than 20 words. The title should be brief and explicit
• Inform and interest the viewer
• Use abbreviations only for common terms. For uncommon terms, the abbreviation should be given in brackets after the first full use of the word
• Single 16:9 PowerPoint slide.
• Nominate the abstract for either an oral or poster presentation. Authors will be asked to nominate if a poster is to be offered in the case that an oral presentation position is not available. Only one option will be offered by the Scientific Committee per abstract. Please note that the submitting author (if different to the presenting author!) will be the one linked to the abstract and will receive all relevant information via email. It is the submitting author’s exclusive responsibility to ensure that all emails to do with the abstract are passed on to the presenting author, and any other relevant parties.
• Use short titles and captions
Photographs Photographs need: • Good contrast • Sharp focus • A scale to indicate size • Clear caption set horizontally.
For all enquires please contact: WFUMB 2019 Congress Secretariat c/- The Association Specialists T: +61 2 9431 8600 E: asum@theassociationspecialists.com.au
WWW.WFUMB2019.ORG