intracardiac echogenic focus likelihood ratio

Intracardiac echogenic focus [26 – 28] 3–4: Down syndrome: Detail evaluation for other markers of aneuploidy More attention if multiple and right ventricle involved: Echogenic bowel [3, 6, 12, 13, 29] 0.2–1.8: Aneuploidy Intrauterine growth restriction Intrauterine fetal demise Cystic fibrosis Congenital infection (esp. Forest plot of positive likelihood ratio (LR) for echogenic intracardiac foci for detection of Down syndrome. 26. For a sonographically isolated echogenic intracardiac focus, the PPV was 3.7%; sensitivity, 19%; specificity, 95%; likelihood ratio, 4.2; and RR, 4.8 (P = .002). Many translated example sentences containing "intracardiac echogenic focus" – Portuguese-English dictionary and search engine for Portuguese translations. Across 11 studies (51,831 pregnancies, 333 Down syndrome cases), random effects sensitivity and specificity were 26% (95% confidence interval 19, 34) and 95.8% (95% confidence interval 92.2, 97.8), respectively, with a positive likelihood ratio of 6.2 (“combined” setting, likelihood ratio 7.0; “isolated” setting, likelihood ratio 5.4). echogenic intracardiac focus. Results: An echogenic intracardiac focus was seen in 147 of the 3,192 karyotypically normal fetuses (4.6%) and 16 of the 53 fetuses with trisomy 21 (30%). An EIF is defined as a small (<6 mm) echogenic area in either cardiac ventricle that is as bright as surrounding bone and visualized in at least two separate planes ( Fig. Themistoklis Dagklis. Combined EIF. View chapter Purchase book. The recent AIUM fetal imaging executive summary states, “An echogenic intracardiac focus is of no importance in the absence of an elevated a priori risk for fetal aneuploidy” Reference Reddy, … ... Echogenic intracardiac focus. Sonographic identification of an echogenic intracardiac focus was associated with a fourfold increased risk of Down syndrome (risk ratio 4.3, 95% confidence interval 1.5–12.3). DATA SOURCES . Echogenic intracardiac focus (EIF) is a small bright spot seen in the baby's heart on an ultrasound exam. If there is more than one bright spot, they are called echogenic foci. RESULTS: An echogenic intracardiac focus was seen in 147 of the 3,192 karyotypically normal fetuses (4.6%) and 16 of the 53 fetuses with trisomy 21 (30%). In their meta-analysis, Smith-Bindman et al. Echogenic intracardiac foci were found in 2223 of 62,111 pregnancies (3.6%), and T21 was diagnosed in 218 pregnancies (0.4%). Ultrasound in Obstetrics & Gynecology, 2008. ICEF was first described by Allan in 1986 as a benign anatomic variant that resolves spontaneously ( 1 ). There were Differences in mean crown–rump length and mean delta nuchal trranslucency between fetuses with and without each of the markers in the chromosomally normal and trisomy 21 fetuses CI = confidence interval. 2005;18:65–66. When an EIF is identified, an experienced provider should perform a detailed fetal anatomic survey and assess for aneuploidy risk factors. Kypros Nicolaides. Isolated echogenic intracardiac focus Overview: An EIF is a common finding, seen in 3-5% of normal fetuses. Therefore the likelihood ratio for aneuploidy associated with this finding is smaller in male than in female fetuses. Likelihood ratio. Sotiriadis A, Makrydimas G, Ioannidis PA. An isolated EIF was not associated with a sta- 22. Echogenic Intracardiac Focus Likelihood ratios of an isolated EIF in mixed, but presumably, high-risk group Bromley 1.4 Nyberg 1.8 Nicolaides 1.0 Echogenic focus Take home message: If isolated in a patients with other normal screening tests (combined screen or NIPT), then the patient’ risk for DS is the same as her pre-ultrasound risk. The positive likelihood ratio was 5.08 (95% confidence interval, 4.04-6.41). An echogenic intracardiac focus (EIF) does not affect health of the baby or how the baby’s heart 5.4. All EIF. Amniocentesis need not be offered to patients who are otherwise at low risk and have an isolated echogenic intracardiac focus. A cardiac echogenic focus does not have histopathologic significance. In our cohort, echogenic intracardiac focus, echogenic bowel, increased nuchal fold thickness, the presence of two (or more) soft markers, and major structural anomalies had a statistically significant positive likelihood ratio for Down syndrome. 96. Isolated EIF. The likelihood ratio is directly related to sensitivity and inversely related to specificity. N. Maiz. Table 2. Shipp TD, Bromley B, Lieberman E, Benacerraf BR. 10.1).EIFs may appear in either cardiac ventricle, although left-sided EIFs are more common, and are thought to represent microcalcifications of … Diagnostic performance of echogenic intracardiac foci for Down syndrome % Sensitivity % Specificity. echogenic intracardiac focus; LR, likelihood ratio eonates with Down syndrome (DS) have a variety of physical features that are potentially detectable by prenatal sonography, including redundant skin on the neck, cardiac abnor-malities, short stature, and gastrointestinal anomalies. Many of these features can be identified in the fetus Borgida AF, Maffeo C, Gianferarri EA, et al. Echogenic intracardiac focus Discrete echogenic spot as bright as bone : 2.8: Pyelectasis Anterior posterior dimension of the renal pelvis >= 4 mm between 16 to 20 weeks' 1.9: Total post-ultrasound likelihood ratio Patient-specific risk for Down syndrome posterior probability The subgroups analysis did not reveal statistically significant differences. Choroid plexus cyst, intracardiac echogenic focus, hyperechogenic bowel and hydronephrosis in screening for trisomy 21 at 11 + 0 to 13 + 6 weeks. Intracardiac echogenic focus As an isolated finding, unlikely to be a marker for trisomy 21. Isolated finding has likelihood ratio of 0.95, thus, in an otherwise low risk pregnancy (i.e. Diagnostic performance of intracardiac echogenic foci for Down syndrome: a meta-analysis. They calculated an average likelihood ratio of 6.2: when the echogenic heart focus was in association with other anomalies, the likelihood ratio was 7.0, and an isolated echogenic heart focus had a likelihood ratio of 5.4. Forest plot of specificity for echogenic intracardiac foci for detection of Down syndrome. While the likelihood ratios associated with the first four are generally less than 2, the likelihood ratios for echogenic bowel, thickened nuchal fold, and ventriculomegaly are all over 5. CONCLUSION: A sonographically isolated echogenic intracardiac focus (no other anomalies or markers noted on a complete genetic sonogram) was associated in our high-risk population with a 4.8-fold (95% CI: 1.8, … An echogenic intracardiac focus has been associated with an increased risk of Down syndrome and trisomy 13 (1), trisomy 18 and monosomy X (2-5). Found in 2% of normal fetuses. There was no significant difference between the two groups in the prevalence of choroid plexus cysts (7.5% vs. 5.0%, P = 0.157). Download : Download high-res image (627KB) Download : Download full-size image; Figure 4. 26. 96. Luciana Duarte. Echogenic intracardiac foci were found in 2223 of 62,111 pregnancies (3.6%), and T21 was diagnosed in 218 pregnancies (0.4%). Multivariate logistic regression correction of RTI showed that the likelihood of EIF was 49 fold higher in pregnant women with RTI than without it (odds ratio [OR] = 49.958, 95% confidence interval [CI], 25.973~96.092, p < 0.05). The overall prevalence of Down syndrome in our study population was 1.6%. A prospective study showed the positive and negative likelihood ratios were 6.3 and 0.75 for echogenic intracardiac foci Reference Aagaard-Tillery, Malone, Nyberg, Porter, Cuckle and Fuchs 7. An intracardiac echogenic focus, or hydronephrosis or hyperechogenic bowel was observed in 75 (32.9%) of the 228 fetuses with trisomy 21 and in 66 (8.3%) of 797 normal fetuses. When each ethnicity was considered separately, the odds ratio of EIF for Down syndrome among Caucasians was 7.24 (95% CI, 2.41–21.76), Hispanics was 1.77 (95% CI, 0.23–13.77), and Asian-Americans was 15.73 (95% CI, 3.01–82.31). The positive likelihood ratio for total cases of a heart echogenic focus and trisomy 21 was 7.25, whereas for an isolated echogenic focus, the positive likelihood ratio was 2.66. Frequency of echogenic intracardiac focus by race/ethnicity in euploid fetuses. After exclusion of cases with major defects the estimated positive LR was 2.8 for intracardiac echogenic focus, 2.7 for short femur, 7.5 for short humerus, 6.1 for echogenic bowel, 1.9 for mild hydronephrosis and 17 for increased nuchal fold. Among fetuses with positive first-trimester combined screening results, the likelihood ratio of trisomy 21 was significantly increased for those with, as compared to without, ICEF (3.5 vs. 0.80, p = 0.012). 13 estimated the likelihood ratio to be 2.8 (95% CI, 1.5–55) based on three publications. 96. We conducted MEDLINE and EMBASE searches (1985 to August 2002) using the key words “intracardiac (echogenic) focus/foci,” “golfballs,” “trisomy 21,” and “Down syndrome.” Hydrops (occasional) Duodenal atresia (after 22 weeks' gestation) To synthesize the accumulated data on the diagnostic performance of intracardiac echogenic foci for Down syndrome, a meta-analysis was performed. J Matern Fetal Neonatal Med. Those that argue isolated echogenic focus is associated with trisomy 21 base their conclusions on likelihood ratios. Assuming a positive likelihood ratio of 6.2, we estimated that the probability of Down syndrome after intracardiac echogenic foci had been detected would be approximately 0.44% in a population with background prevalence of 1:1400, 0.62% in a population with prevalence of 1:1000, and 1.03% in a population with prevalence of 1:600. Results: Echogenic intracardiac foci were found in 2223 of 62,111 pregnancies (3.6%), and T21 was diagnosed in 218 pregnancies (0.4%). The presence of an EIF along with other markers was associated with a statistically significant risk for T21 (positive likelihood ratio [LR], 4.4; 95% confidence interval [CI], 3.2-6.0; P < .05). EIFs are found in about 3–5% of normal pregnancies and cause no health problems. An isolated EIF was not associated with a statistically significant increased risk for T21 in … What Is the Significance of an Echogenic Intracardiac Focus? This is thought to represent mineralization, or small deposits of calcium, in the muscle of the heart. The presence of an EIF along with other markers was associated with a statistically significant risk for T21 (positive likelihood ratio [LR], 4.4; 95% confidence interval [CI], 3.2–6.0; P < .05). Intracardiac echogenic focus (ICEF), a microcalcification localized to the region of the papillary muscle within either or both ventricles of the fetal heart, is a relatively common finding. The positive predictive value (PPV) of an echogenic intracardiac focus in this high-risk population was 9.8%; sensitivity, 30%; specificity, 95%; likelihood ratio, 6.6; and relative risk (RR), 8.2 (P <.001). Obstet Gynecol. 6.2. EICF is found in 1.5-4.0% of pregnancies [ 6 ], but the incidence rate reaches 10-30% in Asian populations [ 7 ]. T his common ultrasound finding is seen in about 1 out of every 20 or 30 pregnancies (~3-5%). <1 in 250 risk from FTS) can be reassured as normal variant and nil further testing is required. The presence of an EIF along with other markers was associated with a statistically significant risk for T21 (positive likelihood ratio [LR], 4.4; 95% confidence interval [CI], 3.2-6.0; P < .05). 7. The positive likelihood ratio and negative likelihood ratio in our cohort are presented in Table 4. The presence of an EIF along with other markers was associated with a statistically significant risk for T21 (positive likelihood ratio [LR], 4.4; 95% confidence interval [CI], 3.2–6.0; P< .05). Pyelectasis. higher prevalence of intracardiac echogenic focus (9.6% vs. 1.5%, P < 0.001), hydronephrosis (17.1% vs. 5.3%, P < 0.001) and hyperechogenic bowel (11.4% vs. 2.4%, P < 0.001) in the trisomy 21 fetuses compared with the normal fetuses. CONCLUSIONS: Fetal EIF is suggested to be associated with maternal RTI during gestation in the present study population. It is usually single and less than 3 mm. it needs to be differentiated from normal papillary muscle which is not as bright as bone and a moderator band which is situated at the ventricular apex. the presence of an echogenic intracardiac focus has to be interpreted in the context of maternal risk factors and other sonographic anomalies Echogenic intracardiac foci EICF is defined as the presence of focal echogenic dots in the papillary muscle of ventricles, which has the same echogenicity as that of bone. Results: Echogenic intracardiac foci were found in 2223 of 62,111 pregnancies (3.6%), and T21 was diagnosed in 218 pregnancies (0.4%). 1995;86:998–1001. However, among fetuses with negative first-trimester combined screening results, the likelihood ratios of trisomy 21 did not differ significantly between those with and without ICEF. often shortened to EIF, a cardiac echogenic focus, or echogenic focus. Echogenic intracardiac focus: a sonographic sign for fetal Down syndrome. Hyperechoic bowel.

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