The following article was written by Elissa Price, M.D., a specialist in Breast Imaging at UCSF Medical Center at Mount Zion.

An article entitled ‘Tipping the Balance of Benefits and Harms to Favor Screening Mammography Starting at Age 40 Years’ was published in this May’s edition of the Annals of Internal Medicine.  The article addresses the highly controversial issue of breast cancer screening with mammography in women under 50.  Using complex mathematical models, the authors suggest that only high-risk women aged 40-49 should undergo screening mammography, and only every other year.  Although interesting, even the authors acknowledge the study does not refute two critical points:

1. Screening mammography reduces breast cancer mortality rates (in randomized trials and nationwide screening programs)

2.  Screening women in their 40s results in a 15% mortality reduction (according to a meta-analysis of 8 individual trials)

In other words, mammography saves lives in women aged 40-49.

As per the teachings of Sun Tzu, let us not underestimate our foe. In 2012, approximately 39,000 American women in the 40-49 age group will be diagnosed with invasive breast cancer.  Over 4,000 American women aged 40-49 will die of breast cancer this year alone — 4000 of our mothers, sisters, daughters and friends.

As suggested by its title, this study assesses benefits and harms of screening mammography – the authors’ definitions of ‘benefit’ and ‘harm’. “We defined harm as the number of false-positive results and benefits as the number of breast cancer deaths averted and number of life-years gained.” By comparing a false positive mammogram to a death averted, the study implies that these outcomes are somehow similar in value.  This demonstrates a huge philosophical difference between the study and our Institution.  Although the distress caused by a false positive mammogram is real, UCSF Breast Imaging believes that averting the death of a mother, daughter, sister or friend far outweighs that distress.

The study also suggests only high-risk women aged 40-49 should be screened.  However, 75-90 percent of breast cancer is diagnosed in women without risk factors.  Therefore, such risk-based screening would mean the vast majority of women who will develop cancer would not be afforded the potential benefit of early detection by screening mammography.  Furthermore, the study defines sufficient risk factors as a first-degree relative with breast cancer, or dense breast tissue on mammography.  The idea of using breast density, a mammographic characteristic, as a criterion for whether or not a woman should undergo mammography is circular logic at best.

The study also fails to adequately address a scientifically-accepted fact: young women are more likely to have aggressive, rapidly-growing breast cancers.  While the authors acknowledge the multiple studies supporting this fact, they continue to recommend biannual screening in the high risk group.  These fast-growing and rapidly metastasizing cancers are the exact cancers we want to find early – by screening every year, not every other year.

In accordance with American Cancer Society guidelines, UCSF continues to recommend ANNUAL screening mammography in women, beginning at age 40.

The following article was written by Linda L. Chao, Ph.D., Associate Adjunct Professor, Department of Radiology and Biomedical Imaging, UCSF and Henry F. VanBrocklin, Ph.D., Professor in Residence, Department of Radiology and Biomedical Imaging, UCSF

The FDA recently approved Amyvid (Florbetapir-F 18) for use in amyloid imaging in patients being evaluated for Alzheimer’s disease (AD) and other causes of cognitive decline. AD is the most common form of dementia, affecting almost half of the U.S. population over 85. Clinical signs of AD include cognitive impairments (particularly memory) and behavioral disturbances. Until recently, the only definitive way of diagnosing AD was by the presence of beta-amyloid plaques and neurofibrillary tangles, pathological hallmarks of the disease, in the brain at autopsy. Although doctors try to diagnose AD by taking the patient’s history and performing physical and mental status exams, 20% of dementia patients diagnosed with AD do not have plaques in their brains, a key component for the neuropathological confirmation of AD, at autopsy

Amyloid imaging basically involves injecting a “dye” that can get into the brain and stick to beta-amyloid plaques. When the “dye” is labeled with a radioactive isotope (such as fluorine 18) and used with a PET scanner, it is possible to see beta-amyloid plaques in a living person’s brain. As expected, amyloid imaging has shown that AD patients have a lot of plaques in their brains, older adults with normal memory function, generally, have little, if any plaques, and individuals with mild memory impairments have intermediate plaque levels.  Consistent with autopsy reports of plaques in the brains of individuals who died of non-AD causes and did not manifest symptoms of AD while they were alive, amyloid imaging has also shown that approximately 20 percent of “cognitively normal” seniors have evidence of plaques in their brains. This suggests that amyloid deposition occurs early in course of AD, beginning prior to the manifestation of disease symptoms. The FDA’s recent approval of Amyvid means that doctors may soon have a reliable way of diagnosing AD in patients with memory complaints while helping to rule out other forms of treatable dementia such as frontal temporal lobe dementia.

Although a large number of AD treatment trials are underway, none have been successful thus far. This has led to the suggestion that AD-modifying therapies may be most beneficial when used early in the disease process, before the onset of significant impairment. Therefore, amyloid imaging may supplement clinical evaluation in selecting patients for future anti-amyloid therapies. Detecting amyloid plaques in the brain may also be useful for determining whether anti-amyloid therapies actually work.

The approval of Amyvid also raises questions such as: How much will the imaging scans cost?  - Potentially $3,000 or more. Who will be able to get the scans? – Any older person concerned about AD. Are the scans worth getting given that there is currently no cure for AD? – It may confirm or rule out other forms of dementia. This is a very important advance that will benefit both patients and scientists.

For addition articles on Alzheimer’s disease, please see here.

The following article was written by Michael W. Weiner, MD, Director of the SFVAMC Center for Imaging of Neurodegenerative Diseases, Principal Investigator of the ADNI, and 2011 recipient of the Ronald and Nancy Reagan Research Award from the Alzheimer’s Association.

In a recent study, published in the March 22 edition of Neuron,  Dr. Ashish Raj and his colleagues at Cornell Weill Medical School in New York using data obtained from my colleagues (from the UCSF Memory and Aging Center and the San Francisco VA Medical Center) reported  a new technique that may be able to predict the physical path of Alzheimer’s disease and other degenerative brain diseases.

This research supports increasing studies and evidence that dementias spread through specific neuronal pathways in the brain, similar to prion diseases as the results were consistent with an emerging concept that brain damage occurs in these neurodegenerative diseases in a diffusive, prion-like propagation.  Prions are infectious, misfolded forms of normal protein that leave destructive amyloid deposits in the brain, causing degeneration and death.

The study’s results suggest that, by using this approach, we may be able to predict the location and course of future brain atrophy in Alzheimer’s, frontotemporal dementia (FTD), and other degenerative brain diseases, based on just one MRI. This would be extremely useful in planning treatment, and in helping patients and families know what to expect as dementia progresses.

To get these results, Dr Raj and coworkers utilized a new MRI computer modeling technique for analyzing brain images to realistically predict the progression of Alzheimer’s disease and FTD. The models were based on an MRI technique that maps the neural pathways, or “communication wires,” that connect different areas of the brain. The spread of disease along those pathways, as predicted by the models, closely matched actual MRI images of brain degeneration in Alzheimer’s patients and FTD patients.

While these results need to be replicated, they are promising for the future treatment of degenerative brain diseases.

For more information on this study, please see here.

The following article was written by Elissa Price, M.D., a specialist in Breast Imaging at UCSF Medical Center at Mount Zion.

A study recently published in the Journal of the National Cancer Institute has received much publicity.  University of Copenhagen researchers looked at 58,000 women who had mammograms between 1991 and 2005.  The study compares risk of developing breast cancer in women who have had a false positive mammogram compared with the risk of developing breast cancer in women who have negative (non-suspicious) mammograms.  A false positive mammogram is one where an abnormality is questioned, and therefore the woman undergoes additional mammographic views and possibly an ultrasound.  For the majority of women in the US, the questioned abnormality is at that point demonstrated to no longer be suspicious, and the woman is recommended to return to screening.  Only a minority of women who get ‘called back’ for additional imaging go on to a minimally-invasive biopsy.

The study reports a 67% increased relative risk of breast cancer in women who have had a false positive mammogram.  Prior studies have shown that women with a history of benign biopsy are at increased risk of cancer, so there may be some truth to the concept that women with a false positive mammogram are at increased risk as well.  However, this study does not prove that assertion, and certainly not if American women are the population in question.  The screening mammography program in Denmark during the study period was extremely different from the recommendations of the American Cancer Society, raising doubts about the applicability of this study to women in the U.S. in 2012.  For example, many women in the Danish study did not receive the 4 mammographic views that are standard for every screening mammogram performed here.  Very importantly, the entire study data set is based on screen-film mammography.  This technique is used in only a minority of American practices today – the majority use more modern digital mammography. UCSF Department of Radiology and Biomedical Imaging uses exclusively digital mammography.

Perhaps most importantly, the authors concede that the risk found in the earlier years of the study (1994-1998) became statistically insignificant in the later years (2000-2005) – that is, for women screened in the 2000’s, there was not an increased risk in breast cancer in women with false positive studies.  Improving technology was certainly a major contributor to this change.  The study is thus reporting on a risk that perhaps once existed, but may no longer – questioning its relevance to women today.

Nonetheless, this data deepens support for annual screening mammograms.  While false positives may cause anxiety and occasionally potentially unnecessary procedures, it is better for patients to be accurately informed of their risk of breast cancer. At UCSF, we choose to find ways to minimize anxiety through prompt diagnostic work up and steady communication with our patients.

This study sheds further light on the importance of women obtaining mammograms regularly, no matter the result of their prior mammogram.  Women must understand that choosing to screen less frequently or forgo mammography altogether means forgoing some or all of the potentially life-saving benefit.  At UCSF, in accordance with American Cancer Society guidelines, we believe screening mammography should be performed every year in women beginning at age 40.

Mammography saves lives.

To see additional research on breast cancer and false positives, please see here.

The following article was written by Lori Strachowski, M.D., Clinical Professor of Radiology, Director of Women’s Imaging at San Francisco General Hospital, and Medical Director of the Avon Comprehensive Breast Care Center

On Friday April 27^th, from 1-3 pm PST, the Avon Comprehensive Breast Care Center at San Francisco General Hospital (SFGH) will host an open house and ribbon-cutting event to celebrate the mammography van’s new look, thanks to a generous gift by Cummins West and Kevin &  Connie Shanahan! The unadorned, plain white face of the old mammography van, sometimes perceived as stark and uninviting, now displays greater-than-life size photographs of women of various ages representing the diverse patient population that the mammovan serves. The beautiful graphics help convey the SFGH Breast Care Program mission statement of providing “Comprehensive breast care, education and research in a compassionate and culturally sensitive environment.” The event is open to the public, so stop by for a peek and light refreshments. Please, simply RSVP to crichmond@sfghf.net by April 23 if you intend to join us!

The Avon Comprehensive Breast Care Center, made possible by the Avon Foundation Breast Cancer Crusade, is a 4500 square foot facility located at the intersection of 22 Street and Main Campus Drive adjacent to SFGH. The state-of-art facility which opened its doors in July 2004, houses 3 digital mammography units, 2 ultrasound machines for targeted breast ultrasounds and ultrasound guided biopsies, and a prone table for stereotactic core biopsies. Breast MRI exams are performed within the main hospital.  The center currently provides over 11,000 breast imaging studies annually, which represents more than a 70% increase in volume over the past 7 years. The center is open to all San Francisco residents and serves as the “safety net” for all uninsured and underinsured women in San Francisco.

The affectionately named “mammovan” was gifted to the San Francisco General Medical Center and hit the streets in February 2005, after the program was resurrected with a complete digital renovation in 2000 by the UCSF Carol Franc Buck Breast Cancer Center with help from the Gap Foundation. The mammovan currently travels several times a week to the neighboring San Francisco Community Health Network clinics breaking the barriers of transportation, access, and language fluency as interpretation services are “part of the package”. In fact, bilingual navigators are available onsite at the center 5 days a week, assisting Spanish, Mandarin, and Cantonese speaking women with patient questionnaires, while also providing both educational and emotional support. In addition, interpretation for more than 15 languages is provided by SFGH Medical Center Interpreter Services, making everyone feel at home.

Remember, breast cancer is the most common cancer among women and the second most fatal after lung cancer, taking the lives of nearly 40,000 women a year.  Breast cancer survival is linked to early detection and treatment with disparities in mortality rates recognized among the underprivileged and certain minorities.  Despite the current uncertainties and controversies in national screening guidelines, what we do know is that “Mammography screening saves lives” with at least a 30% reduction in deaths due to breast cancer in women who are screened annually.  Here in radiology at SFGH and UCSF, we strongly promote early detection with annual screening mammography for women age 40 and above, and strive to provide unparalleled, high-quality breast screening and diagnostic imaging services to all women.

With the mammovan, all women have access to the breast cancer screening options they need and deserve. Learn more information and spread the word today.

The following article was written by William P. Dillon, M.D., Elizabeth A. Guillaumin Professor of Radiology, Executive Vice Chair of Radiology, and Chief of the Neuroradiology Section at UCSF.

I’ve noticed lately, both in patient inquiry and in the news, confusion about the responsibilities, background, and education of the subset of physicians who specialize in diagnostic imaging – radiologists. At UCSF, radiologists are medical doctors who have completed one year of internship, four years of residency training in diagnostic radiology, and one or more years of sub-specialized training in specific disciplines, such as chest, cardiac, neuroradiology, pediatric, or musculoskeletal imaging. Additionally, every radiologist is “board certified” by the American Board of Radiology and/or the American Osteopathic Board of Radiology and, in many instances, additional subspecialty boards.

At the UCSF Medical Center, UCSF radiologists use the most advanced imaging techniques and imaging technology along with their advanced training and experience to diagnose and treat injury and disease. These radiologists are experts in the proper use of radiologic equipment and protocols, and have studied applications of the latest advances in technology in order to perform and to “read” radiological medical imaging studies of the body to make the best recommendations and decisions for treatment.

For more information on the role of radiologists, as well as the training necessary to join the highly-specialized team at UCSF, please see this video:

The following article was written by Christopher P. Hess, M.D., Ph.D, and Derk Purcell, M.D, Assistant Clinical Professor in the Department of Radiology and Biomedical Imaging at UCSF.

The complexity of the organ that determines how a person thinks, moves, feels, and remembers is overshadowed only by its unique vulnerability. The brain is hidden from direct view by the skull, which not only shields it from injury but also hinders the study of its function in both health and disease. The cells in the arteries that supply the brain are so tightly bound that even most normal cells in the bloodstream are prevented from crossing the so-called “blood-brain barrier,” thereby rendering the normal chemistry of the brain invisible to the routine laboratory blood tests that are often used to evaluate the heart, liver or kidneys.

Computed tomography (CT) and magnetic resonance imaging (MRI) have revolutionized the study of the brain by allowing doctors and researchers to look at the brain noninvasively. These diagnostic imaging techniques have allowed for the first time the noninvasive evaluation of brain structure, allowing doctors to infer causes of abnormal function due to different diseases.
_________________________________________________________________

The answer to which imaging modality is better for imaging the brain is dependent on the purpose of the examination. CT and MRI are complementary techniques, each with its own strengths and weaknesses. The choice of which examination is appropriate depends upon how quickly it is necessary to obtain the scan, what part of the head is being examined, and the age of the patient, among other considerations. All imaging studies that are not performed for research should be obtained in close consultation with a physician. Both techniques are designed to examine specific problems. The utility of “screening” CT or MRI, in which a scan is obtained in a healthy patient without any symptoms to look for a brain tumor or any other condition, has not been established.

The advantages of each modality listed below serve as general guidelines that doctors use to decide between head CT and MRI:

Advantages of head CT

• CT is much faster than MRI, making it the study of choice in cases of trauma and other acute neurological emergencies
• CT can be obtained at considerably less cost than MRI, and is sufficient to exclude many neurological disorders
• CT is less sensitive to patient motion during the examination. because the imaging can be performed much more rapidly
• CT may be easier to perform in claustrophobic or very heavy patients
• CT provides detailed evaluation of cortical bone
• CT allows accurate detection of calcification and metal foreign bodies
• CT can be performed at no risk to the patient with implantable medical devices, such as cardiac pacemakers, ferromagnetic vascular clips, and nerve stimulators

Advantages of head MRI

• MRI does not use ionizing radiation, and is thus preferred over CT in children and patients requiring multiple imaging examinations
• MRI has a much greater range of available soft tissue contrast, depicts anatomy in greater detail, and is more sensitive and specific for abnormalities within the brain itself
• MRI scanning can be performed in any imaging plane without having to physically move the patient
• MRI contrast agents have a considerably smaller risk of causing potentially lethal allergic reaction
• MRI allows the evaluation of structures that may be obscured by artifacts from bone in CT images

For more information on specific situations in which CT or MRI may be preferred, please see here.

The following article was written by Michael Lu, M.D., UCSF Radiology Resident.

We recently published a study confirming that healthcare information technology can effectively curb imaging utilization.  The results from the study, “Reducing the Rate of Repeat Imaging: Import of Outside Images to PACS” appear in the March issue of the American Journal of Roentgenology.

Many of our patients have had a previous imaging workup (e.g. CTs, MRIs, etc.) performed at other institutions.  Access to these diagnostic images is critical for clinical decision making.  Typically, patients bring their images on compact discs (CDs).  However, these CDs are easily lost or damaged. Due to limitations of CD-ROM drive speed and size of the studies (often hundreds of megabytes), viewing the CD can be cumbersome and consume a large portion of the clinic visit.  In extreme cases, the CD is not compatible with the clinic computer and cannot be viewed at all.  For these reasons, patients are sometimes re-scanned, which exposes the patient to unnecessary radiation, cost, and delay to treatment.

At UCSF, our solution is to upload these outside CDs to our hospital computer system, so that they are available to all of our physicians with a fast, familiar interface.  We call the upload process “importing” because it requires multiple checks to confirm that the images go to the correct patient record.  We call the radiology computer system “PACS (Picture Archiving and Communications System)”.

In our study, we found that patients who imported their CDs to PACS were nearly five times less likely to have repeat imaging than patients who did not.  This effect persisted after controlling for potential confounders including extent of disease and location of referring hospital.  These findings suggest that importing outside imaging to PACS can effectively reduce repeat imaging.

Patients come to UCSF because of the recognized experience of our surgeons, oncologists, and other clinical specialists.  What is less well-recognized, though equally important, is the expertise of the other physicians who work behind the scenes, such as Radiologists and Pathologists.  Uploading the images to PACS allows them to be viewed by all of the physicians involved in the patient’s care.  Upon review of the outside images, it may become clear a second imaging study is necessary to guide treatment.  However, in many cases the imaging that is already available is sufficient.  When the patient returns for surveillance imaging after treatment, having the original images for comparison can be indispensable for differentiating recurrence from benign post-treatment changes.

In conclusion, we found that importing outside CDs to PACS reduces repeat imaging.  This is an important example of how information technology can reduce healthcare costs and improve patient care.

For more information and addition details on this research, please see here.

The following article was written by Christopher P. Hess, M.D., Ph.D, and Derk Purcell, M.D, Assistant Clinical Professor in the Department of Radiology and Biomedical Imaging at UCSF.

The complexity of the organ that determines how a person thinks, moves, feels, and remembers is overshadowed only by its unique vulnerability. The brain is hidden from direct view by the skull, which not only shields it from injury but also hinders the study of its function in both health and disease. The cells in the arteries that supply the brain are so tightly bound that even most normal cells in the bloodstream are prevented from crossing the so-called “blood-brain barrier,” thereby rendering the normal chemistry of the brain invisible to the routine laboratory blood tests that are often used to evaluate the heart, liver or kidneys.

Computed tomography (CT) and magnetic resonance imaging (MRI) have revolutionized the study of the brain by allowing doctors and researchers to look at the brain noninvasively. These diagnostic imaging techniques have allowed for the first time the noninvasive evaluation of brain structure, allowing doctors to infer causes of abnormal function due to different diseases.

Selected images from a brain MRI obtained in a normal volunteer, all acquired at the same level through the head. Proton density (PD, top left), T1-weighted (T1, bottom left), T2-weighted (T2, top right), and MR angiography (MRA, bottom right) scans have very different image contrast that reveals specific information about various structures in the brain.

_______________________________

Magnetic resonance imaging relies upon signals derived from water molecules, which comprise between 70% and 80% of the average human brain. This ubiquitous biological molecule has two protons, which by virtue of their positive charge act as small magnets on a subatomic scale. Positioned within the large magnetic field of an MR scanner, typically 30 to 60 thousand times stronger than the magnetic field of the earth, these microscopic magnets collectively produce a tiny net magnetization that can be measured outside of the body and used to generate very high-resolution diagnostic images that reveal information about water molecules in the brain and their local environment.

Protons placed in a magnetic field have the interesting property that they will absorb energy at specific frequencies, and then re-emit the energy at the same frequency. To measure the net magnetization, a coil placed around the head is used to both to generate electromagnetic waves and measure the electromagnetic waves that are emitted from the head in response. Unlike CT, which uses x-rays with very high frequency energy, MRI uses electromagnetic waves in the same portion of the electromagnetic spectrum as broadcast FM radio.

MRI is also a tomographic imaging modality, in that it produces two-dimensional images that consist of individual slices of the brain. Images in MRI need not be acquired transaxially, and the table or scanner does not move to cover different slices in the brain. Rather, images can be obtained in any plane through the head by electronically “steering” the plane of the scan. Precise spatial localization is achieved through a process termed gradient encoding. The switching on and off of these magnetic field gradients are the source of the loud clicking and whirring noises that are heard during an MRI scan. While this process requires more time than CT scanning, imaging can be performed relatively rapidly using modern gradient systems.

Image intensity in MRI depends upon several parameters. These are proton density, which is determined by the relative concentration of water molecules, and T1, T2, and T2* relaxation, which reflect different features of the local environment of individual protons. The degree to which these parameters contribute to overall image intensity is controlled by the application and timing of radiofrequency energy through different pulse sequences.

From here, the interpretation of brain images requires a detailed knowledge of anatomy and a comprehensive understanding of how different diseases affect the brain and its supporting structures. Radiologists are medical doctors who specialize in acquiring and interpreting images, while neuroradiologists focus specifically on imaging of the nervous system. These specialists work together with neurologists, neurosurgeons and primary care physicians to use CT and MRI to diagnose disorders of the brain and understand their significance for patients.

For more information on MRI, please see here. For more information on neuroradiology from the UCSF blog, please see here.

The following article was written by Vickie Feldstein, M.D., Professor of Clinical Radiology in the Department of Radiology and Biomedical Imaging at UCSF.

The University of California, San Francisco has recently announced the plan to open a program at the UCSF Medical Center at Mission Bay dedicated to the care of twin pregnancies. The center, called EMBRACE (Evaluating Multiple Births through Research And CarE), will open in early 2013. This new program, which will provide patient-centered coordinated service over the course of pregnancy, will build on a history of excellence in clinical care and research of twins at UCSF. And, pivotal in this endeavor is the involvement of members of the UCSF Radiology and Biomedical Imaging Department who specialize in obstetric ultrasound.

The number of twin pregnancies is on the rise in the US, due, in part, to the increasing widespread use of assisted fertility techniques. Ultrasound is key in the detection of twins and in the evaluation and management of these pregnancies. In fact, ultrasound is the way in which twins are first recognized, so radiologists who perform these diagnostic imaging exams are often the first to share this news with expectant parents.

With this news comes the awareness of increased risk. Many potential complications, to the mother and to the developing fetuses, are increased in twin pregnancies compared to singleton pregnancies. And, among twin pregnancies, the relative risk of complications depends on whether each fetus is attached to its own placenta (dichorionic) or must share a placenta (monochorionic). Several unique and threatening conditions occur only in monochorionic (MC) gestations. The high risks of MC twin gestations are largely related to the vascular anatomy of the shared placenta and the presence of inter-twin vascular connections.

Careful assessment by ultrasound early in the pregnancy can help determine the likelihood of developing significant MC complications, including twin-twin transfusion syndrome (TTTS). This assessment is an area of interest and expertise among members of the Ultrasound section of the UCSF Department of Radiology. We have a long history of collaboration with the multi-disciplinary, highly regarded team of experts who comprise the UCSF Fetal Treatment Center. Together we are investigating new imaging and surgical techniques for in utero identification, assessment and intervention for these high-risk pregnancies.

Some twin pregnancies need careful obstetric and sonographic monitoring in order to optimize timing of delivery. For others, complications arise that threaten the health of both twins and that necessitate in utero intervention. Identifying and treating these cases is done in conjunction with colleagues from the obstetric, perinatology, genetics, neonatology, pediatric/fetal surgery and social work services. For those in whom a procedure is indicated to improve outcome, faculty members of the Ultrasound section are present in the operating room, guiding entry of a fetoscope or other device into the uterus and monitoring the twins during a potentially life-saving intervention.

Sonography has had a dramatic impact on the obstetric management of twin pregnancies. This is based, in part, on the ability, using prenatal ultrasound, to diagnose complications of monochorionic twinning. All twin pregnancies are at higher risk compared with singleton gestations, but complications compound the difficulties in management dramatically. These challenges are being met with promising solutions at UCSF resulting from collaborative investigations, advances in imaging assessment, including Doppler ultrasound and MR techniques, and in utero treatment options.

For more information on ultrasound at UCSF, please see here.