Characterizing inflammation and fibrosis in Crohn's disease (CD) is necessary to guide clinical management, but distinguishing the two remains challenging. Novel ultrasound (US) techniques: contrast-enhanced US (CEUS) and shear wave elastography (SWE) offer great potential in evaluating disease activity in pediatric patients. Three patients ages 16 to 20 with known CD underwent CEUS and SWE to characterize bowel wall inflammation and fibrosis. Magnetic resonance enterography, endoscopy, or surgical pathology findings are also described when available. The patients' disease activity included acute inflammation, chronic inflammation with stricture formation, and a fibrotic surgical anastomosis without inflammation. CEUS was useful in determining the degree of inflammation, and SWE identified bowel wall fibrosis. Used together these techniques allow for better characterization of the degree of fibrosis and inflammation in bowel strictures. With further validation CEUS and SWE may allow for improved characterization of bowel strictures and disease flares in pediatric patients suffering from CD.

Recent technical advances in neurosonography continue broadening the diagnostic utility, sensitivity, and specificity of ultrasound for detecting intracranial abnormalities bed side. The clinical and functional applications of neurosonography have significantly expanded since the 1980s when transcranial Doppler sonography first allowed anatomic and hemodynamic delineation of the intracranial vessels through the thin temporal skull. In the past few years, contrast-enhanced ultrasonography, elastography, 3D/4D reconstruction tools, and high-resolution microvessel imaging techniques have further enhanced the diagnostic significance of neurosonography. Given these advances, a thorough familiarity with these new techniques and devices is crucial for a successful clinical application allowing improved patient care. It is essential that future neurosonography studies compare these advanced techniques against the current "gold standard" computed tomography and magnetic resonance imaging to assure the accuracy of their diagnostic potential. This review will provide a comprehensive update on currently available advanced neurosonography techniques.

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We describe a case of cavernous transformation of the portal vein missed on initial color Doppler, CTA and MRA, but detected with contrast-enhanced ultrasound technique.

has been reviewed by the Editorial Board and by special expert referees. Although it is judged not acceptable for publication in Obstetrics & Gynecology in its present form, we would be willing to give further consideration to a revised version. If you wish to consider revising your manuscript, you will first need to study carefully the enclosed reports submitted by the referees and editors. Each point raised requires a response, by either revising your manuscript or making a clear and convincing argument as to why no revision is needed. To facilitate our review, we prefer that the cover letter include the comments made by the reviewers and the editor followed by your response. The revised manuscript should indicate the position of all changes made. We suggest that you use the "track changes" feature in your word processing software to do so (rather than strikethrough or underline formatting).

CEUS is a valuable bedside technique for use in the pediatric population to evaluate focal lesions in various organs, and will allow for safe, more efficient diagnostic imaging. What is Known: • CEUS offers many advantages over CT and MRI and is underutilized in the United States. • It is only FDA approved for vesicoureteral reflux and liver in the pediatric population. However, off label uses are well described. What is New: • This pictorial essay describes ultrasound findings and contrast enhancement patterns associated with liver hemangioma, liver telangiectasia, splenic hamartoma, hemorrhagic ovarian cyst, urachal remnant, spinning top urethras, and kaposiform hemangioendothelioma. • We demonstrate the utility of CEUS in expanding the diagnostic potential of conventional ultrasound.

IntroductionHIV rates in Baltimore City are among the highest in the United States, with the majority of new infections attributed to male-to-male sexual contact. In 2016, the Baltimore City Health Department (BCHD) implemented a Pre-Exposure Prophylaxis (PrEP) program at their sexually transmitted diseases (STD) clinics. We assessed awareness, interest, and sources of knowledge about PrEP among patients served at these clinics. MethodsWe surveyed a convenience sample of 1675 patients who attended BCHD clinics between 4/12/2016 and 10/3/2016. Participants were provided a self-administered survey that assessed awareness, interest, and sources of knowledge about PrEP, as well as age, race, sex, and sexual preference. Univariate and multivariable logistic regression analysis examined predictors of awareness and interest. Data collection will continue in 2017 to determine if awareness and interest change over time. ResultsMean age of participants was 32.1 (SD=11.8) and 61.0% were male. 91.1% of participants self-identified as African American, 5.7% as white, and 3.2% as “Other.” 20.0% of the participants were aware of PrEP and 42.2% were interested in PrEP. Less than 1% of all participants and 9.2% of men who have sex with men (MSM) reported current PrEP use. White participants were more likely to be aware of PrEP than African Americans (OR=1.76, p=0.026), but there was no significant difference in interest between these groups (p=0.122). By univariate analysis men were more likely to be aware of PrEP than women (OR=1.38, p=0.013), but multivariable analysis eliminated this significant difference (p=0.081). MSM were significantly more likely to be aware (OR=14.29, p<0.001) and interested (OR=1.59, p=0.024) in PrEP. Sources of knowledge included healthcare providers (40.0%), friends (24.7%), and television (16.4%). ConclusionMSM receiving care at the Baltimore City STD Clinics are significantly more likely to be aware and interested in PrEP, but few are taking PrEP, highlighting a need to improve access and promote uptake in this high risk population.

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