三维超声成像对先天性子宫畸形的诊断价值

目的 探讨三维超声成像对先天性子宫畸形的诊断价值.方法 对50例疑为先天性子宫畸形患者行二维超声和三维超声检查,结果进行对比分析.结果50例患者中,双子宫6例,不完全型纵隔子宫20例,完全型纵隔子宫8例,双角子宫10例,弓形子宫4例,单角子宫2例,三维超声诊断准确率为100％,二维超声诊断准确率为84％.双子宫三维超声表现为2个独立子宫;纵隔子宫宫底外形基本正常,不完全型纵隔子宫者内膜呈“Y”形,完全型纵隔子宫者内膜呈“V”形;双角子宫宫底中央凹陷,内膜呈“Y”形,但夹角较大;弓形子宫外形正常,宫底部内膜轻微内凹;单角子宫外形呈梭形,内膜呈单角状.结论三维超声冠状面成像能直观、清晰显示子宫宫腔形态结构及宫底外观轮廓,在对先天性子宫畸形的诊断中明显优于二维超声,是一种简便、易行、准确的子宫畸形的诊断方法.     

阴道三维超声在子宫畸形中的诊断价值

目的探讨阴道三维超声诊断子宫畸形的临床价值。方法选取子宫畸形患者120例,均给予阴道二维超声和三维超声检查,比较其经宫腔镜、MRI检查的诊断符合率。结果经宫腔镜确诊为纵隔子宫82例,经MRI确诊为鞍型子宫18例,经宫腔或者腹腔镜确诊为残角子宫12例,经MRI确诊为双角子宫8例。120例确诊患者中,二维超声诊断符合率为79.17%,三维超声为90.83%,两者比较差异有统计学意义(P0.05)。结论阴道三维超声检查能显示不同子宫畸形的宫腔结构、宫底外观形态,临床诊断子宫畸形符合率较高,可推荐临床应用。     

经阴道实时三维超声VCI-C成像对先天性子宫畸形的诊断价值

目的 评价经阴道实时三维超声VCI-C成像对子宫畸形的诊断价值.方法 对26例可疑先天性子宫畸形的患者分别行经阴道二维及实时三维超声扫查,并与宫腔镜和/或腹腔镜、子宫输卵管碘油造影、手术等结果进行对照.结果 26例患者中,双子宫4例,双角子宫6例,完全纵隔子宫3例,不全纵隔子宫10例,单角子宫3例.结论 经阴道实时三维超声VCI-C成像可直观、准确地显示子宫冠状面及宫腔内膜形态,是一种较便捷诊断子宫畸形的方法.     

经阴道三维超声在纵隔子宫合并妊娠中的应用价值

目的探讨经阴道三维超声在纵隔子宫合并妊娠中的应用价值。方法应用经阴道三维超声获得26例纵隔子宫合并妊娠的子宫冠状切面,观察宫底及宫腔形态。结果26例纵隔子宫合并妊娠患者,不完全纵隔合并妊娠22例,完全纵隔合并妊娠4例;其中10例显示正常早孕声像,8例显示早孕合并宫腔积液,8例显示胚胎停育或稽留流产。合并肌瘤5例。结论经阴道三维超声的冠状面可以清晰显示宫底及宫腔形态,对纵隔子宫合并妊娠有重要的诊断价值,是保胎治疗及人工流产术成功的关键。     

经阴道二维超声与三维超声诊断与鉴别诊断纵隔子宫的对比研究

目的 探讨经阴道二维超声与三维超声诊断与鉴别诊断纵隔子宫的价值.方法 回顾性分析62例经手术、宫腔镜、碘油造影证实的纵隔子宫的二维、三维超声图像并对其诊断符合率进行对比分析.结果 经阴道三维超声诊断纵隔子宫符合率98.4％ (61/62),经阴道二维超声诊断纵隔子宫符合率85.5％ (53/62).结论 经阴道三维超声冠状切面成像,可以清晰显示宫腔内膜形态,可以得到纵隔子宫畸形的准确信息,对于临床少见复杂的、疑难的子宫纵隔能够准确诊断,可为临床选择处理方式提供有价值的信息,经阴道三维超声较二维超声有无可比拟的优越性及显著的临床意义.     

不全纵隔子宫与弓形子宫的三维超声鉴别诊断

目的 探讨不全纵隔子宫与弓形子宫的三维超声鉴别特点.方法 对宫、腹腔镜确诊为不全纵隔子宫和弓形子宫的各50例患者行二维及三维超声多平面成像,分析二者的声像图特点及鉴别要点.结果 二维超声显示42例不全纵隔子宫患者双侧宫腔间见肌层分隔低回声,38例弓形子宫患者宫底部内膜显示不连续,宫底部中央区增厚的肌层向宫腔突出.三维超声显示50例不全纵隔子宫患者可见两侧内膜在子宫下部相互融合,呈“Y”形,夹角深度＞ 10mm,两侧内膜夹角＜ 90°;50例弓状子宫患者宫底处内膜呈浅“V”形,夹角深度＜10mm,两侧内膜夹角＞90°.二维超声诊断不全纵隔子宫和弓形子宫的符合率分别为84％和76％,三维超声诊断不全纵隔子宫和弓形子宫的符合率均为100％,二者比较差异有统计学意义(P＜0.05).结论 三维超声冠状面可清晰显示子宫宫腔结构和外观形态,并可直观显示不全纵隔子宫和弓形子宫的纵隔长度及两侧内膜夹角,对二者的诊断较二维超声更具优势.     

经阴道三维超声自由解剖成像对先天性子宫畸形的诊断价值及图像分析

目的总结先天性子宫畸形经阴道三维超声自由解剖(Omni View)成像图像特征。方法对2012年9月至2013年7月在重庆市渝北区中医院就诊二维超声显示子宫畸形的36例患者行经阴道三维超声扫查,利用Omni View成像获取子宫冠状切面声像图,观察子宫外形,宫腔形态,宫颈管形态,并对子宫底部凹陷深度进行测量,与子宫输卵管碘油造影、宫腔镜、宫腔镜联合腹腔镜手术或磁共振检查结果对照,总结经阴道三维超声Omni View成像图像特征及应用价值。结果 36例患者经阴道三维超声检查诊断为不完全纵隔子宫16例,完全纵隔子宫5例,弓形子宫5例,双角子宫4例,双子宫4例,单角子宫2例。与临床手术或磁共振诊断均符合(36/36)。36例患者子宫畸形Omni View成像图像特征:(1)纵隔子宫21例,子宫冠状切面声像图示12例宫底肌层稍向外凸,9例子宫底肌层轻微凹陷,凹陷深度均≤1.0 cm,平均深度(0.5±0.3)cm;子宫内膜中央均见低回声分隔将子宫内膜分为左右对称的两部分,分隔从子宫底部向宫颈方向延伸;其中不完全纵隔子宫16例,分隔未达宫颈内口,内膜呈"Y"字形,完全纵隔子宫5例,分隔达宫颈内口,内膜呈"V"字形。(2)弓形子宫5例,子宫冠状切面声像图示2例宫底肌层平坦,2例宫底肌层稍向外凸,1例子宫底内膜轻微凹陷,凹陷深度约0.4 cm;5例子宫底中央部内膜均呈弧形凹陷,内膜凹陷深度均≤1.0 cm,平均深度(0.7±0.2)cm。(3)双角子宫4例,子宫冠状切面声像图示子宫底部横径均明显增宽,宫底外缘明显凹陷呈分开的两个子宫角,子宫外形呈"Y"字形,凹陷深度均>1.0 cm(分别为1.7 cm和2.3 cm,2.6 cm和2.8 cm);两侧子宫角内均可见子宫内膜回声,双侧分开的子宫内膜汇合于子宫中下段至宫颈内口处,子宫内膜亦呈"Y"字形。(4)双子宫4例,子宫冠状切面声像图均显示2个完整的子宫体和子宫颈,有各自完整的子宫壁和子宫内膜。(5)单角子宫2例,子宫轮廓偏小,呈梭形,宫底横径较小,1例子宫内膜呈"香蕉"形,1例内膜呈管状。结论经阴道三维超声Omni View成像可在二维超声基础上获取满意的子宫冠状切面超声图像而清晰显示子宫外形和宫腔形态,并可准确测量子宫底凹陷深度,可为先天性子宫畸形分型诊断和鉴别诊断提供更多诊断信息。     

三维超声诊断先天性子宫畸形的价值

目的 探讨三维超声诊断先天性子宫畸形的临床价值.方法 对二维超声检查提示或临床疑有先天性子宫畸形的19例患者,进行三维超声检查.以宫腔镜或腹腔镜检查结果为金标准,评价二维超声和三维超声的敏感性和准确性. 结果二维超声和三维超声诊断先天性子宫畸形的敏感性、准确性分别为78.9%、57.9%和100%、100%,三维超声明显优于二维超声.结论 三维超声简便、有效、无创,对先天性子宫畸形的诊断具有较高的敏感性和准确性.     

三维经阴道超声在先天性子宫畸形中的诊断价值

先天性子宫畸形为形成子宫段副中肾管发育及融合异常所致,是造成临床妇女不孕、不良妊娠及产科并发症的主要因素之一[1-2]。常见的子宫畸形有双子宫、双角子宫、单角子宫、纵隔子宫、残角子宫、弓形子宫,常规二维超声因不能显示子宫及宫腔的冠状切面,易漏诊或误诊。近年来,随着经阴道超声在临床的应用和发展[3],尤其是经阴道三维超声子宫冠状面成像可提供     

经阴道三维超声诊断子宫畸形

目的 探讨经阴道三维超声成像诊断子宫畸形的应用价值.方法 对可疑子宫畸形的病例行经阴道二维扫查及经阴道三维成像,并对两者结果 进行分析.结果 132例明确诊断子宫畸形的病例中,仅利用经阴道二维能明确诊断的有56例,行三维后明确诊断的有76例.结论 经阴道三维超声对子宫畸形诊断具有重要价值,弥补了以往二维超声难以获取冠状面信息的不足.     

经阴道三维超声诊断子宫发育异常的准确性及可重复性

目的 评价经阴道三维超声(TV3DUS)诊断子宫发育异常的价值及测量宫腔的可重复性。方法 随机选择接受TV3DUS检查的30例子宫正常及49例子宫发育异常的患者进行分析,测量其中39例发育异常子宫的宫腔底部宽度、宫底内膜面向宫腔凸起高度或纵隔长度、宫腔长度。由2名医师在双盲情况下分别独立完成图像的分析、测量和诊断,对诊断结果和测量数据进行一致性检验。结果 2名医师诊断子宫发育异常具有高度一致性(Kappa=0.932,P<0.01)。对39例发育异常子宫宫腔径线的测量结果显示,观察者内及观察者间均有高度一致性,组内相关系数均高于0.8。结论 TV3DUS可准确诊断子宫发育异常,其测量宫腔径线的可重复性良好。     

Reproducibility of three-dimensional ultrasound diagnosis of congenital uterine anomalies.

OBJECTIVE: To examine the reproducibility of the diagnosis of congenital uterine anomalies and the repeatability of measurements of uterine cavity dimensions using three-dimensional (3D) ultrasound. METHODS: The reproducibility of diagnosis of congenital uterine anomalies was examined by re-slicing stored 3D ultrasound volumes. Each data set was evaluated by two independent observers. Assessment of uterine morphology was performed in a standardized plane, with the interstitial portions of the Fallopian tubes used as reference points. Additionally, in 35 cases of congenital uterine anomalies the width of the uterine cavity (W), fundal distortion (F) and the length of unaffected uterine cavity (C) were measured. Intraobserver and interobserver variabilities were evaluated by each observer performing all three measurements twice. RESULTS: Eighty-three 3D ultrasound volumes were examined. Both operators classified 27 uteri as normal, 33 as arcuate, 19 as subseptate and three as unicornuate. A single case of uterine anomaly was described as arcuate uterus by one operator and subseptate by another (kappa 0.97). The intraobserver variability for each of the three measurements (W, F and C) was satisfactory with limits of agreement ranging from +/-1.43 to +/-2.51 mm. The examination of the interobserver variability showed no significant differences between the two observers (F = 0.484, P > 0.05). CONCLUSION: 3D ultrasound is a reproducible method for the diagnosis of congenital uterine anomalies and for the measurement of uterine cavity dimensions.     

超声不同成像方法诊断子宫畸形的比较研究

目的探讨二维超声与三维超声（Render模式与Omni view模式）两种成像模式诊断子宫畸形的准确性,筛选出更适用于临床诊断的超声检查方法与成像模式。 方法对2011年9月至2013年1月复旦大学附属妇产科医院临床检查拟诊为子宫畸形的159例患者行二维及三维超声检查,在Render及Omniview两种成像模式下分别对患者子宫三维容积图像进行子宫冠状面的重建,并作出定性和分型诊断。与宫腔（腹腔）镜、磁共振成像或子宫输卵管造影检查结果对照,对子宫畸形患者二维及三维超声（Render模式与Omni view模式）诊断准确性进行分析比较。 结果与宫腔（腹腔）镜、磁共振成像或子宫输卵管造影检查结果对照,三维超声Render模式（78.6%,125/159）和Omni view成像模式（81.8%,130/159）诊断子宫畸形的符合率均高于二维超声（52.8%,84/159）,差异均有统计学意义（Render模式：χ²=23.465,P<0.01;Omni view模式：χ²=30.234,P<0.01）。 结论三维超声两种成像模式对子宫畸形的诊断准确率均高于二维超声,两种成像模式均可用于子宫畸形的诊断。     

Three-dimensional sonography of the endometrium and adjacent myometrium: preliminary observations.

OBJECTIVE: By evaluating a series of patients undergoing pelvic sonography with routine 2-dimensional (2D) as well as 3-dimensional (3D) reconstructed images in the coronal plane, we attempted to characterize the types of additional information that can be obtained. METHODS: Ninety randomly selected patients undergoing transvaginal pelvic sonography were imaged according to a standard 2D protocol. A 3D uterine volume was then acquired in the sagittal plane and reconstructed in the coronal plane. The endometrium and surrounding myometrium were evaluated for architecture, masses, the relationship of masses to the endometrial cavity, and the anatomic configuration of the cavity. RESULTS: Ninety-one studies were obtained. Additional findings were obtained on the coronal view in 28 studies (30.8%). No additional findings were obtained in 63 studies (69.2%). Normal endometrial and myometrial findings were obtained by conventional 2D imaging in 42 of 91 patients. Of this group, additional findings were shown in 2 (5%) patients. Forty-nine of the 91 patients had abnormal findings by 2D imaging. Additional information was obtained in 26 (53%) of these patients. Added information included uterine anomalies, better definition of the endometrium, more accurate delineation and location of endometrial polyps, location of leiomyomas, visualization of cystic areas within the myometrium, and confirmation of the location of intrauterine devices. CONCLUSIONS: The 3D reconstructed view of the endometrium and adjacent myometrium appears to be most helpful after a conventional transvaginal study, showing abnormalities within the endometrium and myometrium but being of little added benefit if the conventional findings are normal.     

三维超声成像对特殊类型子宫畸形的诊断研究

目的探讨经阴道子宫冠状面三维超声成像对特殊类型子宫畸形的诊断价值。方法对可疑子宫畸形的病例分别行经阴道二维扫查或三维扫查诊断，比较两组不同种类子宫畸形的构成比，总结特殊类型子宫畸形声像特征。结果共诊断302例子宫畸形，行二维扫查可获得明确诊断127例，行三维超声获得诊断175例。两组诊断子宫畸形种类的构成比有明显差异（P=0．001），三维超声诊断特殊类型子宫畸形明显多于二维超声（P=0．001）。结论采用子宫冠状切面三维超声成像能够得到子宫发育异常的准确信息，对于临床少见的疑难、复杂的子宫畸形能够起到精确诊断、指导临床处理的作用。     

先天性子宫畸形的磁共振诊断价值

目的：探讨磁共振对先天性子宫畸形的诊断价值。方法：回顾性分析34例先天性子宫畸形的MRI、超声及临床资料,结果与宫腔镜和/或腹腔镜检查结果对照。结果：以宫腔镜和/或腹腔镜检查结果为金标准,MRI、超声诊断子宫畸形的准确率为97.1%和85.3%。结论：MRI能清楚显示宫底外形轮廓和宫腔结构,是诊断先天性子宫畸形的最佳无创性检查方法之一。     

Three-dimensional multiplanar sonohysterography: comparison with conventional two-dimensional sonohysterography and X-ray hysterosalpingography.

The objective of this study was to assess the value of combining transvaginal sonohysterography with three-dimensional multiplanar ultrasonography to optimize assessment of the uterus. To make this assessment, we compared findings on three-dimensional sonohysterography with those on two-dimensional sonohysterography and X-ray hysterosalpingography. Of 20 women who underwent three-dimensional sonohysterography for various indications, 13 also underwent two-dimensional sonohysterography, and 12 had X-ray hysterosalpingography. We reviewed the 3 types of examinations separately and compared the standard techniques with three-dimensional sonohysterography to determine whether three-dimensional sonohysterography provided additional information. In 9 (69%) of 13 comparisons between three-dimensional sonohysterography and two-dimensional sonohysterography and in 11 (92%) of 12 comparisons between three-dimensional sonohysterography and X-ray hysterosalpingography, three-dimensional sonohysterography was advantageous. The coronal plane was most useful for displaying the relationship between lesions and the uterine cavity. Three-dimensional sonohysterography provided additional information compared with standard accepted techniques in the vast majority of women.     

三维超声在输尿管梗阻中的临床应用

目的评价三维超声成像在输尿管梗阻中的临床应用。方法35例输尿管梗阻患者分别经二维超声和三维超声检查,并对两者的图像进行对比分析,并将结果与手术及病理相对照。结果病变经三维超声成像后,较二维超声更清晰,尤其是三维超声成像后可以更清晰地了解病变与输尿管管壁的关系、输尿管管腔及输尿管与病变的空间关系。结论三维超声成像可以获得更丰富的信息,对明确诊断起到重要的作用。     

Three-dimensional ultrasonography of the fetal distal lower extremity: normal and abnormal.

The objective of this study was to compare two-dimensional and three-dimensional ultrasonographic evaluation of fetal distal lower extremities. Data from two-dimensional and three-dimensional ultrasonographic examinations from 40 distal lower extremities in 33 fetuses from a predominantly high-risk patient population were compared. Three-dimensional ultrasonography routinely provided three orthogonal planes (coronal, sagittal, and axial) for distal lower extremity evaluation. Specific features of distal lower extremity evaluation were not different using two-dimensional and three-dimensional ultrasonography. Rotation of the rendered volume provided assistance in assessing all but one of 40 distal lower extremities. Time from image acquisition to assessment for two views (coronal and sagittal) was longer with three-dimensional ultrasonography (8.2 min) than with two-dimensional ultrasonography (3.2 min). Confidence in the diagnosis of abnormal distal lower extremities was slightly improved using three-dimensional ultrasonography compared to two-dimensional ultrasonography. Pregnancy management was assisted in three of the four cases with isolated limb anomalies. In conclusion, three-dimensional ultrasonography improves the ability to evaluate the fetal distal lower extremity because of the multiplanar nature of volume assessment and the ability to rotate volume data sets. In addition, it provides assistance in counseling families, particularly for cases involving isolated limb anomalies.