早中孕期标准颅脑超声切面诊断胎儿颅内畸形

目的：探讨早中孕期标准颅脑超声切面对胎儿颅内畸形的诊断价值。方法：回顾性分析3800例2011年11月至2013年6月孕11～14周的孕妇常规颅脑超声切面检查所得的胎儿颅内超声图像,并与病理结果相对照。结果：3800例孕妇通过早中孕期颅脑超声切面检查共发现颅脑畸形61例，其中包括无脑儿13例，露脑畸形8例，脊柱裂4例，全前脑11例，脑膜脑膨出13例，颈部水囊瘤12例，漏诊颅脑畸形8例,脊柱裂漏诊2例。结论：通过早中孕期标准颅脑超声切面对胎儿颅内超声成像，可早期诊断胎儿颅内畸形，具有重要的临床意义。     

胎儿主动脉弓离断的产前超声诊断

目的探讨胎儿主动脉弓离断的超声诊断特点。方法回顾性分析产前超声诊断为胎儿主动脉弓离断的35胎胎儿资料,同时纳入180胎正常胎儿。二维超声判断胎儿内脏及心脏位置,获取四腔心切面、左右心室流出道切面、三血管切面及三血管-气管切面等横断面,并扫查腔静脉长轴切面、主动脉弓切面及动脉导管弓切面等矢状切面。测量主动脉弓离断胎儿左右心室内径比值及主动脉与肺动脉内径比值,并与相应孕周的正常胎儿进行比较。结果产前二维超声诊断A型、B型及C型主动脉弓离断分别为16、18及1胎,均伴室间隔缺损,共27胎经尸体检查或产后检查证实产前诊断,3胎诊断错误,余5例新生儿失访。四腔心切面及三血管切面发现主动脉弓离断胎儿左右心室内径比值和主动脉与肺动脉内径比值显著小于相应孕周正常胎儿,差异有统计学意义(P均0.01)。矢状切面对主动脉追踪连续扫查可确定主动脉的分支及走行,可明确诊断及分型。A型、B型及C型离断升主动脉走行及分支分别呈现典型的"W型"、"Y型"及"I型"。矢状面扫查及横断面扫查对胎儿主动脉弓离断的诊断率分别为90.00%(27/30)及56.67%(17/30),差异有统计学意义(P0.01)。结论产前二维超声可诊断胎儿主动脉弓离断,横断面扫查可发现某些线索,矢状面连续扫查对诊断胎儿主动脉弓离断具有重要意义。     

超声心动图诊断胎儿冠状静脉窦扩张

目的探讨胎儿冠状静脉窦(CS)扩张的超声诊断思路。方法回顾性分析145胎正常冠状静脉窦胎儿(正常组)和72胎CS扩张胎儿(CS组)的资料,于非标准四腔心切面下显示CS长轴,测量CS的矢状切面面积。采用二维超声结合彩色多普勒超声对所有胎儿分别进行胎儿四腔心切面、左右心室流出道切面、三血管切面、大动脉短轴切面、主动脉弓切面、动脉导管弓切面及腔静脉长轴切面扫查,观察CS的特点。结果胎儿CS矢状切面面积与孕周呈正相关(正常组:r=0.954,P0.05;CS组:r=0.904,P0.05),同孕周正常组胎儿CS矢状切面面积小于CS组(P均0.01)。产前超声诊断72胎CS扩张的胎儿中,52胎为永存左上腔静脉,15胎为完全型肺静脉异位引流,5胎右心压力负荷增大。结论胎儿CS矢状切面的面积与孕周呈正相关;胎儿心脏超声检查发现CS扩张时应同时考虑其他心内畸形;临床应通过多切面、多角度扫查,分析和诊断引起CS扩张的病因。     

三维超声后处理技术在产前诊断中的应用进展

目的三维超声在产前筛查和诊断某些胎儿畸形中有重要作用。后处理技术是获取ROI的三维容积数据后,根据诊断需要对图像做进一步处理,可依据不同断面对组织结构进行全面分析,增加组织对比度,准确测量胎儿不规则结构的体积和心脏容积,对血管的分布和连接情况进行分析,数据存储后可进行脱机分析。三维超声成像的后处理技术已广泛应用于临床。本文对三维超声成像的后处理技术模式和应用现状进行综述。     

应用三维超声体积自动测量技术评价胎儿肺发育不良

目的探讨应用三维超声体积自动测量（VOCAL）技术测量胎儿肺体积的可行性及超声肺重比（UFLB）对胎儿肺发育不良（PH）的诊断价值。方法选取经产前超声检查诊断为先天性发育异常且孕妇选择引产并同意进行尸检的胎儿35胎,胎龄16～36周。应用VOCAL技术获得胎儿肺体积,采用二维超声测得的生物参数经Hadlock方程系统自动生成胎儿质量,进而获得UFLB。将应用VOCAL技术测得的胎儿肺体积与尸检后实测的肺体积进行比较,并评价UFLB对PH的诊断价值。结果应用VOCAL技术测得的胎儿肺体积与实测的肺体积之间的差值为（-0.81±1.77）cm3。应用UFLB诊断胎儿PH的敏感度为83.33%,特异度为95.65%,阳性预测值为90.91%,阴性预测值为91.67%,诊断准确率为91.43%。结论应用VOCAL技术可准确评估胎儿肺体积,UFLB对胎儿PH的产前诊断具有一定意义。     

三维超声检查在新生儿颅脑疾病中的应用进展

小儿颅脑疾病领域超声检查现已普遍开展,其中三维超声应用日渐增多。三维超声具有立体形态成像和体积定量分析等功能,可用于评估新生儿颅脑疾病病灶大小、空间位置及毗邻关系等,为诊断、监测及治疗疾病提供重要参考信息。本文对三维超声技术在诊断及监测新生儿颅脑疾病中的应用进展进行综述。     

胎儿主动脉弓离断的产前超声诊断现状

主动脉弓离断是一种罕见的严重先天性心脏病,胎儿期死亡率极高,其胚胎学起源复杂,表现形式多样,且多合并其他畸形,产前超声诊断困难。超声心动图作为目前临床常用的胎儿心脏检查手段,在先天性心脏病的筛查中发挥重要作用。本文主要从二维超声、三维超声在诊断中的应用及超声鉴别诊断方面对胎儿主动脉弓离断的产前超声诊断现状进行综述。     

《心脏占位性疾病》新书推荐

近几十年来,超声心动图技术得到飞速发展,从早期的M型超声、二维超声、彩色多普勒超声拓展到三维超声、腔内超声、声学造影、组织斑点追踪等,心脏的检查范围也从解剖形态学向功能学转变,在心血管疾病诊断、手术和介入治疗方面具有重要价值。在某些心血管疾病领域,如先天性心脏病、心脏瓣膜病等方面,超声心动图甚至逐渐取代了以往作为"金标准"的心导管检查,成为"一锤定音"的关键角色。尽管如此,在某些心脏疾病领域,如心脏占位的定性诊断方面,超声心动图的检查技术和诊断水平仍有待进一步提高。     

MRI测量正常中晚孕胎儿大脑主要径线的价值

目的探讨3.0T MRI测量正常胎儿头颅主要径线的可重复性及其与孕周的相关性;建立MRI对正常胎儿大脑发育的量化评价方法。方法收集219胎超声检查初步提示胎脑解剖结构正常的胎儿。采用3.0T MR仪扫描胎儿颅脑。由2名MRI医师测量胎儿脑双顶径、脑额枕径、骨双顶径、骨额枕径、头围、胼胝体长度及小脑横径,评价观察者间的可重复性,并对胎儿颅脑主要径线与孕周相关性进行分析。结果 2名医师应用MRI测量胎儿颅脑主要径线的可重复性好(组内相关系数均0.7);胎儿脑双顶径、脑额枕径、骨双顶径、骨额枕径、头围、胼胝体长度、小脑横径与孕周均呈正相关(r=0.957、0.974、0.949、0.959、0.971、0.887、0.985,P均0.001)。结论 3.0T MR用于测量正常中晚孕胎儿大脑主要径线具有较好的可重复性;孕中晚期胎儿脑生物测量参数随孕龄呈二次多项式函数变化趋势。     

经食管实时三维超声心动图在心脏外科手术中的应用进展

术中应用经食管超声心动图（TEE）是提高心脏外科手术质量、减少围术期并发症的重要手段,它在清晰显示心脏结构的同时,又不干扰外科操作,已逐渐被心脏外科医师所接受。食管实时三维超声心动图（real-time three-dimensional transesophageal echocardiogram,RT3D-TEE）的问世更是突破了传统二维TEE只能显示单一解剖切面的局限,其能实时显示心脏三维解剖图象,提供整体直观的心脏解剖信息,更能精确分析病变瓣膜的解剖结构,评估心脏容量变化情况,为心脏外科医师术前制定诊疗策略提供依据;为术中介入操作提供实时引导,并对术后疗效作出精确评价。目前,RT3D-TEE已广泛地应用于心脏瓣膜修复手术、先天性心脏病介入治疗、心脏肿瘤切除以及心脏功能评价等领域,本文对其在心脏外科手术中的应用情况进行综述,为其进一步在临床推广应用打下良好的基础。     

Persistent cloaca: are we ready for a correct prenatal diagnosis?

Cloacal malformations are rare and can present in variable aspects. The importance of ultrasound in detecting these anomalies is well known. Sonographic features vary in accordance with the type of malformation and the gestational age. A positive diagnosis is not possible because of the lack of specific ultrasound findings, which can show similar aspects to other abnormalities. We present 3 cases of prenatal diagnosis of this malformation, emphasizing that in the presence of a plurilobed cystic pelvic fetal mass with associated malformations, such as cardiac, renal, and vertebral anomalies, a persistent cloaca can reasonably be suspected.     

Prenatal diagnosis and management of laparoschisis. Case report

The prenatal diagnosis of laparoschisis may be established by ultrasound early in the end of the first pregnancy trimester. The visualisation of the abdominal wall defect may predict a good fetal prognosis in the absence of the other anomalies and may establish the most favorable moment of birth. Identification of several risk factors for this malformation could lead to the decrease of its incidence.     

Nasal heterotopia versus pilocytic astrocytoma: A narrow border

Failure of the anterior neuropore can lead to three main types of anomalies: nasal dermal sinus, encephalocele and nasal glioma or heterotopia. In this report, we describe a case of intracranial and extracranial glial heterotopia that probably resulted from a common failure of anterior neuropore development. We describe the prenatal radiological assessment based on ultrasound and MRI results, and consider their limitation for early fetal diagnosis. We also discuss the embryogenesis and the possible pathogenic mechanisms involved.     

Sonocubic fine: new three-dimensional ultrasound software to the screening of congenital heart diseases

Congenital heart disease is the most common fetal congenital malformations; however, the prenatal rate detection still is low. The two-dimensional echocardiography is the "gold standard" exam to screening and diagnosis of congenital heart disease during the prenatal; however, this exam is operator-depending and it is realized only in high risk pregnancies. Spatio-temporal image correlation is a three-dimensional ultrasound software that analyses the fetal heart and your connections in the multiplanar and rendering modes; however, spatio-temporal image correlation too is operator-depending and time-consuming. We presenting a new three-dimensional software named Sonocubic fine to the screening of congenital heart disease. This software applies intelligent navigation technology to spatio-temporal image correlation volume datasets to automatically generate nine fetal echocardiography standard views. Thus, this new software tends to be less operator-depending and time-consuming.     

四维超声成像技术在胎儿唇腭裂畸形中的诊断价值分析

目的 分析四维超声成像技术在诊断胎儿唇腭裂畸形中的应用价值。方法 选择2019年1月-2022年 1月于我院进行常规超声检查的12 334例孕妇作为研究对象,发现胎儿疑似唇腭裂畸形者,运用四维超声 成像技术帮助诊断,重点观察胎儿上唇皮肤及上腭骨的连续性,以引产后或分娩后胎儿的颜面部实际情况 作为评价标准,分析四维超声成像技术在胎儿唇腭裂畸形诊断中的准确性。结果 共发现5例唇腭裂畸形胎 儿,与引产后或分娩后胎儿颜面部实际情况一致,四维超声成像技术诊断准确性为100.00%。结论 四维超 声成像技术在胎儿唇腭裂畸形中的诊断准确性较高,对于诊断胎儿唇腭裂畸形具有较好的临床应用价值。     

Normal range of fetal finger movements

A congenital limitation of finger movements is associated with many syndromes that interfere with child well-being. The normal range of fetal finger movements during the second and third trimester is unknown. The aim of this study was to measure the normal range. In this study, fetal finger flexion and extension were examined during routine ultrasound screening in 260 consecutive normal fetuses at gestational age 16-41 weeks. Full extension and flexion of the fingers were noted in 110 fetuses examined at 16-26 weeks. Of the 150 fetuses examined at 27-41 weeks, full flexion and extension were noted in 118 (78.7%), full flexion and partial extension in 30 (20%), and full flexion without extension in two (1.3%). Knowledge of the normal range of fetal finger movements will assist clinicians in the prenatal diagnosis of other anomalies and syndromes.     

Fetal surgery for obstructive uropathy: rational considerations

The widespread use of high resolution dynamic ultrasound imaging methods in obstetrics now permits recognition of structural and/or functional developmental anomalies of fetal genitourinary tract with some considerable accuracy. Detection of congenital obstructive uropathy in the human fetus may occur as early as 16 weeks gestation. In the fetal lamb model, experimental occlusion of the outflow tract results in progressive hydronephrosis, pulmonary hypoplasia, and oligohydramnios. The renal parenchymal changes vary with the fetal age at obstruction ranging from simple hydronephrosis with later obstruction to dysgenesis with earlier obstruction. The pulmonary damage, and to some extent the renal damage, may be halted or even reversed with release of obstruction. These advances in diagnosis and an understanding of the pathophysiology have prompted attempts at chronic in utero diversion therapy in the human fetus with obstructive uropathy yielding encouraging, but as of yet, unproven success. In this report, the methods for such therapy, the rationale for the therapy, and the results of the therapy is reviewed.     

Fetal megaureters masquerading as bowel obstruction

As a result of repeated ultrasound assessments for determination of gestational age, more congenital anomalies are detected in the fetus. Early diagnosis has serious implications for both mother and fetus. We present our experience in the management of a male fetus with obstructive uropathy diagnosed at seventeen weeks of gestation. In serial ultrasounds the tortuous megaureters were mistaken for distended loops of bowel. When the question of obstructive uropathy is raised, and the bladder cannot be visualized, administration of diuretics to the mother may promote fetal bladder filling. Since the advent of intrauterine surgical intervention, distinguishing between megaureters and obstructive bowel disease may have important clinical implications.     

产前超声诊断胎儿尿道下裂进展

尿道下裂是胎儿常见泌尿系统先天畸形。产前二维及三维超声检查均可用于诊断胎儿尿道下裂,二者联合可提高诊断效能;在此基础上进行彩色多普勒超声检查可进一步明确尿道开口位置,提高诊断准确率,降低误诊率。本文对产前超声诊断胎儿尿道下裂进展进行综述。     

Current management of antenatal hydronephrosis

The strategy for the management of children with urinary tract anomalies has changed considerably as a result of the development of ultrasound equipment and techniques that allow for detailed fetal evaluation. Hydronephrosis is the most common urogenital anomaly detected, suggesting that an obstructive process may be potentially present. The goal of postnatal management is to identify and treat those patients whose renal function is at risk, while leaving alone the high percentage of patients who are at no risk of renal damage. This management involves a spectrum of radiological, medical, and surgical interventions for diagnosis, surveillance, and treatment. In this article, we review our current understanding of the natural history of antenatal hydronephrosis and its management.