应用智能时间-空间相关成像技术评估正常胎儿左心室容积的可行性和可重复性

目的 探讨应用智能时间-空间相关成像(iSTIC)技术评估正常胎儿左心室容积的可行性和可重复性。方法 对76名孕妇(共76胎)应用iSTIC技术行胎儿心脏实时三维成像检查,测量正常胎儿左心室舒张末期容积(EDV)和收缩末期容积(ESV),计算左心室每搏输出量(SV)。各指标由2名观察者采用盲法分别进行测算,并由同一观察者在间隔2周后再次采用盲法进行测算。对观察者内及观察者间的可重复性进行统计学分析。结果 同一观察者前后两次测量EDV的ICC为0.980(95%CI:0.969~0.988),测量ESV的ICC为0.988(95%CI:0.981~0.992),计算SV的的ICC为0.927(95%CI:0.887~0.953)。2名观察者间测量EDV的ICC为0.987(95%CI:0.980~0.992),测量ESV的ICC为0.979(95%CI:0.967~0.987),计算SV的ICC为0.948(95%CI:0.919~0.967)。Bland-Altman分析显示,观察者内及观察者间对SV的测值点均位于一致性界限之内。结论 应用iSTIC技术可准确评估正常胎儿左心室容积,且简便可行、重复性较好。     

MSCT测量胃癌体积的层厚选取及可重复性

目的 探讨MSCT测量胃癌体积的层厚选取,评价MSCT测量胃癌体积的可重复性。方法 将33例胃癌的MSCT图像传输至工作站,分别用3 mm、5 mm和7 mm层厚进行胃癌体积测量,并由另1名医师以5 mm层厚对所有胃癌体积进行重复测量。计算观察者内或观察者间的差异。结果 3 mm、5 mm、7 mm层厚测得胃癌体积分别为 (65.06±46.87)cm³、(64.74±47.13)cm³和(63.56±45.82)cm³(F=5.409,P<0.05)。3 mm和5 mm层厚测量胃癌体积差异无统计学意义(P=0.298);3 mm和7 mm层厚、5 mm和7 mm层厚测量结果差异有统计学意义(P均<0.05)。3 mm和5 mm、3 mm和7 mm、5 mm和7 mm层厚测量胃癌体积的组内相关系数分别为0.992、0.990、0.988。用3 mm、5 mm、7 mm层厚测量胃癌体积所需时间分别为(30.6±15.5) min、(20.0±11.8) min和(12.3±6.4)min。两名观察者用5 mm层厚测量的胃癌体积平均值分别是(64.74±47.13)cm³和 (65.32±45.82)cm³,差异无统计学意义(F=1.386,P=0.248),组内相关系数为0.998。结论 MSCT测量胃癌体积时选用3 mm和5 mm层厚较佳;选用5 mm层厚测量胃癌体积节省工作时间;MSCT胃癌体积测量具有较高的一致性和可重复性。     

比较超声和MRI评估正常胎儿胸廓发育

目的 比较超声和MRI评估正常胎儿胸廓发育的可重复性和一致性。方法 选取30胎正常胎儿,分别以超声和MRI测量胎儿胸廓横径、前后径、面积、胸围、胸廓体积和肺体积,采用组内相关系数（ICC）及Bland-Altman图分析同一医师及不同医师间测量结果的可重复性和一致性,以Pearson相关分析观察超声测量胎儿肺体积、胸廓体积与MRI测量值的相关性。结果 同一医师及不同医师以超声测量胎儿胸廓二维指标的可重复性和一致性均高于MRI,而以MRI测量胎儿胸廓体积和肺体积的可重复性和一致性均高于超声;同一医师以超声测量胎儿胸廓横径的可重复性最高[ICC=0.996 4,95%CI（0.992 5,0.998 3）],且一致性最高[界限宽度－0.004 7±0.057 3,95%CI（－0.026 1,0.016 7）]。超声与MRI测量胎儿肺体积和胸廓体积高度相关（r=0.915、0.957,P均<0.001）。结论 超声和MR均可评估正常胎儿胸廓发育,胎儿胸廓发育的二维指标测量超声优于MRI;三维指标测量MRI优于超声,但两者相关性高。     

MSCT测量肺癌病灶大小的最佳参数

目的 探讨MSCT反映肺癌病灶大小的最佳测量参数。方法 回顾性分析100例肺癌患者的胸部MSCT图像,共113个病灶。4名具有3年以上胸部疾病诊断经验的放射科医师独立测量每个病灶的大小,其中1名放射科医师独立测量每个病灶3次,3次测量间隔时间至少1周。测量参数包括最大长径、宽度、高度、最大长径和宽度的乘积、周长、面积以及体积。采用组内相关系数（ICC）和一致性相关系数（CCC）评价每一项测量参数的可重复性及可靠性。结果 各测量参数观察者内的ICC和CCC均高于观察者间;周长的观察者内ICC（ICC=0.998,P<0.001）和CCC（CCC=0.998,P<0.001）、观察者间ICC（ICC=0.994,P<0.001）和CCC（CCC=0.988,P<0.001）均高于其他6项测量参数。结论 MSCT测量肺癌大小的最佳参数是肿瘤的周长,其可重复性和可靠性均较高,可为肺癌放化疗后的疗效评价提供较为准确的参考。     

ADC值对子宫内膜癌宫颈浸润的诊断价值

目的 探讨磁共振扩散加权成像(DWI)表观扩散系数(ADC值)对子宫内膜癌宫颈浸润的诊断价值。方法 实验组:选取经病理证实有宫颈浸润的子宫内膜癌患者26例;对照组:随机选取无宫颈浸润的子宫内膜癌患者26例。分别测量每例患者宫腔内癌灶、宫颈内口、外口的ADC值,进行ROC分析。结果 实验组宫腔内癌灶的ADC均值 ,与宫颈内口的ADC均值 差异无统计学意义(t=－0.45,P=0.66)。对照组宫腔内癌灶ADC均值 显著低于宫颈内口的ADC值 ,差异有统计学意义(t=－6.86,P＜0.001),与实验组宫腔内癌灶ADC均值比较差异无统计学意义(t=0.74,P=0.47)。以宫颈内口ADC值进行ROC分析,曲线下面积为0.86,最佳诊断界值为1.02×10^－3 mm²/s,敏感度为73.1%,特异度为96.2%。结论 DWI有助于诊断子宫内膜癌宫颈浸润。     

磁共振DWI结合标准T2WI判断直肠癌局部复发

目的 评价MR DWI结合标准T2WI判断直肠癌局部复发的价值。方法 对325例直肠癌患者术后随访期间均行MR轴位、冠状位、矢状位T2W和轴位DWI（b=0、1000 s/mm²）;其中89例存在盆腔异常表现,2名医师（观察者1、2）分别采用两种方法（T2WI、DWI+T2WI）进行阅片,探讨DWI+T2WI对直肠癌局部复发的诊断效能。结果 89例盆腔局部异常表现患者中,32.58%（29/89）为直肠癌局部复发。2名医师单独采用T2WI判断局部复发的准确率分别为85.39%（76/89）、80.90%（72/89）;采用DWI+T2WI的准确率分别达91.01%（81/89）、87.64%（78/89）。DWI+T2WI的ROC曲线下面积均高于T2WI（观察者1：0.907 vs 0.856;观察者2：0.882 vs 0.823）。采用T2WI时,2名阅片者的一致性良好（Kappa=0.674）;采用DWI+T2WI时,一致性非常好（Kappa=0.831）。结论 标准T2WI诊断直肠癌术后局部复发的准确率较高,结合DWI可进一步提高诊断效能。     

基于心腔内超声造影测量左心室肥厚患者室壁厚度

目的 采用左心室腔内超声造影(LVO)改善心内膜显影,评价LVO诊断左心室心肌肥厚的价值。方法 选择经常规超声心动图检查不能清晰显示并测量左心室壁厚度的患者66例,测量造影前后室间隔、左心室侧壁基底段、中间段及心尖段的室壁厚度,并用Bland-Altman法分析观察者内和观察者间的一致性。结果 LVO后,65例(98.48%,65/66)心内膜边缘的清晰程度明显改善,易于测量室壁厚度。LVO测定的室壁厚度与常规超声心动图所测厚度的差异有统计学意义(P<0.05)。常规超声与LVO测量的室壁厚度相符仅31个节段。Bland-Altman法分析显示,左心室壁厚度测LVO值的观察者内和观察者间的一致性较好。结论 LVO能够通过增进左心室腔的显影,改善心内膜边缘的清晰度,有利于准确测定心肌厚度。     

比较阈值调节测量法与常规测量法对评价大脑中动脉狭窄的价值

目的 探讨阈值调节测量法和常规测量法对容积CT数字减影血管造影(VCTDSA)大脑中动脉狭窄程度评价的准确性。方法 用常规测量法和阈值调节测量法对80例大脑中动脉狭窄患者进行分析,评估观察者内及观察者间重复性及一致性,用两种方法测量狭窄处及正常血管管径大小,计算各狭窄处的狭窄率,判定狭窄程度。结果 观察者内及观察者间两种方法对狭窄部位判定有良好一致性(K=0.99、0.99),观察者内阈值调节测量和常规测量狭窄程度一致性强(K=0.92、0.89),观察者间阈值调节测量和常规测量狭窄程度一致性强(K=0.98、0.87)。阈值调节测量比常规测量多检出轻中度血管狭窄共9处,分别是M1段轻度狭窄2处,M1段中度狭窄1处,M2段轻度狭窄5处,M2段中度狭窄1处;阈值调节测量优于常规测量( _阈> _常),两种测量法对血管狭窄程度的判断差异具有统计学意义(P<0.01)。结论 CT血管造影(CTA)测量在观察者内及观察者间具有良好的一致性,阈值调节测量法可减少轻中度狭窄漏诊率,较常规测量更准确反映血管狭窄,为临床介入治疗提供可靠的血管狭窄影像依据。     

应用新的四维左心室半自动定量工具测量正常人左心室容积和射血分数

目的 探讨新的四维左心室半自动定量工具(4DLVQ)评价正常人左心室容积和射血分数的可行性和可重复性。方法 采用新的实时三维超声心动图(RT3DE)心室容积分析工具4DLVQ和传统的RT3DE分析工具TomTec分别测量24名健康志愿者左心室舒张末容积(LVEDV)、左心室收缩末容积(LVESV)及左心室射血分数(LVEF),分析4DLVQ测量正常人左心室容积和射血分数的可行性和可重复性。结果 与TomTec比较, 4DLVQ测定左心室容积和射血分数耗时明显减少(P＜0.05),二者测得的LVEDV、LVESV及LVEF差异无统计学意义(P均＞0.05)。采用两种分析工具测定LVEDV、LVESV及LVEF相关性良好(r=0.72、0.62、0.53,P均＜0.05),Bland-Altman分析结果显示二者一致性高。与TomTec比较,采用4DLVQ测定LVEF的观察者内和观察者间变异系数小、组内相关系数(ICC)高。结论 4DLVQ分析速度快、操作简便、重复性好,是测定左心室容积和功能的一种新的分析工具。     

多普勒、M型及四维时空关联成像检测胎儿左心室每搏输出量的对比观察

目的 比较多普勒、M型与四维时空关联成像(STIC)测量胎儿左心每搏输出量的重复性及测量者间的一致性。方法 2名超声科医师采用双盲法分别应用多普勒、M型与四维STIC测定30胎26~30周正常单胎胎儿左心室输出量,计算组内相关系数(ICC),进行Bland-Altman图分析,评估上述测量方法的重复性和测量者间一致性。结果 ①同一测量者用3种方法测定胎儿左心室输出量的差异无统计学意义(P均>0.05);②2名观察者间3种方法测量重复性比较,其ICC值STIC法最高(多普勒法ICC:0.93,95%可信区间:0.86~0.95;M型法ICC:0.89,95%可信区间:0.82~0.91;STIC法ICC:0.95,95%可信区间:0.88~0.97);③应用Bland-Altman分析2名观察者测量的一致性,STIC法的系统偏倚及一致界限较多普勒法和M型法好(多普勒法平均差值:-0.04 ml,95%可信区间-0.22~0.14 ml;M型法平均差值:-0.06 ml,95%可信区间-0.20~0.08 ml;STIC法平均差值:-0.01 ml,95%可信区间-0.11~0.09 ml)。结论 3种方法均可用于测量胎儿左心室输出量,以STIC法测量的可重复性和一致性最高,是一种较好的选择。     

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.     

Ovarian volume measurements in mice with high-resolution ultrasonography.

OBJECTIVE: The aim of our study was to evaluate the intraobserver and interobserver variability of ovarian volume measurements in mice with high-resolution 2-dimensional ultrasonography (2DUS) and 3-dimensional ultrasonography (3DUS). METHODS: Ovaries of 10 nude mice were visualized with a small-animal ultrasound scanner and a 40-MHz probe. For each ovary, volume was measured 3 times by 2 independent readers using both 2DUS and 3DUS methods. The 2DUS method used a biplane ellipsoid model. The 3DUS method estimated the volume by integrating 10 to 12 parallel image planes of the ovary after semiautomated outlining of the boundaries. For each type of measurement, intraobserver and interobserver standard error of measurement (SEM) values and minimal detectable volume changes were calculated by analysis of variance. RESULTS: Two-dimensional ultrasonography showed much poorer reproducibility, with higher absolute intraobserver and interobserver SEM values (0.50 and 0.61 mm3, respectively) than 3DUS (0.20 and 0.35 mm3; P < .01). Relative intraobserver and interobserver SEM values were also much higher for 2DUS (12.20% and 14.88%) than for 3DUS (5.12% and 8.97%; P < .01). The minimal volume changes that could be detected with a 95% confidence level in successive measurements by the same (or different) observers were 33.90% (41.22%) for 2DUS and 14.10% (24.87%) for 3DUS. CONCLUSIONS: High-resolution 3DUS can provide a reliable tool for noninvasive, longitudinal ovarian volume measurements in mice.     

Reproducibility of the measurement of submucous fibroid protrusion into the uterine cavity using three-dimensional saline contrast sonohysterography.

OBJECTIVE: To determine the intraobserver and interobserver reproducibility of measurement of the percentage of protrusion of submucous fibroids into the uterine cavity using three-dimensional saline contrast sonohysterography (3D-SCSH). METHODS: Women diagnosed with submucous uterine fibroids on B-mode two-dimensional (2D) ultrasound scan were invited to join the study and 3D-SCSH was carried out. 3D volume datasets were stored digitally and were examined later using the technique of planar reformatted sections. The reproducibilities of the measurement of fibroid diameter and protrusion ratio into the uterine cavity (ratio of the size of the segment of the fibroid protruding into the cavity to the total diameter of the fibroid) were examined by two independent observers who were unaware of the initial 2D scan findings. Interobserver reproducibility was assessed by calculating the difference between measurements taken by the two operators (limits of agreement) and interclass correlation coefficient. Intraobserver repeatability was assessed by calculating the difference between two measurements for each variable (limits of agreement) and further expressed as an intraclass correlation coefficient. RESULTS: Thirty-three 3D ultrasound volumes were examined. There was a good agreement between the observers in classifying the fibroids as greater or less than 50% confined to the myometrium (Cohen's kappa 0.81). There was no bias in measurements for both variables either between observers or with repeated measurements by each observer. For fibroid diameter and protrusion ratio the inter- and intraclass correlation coefficients were high (0.984-0.995), with narrow limits of agreement. CONCLUSION: 3D-SCSH is a reproducible method for the quantification of the percentage of a submucous fibroid protruding into the uterine cavity.     

Ultrasound grading of thyroid nodules using the BTA U-scoring guidelines – Is there evidence of intra-and interobserver variability?

IntroductionU-score ultrasound classification (graded U1-U5) is widely used to grade thyroid nodules based on benign and malignant sonographic features. It is well established that ultrasound is an operator-dependent imaging modality and thus more susceptible to subjective variances between operators when using imaging-based scoring systems. We aimed to assess whether there is any intra- or interobserver variability when U-scoring thyroid nodules and whether previous thyroid ultrasound experience has an effect on this variability.MethodsA total of 14 ultrasound operators were identified (five experienced thyroid operators, five with intermediate experience and four with no experience) and were asked to U-score images from 20 thyroid cases shown as a single projection, with and without Doppler flow. The cases were subsequently rescored by the 14 operators after six weeks. The first and second round U-scores for the three operator groups were then analysed using Fleiss’ kappa to assess interobserver variability and Cochran’s Q test to determine any intraobserver variability.ResultsWe found no significant interobserver variability on combined assessment of all operators with fair agreement in round 1 (Fleiss’ kappa = 0.30, p <0.0001) and slight agreement in round 2 (Fleiss’ kappa = 0.19, p < 0.0001). Cochran’s Q test revealed no significant intraobserver variability in all 14 operators between round 1 and round 2 (all p>0.05).ConclusionsWe found no statistically significant inter- or intraobserver variability in the U-scoring of thyroid nodules between all participants reinforcing the validity of this scoring method in clinical practice, allaying concerns regarding potential subjective biases in reporting.     

三维超声容积自动测量技术的准确性及重复性研究

目的：评价三维超声容积自动测量方法的准确性及重复性。方法：用二维及三维超声分别对22个规则水囊模型和25个不规则水囊模型作容积测量。二维超声测量采用标准的椭圆体计算公式，三维超声测量采用自动测量技术。结果：1，二维超声对规则及不规则模型的测量误差，系统偏倚及一致界限均较三维超声大（均P＜0．05）。三维超声对规则和不规则模型容积的测量误差无显著性差异（P＞0．05）；2，二维及三维超声测量规则及不规则模型容积与实际容积间均有良好的相关性，但三维超声测量值与实际容积间的相关系数稍高；3，三维容积自动测量技术测量规则及不规则模型时观察者内及观察者间的变异极小，有良好的重复性；4，三维容积自动测量技术测量规则模型及不规则模型平均耗时分别为6．7分钟和7．2分钟（P＞0．05）。结论：与二维超声比较，三维超声自动容积测量技术测量容积误差及系统偏倚小，与实际容积间的相关性好，有良好的重复性。与三维超声平行面积法比较，测量耗时明显缩短。     

Measurement of endometrial thickness with transvaginal ultrasonography: is it reproducible?

To assess the intraobserver and interobserver variability of transvaginal ultrasonographic measurement of endometrial thickness, two investigators (M.V., M.-F. D.) independently evaluated two successive measurements in 55 patients with a 5.0 MHz transvaginal transducer. Each observer was blinded to his or her own and to the other's results. Measurements were taken at the maximal thickness in the longitudinal uterine axis. The intraclass coefficients evaluating the agreement between two measures of a same observer were 94% and 97%; the coefficient was 94% between the two investigators. Intraobserver kappa values (agreement on endometrium < or = 5 mm and > 5 mm) were 0.70 and 0.81, respectively; the interobserver kappa value was 0.74. Transvaginal sonographic measurement of endometrial thickness has excellent intraobserver and good interobserver agreement. However, in clinical practice, an endometrial thickness measuring +/- 1 mm of a cut-off value should be interpreted with caution, especially when this may modify the clinical management.     

Intraobserver and interobserver variability of ovarian volume, gray-scale and color flow indices obtained using transvaginal three-dimensional power Doppler ultrasonography.

OBJECTIVE: To assess intraobserver and interobserver variability in ovarian volume and gray-scale and color flow index measurements using transvaginal, three-dimensional, power Doppler ultrasonography. METHODS: Eleven women (22 ovaries) were examined on day 8 of controlled ovarian hyperstimulation therapy, which was part of their in vitro fertilization treatment protocol. The patients were examined twice by the first observer and once by the second observer. The acquired volume datasets were analyzed using the VOCAL imaging program, enabling the assessment of ovarian volume, vascularization index (VI), flow index (FI), vascularization flow index (VFI) and mean grayness (MG). For these parameters the intraclass (intra-CC) and interclass (inter-CC) correlation coefficients, within-observer and between-observers repeatability coefficient (r) and limits of agreement were calculated. RESULTS: Both intraobserver and interobserver repeatability of ovarian volume measurements were considered very good with an intra-CC value of 1.00 and inter-CC value of 0.99, respectively. Also VI, FI, VFI and MG measurements were repeatable by a single observer, the intra-CC ranging from 0.82 to 0.91. The interobserver reproducibility was also good for VI, VFI and MG measurements (inter-CC values 0.73, 0.70 and 0.81, respectively), but for FI measurements the reproducibility was poor (inter-CC = 0.29, r = 7.87). CONCLUSIONS: In general, the intraobserver reproducibility was better than interobserver reproducibility for all parameters. The volume assessments were reproducible both by one observer and by two separate observers. The intraobserver and interobserver variabilities were acceptable for VI, VFI and MG, whereas for FI the interobserver reproducibility was poor. Our results suggest that measurement of gray-scale and color Doppler flow indices is reproducible thus allowing them to be used in clinical practice and research.     

Reproducibility of 3-dimensional sonographic measurements of fetal and placental volume at gestational ages of 11-18 weeks

PURPOSE: Determine the reproducibility of 3D ultrasound (3DUS) measurements of fetal and placental volumes. METHODS: We included 34 pregnant women between gestational weeks (GW) 11-18. Two operators independently acquired fetal and placental volumes using 3DUS. Each volume was acquired twice and stored on disk for off-line analysis. Intra- and interobserver reproducibility was expressed in the intra- and interclass correlation coefficient (intra-CC and inter-CC). In addition, the 3DUS volumes acquired by the first operator were calculated by the second and vice-versa to evaluate the effect of volume acquisition and caliper placement. A value >0.75 was considered a good agreement. RESULTS: Fetal and placental volume measurements were successful in 97% of all cases. Between GW 11-14 and 14-18 the median fetal volume was 20.8 (5.0-35.1) and 51.7 (37.9-132.8) ml, the median placental volume was 71.3 (40.9-111.9) and 120.7 (94.2- 273.7) ml. Bland-Altman plots were used for statistical analysis. The intraobserver reproducibility was good for fetus (intra-CC: 0.99; 0.99) and placenta (intra-CC: 0.99; 0.98). Also, interobserver reproducibility was good for fetus (inter-CC 0.98) and placenta (inter-CC 0.98). In addition, regardless of the operator who acquired the volumes, the inter-CC remained good for both fetus (inter-CC: 0.99; 0.99) and placenta (inter-CC: 0.97; 0.99). CONCLUSION: The reproducibility of fetal and placental volume measurements by 3DUS between GW 11-18 is good. In addition, individually chosen caliper placement and volume acquisition has no effect on the calculation of either volumes.     

Application of 3‐Dimensional Ultrasonography to Imaging the Fetal Anal Canal

Objective. Ultrasonography has been applied previously to the assessment of the fetal anal canal. We aimed to examine the potential of 3‐dimensional ultrasonography (3DUS) in the evaluation of the fetal anal canal and to obtain normal fetal anal canal measurements. Methods. Patients were recruited from an unselected population of gravidas with known gestational age (by dates or first‐trimester ultrasonography) and without known fetal anomalies presenting for fetal evaluation in the ultrasound units of 2 tertiary care centers between 16 and 39 gestational weeks. In addition to the ordered scan, 3DUS imaging of the fetal anal canal was performed. Transverse and sagittal views and volumes were obtained. Measurements of the fetal anal canal anteroposterior diameter, lateral diameter, and length were performed in transverse and sagittal planes, respectively, and scatterplots of these dimensions were created. Measurements were performed and repeated on raw data sets by 2 independent observers, and the results were analyzed to estimate interobserver and intraobserver reliability. Results. A total of 186 patients were examined for this study at 16 to 39 weeks' gestation (mean, 27.4 weeks). The anteroposterior diameter of the fetal anal canal in this study group ranged from 4 to 21 mm (mean, 11.2 mm; SD, ±3.5 mm), whereas the lateral diameter ranged from 7 to 18 mm (mean, 9.1 mm; SD, ±3.0 mm). The length of the fetal anal canal in this study group ranged from 3 to 24 mm (mean, 14.3 mm; SD, ±3.8 mm). Conclusions. Ultrasonographic assessment of the fetal anal canal with 3DUS is feasible. Scatterplots were created for internal anal sphincter width and length measurements from 16 to 39 weeks' gestation. Larger studies are necessary to establish nomograms of these measurements and their application to the evaluation of pathologic cases. We speculate that 3DUS assessment of the fetal anal canal may improve detection rates of disorders involving this system.     

三维超声ESHRE-ESGE共识诊断子宫畸形

目的 探讨三维超声（3DUS）ESHRE-ESGE共识诊断子宫畸形的价值。方法 回顾性分析92例常规检查怀疑为子宫畸形患者的3DUS和MRI资料。以MRI结果为金标准,计算3DUS的ESHRE-ESGE共识诊断不同类型子宫畸形的敏感度、特异度、阳性预测值、阴性预测值、Youden指数、Kappa值。结果 3DUS的ESHRE-ESGE共识诊断正常子宫的敏感度80.00%（12/15）、特异度100%（77/77）、阳性预测值100%（12/12）、阴性预测值96.25%（77/80）、Youden 指数0.80、Kappa值0.87;诊断纵隔子宫的敏感度100%（60/60）、特异度84.38%（27/32）、阳性预测值92.31%（60/65）、阴性预测值100%（27/27）、Youden指数0.84、Kappa值0.88;诊断双角子宫敏感度81.82%（9/11）、特异度100%（81/81）、阳性预测值100%（9/9）、阴性预测值97.59%（81/83）、Youden指数0.82、Kappa值0.89;诊断单角子宫敏感度、特异度、阳性预测值、阴性预测值均为100%,Youden指数和Kappa值均为1。结论 3DUS的ESHRE-ESGE共识诊断子宫畸形与MRI有较强的一致性,有较高的诊断价值。