三维超声对胎儿正常唇及唇裂的诊断评价并与传统二维超声诊断对照分析

目的：应用三维超声表面成像技术诊断胎儿唇腭裂,就其诊断价值与传统二维超声诊断进行比较。方法：应用Voluson530D三维容积探头对52例24－40周胎儿唇部进行观察,结果：52例,应用三维或二维超声能看到胎儿唇部有47例,看胎儿唇部结构有5例。47例中4例为胎儿蜃裂（腭裂）,用三维及二维超声均能估出诊断,余下政党唇43例,二维显示率为84％（36／43）,三维显示率为88％（38／43）。结率：三维超声在诊断胎儿唇裂中图像逼真直观,可做为二维超声空间信息补充,二者结合可使胎儿先天畸形诊断率进一步提高,也是产前检查胎儿唇裂的有效方法。     

三维超声对胎儿正常唇及唇裂的诊断评价--与传统二维超声对比

目的:探讨三维超声对胎儿正常唇及唇裂的诊断评价--与传统二维超声对比。方法:选取2017年5月-2019年5月我院收治的唇裂胎儿孕母27例作为研究组,并选取同期来我院进行产检的健康胎儿孕母18例作为对照组,为其进行二维超声以及三维超声检查,分析三维超声对胎儿正常唇及唇裂的诊断。结果:三维超声诊断符合率高于二维超声(P<0.05);二维超声检查唇裂,在孕周25-34周时诊出率高于孕18-24周、35-39周(P<0.05);三维超声检查唇裂,在孕周25-34周时诊出率高于孕18-24周、35-39周(P<0.05)。结论:三维超声在胎儿唇裂筛查中具有非常高的疾病诊出率,且在孕25-34周时其诊出率最高,可以在临床中进行进一步推广应用。     

三维超声诊断胎儿面部畸形的价值

目的探讨三维超声对胎儿面部畸形的诊断价值.方法利用Voluson 730 pro三维超声成像系统对163例孕22～40周的胎儿面部结构进行三维超声成像.结果 163例中发现唇裂(含腭裂)6例,眼间距增宽1例(唐氏面容),独眼1例,面部复合畸形1例,均经引产后证实.结论三维超声能直观显示胎儿的面部结构,是诊断胎儿面部畸形的首选方法.     

实时三维超声表面成像在胎儿唇腭裂诊断中的应用

目的:探讨实时三维超声表面成像技术在孕妇子宫内胎儿唇腭裂畸形中的诊断价值及临床应用。方法:回顾性收集本院2018年1月—2019年12月经临床证实为孕妇的胎儿唇腭裂患者45例,总结二维及三维实时表面成像的超声表现特点,并与产后结果对照,分析实时三维超声表面成像技术的诊断正确率。结果:45例胎儿的二维及三维超声图像清晰,满足诊断的要求,均对胎儿鼻唇部的三维成像显示满意;其中20例胎儿有唇裂畸形,10例胎儿有腭裂畸形,15例胎儿有唇腭裂畸形,均经引产或产后证实,三维超声检查的诊断正确率为100%。结论:实时三维超声表面成像技术操作方便、简单、快速,能清晰、直观、准确地显示子宫内胎儿的唇腭部,结合二维超声检查能明显提高胎儿唇腭裂畸形的检出率。     

二维超声及三维超声多种成像技术在胎儿唇腭裂畸形诊断中的联合应用

目的研究二维超声及三维超声多种成像技术在胎儿唇腭裂畸形诊断中的图像特征。 方法选取2016年1月至2017年12月在南京医科大学附属苏州医院产科接受中孕期结构畸形筛查发现唇腭部异常的胎儿均行三维超声表面成像、断层成像（TUI）及自由解剖成像（OmniView模式）多种成像技术联合检查,并随访至出生后或引产后。结合产前超声检查图像,研究唇腭裂胎儿颜面部三维超声图像特征。 结果产前超声筛查的19 168例中孕期胎儿中检出唇腭部结构畸形36例（0.19%）。36例唇腭裂胎儿超声征象：单纯唇裂（CL）8例,二维、TUI及OmniView模式均检出胎儿唇裂;三维表面成像漏诊1例唇红裂。二维及三维成像技术均显示胎儿上唇连续性中断,但三维成像显示更直观。唇裂合并上牙槽突裂（CLA）11例,二维超声显示8例,三维表面成像、TUI均诊断9例,漏诊2例,OmniView技术诊断10例,漏诊1例,联合检查诊断10例,漏诊1例。主要超声征像：上唇及上牙槽突连续性中断,二维超声对于牙槽突裂显示较困难,TUI及OmniView可从多角度显示牙槽突裂。唇裂合并腭裂（CLP）17例,二维超声（诊断10例）、三维超声表面成像模式（诊断13例）、TUI（诊断15例）、OmniView模式（诊断16例）均未全部检出;而17例CLP经联合检查全部检出。超声征象为上唇、原发腭及继发腭的连续中断,断层成像及OmniView可从多角度显示原发腭及继发腭,优于二维超声对于原发腭及继发腭的显示。 结论产前二维超声及三维超声能清晰显示胎儿唇裂,但对于腭裂,三维超声多种成像模式图像优于二维超声,产前超声筛查联合三维多成像技术能清晰显示胎儿颜面部异常,减少唇腭裂的漏诊。     

胎儿面部三维超声成像研究

目的：评价三维超声在胎儿面部成像中的应用价值。方法：应用Medison Krez Voluson530D三维超声系统对我院门诊及住院孕16-39周高危孕妇67例进行检查，该系统可完成常规二维超声检查及三维超声成像。结果：63例胎儿面部正常，孕16-24周胎儿面部瘦削。图像质量稍差，孕25-39周胎儿面部逐渐丰满，解剖结构越来越清晰，4例唇裂胎儿均经三维超声检出。结论：三维超声提供了直观立体的胎儿面部图像，对二维图像具有重要的补充作用。     

实时三维超声对胎儿唇腭裂的诊断价值

目的应用实时三维超声成像诊断胎儿唇腭裂,就其诊断价值与二维超声诊断进行比较探讨。方法应用esaote Mylab 90实时三维超声显像仪,三维容积探头和二维腹部探头,对2798例16～40周胎儿唇部进行观察。结果 2798例中,应用实时三维或二维超声能看到胎儿唇部者2644例,显示率为94.5%,看不清胎儿唇部者154例。二维显示率为84.6%(2367/2798),实时三维显示率为89.7%(2510/2798)。应用实时三维或二维超声共发现胎儿唇腭裂畸形11例,与引产或足月产后相符合。二维及实时三维超声产前均检出唇腭裂10例,漏诊1例,检出率90.9%(10/11)。结论实时三维超声在诊断胎儿唇裂中图像逼真直观,对二维图像具有重要的补充作用,二者结合诊断胎儿唇腭裂是更有效的方法。     

二维和三维超声在胎儿唇裂产前诊断中的应用对比分析

选取2013年4月~2014年4月在我院门诊行产前超声检查且年龄超过30周岁的82例孕妇,均行二维及三维超声检查,比较两种超声检查的唇部显示情况。结果 18~23w胎儿唇部的三维超声显示率要显著高于二维超声(P<0.05);对24~35w的胎儿,无论是二维还是三维超声均能够充分查扫出唇部;而处于36~40w时,胎儿唇部的显示率中二维超声则要明显高于三维超声检查,差异显著(P<0.05)。在我们的产检过程中,共发现有3例唇裂胎儿且均被转诊至上级医院确诊,并行人工引产;其余受检孕妇在分娩后未发现有唇裂患儿。三维超声和二维超声作为产前诊断的重要途径,能有效地筛查出胎儿唇裂;但是三维超声能直观地显示图像,补充二维超声欠缺的一些空间结构信息,两者结合使用可以进一步提高诊断唇裂的准确性,对优生优育具有很大的应用价值。     

二维及三维超声在观察胎儿面部结构中的比较分析

目的探讨应用二维和三维超声观察胎儿面部正常或异常结构的临床价值。方法应用Voluson730三维容积探头表面成像模式及二维探头对孕18~40周,1288例胎儿进行超声检查,重点观察胎儿颜面部结构。结果1288例中,孕23周后应用二维及三维超声观察胎儿颜面部结构,显示率分别为84.6%、87.2%,两者无明显差异;孕23周前三维高于二维。诊断唇裂11例,两者均能作出判断。漏诊单鼻孔畸形1例,腭裂1例。结论只要掌握好最佳检查时机和操作技巧,孕23周后二维和三维超声观察胎儿颜面部结构在显示率上无明显差异,但各有其临床价值,两者可作为信息互补来进行综合评价。     

实时三维超声对胎儿唇腭裂的诊断价值

目的：探讨实时三维超声对胎儿唇腭裂畸形的诊断价值。方法：对妊娠25周以上孕妇行二维超声系统产科检查,对疑诊唇腭裂胎儿行实时三维超声检查。回顾性分析经分娩后证实的24例唇腭裂胎儿声像图表现,并对照分析210例正常胎儿鼻唇部结构。结果：24例唇腭裂胎儿中,单纯唇裂12例,唇裂伴腭裂11例,单纯腭裂1例,无正中裂。二维超声诊断符合率为83.33％,实时三维超声诊断符合率为91.66％,统计学处理,没有明显差异。结论：在胎儿唇腭裂超声诊断中,二维超声与三维超声诊断率基本相同,但三维超声在诊断胎儿唇腭裂中图像逼真、直观,可做为二维超声空间信息的补充。     

胎儿鼻后三角在妊娠早期筛查颜面部畸形中的应用价值

目的探讨鼻后三角切面在妊娠早期筛查颜面部畸形中的价值,对比不同孕周组间鼻后三角的二维图像成像效果。方法将300例常规行11~13+6周超声检查的胎儿按孕周分为三组,分别为11~11+6周组65例、12~12+6周组115例及13~13+6周组120例。常规留取胎儿鼻后三角的二维图像,对比各孕周组间显示图像质量情况,对鼻后三角形态异常者进行分析。结果①各孕周组鼻后三角显示合格率情况:11~11+6周组为90.8%,12~12+6周组为92.2%,13~13+6周组为90.0%,三组间比较差异无统计学意义;②273例获得合格鼻后三角切面的胎儿中,鼻后三角形态异常者4例,其中2例鼻后三角顶点缺失合并腭骨回声缺失或中断,超声诊断为鼻骨缺失、唇腭裂;2例鼻后三角顶点缺失,超声诊断为鼻骨缺失;其余病例的随访结果与超声诊断符合;③27例鼻后三角切面显示不合格或无法成像的胎儿中,1例于孕22周行系统超声检查发现为唇腭裂并经出生后证实。结论鼻后三角是妊娠早期筛查鼻、腭部异常的可行、可靠的声像学标志。     

联合应用二维及三维超声对胎儿脑膨出的诊断价值

目的 探讨联合应用二维及三维超声对胎儿脑膨出的诊断价值.方法 分析6例经引产后证实为胎儿脑膨出患者二维及三维超声表现.结果 二维及三维超声能清晰显示胎儿颅骨缺损的部位、大小,根据膨出物的特点判断脑膨出的类别.结论 联合应用二维及三维超声检查在诊断胎儿脑膨出畸形中具有重要的诊断价值.     

Use of three-dimensional ultrasound imaging in the diagnosis of prenatal-onset skeletal dysplasias.

OBJECTIVE: Recognition of prenatal-onset skeletal dysplasias has improved with advances in ultrasound imaging. Skeletal abnormalities can be recognized by two-dimensional (2D) ultrasound, but generating a precise diagnosis can be challenging. We aimed to determine whether three-dimensional (3D) imaging conferred any advantages over 2D imaging in these cases. METHODS: We studied five women with fetuses of 16-28 gestational weeks referred for abnormal ultrasound skeletal findings. First 2D and then 3D sonography was performed and the results compared. RESULTS: The pregnancies resulted in the following skeletal dysplasias: thanatophoric dysplasia, achondrogenesis II/hypochondrogenesis, achondroplasia, chondrodysplasia punctata (rhizomelic form) and Apert's syndrome. For all five fetuses, the correct diagnosis was made in the prenatal period by analysis of the 2D images. In each case the 3D images confirmed the preliminary diagnosis and for many findings it improved the visualization of the abnormalities. CONCLUSION: The 3D imaging had advantages over the 2D imaging when it came to evaluation of facial dysmorphism, relative proportion of the appendicular skeletal elements and the hands and feet. Most importantly, the patient and referring physician appreciated the 3D images of the abnormal findings more readily which aided in counseling and management of the pregnancy.     

三维超声骨骼成像模式对胎儿上颌骨检测的应用研究

目的探讨不同孕期胎儿上颌骨三维超声成像特点。方法对我院261例经常规超声检查颜面部发育无异常胎儿的上颌骨形态进行静态三维超声成像,并比较各孕期三维超声成像的成功率;同时对3例非颜面部畸形引产后胎儿上颌骨标本进行解剖及体外三维超声成像,对8例腭裂畸形胎儿进行上颌骨三维重建。结果孕12～27+6周胎儿上颌骨三维成像的成功率均≥96%,孕36～40周成像成功率为27.5%;8例腭裂畸形胎儿均成功显像。孕12～15周胎儿上颌骨三维立体图像显示似平放的直角三角形;孕16周时可清晰显示鼻切迹及鼻前棘,胎儿上颌骨与成人相似。结论三维超声骨骼成像模式在显示胎儿上颌骨解剖结构和形态特征方面具有明显的优势,可作为二维常规超声检查的重要补充。     

Two- and three-dimensional sonographic assessment of the fetal face. 1. A systematic analysis of the normal face.

OBJECTIVES: To detail fetal facial examination in utero using ultrasound, to distinguish between requirements for routine screening and those for precise analysis of fetal facial features, and to assess the use of three-dimensional (3D) ultrasound imaging in fetal facial examination. METHODS: This was a retrospective study, based on the examination of approximately 10,500 fetuses. The usual age at screening ultrasound examination was 22 +/- 1 gestational weeks. RESULTS: The sonographic anatomy of the normal fetal face was depicted, and the relevance of the three reference scanning planes, sagittal, coronal and axial, was specified. CONCLUSIONS: At routine screening using two-dimensional sonography, at least two selected views must be imaged: the mid-sagittal plane (search for facial dysmorphology) and the anterior 'nose-mouth' coronal plane (search for disruption in lip continuity or deformation of the narinal bend). Precise analysis of fetal facial anomalies requires visualization and thorough step-by-step analysis in the three planes. The difference between routine screening and precise facial features' analysis has been greatly decreased since 3D and 4D sonography have become readily available. Using this modality, after surface analysis of the fetal face, the three reference planes are simultaneously imaged, using the multiplanar modality, and detailed. 3D/4D ultrasound imaging allows easier, more rapid screening and more precise evaluation of the different facial features.     

胎儿下颌畸形的产前超声诊断分析

目的探讨胎儿下颌畸形的产前超声表现、检查技巧及临床意义,提高此类畸形的产前检出率。方法对山东省枣庄矿业集团中心医院常规产前筛查或在外院超声检查发现其他异常来我科会诊的胎儿颜面部进行常规多切面扫查。先通过二维超声正中矢状切面主观目测是否存在下颌发育畸形,同时对可疑病例进行颜面部的冠状面及横切面补充扫查,仔细测量下颌骨前后径,并与双顶径进行比较,然后启动三维表面重建成像协助明确产前诊断。所有经产前超声诊断的患者均经引产后证实。结果产前共检出下颌发育畸形胎儿11例,其中小下颌畸形9例,下颌骨缺失2例。结论产前二维超声可以明确诊断胎儿下颌发育畸形,正中矢状切面是诊断此类畸形的首选切面;颜面部三维表面成像具有空间立体显像优势,可全面、直观地再现颜面结构的外形及细部缺陷,是提高胎儿颜面畸形诊断准确度的有效辅助手段。     

二维联合动态三维超声时空关联成像技术诊断胎儿完全型心内膜垫缺损

目的探讨二维联合动态三维超声时空关联成像(STIC)技术诊断胎儿完全型心内膜垫缺损(CTECD)的价值。方法应用超声心动图检查28 388例孕18~40周的胎儿,二维及彩色多普勒超声以胎儿四腔心切面为常规扫查切面,多切面扫查观察胎儿心脏大小、形态、房室结构、房室瓣开闭、左右心室流出道及其血流动力学改变,发现心脏解剖结构异常后应用动态三维超声STIC技术实时、动态观测胎儿三维房室结构及其血流动力学改变。结果本组28 388例孕妇中,超声心动图明确存在先天性心脏病胎儿861例,其中诊断CTECD 68例。结论二维联合动态三维超声STIC技术可诊断胎儿CTECD,可在短时间内直观地显示胎儿CTECD的大小、形态及其血流动力学改变。     

Prenatal three-dimensional ultrasound and magnetic resonance imaging evaluation of a fetal oral tumor in preparation for the ex-utero intrapartum treatment (EXIT) procedure.

Recent attempts at predelivery management of obstructed fetal airways have focused on the EXIT (ex-utero intrapartum treatment) procedure, which allows sufficient time to secure the fetal airway through preservation of uteroplacental gas exchange. We report a fetus with an exophytic oral tumor noted at 34 weeks of gestation. In this case, three-dimensional (3D) ultrasound allowed a complete and interactive evaluation of the tumor and related facial anatomy, and confirmed that access to the fetal airway was unlikely during delivery. Fetal magnetic resonance imaging (MRI) further demonstrated that the tumor originated in the nasopharynx and obstructed the upper airway. Both imaging results led to a final decision to offer an EXIT procedure for the neonate. At 36 weeks' gestation, a successful EXIT procedure was performed to reduce the risk of respiratory distress immediately after birth. This report highlights the value of 3D ultrasound and MRI as essential prerequisites for optimization of the triage process in selecting EXIT candidates.     

The prenatal diagnosis of Binder syndrome before 24 weeks of gestation: case report.

A case of Binder syndrome was diagnosed at 21 weeks of gestation using two-dimensional and three-dimensional ultrasound. The first indication of any abnormality was a flattened fetal nose demonstrated in the mid-sagittal plane. Further ultrasound imaging showed the virtual absence of the naso-frontal angle, giving the impression of a flat forehead and small fetal nose. Suspected mild hypertelorism was also seen using transverse and coronal planes. Differential diagnosis of this condition is discussed.