Prenatal depiction of angioarchitecture of an aneurysm of the vein of Galen with three-dimensional color power angiography.

A fetus with a large supratentorial cyst and cardiomegaly was encountered at 33 weeks of gestation. The cyst appeared as an aneurysmal, fluid-filled structure extending posteriorly with a finger-like appendage. Using color flow mapping, we disclosed rapid in-and-out blood flow with marked turbulence within the cyst. For evaluation of its blood supply and venous drainage of the vascular malformation, a three-dimensional reconstruction of the power Doppler image was conducted. The results revealed that the vascular malformation was supplied by a small contralateral aneurysm from the branches of Willis' circle, draining posteriorly into an abnormal falcine sinus and then into the superior sagittal sinus. No other fetal abnormality such as hydrocephalus or hydrops was discovered. The prenatal diagnosis of an aneurysm of the vein of Galen was made on the basis of the gray-scale, color Doppler findings, and also the angioarchitecture obtained by three-dimensional power Doppler imaging. The woman was admitted at 37 weeks of gestation due to labor onset and delivered the baby via the vaginal route without complication. Postnatal angiography and magnetic resonance imaging confirmed the diagnosis of an aneurysm of the vein of Galen, and the angioarchitecture depicted it before birth. We suggest that three-dimensional power Doppler ultrasonography may assist in the diagnosis of an aneurysm of the vein of Galen, and precisely delineate the complicated corresponding vasculature. This may guide postnatal management and predict the prognosis more accurately.     

Prenatal diagnosis of thrombosed aneurysm of vein of Galen.

Aneurysm of the vein of Galen in the fetus is a rare malformation that has been described in a small number of case reports. Thrombosis of aneurysm of the vein of Galen is a rare occurrence reported in postnatal cases. We report a case of thrombosis of vein of Galen aneurysm occurring in a fetus of 21 weeks' gestation. The fetus showed an echogenic mass posterior and superior to the thalamus. It also showed dilated dural venous sinuses, dilated neck vessels, cardiomegaly and minimal ascites. The pregnancy was terminated and autopsy confirmed the diagnosis. The present case is the first report of the prenatal sonographic features of this condition in the literature.     

Perinatal three-dimensional color power Doppler ultrasonography of vein of Galen aneurysms.

OBJECTIVE: To present the prenatal and postnatal three-dimensional color power Doppler ultrasonographic features in cases of vein of Galen aneurysmal malformation. METHODS: Prenatal three-dimensional color power Doppler ultrasonography was used to image the neurovascular malformations in 3 fetuses with vein of Galen aneurysms and in unaffected control fetuses at the same gestational age. Postnatal transfontanel three-dimensional power Doppler ultrasonography was also performed in the third affected case and in an unaffected control neonate. The feeding and drainage vessels were analyzed in the three-dimensional rendering mode. RESULTS: The first case was complicated by porencephaly and fetal heart failure, and the pregnancy was terminated. The other 2 cases were uncomplicated prenatally, but 1 of the infants died after aneurysmal embolization due to acute cerebral ischemia. The angioarchitecture of the arteriovenous fistula was characterized in greater detail by three-dimensional color power Doppler ultrasonography than by two-dimensional ultrasonography, especially regarding the anatomic features of the feeding and drainage vessels and their connections with the dilated vein of Galen. CONCLUSIONS: Three-dimensional color power Doppler ultrasonography provided detailed images of the aneurysmal malformation and its vascular connections. Further studies are needed to correlate three-dimensional vascular imaging patterns with outcome.     

三维能量多普勒产前诊断胎儿Galen静脉血管瘤1例

孕妇20岁,孕2产0,孕36+3周,外院检查发现胎儿颅内囊性占位.曾自然流产1次,无畸胎家族史.此次妊娠2个月时曾服用"安宫黄体酮"(用量不详).超声:于胎儿脑中线脑后方见椭圆形无回声囊性占位,约2.38 cm×1.79 cm×1.81 cm,囊壁规则,囊液清亮,与脑室系统不相通;CDFI示囊性无回声区内充满丰富血流信号(图1);脉冲多普勒显示静脉频谱内见动脉血流频谱,PI 0.79,RI 0.55,S/D 2.2,Vmax 24.12 cm/s(图2);利用三维能量多普勒进行三维重建,图像显示该病变部位为瘤样扩张的大脑大静脉,经直窦直接汇入上矢状窦,同时有血管与颅底Willis环连通(图3);胎儿生物学测量指标及胎儿附属物情况与孕周相符.超声提示:宫内单活胎;胎儿发育异常(Galen静脉血管瘤).引产后证实.     

肝癌的能量多普勒和三维彩色血管能量成像研究

目的 探讨肝癌的血供特点及能量多普勒（CPA）和三维彩色血管能量成像（3D-CPA）对肝癌的诊断价值。方法 采用ATLHDI-3000超声仪,C4-2超宽频探头,对53例原发性肝癌（HCC）和44例肝转移癌（HM）进行CPA检查,其中57例3D-CPA检查与X线动脉造影（AG）对比,32例与病理学检查结果对照。结果 HCC与HM均以瘤外弧形血流及瘤内树枝状分支血流为特点。3D-CPA检查66.67%的肝癌病例表现为特征性的“众星捧月征”,此结果与AG及病理检查结果相一致。结论 3D-CPA目前可人微言轻评价肝癌血供的首选方法。     

Prenatal diagnosis of an intra-abdominal ectasia of the umbilical vein with color Doppler ultrasonography.

A cystic lesion in the anterior upper part of the abdomen was detected in utero by ultrasonography. Color and pulsed Doppler studies performed over the mass revealed a marked turbulent flow through the cystic lesion in connection with the umbilical vein, suggesting the existence of an intra-abdominal ectasia of the umbilical vein.     

经阴道三维彩色血管能量成像对卵巢良恶性肿瘤的诊断价值

目的:探讨经阴道三维彩色血管能量成像(TV3D-CPA)对卵巢肿瘤的诊断价值及其与恶性肿瘤临床分期的关系。方法:术前应用TV3D-CPA技术检测65例卵巢肿瘤(47例恶性肿瘤,18例良性肿瘤),定量计算肿瘤内血管指数(VI),分析VI值在良、恶性肿瘤中的差异性及其与恶性肿瘤临床分期的关系。结果:卵巢恶性肿瘤VI值(0.080±0.052)条/cm³,明显高于良性组(0.043±0.031)条/cm³(P<0.05)。以VI≥0.035条/cm³诊断卵巢恶性肿瘤敏感性87.8%,特异性75%。Ⅲ、Ⅳ期卵巢恶性肿瘤VI值(0.089±0.037)条/cm³,明显高于Ⅰ、Ⅱ期(0.056±0.04)条/cm³(P<0.05)。结论:应用TV3D-CPA计测VI值是鉴别卵巢良、恶性肿瘤的有效方法。VI值随临床分期的增高而升高,是预后评价的重要指标。     

Arteriovenous malformation of mesosalpinx associated with a 'vanishing' ectopic pregnancy: diagnosis with three-dimensional color power angiography.

We describe two cases of pelvic arteriovenous malformation diagnosed with the aid of three-dimensional color power angiography. In both cases, beta-human chorionic gonadotropin (beta-hCG) increased to significant levels (8413 and 1560 mIU/ml, respectively); however, neither an intrauterine nor an adnexal gestational sac could be found. In each case, we observed an adnexal mass with several tortuous areas exhibiting abundant turbulent flow. The diagnosis of arteriovenous malformation was made and further assessment by three-dimensional color power angiography and magnetic resonance imaging (MRI) was carried out. The complex vascular anatomy of arteriovenous malformation, including its feeding vessels and drainage, was clearly depicted by three-dimensional color power angiography and correlated well with magnetic resonance angiography. Levels of beta-hCG decreased in subsequent tests, and eventually became negative 2-3 months later without and intervention. We believe that an involutional ectopic pregnancy induced the rapid growth of the arteriovenous malformations within the mesosalpinx. Three-dimensional color power angiography can be performed quickly and easily, using existing ultrasound equipment. It improves our understanding of complicated vasculature, and thus is a useful adjunct to two-dimensional and color Doppler ultrasound in the diagnosis of arteriovenous malformation.     

骨肉瘤的三维彩色血管能量成像研究

Objective To evaluate the value of three-dimensional color power angiography(3D-CPA,) in osteosarcoma diagnosis. Methods Forty-three cases with osteosarcoma were detected with 3D-CPA to assess the vascular classification(3D-CPA Ⅰ to Ⅲ) and measure the vascular parameters including vascularization index(VI), flow index(FI) and vascularization-flow index(VFI). Results All of the 43 cases were classified into 3D-CPA Ⅲ type. The space structure shape of blood vessels and the origin of nutrient vessels was clear. The quantitative measurement showed that VI was 25.84±6.87,FI was 34, 18±2.93, VFI was 9.02±4.04. Conclnsions It is a new method to analyze and diagnose osteosarcoma with 3D-CPA because it can show the nutrient vessels and the embranchments of blood vessels clearly, tridimensionally and integrally and Bake quantitative or partial-quantitative analysis.     

骨肉瘤的三维彩色血管能量成像研究

目的 探讨三维彩色血管能量成像(3D-CPA)对骨肉瘤的诊断价值.方法 应用3D-CPA检测骨肉瘤43例,评定血管分型(3D-CPA Ⅰ-Ⅲ型),并测量相应的血管参数:血管形成指数(VI)、血流指数(FI)、血管形成-血流指数(VFI).结果 43例骨肉瘤均为3D-CPA Ⅲ型.瘤内外血管空间结构形态直观,滋养血管来源明确.骨肉瘤定量测量的血管参数为VI=25.84±6.87,FI=34.18±2.93,VFI=9.02±4.04.结论 3D-CPA可清晰,立体、完整显示骨肉瘤的滋养血管及瘤内的血管分支,并可半定量、定量分析,为骨肉瘤的诊断提供了一种新方法.     

三维彩色血管能量成像鉴别乳腺肿瘤良恶性的应用价值

目的 探讨三维彩色血管能量成像在鉴别诊断乳腺肿瘤良恶性中的应用价值.方法 对114例女性患者共121个乳腺实质性肿块进行三维彩色血管能量成像检查(恶性组63个,良性组58个),并对血管血流等参数进行分析,应用受试者工作特征(ROC)曲线比较各项参数的诊断价值.结果 与良性组相比,恶性组肿块内血流指数( FI1)、包含肿块周边3 mm组织的血流指数(FI2)及上述两种参数的比值G2 (FI2/FI1)在两组间差异有统计学意义(P均＜0.05).FI2的ROC曲线下面积最大,FI2与G2曲线下面积比较差异无统计学意义(P＞0.05),FI2与FI1曲线下面积比较差异有统计学意义(P＜0.05).以FI2≥27.385作为临界值,诊断乳腺恶性肿瘤的敏感性为88.9％,特异性为81.0％,阳性预测值为83.6％,阴性预测值为87.0％.结论 三维彩色能量成像参数FI2诊断乳腺恶性肿瘤的特异性和敏感性较高;FI2的最佳临界点为≥27.385,有助于乳腺良恶性肿瘤的鉴别诊断.     

二维及三维能量多普勒超声联合应用诊断脐带异常

目的：探讨二维超声及三维能量多普勒超声成像（3D-CPA）联合应用显示胎儿脐带异常的方法和临床应用价值。方法：对154例胎儿脐带形态可疑者进行常规二维检查后,对感兴趣区域行3D-CPA,结果与术后随访结果对照分析。结果：二维超声及3D-CPA均能诊断多种脐带异常,而3D-CPA尤其对脐带打结及脐带绕体的图像显示更加直观,逼真,易于理解。结论：3D-CPA可以更清晰显示脐带形态的立体空间关系,二维超声结合3D-CPA可以提高脐带异常的诊断率。     

Color Doppler velocimetry and three-dimensional color power angiography of cervical carcinoma.

OBJECTIVES: To investigate the blood flow within invasive cervical carcinoma by transvaginal two-dimensional (2D) color spectral Doppler and three-dimensional (3D) color power angiography and to correlate these parameters with the clinicopathological characteristics. METHODS: Seventy-four patients with invasive cervical carcinoma were enrolled for the analysis. Squamous cell carcinoma serum antigen levels (SCC) were obtained for all the patients. Sections of all malignant tissues were analyzed for tumor expression of cyclooxygenase-2 (COX-2). All patients underwent color and spectral Doppler examination and 44 patients had 3D color power angiography. Color spectral Doppler parameters (color score, lowest resistance index (RI), highest peak systolic velocity (PSV)) and 3D color power angiography indices (relative color, average color, flow measure) of FIGO I/II cervical cancers were compared with those obtained in a control group of 24 patients with a normal uterine cervix. Pulsed Doppler parameters and the 3D vascular indices were compared with clinicopathological parameters, SCC serum antigen levels and tumor COX-2 expression. RESULTS: At color Doppler analysis 72 patients (97%) showed intralesional detectable vessels. Color spectral Doppler and 3D-derived parameters were significantly different in FIGO I/II cervical cancers compared with those in women with a normal cervix. A significantly higher color score (P = 0.0008), lower RI (P = 0.032) and higher PSV (P = 0.004) were associated with a tumor diameter > or =4 cm compared with smaller tumors. The highest PSV was significantly higher in patients with FIGO stage III/IV compared with FIGO stage I/II (P = 0.0069). There was a direct correlation between PSV and SCC (r = +0.44, P = 0.003). The median relative color was significantly higher in patients with a higher color score (P = 0.0006). No statistically significant correlations were found between 3D color power angiography parameters and the clinicopathological characteristics or between the 3D vascular parameters and biological factors. CONCLUSIONS: Alterations of 3D ultrasound-derived vascular indices were found in patients with cervical cancer compared with those with a normal cervix. Moreover, some vascular indices proved to be associated with tumor size. The assessment of a possible clinical role of 2D and 3D ultrasound-derived vascular indices in cervical cancer deserves further investigation.     

Prenatal diagnosis of pulmonary sequestration using three-dimensional power Doppler ultrasound.

OBJECTIVE: To investigate the contribution of three-dimensional power Doppler ultrasound to the prenatal diagnosis of pulmonary sequestration. METHODS: Prenatal three-dimensional power Doppler ultrasound was used to screen for an abnormal pulmonary blood supply in eight fetuses with hyperechogenic lung lesions and to image the pulmonary blood supply in 50 normal controls. A comparison was made with postnatal findings. RESULTS: Postnatally the eight pulmonary lesions were found to be an isolated pulmonary sequestration (n = 3), a microcystic congenital adenomatoid malformation (n = 4), and a mixed (macrocystic and microcystic) congenital adenomatoid malformation (n = 1). Prenatal three-dimensional power Doppler ultrasound demonstrated an abnormal blood supply in all cases of pulmonary sequestration and in none of the other cases. Among the three cases that turned out to be pulmonary sequestrations, conventional two-dimensional ultrasound failed to identify the feeding vessel in one case and identified it at a later stage of gestation than did three-dimensional power Doppler in the other two. CONCLUSION: Prenatal three-dimensional power Doppler ultrasound may be useful in identifying the feeding vessel and thus establishing the diagnosis of pulmonary sequestration in the presence of a hyperechogenic pulmonary lesion, allowing its differentiation from congenital cystic adenomatoid malformation.     

三维彩色血管能量成像在诊断乳腺肿瘤及预测肿瘤血管生成的应用价值

目的探讨三维彩色血管能量成像在诊断乳腺肿瘤及预测肿瘤血管生成的临床应用价值。方法对85例由手术及病理证实乳腺肿瘤患者行三维彩色血管能量成像检查，并对肿瘤血管三维图像进行定量及半定量分析。采用链霉素-生物素免疫组化技术对所有乳腺肿瘤进行CD34指标检测。结果乳腺良恶性肿瘤的三维血管形态不一，以血管分型Ⅲ型诊断乳腺恶性肿瘤，其敏感性为88．24％，特异性为68．29％。其定量指标血管指数也有明显差异，以血管指数〉0．3条／cm^3诊断恶性肿瘤敏感性为81．57％，特异性为67．56％。良性肿瘤血管指数与微血管密度无显著相关性（P〉0．05），恶性肿瘤血管指数与微血管密度有显著相关性（P〈0．05）。结论三维彩色血管能量成像技术为乳腺肿瘤的诊断提供了新的途径和方法，并且可初步评估肿瘤组织微血管的丰富程度，从而预测预后及为抗肿瘤血管生成的基因疗法、手术切除等治疗方案的选择提供重要的依据。