胎盘间叶发育不良超声图像及临床特征分析

目的 分析胎盘间叶发育不良的超声图像及临床特征。方法 回顾性分析经病理证实的8例胎盘间叶发育不良的超声图像，总结胎盘间叶发育不良的超声特征。结果 8例患者超声图像异常最早孕周为妊娠9周，最晚为妊娠13周。超声异常表现主要为胎盘厚度的改变(8/8)及胎盘胎儿面蜂窝状回声(7/8)。彩色多普勒血流成像显示，胎盘回声异常区域内血流信号：少量血流信号(4/8),无血流信号(4/8)。随孕周进展胎盘厚度及胎盘回声异常区域先增大，至妊娠19周胎盘厚度逐渐减小，胎盘回声异常区域范围缩小，甚至消失。超声筛查检出胎儿脐膨出合并双足多趾1例，余7例胎儿结构未见明显异常。结论 胎盘间叶发育不良的胎盘回声改变为位于胎盘胎儿面蜂窝状回声，随孕周进展可伴有不同的声像图特征，尽早规律的超声检查，有利于胎盘间叶发育不良的早期诊断。     

高频超声在女性腹股沟囊性病变鉴别诊断中的应用

目的评价高频超声在女性腹股沟囊性病变鉴别诊断中的价值。方法回顾性分析35例女性腹股沟囊性病变超声声像图特征。用似然比检验比较不同种类腹股沟囊性病变在腹股沟T型分区中的差异,采用Fisher确切概率法比较不同种类腹股沟囊性病变的超声声像图特征差异。如T型分区有统计学意义,与各项有统计学意义的声像图特征相结合,计算超声诊断符合率。结果似然比检验显示病变在T型分区的分布有差异(P0.01)。不同声像图特征中茎秆样回声、周围脂肪回声、管道样回声及有无血流在各种囊性病变中差异性极显著(P0.01)。T型分区与腹股沟韧带上方病变的声像图特征,包括茎秆样回声、管道样回声、内部充满血流等相结合,超声诊断符合率分别为82.9%、94.3%、97.1%。结论高频超声对女性腹股沟囊性病变的鉴别诊断有重要临床价值。     

彩超在甲状腺囊实性病变诊断中的价值

目的通过分析甲状腺囊实性病变的声像图特征,探讨结节性甲状腺肿囊性变、甲状腺腺瘤囊性变、甲状腺乳头状癌囊性变超声鉴别诊断要点。方法对112例经手术及病理证实的甲状腺囊实性病变的声像图进行回顾性分析。结果甲状腺囊实性病变多见于甲状腺腺瘤、结节性甲状腺肿以及甲状腺乳头状癌的囊性变,三者的声像图有一定差异。甲状腺腺瘤的包膜、边缘晕环以及环状血流;结节性甲状腺肿病变一般为多发结节,周围组织回声异常,结节内血流缺乏;甲状腺癌的低回声、后方回声衰减及内部砂粒样钙化在诊断中有较高的特异性。结论彩超对甲状腺囊实性病变的诊断及鉴别诊断具有重要临床价值。     

经阴道超声鉴别诊断葡萄胎与胚胎停育价值

目的：探讨经阴道超声鉴别诊断葡萄胎与胚胎停育的价值。方法：回顾性分析经病理证实29例完全性葡萄胎患者、22例部分性葡萄胎患者、62例胚胎停育患者阴道超声资料。结果：经阴道超声诊断完全性葡萄胎、部分性葡萄胎及胚胎停育的符合率分别为100％、72．7％、98．4％;完全性葡萄胎超声声像显示宫腔内水泡样结构,水泡回声密集,囊壁薄,回声强,与周围组织分界清楚,呈蜂窝状,水泡后方回声较均匀;19例（86．4％）部分性葡萄胎超声声像显示宫腔内见水泡样结构,声像图表现与完全性葡萄胎相同;宫腔内均可见孕囊或胎儿及附属物结构;6例（9．7％）胚胎停育超声声像显示宫腔内见水泡样结构,水泡多稀疏,囊壁欠清晰,水泡后方回声杂乱,强弱不均;62例均未合并卵巢黄素囊肿。无胎盘退行性变时超声声像显示子宫多小于孕周,宫腔内无水泡样结构,若存在胎盘退行性变,可见类水泡样结构,水泡较稀疏,与周围组织分界不清,水泡后方回声杂乱。结论：经阴道超声在葡萄胎、胚胎停育的诊断与鉴别诊断中具有较高临床价值。     

胎盘间叶发育不良产前超声表现一例

30岁初产妇,唐氏筛查正常,未做胎儿染色体核型检查,妊娠早期血HCG水平在正常范围内。妊娠22周产前超声检查发现胎盘局部回声减低,内略呈网格样改变,范围69mm×60mm×33mm,与正常胎盘间分界较清晰,CDFI该区域内未见明显血流分布（图1）;妊娠中晚期超声复查,胎盘异常回声区仍可见,边界欠清晰。     

胎儿气道梗阻性病变的超声诊断与鉴别诊断

目的:探讨胎儿气道梗阻性病变的超声诊断与鉴别诊断问题。方法:选取2010年1月—2020年1月在临沂市妇幼保健院超声检查为胎儿先天性高位气道梗阻综合征、主支气管闭锁和叶支气管闭锁的11例孕妇,分析其超声图像特征,并探讨胎儿隔离肺和胎儿先天性肺囊性腺瘤样畸形(Ⅲ型)的鉴别诊断。结果:本组11例孕妇中,超声诊断胎儿先天性高位气道梗阻综合征4例,主支气管闭锁5例,叶支气管闭锁2例。超声表现,4例表现为胎儿双侧肺体积明显增大、回声增强,气管、支气管扩张、充满液体呈无回声,双侧膈肌受压变平坦、下移。4例表现为胎儿右侧肺明显增大、回声增强,右侧支气管扩张、充满液体呈无回声,纵隔受压向左移位,右侧横膈受压下移。1例表现为胎儿左侧肺体积增大、回声增强,左侧支气管扩张、充满液体呈无回声,纵隔受压向右移位,左侧横膈受压下移。2例表现为纵隔右侧见高回声团块,近纵隔一侧团块内见管状无回声。结论:胎儿气道梗阻性病变罕见。超声检查胎儿先天性高位气道梗阻综合征和主支气管闭锁表现典型,容易诊断,而叶支气管、段支气管闭锁的超声诊断则有一定困难,因此,在检查中需要注意鉴别诊断,特别是与胎儿隔离肺和胎儿先天性肺囊性腺瘤样畸...     

鹰嘴皮下滑液囊病变的超声诊断

目的 阐述肘关节后侧尺骨鹰嘴皮下滑液囊病变的声像图表现,探讨超声检查对尺骨鹰嘴皮下滑液囊病变的诊断价值.方法 使用高频超声对肘后区进行扫查,由浅至深依次观察肘后部皮肤、病变的鹰嘴皮下滑液囊、肱三头肌腱、尺骨鹰嘴骨质回声特征;对病变的滑液囊测量其大小,观察其形态、内部回声特征、滑膜厚度、增厚的滑膜及滑囊内结构上血流分布情况.结果 本组病例中,均可见鹰嘴皮下滑液囊增大,因病因及病史不同,声像图可表现为:(1)单纯性滑液囊积血或积脓:囊内可见无回声区及散在的点状或斑片状回声;(2)滑液囊积液:囊内无回声区内可见纤细分隔或散在的点片状回声;(3)滑液囊滑膜增生性病变:囊壁明显增厚,囊内可见团状、乳头状回声或粗大的皱褶回声;(4)滑液囊内为类实质样改变:囊内充满细点状回声;(5)肘关节周围软组织病变.结论 超声检查可对肘后鹰嘴皮下滑液囊病变的诊断简便、快捷,同时还可对肘关节周围软组织内的病变做出诊断,并能在超声引导下进行穿刺诊断及治疗.     

涎腺疾病灰阶超声诊断

目的 探讨灰阶超声对涎腺疾病的诊断价值,分析各类疾病的声像图特点。方法 回顾分析54例经病理证实的涎腺疾病的灰阶超声声像图。结果 灰阶超声鉴别涎腺囊、实性病变准确性较高,囊肿诊断准确率100％;混合瘤和腺淋巴瘤可根据肿块形态,内部及后方回声,病灶个数等方面进行鉴别;恶性肿瘤的声像图与良性肿瘤比较,缺乏一定特征,鉴别尚有一定困难,结合临床资料有一定帮助。涎腺弥漫性炎症根据腺体内部回声及肿块无明显边界诊断容易,涎腺导管结石诊断可靠。涎腺淋巴结炎症或结核为多发、边界清晰的低回声光团。结论 灰阶超声对良性病变有较好的鉴别价值,对良、恶性肿瘤鉴别尚有一定困难,结合临床表现有助超诊断。     

胎盘囊肿的超声诊断

目的：探讨胎盘囊肿的声像图特征，为临床诊治提供客观依据。方法：本组15例，孕龄28－41周，使用Apogee-CX型彩超仪，探头频率3.5MHz，常规对胎儿、胎盘及羊水情况进行观察。结果：在胎盘子面均见向外突出的囊性肿物，单发11例，多发4例。超声诊断均与临床、病理诊断相符。结论：超声诊断胎盘囊肿可为临床诊治及鉴别诊断提供客观依据。     

不同类型胎儿泌尿系发育不良的超声声像图特征及诊断价值

目的分析不同类型胎儿泌尿系发育不良的超声声像图特征及诊断价值。方法随机抽取在我院接受产前超声诊断并确诊为泌尿系统发育不良的84例胎儿作为研究对象,所有胎儿接受病理诊断。比较产前超声诊断符合率,总结超声声像图特征,探究其临床价值。结果经病理学诊断,84例胎儿中有82例确诊为泌尿系发育不良,产前超声诊断符合率为97.62%;产前超声诊断84例泌尿系发育不良胎儿中单纯肾积水占比最高,为65.48%,其次为肾盂积水合并输尿管扩张,占10.71%;声像图特征分析发现单纯肾积水主要表现为肾盂扩张;肾发育不全声像图可见肾脏表面粗糙,肾脏较正常小,存在较强实质回声。结论产前超声诊断具有较高分辨率、图像清晰、诊断符合率高及操作简单等优势,能够有效检出不同类型胎儿泌尿系发育不良。     

Three‐Dimensional Sonography of Placental Mesenchymal Dysplasia and Its Differential Diagnosis

Objective. Placental mesenchymal dysplasia (PMD) is an uncommon vascular anomaly of the placenta characterized by mesenchymal stem villous hyperplasia. Its main sonographic feature is a thickened placenta with hypoechoic areas, and an accurate sonographic diagnosis is challenging. The aim of this study was to report 2 cases of PMD and discuss the differential diagnosis of its sonographic features. Methods. Cases of placental masses were studied by 2‐dimensional (2D), 3‐dimensional (3D), and color Doppler imaging. Results. In case 1, a thick placenta with multiple hypoechoic areas was noted at 13 weeks' gestation. At 19 weeks, the multicystic area, clearly demarcated from a normal‐looking placenta, measured 6.5 × 8.5 cm and enlarged gradually. The patient gave birth to a 625‐g female neonate after spontaneous labor at almost 26 weeks' gestation. In case 2, a first sonographic examination at 25 weeks' gestation revealed a thickened placenta with hypoechoic areas and a fetus with a single umbilical artery and a ventricular septal defect. At 27 weeks, the abnormal area of the placenta measured 14.5 × 7.5 cm. At 32 weeks' gestation, a caesarean delivery was performed because of a nonreassuring fetal heart tracing, and a 1415‐g female neonate was delivered. Both cases were evaluated by 2D, 3D, and color Doppler imaging, and the pathologic features of both placentas were consistent with PMD. Conclusions. Placental mesenchymal dysplasia should be considered in the differential diagnosis of every placental mass, especially in cases of multicystic placental lesion with lack of high‐velocity signals inside the lesion, and a normal karyotype.     

Placental mesenchymal dysplasia associated with trisomy 13: sonographic findings

Placental mesenchymal dysplasia (PMD) is a rare placental abnormality with sonographic and macroscopic features similar to those seen in a partial hydatidiform mole, and which has usually been reported with a normal female karyotype. We report a case of prenatally suspected PMD associated with trisomy 13. Sonography performed at 17 weeks' gestation showed multiple cystic spaces in the placenta resembling molar tissue, and a fetus with postaxial polydactyly and an atrial septal defect. An amniocentesis revealed a fetal karyotype of 46,XY,der(13), t(13;13)(q11;q11)[20]/47,XY,+13[11], consistent with trisomy 13. Cordocentesis confirmed the cytogenetic diagnosis. Histopathologic examination of the placenta following termination of the pregnancy at 22 weeks' gestation showed enlarged stem villi with loose connective tissue and cistern formation and no evidence of trophoblastic hyperplasia or stromal trophoblastic inclusions, which was consistent with PMD. PMD should be considered in the differential diagnoses of a placenta showing multiple cystic lesions on prenatal sonography, and karyotypic analysis should be performed.     

胎儿颅内出血的产前超声特征与妊娠结局

目的探讨胎儿颅内出血的产前超声声像图特征.方法对30例颅内出血胎儿产前及产后颅脑超声声像图进行对照分析.结果30例颅内出血胎儿超声声像图特征:(1)颅内异常回声特征:30例均显示颅内异常占位回声(双侧异常回声14例,单侧异常回声16例),但出血量、出血时间不同异常回声表现不同;其中15例(15/30,新鲜出血期)颅内出血区呈高回声,11例(部分液化期)颅内出血区呈混合性回声,4例(完全液化期)颅内出血区呈囊性无回声.(2)异常回声区边界及血流特征:异常回声区边界清晰,彩色多普勒血流成像示异常回声区内部及周边未见明显彩色血流信号.(3)超声分级诊断与随访结果:超声诊断Ⅰ级颅内出血17例(均为室管膜下出血),表现为单侧或双侧室管膜下高回声区、混合性回声区或囊性无回声区,大小3~21 mm,双侧侧脑室无扩张(侧脑室宽度均<15 mm);胎儿预后较好,颅脑超声随访(12例)均证实为颅内出血,引产1例,失访4例.Ⅱ级颅内出血5例,均无脑室扩张,单侧或双侧侧脑室内高回声区,大小8~28 mm,与脉络丛分界尚清,双侧侧脑室无扩张(侧脑室宽度均<15 mm);产后颅脑超声随访证实2例为颅内出血,引产2例,失访1例.Ⅲ级颅内出血6例,脑室内出血合并脑室扩张,单侧或双侧脑室内呈高回声或混合性回声区(单侧或双侧侧脑室宽度≥15 mm);胎儿MRI诊断颅内出血1例,引产5例,失访1例.Ⅳ级颅内出血2例(双胎1例),Ⅰ~Ⅲ级脑出血合并脑室周围实质内大范围出血,脑室周围实质呈高回声或混合性回声区;胎儿MRI诊断颅内出血1例,2例均引产(1例双胎之一胎死宫内).(4)颅内出血合并异常:合并宫内发育迟缓5例,胎盘异常3例,羊水异常3例.(5)临床结局:14例临床预后较好(Ⅰ级12例,Ⅱ级2例),产后新生儿存活,无严重神经系统并发症;引产10例预后均较差(Ⅰ级1例,Ⅱ级2例,Ⅲ级5例,Ⅳ级2例),失访6例.结论胎儿颅内出血产前超声表现为颅内异常占位回声区,回声边界清晰,其内无血流信号,超声分级诊断有助于判断胎儿颅内出血严重程度,可估测胎儿预后和协助产前咨询.     

Ultrasound diagnosis of severe thrombotic placental damage in the second trimester: an observational study.

OBJECTIVES: To screen women with uteroplacental insufficiency between 18 and 26 weeks' gestation for sonographic evidence of destructive placental lesions, to observe the effect of low molecular-weight heparin (LMWH) in these cases, and to compare the outcome with similar but untreated controls. METHODS: We screened 180 women at high risk for placental damage using 16-week maternal serum screening (alpha-fetoprotein and human chorionic gonadotropin), placental shape and texture, and uterine artery Doppler waveforms at the 18-20-week level II examination. Serial gray-scale examinations of placental texture were performed at 22, 24 and 26 weeks. LMWH was offered to women with ultrasound evidence of destructive placental lesions in the absence of intrauterine growth restriction and/or pre-eclampsia. RESULTS: We prospectively identified six women (3.3%) with abnormal maternal serum screening and uterine artery Doppler in whom abnormal placental texture (echogenic cystic lesions) suggestive of destructive lesions in the placental parenchyma was found either at the 18-20-week ultrasound examination (n = 4), or by 26 weeks of gestation (n = 2). All six received LMWH and had live births (gestational age at delivery, 33-37 weeks; birth weight, 1000-3200 g). A further 14 women were referred with similar multiparameter evidence of placental damage at or after 26 weeks, outside the screening study. All had significant fetal growth restriction and were therefore not offered heparin. In 9/14 cases there was a perinatal death. Ischemic and/or thrombotic placental pathology was confirmed in each case, but no maternal thrombophilia disorders were identified in the 20 women. CONCLUSIONS: Integrated biochemical and ultrasound testing of placental function at 16-20 weeks of gestation, followed by serial placental gray-scale ultrasound, may be an effective method of identifying a subset of pregnancies at high risk of adverse pregnancy outcome due to destructive lesions in the placental parenchyma. This strategy of identifying thrombo-occlusive placental lesions before the development of pregnancy complications may prove useful in the design of trials to study the effectiveness of LMWH in the prevention of clinical complications resulting from thrombo-occlusive placental disease.     

Focal aneurysmal dilatation of subchorionic vessels simulating chorioangioma.

Subchorionic vascular aneurysms of the placenta are rare lesions and may present confusion with chorioangioma or focal mesenchymal dysplasia on sonography. To our knowledge, the findings of placental aneurysms have not been reported in the ultrasound literature. We present a case with detailed sonographic evaluation, including spectral and color Doppler and pathological analysis, that was mistaken for chorioangioma prenatally. Knowledge of this benign entity may allow the sonologist to recommend conservative management in similar cases.     

胎盘早剥的声像图表现

目的探讨超声诊断胎盘早剥的临床价值及声像图特点。方法回顾性分析22例胎盘早剥患者的声像图表现及临床结局,结合患者临床表现行超声分型与临床分型对比分析。结果19例胎盘早剥患者的超声诊断与临床和病理诊断结果一致,超声诊断错误3例。其中超声诊断轻型胎盘早剥与病理符合3例(3/5),误诊2例(1例误诊为黏膜下肌瘤,1例误诊为胎盘囊肿);超声诊断重型胎盘早剥与病理诊断符合16例(16/17),1例超声仅表现为胎盘增厚而漏诊(1/17)。胎盘早剥临床类型及检查时期不同声像图表现不同,22例胎盘早剥患者中超声检出混合型13例,团块型6例,胎盘增厚型2例,积液型1例。结论重型胎盘早剥的声像图特点突出,超声检查能及时作出诊断,但胎盘剥离早期容易漏诊,应在母儿安全的情况下行超声动态观察。轻型胎盘早剥因胎盘剥离面积小,声像图表现多变,易漏诊或错误诊断,应结合临床及时对患者进行治疗和处理。     

彩色多普勒超声在胎盘植入诊断与治疗中的应用价值

目的 探讨胎盘植入的产前、产后及治疗中的声像图特征,提高彩色多普勒超声对胎盘植人的诊断和临床应用价值。方法 回顾性分析我院经临床治疗和病理证实的胎盘植入患者40例,分析产前、产后胎盘植入及其治疗中的超声表现,比较产前、产后胎盘植入的检出率。结果 40例胎盘植入患者中,产前超声诊断11例,检出率为27．5％,声像图特征表现为胎盘内漩涡形成,胎盘后间隙消失及局部肌壁菲薄为主;彩色多普勒超声显示胎盘漩涡内血流丰富,胎盘基底血管丛增多。产后超声诊断25例,检出率为86．2％,声像图特征表现为局部肌壁菲薄,以胎盘与肌壁分界不清为主。临床予以化疗药物5-FU和MTX,再配合米非司酮保守治疗,治疗随访中见胎盘植入处肌壁明显增厚,胎盘基底血管血流减少为治疗有效。结论 彩色多普勒超声能有效检出胎盘植入,具有重要的临床应用价值。     

超声造影在产后胎盘植入诊断中的临床应用

目的：探讨胎盘植入超声造影图像特征及其在产后胎盘植入诊断中的临床价值。方法采用造影剂SonoVue对2009年4月至2013年5月湖北省妇幼保健院临床疑诊为胎盘植入的12例患者行超声造影检查,观察患者子宫内病灶部位、范围及造影剂灌注特点,结合临床及手术病理诊断结果,总结胎盘植入超声造影分型表现及图像特征。结果12例患者子宫超声造影增强表现：11例胎盘植入病灶造影表现呈高增强,1例呈无增强（术后病理诊断为胎盘组织变性及钙化）。12例患者子宫超声造影分型表现及术后病理诊断结果：1例（粘连型）造影表现为宫腔内高增强病灶与周边子宫肌层间界限清楚,术后病理诊断为胎盘粘连。6例（植入型）造影表现为残留胎盘附着处子宫浆膜层菲薄,子宫浆膜层部分连续性不好,呈毛刺样改变,术后病理诊断为胎盘植入。5例（穿透型）造影表现为残留胎盘穿透子宫浆膜层,子宫浆膜层连续性中断,造影剂外溢,术中或术后病理诊断为子宫胎盘植入,穿透浆膜层、子宫破裂。超声造影诊断并经临床手术诊治12例患者均治愈。结论超声造影通过组织灌注成像之间的差异诊断胎盘植入,注射造影剂后胎盘植入病灶呈高增强,子宫浆膜层呈毛糙锯齿样改变,造影剂外溢时应考虑胎盘穿透子宫浆膜层。超声造影对产后胎盘植入诊断及子宫破裂术后治疗修复的观察均有重要临床应用价值。     

超声造影诊断胎盘植入的应用价值

目的 探讨超声造影在胎盘粘连植入及胎盘穿透中的临床诊断价值.方法 对20例临床怀疑胎盘粘连或植入的患者常规超声检查后采用造影剂SonoVue行超声造影,观察实时超声造影过程,分析各组的造影剂灌注特征.结果 15例超声造影与清官术结果对照显示:8例造影显示官腔内残留病灶与子宫肌壁关系清楚,7例残留病灶与子宫浆膜层之间厚度仅2～4 mm.5例超声造影与手术结果对照,3例造影示胎盘附着处子宫浆膜层菲薄,连续不完整,毛糙呈锯齿样,手术结果为胎盘植入穿透;1例合并子宫破裂病例造影表现子宫肌层与浆膜层造影剂灌注缺失;1例超声造影怀疑滋养细胞疾病,术后病理诊断为胎盘植入.结论 超声造影表现子宫浆膜层毛糙呈锯齿样,造影剂外溢,对诊断胎盘植入与穿透提供了重要的信息.     

超声造影诊断胎盘植入的应用价值

目的 探讨超声造影在胎盘粘连植入及胎盘穿透中的临床诊断价值.方法 对20例临床怀疑胎盘粘连或植入的患者常规超声检查后采用造影剂SonoVue行超声造影,观察实时超声造影过程,分析各组的造影剂灌注特征.结果 15例超声造影与清官术结果对照显示:8例造影显示官腔内残留病灶与子宫肌壁关系清楚,7例残留病灶与子宫浆膜层之间厚度仅2～4 mm.5例超声造影与手术结果对照,3例造影示胎盘附着处子宫浆膜层菲薄,连续不完整,毛糙呈锯齿样,手术结果为胎盘植入穿透;1例合并子宫破裂病例造影表现子宫肌层与浆膜层造影剂灌注缺失;1例超声造影怀疑滋养细胞疾病,术后病理诊断为胎盘植入.结论 超声造影表现子宫浆膜层毛糙呈锯齿样,造影剂外溢,对诊断胎盘植入与穿透提供了重要的信息.