Three‐Dimensional Ultrasonography of the Fetal Vermis at 18 to 26 Weeks' Gestation

Objective. The purpose of this study was to establish the normality of the fetal vermis, ie, the time of appearance of the primary fissure, as well as its measurements between 18 and 26 weeks' gestation, using 3‐dimensional (3D) ultrasonography. Methods. A prospective cross‐sectional study of normal singleton pregnancies was conducted. Examinations were performed with high‐resolution transabdominal ultrasonography using the axial plane in 173 fetuses between 18 and 26 weeks' gestation. Postprocessing measurements of the fetal vermis were done with 4‐dimensional software using static volume contrast imaging and tomographic ultrasound imaging in the C‐plane. Detection of the primary fissure was evaluated in all cases, and the time of appearance was documented. Results. Adequate vermis measurements were obtained in 173 fetuses. Vermian length as a function of gestational age was expressed by regression equations, and the correlation coefficients were found to be highly statistically significant (P < .001). The normal mean ± 2 SD for each gestational week was defined. The primary fissure was observed at 24 weeks' gestation in all cases, at 22 weeks in 94% of cases, and as early as 18 weeks in 40%. Conclusions. This 3D study documents the appearance of the primary fissure and presents the normal range of vermian measurements, confirming normal development of the fetal vermis starting as early as 18 weeks' gestation. It also shows an easy method for visualizing the vermis with 3D ultrasonography at every gestational week regardless of fetal presentation.     

Intraductal Sonography in Patients With Portal Cavernoma Cholangiopathy

Intraductal sonography generates high‐resolution images of the entire length of the biliary tree and peribiliary tissues, including 3‐dimensional dual‐ and muti‐plane reconstructions to depict complex anatomy. Portal cavernoma cholangiopathy (previously called portal biliopathy) can have multiple etiologies of obstructive cholestasis in the same patient, which can be difficult to define even with advanced imaging techniques.We describe 2 difficult cases of portal cavernoma cholangiopathy in which intraductal sonography helped in clinical management decisions. We think that intraductal sonography should be part of the standard management algorithm for patients with portal cavernoma cholangiopathy and describe the intraductal sonographic correlates of the cholangiographic changes in this condition.     

Three‐Dimensional Sonography in the Evaluation of Primary Hyperparathyroidism

Three‐dimensional sonography is useful in the preoperative evaluation of patients with primary hyperparathyroidism. In this pictorial essay, we review the characteristic spectrum of grayscale and Doppler appearances of parathyroid glands on 2‐dimensional sonography and demonstrate the additional benefits of 3‐dimensional scanning.     

三维超声成像技术在胆系占位性病变中的临床应用

目的　探讨三维超声成像技术在胆系占位性病变中的临床应用价值。方法　对胆囊隆起性病变、胆囊癌和胆管癌等 33例不同的胆系占位性病变行三维重建。结果　重建后的胆系三维图像清晰、直观 ,立体感强 ,可以显示胆系占位性病变的表面形态、空间位置、基底情况及其与周围组织结构的解剖关系 ,与术中所见相符。结论　三维超声成像技术有助于胆系占位性病变的诊断和鉴别诊断 ,有利于病变进程的评价和手术方式的确定 ,作为二维超声的补充手段 ,具有重要的临床应用价值。     

三维超声成像在胆道梗阻性疾病中的应用

目的：评价三维超声成像在胆道梗阻性疾病中的临床应用价值。方法：29例梗阻性黄疸患者在常规二维超声检查后进行三维超声检查，三维超声重建图像与二维超声图像对比，确定是否可以获得更多的诊断信息。结果：所有患者可以准确地显示梗阻水平，三维最小透明模式可清晰地显示扩张的胆管树结构，包括肝内胆管、肝总管、胆囊以及胆总管。三维最小透明模式与X线模式组合，可显示扩张的胆管与病变组织的空间位置关系。结论：三维超声重建可以更客观地显示胆管解剖，能够提供较二维超声更丰富的信息，对明确诊断及确定治疗方案有重要的临床意义。     

Biliary dilatation secondary to lithiasis in a child affected by Langerhans' cell histiocytosis

Langerhans' cell histiocytosis (LCH) is a disease of unknown pathogenesis, caused by clonal proliferation of Langerhans' cells. Liver involvement results in a cholangiopathy, which has the radiologic appearance of sclerosing cholangitis. Only 1 case of obstructive jaundice due to common bile duct stone in a patient with LCH has been described. We present a case of a 31‐month‐old child with LCH and liver involvement on the waiting list for liver transplantation. During the follow‐up, there was a rapid onset of jaundice due to sludge and lithiasis. The patient was treated first with an endoscopic biliary plastic stent and then with percutaneous biliary drainage and bilioenteric anastomosis. © 2009 Wiley Periodicals, Inc. J Clin Ultrasound 2009     

Three‐Dimensional Sonography of Axillary Lymph Nodes in Patients With Breast Cancer

Sonography is useful in the evaluation of axillary lymph nodes in patients with breast cancer. In this pictorial essay, we review the range of grayscale and Doppler appearances of abnormal axillary lymph nodes on 2‐dimensional and 3‐dimensional imaging.     

Catastrophic mitral prosthesis dehiscence diagnosed by three‐dimensional transesophageal echocardiography

In emergency situations, real‐time three‐dimensional transesophageal echocardiography (RT 3‐dimensional TEE) may provide unique anatomic insights on prosthetic valves when two‐dimensional imaging is inconclusive. We report the case of a 76‐year‐old woman, in cardiogenic shock, who had undergone mitral valve replacement 3 months ago. RT 3‐dimensional TEE revealed almost total, catastrophic prosthesis dehiscence following infective endocarditis, the prosthesis being perpendicular to the normal mitral plane. Corrective surgery was not feasible, and the patient died shortly after admission. Although the outcome was unfortunate, RT 3‐dimensional TEE helped rapidly reach a definitive diagnosis, essential for decision‐making. Three‐dimensional TEE should be used as a complementary technique in difficult cases. © 2013 Wiley Periodicals, Inc. J Clin Ultrasound 42:249–251, 2014     

三维螺旋CT胆道造影的临床应用

目的：评价三维螺旋ＣＴ胆道造影的诊断价值。方法：在静脉输入胆道造影剂Ｂｉｌｉｓｃｏｐｉｎ后，４２个病人进行了上腹部螺旋ＣＴ扫描，利用三维重建技术对胆道系统正常、正常变异及部分病变进行分析研究，并将其结果与两天之内进行的ＥＲＣＰ进行比较。结果：三维螺旋ＣＴ胆道造影准确地诊断胆道系统所有的正常、正常变异及所有的胆道梗阻、胆道结石，但在胆道结石的定量诊断方面有２（２／６）个病人的结石数量被低估；一个病人三维螺旋ＣＴ胆道造影仅诊断出胆总管结石而未能诊断出胆囊癌，但轴位图象可以清楚地显示出胆囊癌。模拟内窥镜方式可以更加直观地显示病变。结论：三维螺旋ＣＴ胆道造影可以作为一种准确而无创性的胆道系统检查方法。     

Successful treatment of gallbladder dyskinesia by laparascopic cholecystectomy: Report of a case

A 75‐year‐old woman entered the hospital emergency room complaining of severe epigastric pain. She had experienced similar repeated abdominal pain for some time. Biliary tract dyskinesia was suspected based on the Roma III criteria. When drip infusion cholangiography‐CT with egg yolk load was performed, the contraction rate of the gallbladder before and after applying the load was as low as 33.5%. Upon biliary tract scintigraphy, biliary excretion into the intestinal tract was found to be normal, but after the egg yolk load, the biliary excretion rate in the gallbladder decreased to 14.5%. Laparoscopic cholecystectomy was performed under a diagnosis of flaccid‐type gallbladder dyskinesia. A few reports exist describing cases in which cholecystectomy was performed for gallbladder dyskinesia, so we are submitting this report with some bibliographic consideration.     

Intraoperative fluorescent cholangiography using indocyanine green for laparoscopic fenestration of nonparasitic huge liver cysts

Bile duct injury is one of the known serious complications of laparoscopic fenestration for nonparasitic liver cysts. Herein, we report the case of a huge liver cyst for which we performed laparoscopic fenestration using intraoperative fluorescent cholangiography with indocyanine green. A 71‐year‐old woman with abdominal distention was referred to our hospital. CT demonstrated a 17 × 11.5‐cm simple cyst replacing the right lobe of the liver, so laparoscopic fenestration was performed. Although the biliary duct could not be detected because of compression by the huge cyst, fluorescent cholangiography with indocyanine green through endoscopic naso‐biliary drainage tube clearly delineated the intrahepatic bile duct in the remaining cystic wall. The patient had no complications at 3 months after surgery. Fluorescent cholangiography using indocyanine green is a safe and effective procedure to avoid bile duct injury during laparoscopic fenestration, especially in patients with a huge liver cyst.     

Prenatal Visualization of the Pituitary Gland Using 2‐ and 3‐Dimensional Sonography

The pituitary gland is crucially important in the function of the endocrine axis. So far, antenatal depiction of the pituitary gland was possible only using magnetic resonance imaging. We describe antenatal visualization of the pituitary gland using 2‐ and 3‐dimensional sonography. The appearance of the gland on sonography seems to be superior compares to prenatal magnetic resonance imaging. In cases with midline anomalies of the brain, face, or cranium, depiction of the pituitary gland is feasible and recommended.     

Multidirectional Scattering Models for 3‐Dimensional Ultrasound Imaging

An ultrasound image is created from backscattered echoes originating from both diffuse and directional scattering. It is potentially useful to separate these two components for the purpose of tissue characterization. This article presents several models for visualization of scattering fields on 3‐dimensional (3D) ultrasound imaging. By scanning the same anatomy from multiple directions, we can observe the variation of specular intensity as a function of the viewing angle. This article considers two models for estimating the diffuse and specular components of the backscattered intensity: a modification of the well‐known Phong reflection model and an existing exponential model. We examine 2‐dimensional implementations and also propose novel 3D extensions of these models in which the probe is not constrained to rotate within a plane. Both simulation and experimental results show that improved performance can be achieved with 3D models.     

Polymeric nanofibrous substrates stimulate pluripotent stem cells to form three‐dimensional multilayered patty‐like spheroids in feeder‐free culture and maintain their pluripotency

Expansion of pluripotent stem cells in defined media devoid of animal‐derived feeder cells to generate multilayered three‐dimensional (3D) bulk preparations or spheroids, rather than two‐dimensional (2D) monolayers, is advantageous for many regenerative, biological or disease‐modelling studies. Here we show that electrospun polymer matrices comprised of nanofibres that mimic the architecture of the natural fibrous extracellular matrix allow for feeder‐free expansion of pluripotent human induced pluripotent stem cells (IPSCs) and human embryonic stem cells (HESCs) into multilayered 3D 'patty‐like' spheroid structures in defined xeno‐free culture medium. The observation that IPSCs and HESCs readily revert to 2D growth in the absence of the synthetic nanofibre membranes suggests that this 3D expansion behaviour is mediated by the physical microenvironment and artificial niche provided by the nanofibres only. Importantly, we could show that such 3D growth as patties maintained the pluripotency of cells as long as they were kept on nanofibres. The generation of complex multilayered 3D structures consisting of only pluripotent cells on biodegradable nanofibre matrices of the desired shape and size will enable both industrial‐scale expansion and intricate organ–tissue engineering applications with human pluripotent stem cells, where simultaneous coupling of differentiation pathways of all germ layers from one stem cell source may be required for organ formation. Copyright © 2014 John Wiley & Sons, Ltd.     

Influence of the three‐dimensional culture of human bone marrow mesenchymal stromal cells within a macroporous polysaccharides scaffold on Pannexin 1 and Pannexin 3

Because cell interactions play a fundamental role for cell differentiation, we investigated the expression of Pannexin 1 and Pannexin 3 in human bone marrow mesenchymal stromal cells (HBMSCs) in a three‐dimensional (3D) microenvironment provided by a polysaccharide‐based macroporous scaffold. The pannexin (Panx) family consists of three members, Panx1, Panx2, and Panx3. The roles of Panx large‐pore ion and metabolite channels are recognized in many physiological and pathophysiological scenarios, but the role of these proteins in human physiological processes is still under investigation. Our study demonstrates that HBMSCs cultured within 3D scaffolds have induced Panx1 and Panx3 expression, compared with two‐dimensional culture and that the Panx3 gene expression profile correlates with those of bone markers on mesenchymal stromal cells culture into the 3D scaffold. We showed that Panx1 is involved in the HBMSCs 3D cell–cell organization, as acting on the size of cellular aggregates, demonstrated by the use of Probenecid and the mimetic peptide 10panx1 as specific inhibitors. Inhibition of Panx3 using siRNA strategy shows to reduce the expression of osteocalcin as osteoblast‐specific marker by HBMSCs cultured in 3D conditions, suggesting a role of this Panx in osteogenesis. Moreover, we evaluated Panx1 and Panx3 expression within the cellularized scaffolds upon subcutaneous implantation in NOG (NOD/Shi‐scid/IL‐2Rγ^null) mice, where we could observe a more intense expression in the constructs than in the surrounding tissues in vivo. This study provides new insights on the expression of pannexins in HBMSCs on a 3D microenvironment during the osteogenic differentiation, in vitro and in vivo.     

3D matrix‐embedding inhibits cycloheximide‐mediated sensitization to TNF‐alpha‐induced apoptosis of human endothelial cells

The programmed form of cell death (apoptosis) is essential for normal development of multicellular organisms. Dysregulation of apoptosis has been linked with embryonal death and is involved in the pathophysiology of various diseases. Others and we previously demonstrated endothelial biology being intertwined with biochemical and structural composition of the subendothelial basement membrane. We now demonstrate that a three‐dimensional growing environment significantly shields endothelial cells from cytokine‐induced apoptosis. Detailed analysis reveals differences in intracellular signaling pathways in naive endothelial cells and cytokine‐stimulated endothelial cells when cells are grown within a three‐dimensional collagen‐based matrix compared to cells grown on two‐dimensional tissue culture plates. Main findings are significantly reduced p53 expression and level of p38‐phosphorylation in three‐dimensional grown endothelial cells. Despite similar concentrations of focal adhesion kinase, three‐dimensional matrix‐embedded endothelial cells express significantly less tyrosine‐phosphorylated focal adhesion kinase. Pretreatment with antibodies against integrin α_vβ₃ partially reversed the protective effect of three‐dimensional matrix‐embedding on endothelial apoptosis. Our findings provide detailed insights into the mechanisms of endothelial apoptosis with respect to the spatial matrix environment. These results enhance our understanding of endothelial biology and may otherwise help in the design of tissue‐engineered materials. Furthermore, findings on focal adhesion kinase phosphorylation might enhance our understanding of clinical studies with tyrosine kinase inhibitors.     

Three‐Dimensional Ultrasonography‐Based Virtual Cystoscopy of the Pediatric Urinary Bladder

Objective. The purpose of this study was to validate the feasibility and potential of 3‐dimensional ultrasonography (3DUS)‐based virtual cystoscopy in the pediatric urinary bladder. Methods. Twenty patients (age range, newborn–14 years) underwent urinary tract ultrasonography and 3DUS of the urinary bladder. From this data set, virtual cystoscopy was reconstructed for visualization of the inner bladder surface. Three‐dimensional ultrasonography was compared with 2‐dimensional ultrasonographic (2DUS) findings, voiding cystourethrography (VCUG) results, and reports from cystoscopy or surgery when available. Results. Three‐dimensional ultrasonography was feasible in all patients. Data quality was sufficient for virtual cystoscopy without major motion artifacts. The 3DUS results matched all other findings; particularly, 3DUS superiorly visualized the ureteral ostium and the bladder neck configuration; in 5 patients, 3DUS depicted pathologically shaped ostia not detected by 2DUS. This correlated with the presence of vesicoureteral reflux on VCUG. Performing virtual cystoscopy added 1 minute to the investigation time (range, 0.5–2 minutes) and 3 minutes for postprocessing and viewing (range, 2–5 minutes). Conclusions. Three‐dimensional ultrasonography‐based virtual cystoscopy is feasible in the pediatric urinary bladder without sedation. It reveals surface information not accessible by 2DUS, improving detection of pathologic conditions such as atypically shaped ureteral ostia. Three‐dimensional ultrasonography‐based cystoscopy may become a valuable adjunct to 2DUS of the pediatric urinary tract, improving selection criteria for further imaging such as VCUG, and potentially may help reduce the need for endoscopic cystoscopy. However, these preliminary results still have to be confirmed in prospective studies with larger patient numbers.     

Pneumobilia: benign or life-threatening

Pneumobilia, or air within the biliary tree of the liver, suggests an abnormal communication between the biliary tract and the intestines, or infection by gas-forming bacteria. Pneumobilia usually can be distinguished from air in the portal venous system by its appearance on computed tomography (CT) scan. The most common conditions associated with pneumobilia include: 1) a biliary-enteric surgical anastamosis, 2) an incompetent sphincter of Oddi, or 3) a spontaneous biliary-enteric fistula. Three cases of pneumobilia associated with its most common causes are presented and further differential diagnostic possibilities as well as the implications of this finding on patient management are discussed.     

Spontaneous Left Main Coronary Artery Dissection and the Role of Intravascular Ultrasonography

Objective. Spontaneous left main coronary artery (LMCA) dissection is a rare event with an unknown incidence and high risk of sudden cardiac death. The diagnosis of LMCA dissection is often challenging given the limitations of 2‐dimensional angiography. The 3‐dimensional perspective of intravascular ultrasonography (IVUS) is often indispensable in confirming or excluding the diagnosis of spontaneous LMCA dissection. We report 2 cases of spontaneous LMCA dissection with unique angiographic presentations wherein IVUS was essential in defining the extent of LMCA involvement and facilitated the subsequent referral for emergent coronary artery bypass grafting. Methods. Two patients presented to our facility with acute coronary syndrome prompting coronary angiography, which was notable for an unusual angiographic appearance of the LMCA. Intravascular ultrasonography was performed in each case, revealing spontaneous LMCA dissection. Results. Intravascular ultrasonography permitted the prompt diagnosis and aided in definitive surgical intervention in our 2 cases of spontaneous LMCA dissection. Conclusions. Intravascular ultrasonography is a useful adjunctive imaging modality in the diagnosis and management of spontaneous LMCA dissection.     

TGFβ3 secretion by three‐dimensional cultures of human dental apical papilla mesenchymal stem cells

Mesenchymal stem cells (MSCs) can be isolated from dental tissues, such as pulp and periodontal ligament; the dental apical papilla (DAP) is a less‐studied MSC source. These dental‐derived MSCs are of great interest because of their potential as an accessible source for cell‐based therapies and tissue‐engineering (TE) approaches. Much of the interest regarding MSCs relies on the trophic‐mediated repair and regenerative effects observed when they are implanted. TGFβ3 is a key growth factor involved in tissue regeneration and scarless tissue repair. We hypothesized that human DAP‐derived MSCs (hSCAPs) can produce and secrete TGFβ3 in response to micro‐environmental cues. For this, we encapsulated hSCAPs in different types of matrix and evaluated TGFβ3 secretion. We found that dynamic changes of cell–matrix interactions and mechanical stress that cells sense during the transition from a monolayer culture (two‐dimensional, 2D) towards a three‐dimensional (3D) culture condition, rather than the different chemical composition of the scaffolds, may trigger the TGFβ3 secretion, while monolayer cultures showed almost 10‐fold less secretion of TGFβ3. The study of these interactions is provided as a cornerstone in designing future strategies in TE and cell therapy that are more efficient and effective for repair/regeneration of damaged tissues. Copyright © 2015 John Wiley & Sons, Ltd.