连续顺序追踪超声法在产前超声筛查胎儿肢体畸形中的应用价值

目的探讨连续顺序追踪超声法（SCSA）在筛查胎儿肢体畸形中的应用价值。方法应用超声诊断仪对2011年5月至2013年5月在我院产前超声筛查的3680名孕18～24周的孕妇,行胎儿肢体SCSA检测,观察胎儿有无肢体形态、结构、姿势、运动等异常,仔细排查有无其他合并畸形,分析各种类型胎儿肢体畸形的超声声像图特征。结果SCSA共检出26例,13种69处胎儿肢体畸形,2例3处漏诊,其中单纯肢体畸形9例,肢体畸形合并其他结构异常19例,以上所有畸形病例均在我院引产后得到证实。结论SCSA是筛查胎儿肢体畸形的重要影像学诊断方法。     

胎儿胸腔占位性病变的产前超声诊断及其预后分析

目的探讨产前超声诊断胎儿胸腔占位性病变的临床应用价值及其转归和预后。方法对2012年1月—2016年11月海军总医院超声医学科常规产前超声筛查怀疑胎儿胸腔占位性病变的45例胎儿行进一步系统超声检查,重点观察胎儿胸腔占位性病变的来源、部位、病变的回声特征和血供情况等,并注意观察有无胎儿水肿和其他结构异常,初次检出孕周为20~35周,孕妇年龄22~42岁。结果在检查的45例胎儿胸腔占位性病变中,先天性肺囊腺瘤样畸形13例（13/45,28.90%）,隔离肺10例（10/45,22.22%）,先天性膈疝11例（11/45,24.44%）,胸腔积液10例（10/45,22.22%）,心脏肿瘤1例（1/45,2.22%）。胎儿胸腔占位性病变多发生在左侧,7例隔离肺和5例胸腔积液随孕周增加病灶逐渐缩小或消失,先天性膈疝多合并其他结构和染色体异常,先天性肺囊腺瘤样畸形出生和引产各半,染色体异常共5例（5/45,11.11%）。结论产前彩色多普勒超声诊断胎儿胸腔占位性病变和评估预后有重要价值。     

胎儿先天性膈疝的产前超声诊断

目的:讨论先天性膈疝的超声产前诊断及评估围生儿预后的方法.材料和方法:收集1999-09～2010-03在新华医院产科经产前诊断和出生后7d内诊断的先天性膈疝病例24例,比较分析不同类型膈疝二维声像图特点.结果:24例中产前诊断23例(95.8%),平均诊断时间在孕28+3周,新生儿存活6例(25%),均为左侧膈疝.有合并畸形的胎儿围生期结局均不良.结论:目前先天性膈疝胎儿的存活率仍较低,须根据超声检查胎儿膈疝的部位、肺发育情况、有无合并畸形综合评估胎儿的预后.     

超声诊断胎儿先天性消化道异常及腹壁缺损的价值

目的　评价超声诊断胎儿先天性消化道异常及腹壁缺损的价值。方法　对美国加州一产前诊断中心 5年中超声发现的13 6例消化道异常及 41例腹壁缺损的孕妇检查结果进行声像图特点分析。结果　发现 13 6例消化道异常中 ,食管闭锁 9例 ,十二指肠闭锁 19例 ,空肠闭锁 12例 ,强回声小肠 68例 ,胎粪性腹膜炎 19例 ,膈疝 9例。 41例腹壁缺损中 ,腹裂 11例 ,脐疝 18例 ,羊膜带综合征 12例 ,各类型有其特异声像图表现 ,其特征与其胚胎发育过程异常相关。结论　超声能准确地发现各种畸形 ,在诊断胎儿先天性消化道异常及腹壁缺损中有重要价值     

产前超声诊断胎儿眼部异常的声像图特征及临床价值

目的探讨产前超声诊断胎儿眼部异常的声像图特征及临床价值。方法回顾性分析36例产前超声诊断为胎儿眼部异常的临床资料,总结其声像图特征。结果 40 000例胎儿(妊娠11～40周)中共检出眼部异常36例(0.09%),其中先天性白内障21例(双侧16例,单侧5例),小眼畸形3例,独眼2例,无眼1例,眼距异常9例(眼距过宽3例,眼距过窄6例);其中14例合并其他畸形。引产后病理结果证实31例与产前超声诊断相符,5例失访。结论超声检查能直观显示胎儿眼部的结构,胎儿眼部异常的声像图特征明显,超声筛查11～40周孕期胎儿眼部异常具有无可比拟的优势。     

产前超声诊断胎儿完全性房室间隔缺损的价值

目的 探讨产前超声心动图诊断胎儿完全性房室间隔缺损(cAVSD)的临床价值.资料与方法 回顾性分析2006～2010产前超声诊断的21例cAVSD胎儿的超声资料,分析其与染色体异常的关系及胎儿的临床结局.结果 产前超声显示12例为单纯cAVSD,9例合并其他结构异常,即复合型cAVSD.12例单纯cAVSD胎儿中2例核型异常,9例复合型房室间隔缺损胎儿中6例核型异常.经产前咨询后,9例孕妇选择终止妊娠;12例胎儿中,4例宫内死亡,出生的8例胎儿中,2例未接受手术在新生儿期死亡;6例接受手术,4例存活均为单纯cAVSD.结论 胎儿cAVSD常合并其他结构畸形,且与染色体异常关系密切.复合型cAVSD结局较差,单纯型cAVSD结局相对较好,但围生期胎儿丢失率超过50％.     

18-三体综合征胎儿超声指标分析

目的 探讨18-三体综合征胎儿的声像特征及产前超声诊断的临床意义.方法 回顾分析经羊水穿刺或脐血穿刺胎儿染色体检查确诊为18-三体综合征的胎儿声像特征.结果 19例18-三体综合征16例有两个及以上异常声像表现.最常见异常为心脏畸形(9例),其次为手畸形(5例),再其次为脉络丛囊肿,脐膨出,Dandy-Walker综合征,唇裂,食道闭锁,小颌畸形,足内翻,膈疝,单脐动脉等.结论 中、晚孕期超声筛查是提高产前检出18-三体综合征的有效措施.     

胎儿肢体畸形的产前超声诊断价值

目的探讨超声筛查诊断胎儿肢体畸形的价值。方法超声筛查8 368名孕16~34周的孕妇,运用二维连续顺序追踪超声检测法(SCSA)结合三维超声表面及透明成像模式检查胎儿肢体。结果引产后胎儿肢体畸形22例,产前超声检出21例[9例双足内翻,1例一足外翻,2例四肢短小畸形,1例左小腿缺如,1例双上肢前臂缺如,3例肢体姿势异常,1例双侧桡骨缺失,3例多指(趾)]。其中19例合并其他畸形,1例漏诊及3例部分漏诊。结论二维超声连续顺序追踪检测法结合三维超声表面及透明成像法是产前检出胎儿肢体畸形的有效方法。     

超声五切面在筛查胎儿先天性心脏病中的临床价值

目的探讨超声五切面(UAT、4C、LVOT、RVOT和3VT)在产前筛查胎儿先天性心脏病中的临床价值。方法采用超声五切面对9237例孕16～41周胎儿进行心脏超声筛查,发现心血管异常或可疑异常,即进行详细的胎儿超声心动图检查。将产前超声检查结果与引产后尸解结果和产后超声心动图检查结果进行对照分析。结果 9237例胎儿产前超声诊断胎儿先天性心脏病38例,其中4例(10.53%,4/38)合并其它心内畸形,11例(28.95%,11/38)合并心外畸形。胎儿心脏畸形在五切面上的产前超声图像特征包括腹部大血管位置异常、心尖指向异常、非四腔心结构、四腔心不对称、室间隔缺损、冠状静脉窦扩张、室壁增厚、心腔占位、胸部大血管连接、数目、位置、瓣膜和内径比例异常、房室瓣反流、穿隔血流、主、肺动脉弓血流反向。38例胎儿心脏畸形均经病理解剖或产后随访验证,其中36例与产前诊断结果符合,1例法洛四联症误诊为永存动脉干,1例主动脉弓缩窄胎儿经产后超声心动图复查正常。漏诊3例,包括2例室间隔缺损和1例房间隔缺损。超声五切面筛查胎儿先心病的敏感度为90.24%,特异度为100%。结论超声五切面在产前筛查胎儿先天性心脏病中具有重要的临床价值,能够筛查出大多数的先心病,但对部分室间隔缺损和房间隔缺损易漏诊。     

彩色多普勒超声诊断先天性膈疝的产前分析

目的：探讨先天性膈疝的产前超声表现。材料和方法：回顾性分析6例先天性膈疝胎儿声像图表现特征,并与病理结果相对照。结果：左侧膈疝5例,右侧膈疝1例,其中2例伴有其它复杂畸形。超声显示胎心、纵隔受压移位,心轴偏移明显。疝入器官见有胃泡、肠管、肝脏,胎儿呼吸样运动可致疝入器官运动幅度增加。结论：先天性膈疝的特征性声像图表现,可作为诊断的重要依据。     

Helical CT amniography of congenital diaphragmatic hernia

OBJECTIVE: Accurate prenatal diagnosis of congenital diaphragmatic hernia is important for perinatal planning and potential fetal surgery. We describe the application and usefulness of helical CT amniography in the evaluation of suspected congenital diaphragmatic hernia in three fetuses. CONCLUSION: Helical CT amniography is an efficient means for evaluation of congenital diaphragmatic hernia. Accurate diagnosis was made in all three patients.     

超声联合MRI在胎儿胸部异常诊断中的应用

目的 对比分析产前超声和MRI在胎儿胸部发育异常中的诊断价值及各自的优、劣势,并初步探讨两者联合应用在胎儿胸部异常中的临床价值.方法 回顾性分析胸部异常胎儿的产前超声和MRI图像,94例产前超声诊断胸部异常的胎儿,征其家属同意后,于检查后1 d或2 d内行MRI检查.所有病例均经产后尸检或生后随访证实.结果 94例胸部异常包括先天性肺囊腺瘤48例,隔离肺33例,膈疝10例,原发性肺发育不良3例.超声正确诊断78例,诊断符合率约82.98%;超声联合MRI正确诊断88例,诊断符合率约93.62%.超声联合MRI诊断胎儿胸腔病变与单一超声相比差异有统计学意义(P<0.05).结论 超声和MRI均能较好地诊断胎儿胸部异常,但其各有优、劣势.两者联合应用能够提高产前诊断敏感性和准确性,在诊断胎儿胸部发育异常方面更具优势.     

胎儿先天性膈疝MRI诊断的探讨

目的 探讨MRI在胎儿先天性膈疝诊断中的应用价值.方法 14名孕妇,孕龄16～39周.产前常规行超声(US)检查怀疑胎儿先天性膈疝后在24-48 h内行MR检查,采用二维快速平衡稳态采集(2D FIESTA)序列、单次激发快速自旋回波(SSFSE)序列以及快速反转恢复运动抑制(FIRM)序列,行胎儿颅脑、胸、腹部常规及胸腹部重点冠状面、矢状面及横断面扫描,将产前MRI、US表现与出生后影像表现或手术(13例胎儿)、引产后尸体解剖(1例胎儿)结果对照.结果 12例为单胎,2例为双胎之一.膈疝位于左侧12例,右侧2例.随访结果与产前MRI诊断完全一致,产前US误诊2例、漏诊2例.12例左侧疝中1例为左胸部被巨大结肠占据,1例仅整个胃泡疝入,5例仅部分肠管疝入,5例整个胃泡和部分肠管同时疝入;2例右侧疝中1例仅部分肠管疝入,1例为肝脏部分和部分肠管同时疝入.结论 MRI对胎儿先天性膈疝诊断具有较高的应用价值.     

Congenital chest lesions: diagnosis and characterization with prenatal MR imaging.

PURPOSE: To evaluate prenatal magnetic resonance (MR) imaging for diagnosis of fetal chest masses and to determine if MR imaging provides information in addition to that of ultrasonography (US). MATERIALS AND METHODS: Eighteen pregnant women were referred for MR imaging of possible fetal chest tumors seen at US (16 congenital cystic adenomatoid malformation [CCAM], two bronchopulmonary sequestration [BPS]). The presence, position, size, and characteristics of masses were determined and correlated with postnatal results. RESULTS: The MR imaging diagnoses were three cases of congenital diaphragmatic hernia, nine of CCAM, two of BPS, and one each of foregut cyst, lung atresia, tracheal atresia, and bronchial stenosis. MR imaging results were in agreement with US results in nine fetuses and in disagreement in nine. MR imaging diagnoses were confirmed at surgery or autopsy in 17 fetuses. MR imaging results led to an error in diagnosis in one fetus with BPS. CONCLUSION: Fetal chest masses had characteristic MR imaging appearances. MR imaging was accurate for distinguishing congenital diaphragmatic hernia from CCAM and was useful for less common diagnoses and determination of the origin of very large chest tumors. Prenatal diagnosis was changed in some patients owing to MR results and affected treatment and counseling of parents. MR imaging is a valuable adjunct to US for prenatal diagnosis of fetal chest masses.     

Prenatal Diagnosis of Bilateral Pulmonary Agenesis: a Case Report

We report a case of bilateral pulmonary agenesis (BPA), which was suspected during a prenatal US examination and diagnosed by fetal magnetic resonance imaging (MRI). BPA is an extremely rare congenital anomaly and, although many fetal structural defects can be detected with a high degree of confidence after introducing high-resolution US, the prenatal diagnosis of BPA remains problematic. Other thoracic abnormalities, such as a congenital diaphragmatic hernia, congenital cystic adenomatoid malformation, and pulmonary sequestration, should be excluded from the list of possible diagnoses before coming to the conclusion of BPA, because BPA is absolutely incompatible with extrauterine life, and an accurate internal diagnosis can prevent a futile intervention from being performed.     

Valoración radiológica de la hernia diafragmática congénita fetal

A diaphragmatic hernia is defined as the protrusion of abdominal viscera into the thoracic cavity through a normal or pathological orifice. The herniated viscera compress the lungs, resulting in pulmonary hypoplasia and secondary pulmonary hypertension, which are the leading causes of neonatal death in patients with congenital diaphragmatic hernia. Congenital diaphragmatic hernia is diagnosed by sonography in routine prenatal screening. Although magnetic resonance imaging is fundamentally used to determine whether the liver is located within the abdomen or has herniated into the thorax, it also can provide useful information about other herniated structures and the degree of pulmonary hypoplasia. The aim of this article is to review the fetal magnetic resonance findings for congenital diaphragmatic hernia and the signs that enable us to establish the neonatal prognosis when evaluating pulmonary hypoplasia.     

Air transport of the neonate with a congenital diaphragmatic hernia

A congenital diaphragmatic hernia is the prenatal herniation of abdominal contents into the chest cavity; the infant usually has a hypoplastic lung on the side of the hernia. The neonate presents with cyanosis, tachypnea, retractions, and a scaphoid abdomen. A simple chest X-ray will confirm the diagnosis by revealing hollow viscera in the chest cavity. Survival is dependent upon rapid transport to a major surgical center equipped to perform the necessary surgery and provide the post-operative care. The newborn should be kept warm, well oxygenated, and normocapneic to avoid acidosis. Acidosis could result in reversal to fetal circulation, rapid deterioration, and death. Should we be called upon to transport a neonate with a congenital diaphragmatic hernia we must realize the severity of this anomaly and be prepared to prevent, recognize, and/or treat any life-threatening emergencies that occur.     

Congenital diaphragmatic hernia: prenatal evaluation with MR lung volumetry--preliminary experience.

PURPOSE: To determine the interobserver variability of prenatal magnetic resonance (MR) lung volumetry and to assess the value of MR lung volumetric findings as predictors of outcome in fetuses with congenital diaphragmatic hernia. MATERIALS AND METHODS: Prenatal MR imaging was performed in 26 fetuses with unilateral congenital diaphragmatic hernia. Two independent observers performed planimetric measurement of lung volume. Relative lung volume was calculated as the observed total lung volume expressed as a percentage of the total lung volume predicted from fetal size. Relative lung volume was correlated with the ultrasonographic lung-head ratio in left-sided congenital diaphragmatic hernias evaluated before 27 weeks gestation (n = 21) and with pregnancy outcome in all cases of isolated left-sided congenital diaphragmatic hernia without prenatal intervention (n = 11). RESULTS: Observers demonstrated excellent agreement in total lung volume measurements at MR imaging, with an intraclass correlation coefficient of 0.95. Relative lung volume was positively correlated with lung-head ratio (r = 0.78, P <.001). By using rank order analysis in the pregnancy outcome group, relative lung volume was predictive of prognosis (P <.05) when adjusted for gestational age at delivery and birth weight. Three of four fetuses with a relative lung volume of less than 40% died. CONCLUSION: Interobserver agreement is high at MR lung volumetry, and its findings are predictive of outcome in fetuses with isolated left-sided congenital diaphragmatic hernia.     

单次激发快速自旋回波序列MR检查在胎儿先天性肠道闭锁中的应用

目的探讨单次激发快速自旋回波序列(SSFSE)在胎儿MR检查先天性肠道闭锁的应用价值。资料与方法对8例孕20周以上超声提示存在先天性肠道闭锁的胎儿行MR检查。采用SSFSE,选择胎儿头颅、躯干的常规体位,并重点行胎儿躯干横断位、冠状位、矢状位扫描,将产前MRI表现与引产后尸体解剖结果相对照。结果8例先天性肠闭锁,引产后尸检证实闭锁部位分别为空肠近段5例和回肠中段3例,后者同时合并胎儿腹腔积液,SSFSE上见扩张肠管以高信号为主;其中2例肠闭锁并发先天性肛门闭锁,SSFSE上扩张肠管内可见低信号胎粪;1例肠闭锁并发先天性食管闭锁,SSFSE上可见食管中段闭锁处高信号;1例肠闭锁并发膈疝,SSFSE冠状位上疝入物为部分肠管,可见左侧胸腔内少许散在高信号。结论 SSFSE MR检查能清楚显示胎儿先天性肠道闭锁,具有一定的临床诊断价值。