Antenatal 3-dimensional sonographic diagnosis of fetal oropharyngeal teratoma

We report a case of a large fetal oropharyngeal teratoma in a 19-week fetus evaluated with 3-dimensional (3D) sonography. The 3D sonographic surface and maximum mode rendering of the tumor allowed detailed visualization of the mass lesion and thus enabled active patient participation in the management of the pregnancy.     

Three-dimensional volume sonographic study of fetal anatomy: intraobserver reproducibility and effect of examiner experience.

OBJECTIVE: The purpose of this study was to evaluate the accuracy of 3-dimensional (3D) sonography in assessing fetal anatomy and to determine the intraobserver reproducibility and the effect of examiner experience. METHODS: Three-dimensional volumes of the head, face, thorax, and abdomen were obtained for 40 fetuses. The volume data sets obtained were explored offline with multiplanar navigation and tomographic ultrasound imaging on a personal computer. Each case was examined twice by the same observer at least 3 months apart. The percentage for identification of fetal anatomic structures, 2-dimensional (2D) and 3D measurements, and the time spent on 2D and 3D examinations were calculated and compared. RESULTS: Ninety-two percent of fetal anatomic structures were identified with multiplanar navigation and tomographic ultrasound imaging. The genitals, the entry of the vena cava, and the ears were visualized in less than 70% of cases. Tomographic ultrasound imaging allowed viewing of 14 structures not seen in the multiplanar study. Intraobserver agreement for anatomic examinations was good (kappa = 0.78). Intraobserver agreement for fetal measurements showed differences between both examinations that approached 0 and intraclass correlation indices close to 0.9. The mean 2D scanning time +/- SD was 10.11 +/- 2.5 minutes, and the acquisition time for the 3D volumes was 1.54 +/- 0.35 minutes. The total time for the second 3D study was 7.23 +/- 1.17 minutes, significantly shorter than the 9.96 +/- 1.53 minutes spent on the first study (P < .001). CONCLUSIONS: Three-dimensional volumes are highly effective for complete fetal anatomic surveys. They show excellent intraobserver reproducibility and take less time to study as the examiner's experience increases.     

Reproducibility of fetal lung volume measurements with 3-dimensional ultrasonography.

OBJECTIVE: To build a nomogram of normal fetal lung volumes and to assess the reproducibility of measurements using 3-dimensional ultrasonography. METHODS: Inclusion criteria were healthy women, singleton normal pregnancies, reliable dating, and 20 to 30 weeks' gestation. Exclusion criteria were discordance between clinical and ultrasonographic dating, patients lost to follow-up, and birth weight disorders. Patients were scanned at intervals longer than 2 weeks. Three volumes were acquired for each patient; only data from the volume with the best image quality was used for analysis. Volumes were rated and measured by the manual tracing method. We recorded whether the clavicle was visualized. Only good-quality volumes were included in analysis. The best volume was chosen, and each lung was measured. RESULTS: A total of 75 patients were studied over a 9-month period, from which 182 volumes were analyzed. Of the 182 volumes, 15 (8.2%) were excluded for poor quality. The remaining 167 volumes were included in the final analysis. In 83 volumes (50%), the clavicle was not visualized. The best fit for total lung volume was a second-degree polynomial regression curve. Lung volume was 10.28 mL at 20 weeks and 51.49 mL at 30 weeks. Assessment of agreement was studied by selection of 40 volumes. Intraobserver variability was 5.48 mL (10.6%) and 3.07 mL (5.96%). Interobserver variability was 7 mL. CONCLUSIONS: Our findings suggest that 3-dimensional ultrasonographically derived measurements are reliable and reproducible up to 30 weeks if a standard measurement technique is used.     

Reproducibility of ultrasonic fetal volume blood flow measurements

The intraobserver reproducibility of ultrasonic volume blood flow measurements in the human fetus was evaluated in this study. A new approach, simultaneous measurement of the vessel diameter and the flow velocity with a pulsed-wave Doppler ultrasound synchronized with a real-time ultrasound phase-locked echo-tracking system, was used to estimate volume blood flow (VBF) in the fetal descending aorta. Measurements were performed in a longitudinal study on 20 normally grown fetuses. Intraobserver reproducibility of repeated estimations of mean blood flow velocities throughout gestation was very good, with high values of intraclass correlation coefficient (IntraCC 0·80–0·91) and low values of coefficient of variation (CV 4–11%). The IntraCC of repeated vessel diameter measurements throughout gestation was low (0·30–0·68), whereas the values of CV were acceptable (< 12%), with the exception of the period between 140 and 167 gestational days (CV > 12%). The lower reproducibility of vessel diameter measurement contributed directly to the relatively low reproducibility of VBF estimations overall (IntraCC 0·25–0·70; CV 17–28%), as these are calculated from a formula using both flow velocity and vessel diameter. Nevertheless, the synchronized approach gives absolute values of vessel diameter, flow velocity and VBF comparable with values reported in the human fetus previously. The new method provides, by taking the vessel wall pulsations into consideration and by measuring diameter and velocity simultaneously, a more complete information on fetal haemodynamics and fetal physiology.     

三维超声测量胎儿肾脏及其血流容积与孕龄的相关性研究

目的探讨三维超声测量胎儿肾脏体积及肾脏血流容积与孕龄相关关系。方法应用三维超声重建技术测量89例(150枚肾脏)正常胎儿肾脏体积(Vr)及肾脏血流容积(Vf)并计算其比值(Vi)。结果①胎儿肾脏体积(Vr)与孕龄呈正相关(r=0.895,P<0.01);②胎儿肾脏血流容积(Vf)与孕龄呈正相关(r=0.752,P<0.01);③胎儿肾脏体积(Vr)及肾脏血流容积(Vf)的比值(Vi)与孕龄无明显相关性。结论三维超声可较准确测量胎儿肾脏及其血流容积,二者与孕龄呈线性正相关。     

11～13~(+6)孕周唐氏综合征与正常妊娠孕妇血清胎盘生长因子水平对比分析

目的探讨孕妇血清胎盘生长因子(PLGF)在孕早期唐氏综合征筛查的潜在价值。方法选择2011年1月至2013年11月于11~13~(+6)孕周在该院接受孕早期唐氏筛查的600例孕妇作为研究对象,孕育唐氏综合征胎儿孕妇42例纳入病例组,健康孕妇558例纳入对照组。所有孕妇接受孕妇血清妊娠相关蛋白A(PAPP-A)、血清游离β-人绒毛膜促性腺激素(freeβ-hCG)、PLGF检测及B超测定胎儿头臀径(CRL)。结果病例组孕妇PAPP-A和PLGF水平的中位数比对照组低,freeβ-hCG水平的中位数比对照组高,差异均有统计学意义(P0.05)。健康孕妇血清PLGF、PAPP-A水平与孕周呈正相关,血清freeβ-hCG水平与孕周呈负相关。血清PLGF水平与PAPP-A水平呈正相关,与freeβ-hCG水平无相关性。结论 PLGF也可作为孕早期唐氏综合征筛查一项潜在生化标志物,用以筛查该疾病的高风险妊娠。     

不同孕周正常胎儿心脏大小的超声检测与临床意义

目的 探讨产前超声检查胎儿心脏生长指标与孕周的相关性.方法 应用二维超声测量14～39周正常胎儿左心房(LA)、右心房(RA)、左心室(LV)、右心室(RV)、主动脉(AO)和肺动脉(PA)内径及卵圆孔大小(FO)、心脏面积(HA)、胸腔面积(TA)、心脏周长(HC)、胸廓周长(TC),分析孕周与测量值的关系. 结果 线性回归分析表明,胎儿时期心脏各腔室大小、AO、PA及室间隔(IVS)厚度随孕龄增加而增大,与孕周呈显著正相关;肺动脉与主动脉内径比值(PA/AO)、左心房与右心房内径比值(LA/RA)、左心室与右心室内径比值(LV/RV)、心脏周长与相应胸廓周长比值(HC/TC)、心脏面积与相应胸廓面积比值(HA/TA)与不同孕周比较各比值变化不明显. 结论胎儿心脏随孕龄增加而增大,其中心脏面积与孕周最具相关性.     

Prenatal diagnosis of holoprosencephaly with ethmocephaly via 3-dimensional sonography

We present the prenatal 3-dimensional (3D) sonographic findings in a case of holoprosencephaly with ethmocephaly at 32 weeks' gestation. The sonographic diagnosis was based on the intracranial findings of a single ventricle and bulb-shaped appearance of the thalami and facial abnormalities, including hypotelorism with proboscis. Chromosome study of the fetus revealed a normal female karyotype (46,XX). Postmortem examination confirmed the 3D sonographic findings. This case demonstrates that the use of 3D sonography improves the imaging and the understanding of the condition of the intracranial abnormalities and the facial anomalies.     

妊娠23-24周三维容积超声部分肢体体积预测胎儿晚发型生长受限的应用价值

目的 测量妊娠23-24周胎儿三维容积超声部分肢体体积,和常规二维超声参数比较,探讨对预测晚发型生长受限(fetal growth restriction,FGR)的应用价值。方法 选取2018年1月至2019年12月在我院行产前检查并最终确诊为晚发型FGR的74例孕妇,定义为病例组,另选取同期正常孕妇200例为对照组。在超声诊断仪规范化测量妊娠23-24周胎儿二维超声参数：双顶径、头围、腹围、股骨长度,记录二维超声参数生成的胎儿体重(estimated fetal weight,EFW)。三维容积超声测量部分肢体体积：上臂中段50%的体积(fractional arm volume, AVol)和大腿中段50%的体积(fractional thigh volume,TVol)。比较二组各个数值差异,应用ROC曲线下面积AUC比较各个参数预测晚发型FGR的价值。结果 病例组和对照组的双顶径、头围、腹围、股骨长度及EFW无统计学差异。两组间的AVol和TVol比较差异有统计学意义。ROC曲线分析显示,AVol和TVol预测晚发型FGR的曲线下面积(AUC)为0.70和0.74,二者差异无统计学意义,最佳截断值分别为4.5 mL和9.4 mL,,预测晚发型FGR的敏感性、特异性、准确性分别为63.5%和69.4%、89.4%和88.1%、81.4%和83.2%。二者联合预测晚发型FGR敏感性、特异性和准确率分别为79.0%、94.8%和90.1%。     

Prenatal 3D sonographic diagnosis of an isolated lateral facial cleft

We report a case of lateral facial cleft (Tessier 7) diagnosed by sonography at a gestational age of 24 weeks. Two-dimensional sonography revealed a fetus appropriate for gestational age without obvious anomaly, but a three-dimensional sonogram with surface mode rendering showed asymmetrical macrostomia as a result of a left lateral facial cleft. Our case highlights the advantage of using three-dimensional sonography in the prenatal diagnosis of lateral facial clefts.     

Comparison of sonographic triplet fetal growth measurements between Japanese and American populations

Objective: To evaluate changes in several triplet fetal growth parameters associated with gestational age by means of a longitudinal study designed to compare ethnic differences in fetal growth in Japanese and American populations.Subjects: Twenty-one Japanese triplet fetuses (7 triplet pregnancies) and 21 American triplet fetuses (7 triplet pregnancies). The Japanese pregnancies were in middle-class Japanese women living in the Kagawa area; the American pregnancies, in middle-class white women living in the Houston area.Methods: Head circumference, abdominal circumference, femur length, and estimated weight were measured every 2 to 3 weeks from 15 weeks of gestational age until delivery. Values for each parameter at each gestational age were measured in each fetal group, and the data of the groups were compared.Results: Head circumference, abdominal circumference, femur length, and estimated weight were significantly lower in the Japanese than in the American triplet fetuses after 20 weeks of gestation (p<0.01).Conclusion: These results suggest that triplet fetal growth in Japanese populations and American populations differs significantly in the second half of pregnancy.     

Quality of 2‐ and 3‐Dimensional Fast Acquisition Fetal Cardiac Imaging at 18 to 22 Weeks

Objective. The purpose of this study was to evaluate the frequency with which 6 different fetal cardiac views taken during a fetal ultrasound examination at 18 to 22 weeks' gestation can be obtained satisfactorily for cardiac anomaly screening using either a 2‐dimensional (2D) static or 3‐dimensional (3D) fast acquisition technique. Methods. A prospective study of 100 low‐risk women undergoing an anatomic survey was performed. Standard static 2D and 3D fast acquisition volumes were obtained on all patients. The 2D and 3D images were assigned, in a random order, to be independently graded by 3 reviewers. The degree of inter‐reviewer agreement was assessed through the use of the Cohen κ statistic. The factors contributing to satisfactory imaging were evaluated by random effects logistic regression. Results. A significant proportion of both 2D and 3D images were judged unsatisfactory for screening purposes. However, 2D images were significantly more likely, for all cardiac views, to be judged satisfactory (P < .05). The odds ratios for the 2D technique's being more likely than the 3D technique to provide images satisfactory for screening were 2.6 for the 4‐chamber view, 2.4 for the right ventricular outflow tract, 4 for the left ventricular outflow tract, 3.2 for the 3‐vessel view, 8.6 for the aortic arch, and 2.2 for the ductal arch. Conclusions. In this prospective study, static 2D imaging was significantly more likely than fast acquisition 2D imaging to yield cardiac views of high enough quality to satisfactorily screen for anomalies.