163例胎儿肾盂扩张的产前、产后超声观察

目的:探讨胎儿不同程度肾盂扩张的预后。方法:2004年7月~2006年1月南京大学医学院附属鼓楼医院产前诊断中心对在本院门诊定期产前检查及住院分娩的孕妇进行胎儿产前多参数超声筛查12902例,超声测量胎儿双侧肾盂宽度,对肾盂扩张≥5mm者,分组进行随访观察。结果:发现一侧或双侧肾盂扩张≥5mm的胎儿有226例,除58例失访,5例引产外,对163例241只肾脏在不同孕龄及出生后的孩子进行了随访。241只肾脏按肾盂扩张在5~10mm间209只(占86.72%),在10~15mm间30只(占12.45%),≥15mm者2只(占0.83%)分组观察,随访结局如下:137例214只肾盂在胎儿期或孩子出生后15个月内恢复正常,肾盂扩张<5mm(占88.80%):其中16例21只肾盂在胎儿期恢复至5mm以下(占8.71%),121例193只肾盂在孩子出生后15个月内恢复至5mm以下(占80.09%)。20只肾盂扩张在5~10mm间(占8.30%)。4只肾盂扩张在10~15mm间(占1.66%)。3只肾盂扩张≥15mm(占1.24%)。结论:胎儿期肾盂扩张<15mm者大多数转归良好。胎儿期肾盂扩张≥15mm,或肾盂扩张<15mm,但输尿管扩张≥15mm者泌尿生殖道异常率增高。     

三维超声在胎儿神经系统畸形诊断中的应用价值

目的评价三维超声在胎儿神经系统畸形诊断中的应用价值。方法应用PHILIPS HD 14000、PHILIPS iu22三维超声对42789例孕18-40周胎儿进行常规二维和实时三维超声检查。结果42789例胎儿中共检出胎儿神经系统畸形157例,其中,脑积水31例（合并脊柱裂20例）,露脑畸形15例,无脑儿22例,脑膨出4例,Dandy-Walker综合征3例,全前脑10例,脑裂2例,胼胝体发育不全18例,蛛网膜囊肿7例,室管膜囊肿6例,脉络膜囊肿38例,颅内出血1例。结论三维超声成像较二维超声能提供更丰富的诊断信息,直观显示胎儿颅内结构,提高了胎儿神经系统畸形的检出率,对指导临床及时终止妊娠和保证出生人口质量具有重要意义。     

超声检查胎儿成熟度的方法

胎儿成熟度的判断在高危妊娠管理中有非常重要的意义。许多高危孕妇需要采用计划分娩提前终止妊娠,在保证孕产妇安全的前提下,围产儿能否存活,取决于胎儿成熟度,更重要的是胎肺的成熟度。胎肺是胎体重要器官,其成熟度标志着胎儿能否在子宫外存活。因此,在高危妊娠计划分娩前,了解肺成熟度是提高早产儿成活率的关键。目前胎儿成熟度的测定方法有多种,主要为胎肺成熟度的测定。以下就胎肺成熟度的检查方法进行综述。     

Ultrasonic evaluation of fetal ventricular growth

Summary The ratio of lateral ventricle to hemispheric width was measured in 200 normal pregnancies. Statistical curve fitting was tried to predict normal value and 5 and 95 percentiles. Anatomical sections of fetal head are provided to correlate the ultrasonic pictures. A typical case of application is described.Original presentation: 9th Congress of the European Society of Neuroradiology Brussels, 12–13 September 1980     

Extrafetal findings at fetal MR: evaluation of the normal placenta and correlation with ultrasound

Despite the increasing use of magnetic resonance (MR) for fetal imaging, few studies have addressed the MR appearance of the normal placenta. The goal of this paper is to describe the MR features and thickness of the normal placenta during the second and early third trimester of gestation, based on a retrospective study comparing MR with the reference standard of obstetric imaging, ultrasound.     

超声对小儿肾钙质沉着症的诊断价值

目的探讨超声对小儿钙质沉着的诊断价值。方法回顾性分析1986年1月～2009年10月超声检查诊断肾钙质沉着56例,与临床资料之间对比分析。结果 56例钙质沉着的病例中,30例临床诊断为肾小管酸中毒;5例肾脏结石;4例为VitD中毒;3例为急性肾炎;甲状旁腺功能亢进及假性甲状旁腺功能减低各1例;12例病因不明确。结论超声能发现小儿肾钙质沉着症,为临床诊断提供依据。     

产前超声筛查胎儿先天性心脏病的临床应用研究

目的:探讨胎儿超声心动图(FECG)产前筛查胎儿先天性心脏病(CHD)的临床应用价值。方法:采用四腔心、左室流出道、右室流出道、三血管切面"四切面法"对4 200例孕20~41周孕妇进行产前FECG筛查,以引产后尸解或产后新生儿ECG作为对照标准。结果:4 200例胎儿中,经引产或产后证实的各种CHD 43例,四切面检出CHD 41例,其中37例经证实为CHD,敏感性86.05%(37/43),漏诊6例,误诊4例。结论:四切面检查方法简便可靠,是显示胎儿心脏结构及产前筛查胎儿CHD的重要影像诊断方法。     

In utero development of the fetal gall bladder in the Korean population.

OBJECTIVE: To provide reference ranges of the fetal gall bladder in the Korean population. MATERIALS AND METHODS: Fetal gall bladder development was evaluated in well-dated, non-anomalous fetuses in the Korean population between February and April 2003 and the visualization rate and reference values were determined from the obtained data. RESULTS: The visualization rate of the fetal gall bladder increased as gestation advanced to a plateau above 90%, which was maintained between 16 and 34 weeks. The measured parameters from the fetal gall bladder had a significant positive relationship with gestational age (p = 0.000 for all cases), and the correlation of length and area with the gestational age (r = 0.741 and r = 0.690, respectively) was better than the correlation of width, height, and volume with gestational age. The repeatability coefficients and coefficients of variation between the two operators were 5.56 mm and 12.9% for the length and 344.11 mm(2) and 33.52% for the area. The median length of the fetal gall bladder in the Korean population was not significantly different from the mean length of gall bladders in the Caucasian and African-American populations (p = 0.915). CONCLUSION: We have provided reference values for the fetal gall bladder throughout the gestation period in the Korean population.     

Sonographic markers for early diagnosis of fetal malformations

Fetal malformations are very frequent in industrialized countries. Although advanced maternal age may affect pregnancy outcome adversely, 80%-90% of fetal malformations occur in the absence of a specific risk factor for parents. The only effective approach for prenatal screening is currently represented by an ultrasound scan. However, ultrasound methods present two important limitations: the substantial absence of quantitative parameters and the dependence on the sonographer experience. In recent years, together with the improvement in transducer technology, quantitative and objective sonographic markers highly predictive of fetal malformations have been developed. These markers can be detected at early gestation (11-14 wk) and generally are not pathological in themselves but have an increased incidence in abnormal fetuses. Thus, prenatal ultrasonography during the second trimester of gestation provides a “genetic sonogram”, including, for instance, nuchal translucency, short humeral length, echogenic bowel, echogenic intracardiac focus and choroid plexus cyst, that is used to identify morphological features of fetal Down’s syndrome with a potential sensitivity of more than 90%. Other specific and sensitive markers can be seen in the case of cardiac defects and skeletal anomalies. In the future, sonographic markers could limit even more the use of invasive and dangerous techniques of prenatal diagnosis (amniocentesis, etc.).     

Abnormalities of fetal rib number and associated fetal anomalies using three dimensional ultrasonography

Aim

To determine incidence of abnormal number of fetal ribs and its association with other fetal anomalies using 3D ultrasonography.

Materials and methods

A prospective study conducted on 188 singleton pregnant women searching for fetal anomalies including the incidence of abnormal number of fetal ribs and other anomalies. Static 3D volumes with volume contrast imaging using spine map were used. Rendered images were displayed and the ribs were counted.

Results

173 fetuses (92%) were having normal number of ribs. Fifteen fetuses (8%) were found to have abnormal number of ribs; ten fetuses (5.3%) had 11 ribs. On the other hand five fetuses (2.7%) had supernumerary 13 ribs. Eight fetuses (4.2%) were having abnormal number of ribs with no associated anomalies (isolated abnormal number). Seven fetuses (3.7%) in this study had associated anomalies.

Conclusion

Abnormal number of fetal ribs more to be an isolated finding (4.3%) but it may also be seen with other anomalies (3.7% in this study). 3DUS is useful for scanning the fetal ribs in the mid trimester of the pregnancy for early detection of associated genetic aberrations.     

Towards automated extraction of 2D standard fetal head planes from 3D ultrasound acquisitions: A clinical evaluation and quality assessment comparison

IntroductionClinical evaluation of deep learning (DL) tools is essential to compliment technical accuracy metrics. This study assessed the image quality of standard fetal head planes automatically-extracted from three-dimensional (3D) ultrasound fetal head volumes using a customised DL-algorithm.MethodsTwo observers retrospectively reviewed standard fetal head planes against pre-defined image quality criteria. Forty-eight images (29 transventricular, 19 transcerebellar) were selected from 91 transabdominal fetal scans (mean gestational age = 26 completed weeks, range = 20⁺⁵–32⁺³ weeks). Each had two-dimensional (2D) manually-acquired (2D-MA), 3D operator-selected (3D-OS) and 3D-DL automatically-acquired (3D-DL) images. The proportion of adequate images from each plane and modality, and the number of inadequate images per plane was compared for each method. Inter and intra-observer agreement of overall image quality was calculated.ResultsSixty-seven percent of 3D-OS and 3D-DL transventricular planes were adequate quality. Forty-five percent of 3D-OS and 55% of 3D-DL transcerebellar planes were adequate.Seventy-one percent of 3D-OS and 86% of 3D-DL transventricular planes failed with poor visualisation of intra-cranial structures. Eighty-six percent of 3D-OS and 80% of 3D-DL transcerebellar planes failed due to inadequate visualisation of cerebellar hemispheres. Image quality was significantly different between 2D and 3D, however, no significant difference between 3D-modalities was demonstrated (p < 0.005). Inter-observer agreement of transventricular plane adequacy was moderate for both 3D-modalities, and weak for transcerebellar planes.ConclusionThe 3D-DL algorithm can automatically extract standard fetal head planes from 3D-head volumes of comparable quality to operator-selected planes. Image quality in 3D is inferior to corresponding 2D planes, likely due to limitations with 3D-technology and acquisition technique.Implications for practiceAutomated image extraction of standard planes from US-volumes could facilitate use of 3DUS in clinical practice, however image quality is dependent on the volume acquisition technique.     

Prenatal ultrasound and fetal MRI: the comparative value of each modality in prenatal diagnosis

Fetal MRI is used with increasing frequency as an adjunct to ultrasound (US) in prenatal diagnosis. In this review, we discuss the relative value of both prenatal US and MRI in evaluating fetal and extra-fetal structures for a variety of clinical indications. Advantages and disadvantages of each imaging modality are addressed. In summary, MRI has advantages in demonstrating pathology of the brain, lungs, complex syndromes, and conditions associated with reduction of amniotic fluid. At present, US is the imaging method of choice during the first trimester, and in the diagnosis of cardiovascular abnormalities, as well as for screening. In some conditions, such as late gestational age, increased maternal body mass index, skeletal dysplasia, and metabolic disease, neither imaging method may provide sufficient diagnostic information.     

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。     

产前超声诊断中晚孕期胎儿心脏畸形48例的应用分析

目的：探讨产前超声在胎儿心脏畸形诊断中的应用价值。方法回顾性分析2012年9月至2013年6月于我院产前超声筛查中诊断的心脏畸形胎儿48例的临床资料及声像图表现,并分析总结3例漏诊的原因。结果37例胎儿心脏畸形于中孕期检出,占总数的77％;晚孕期检出11例,占23％,其中,1例室间隔缺损胎儿于孕晚期复查时缺损完全愈合,漏诊3例均于出生后经超声心动图确诊。结论产前常规超声检查可提高胎儿心脏畸形的检出率,并减少漏诊、误诊的发生。     

超声监测心头比及颈项透明层厚度预测胎儿出生缺陷临床价值分析

目的 探讨超声监测心头比(CBR)及颈项透明层厚度(NT)对预测胎儿出生缺陷的临床价值.方法 选取2018年1月至2020年1月在我院超声检查的86例孕妇,根据胎儿有无出生缺陷分为无出生缺陷组(61例)和有出生缺陷组(25例).比较产妇的一般临床资料、CBR和NT;采用受试者工作特征曲线(ROC)CBR和NT预测胎儿出...     

B超測量晚期妊娠胎兒肝臟大小預測胎兒體重的價值

目的:探討B型超聲測量晚期妊娠胎兒肝臟長度與厚度之和(FLL and FLT)預測胎兒出生體重的臨床價值。方法:應用超聲測量378例晚期妊娠胎兒肝臟長度和厚度,計算二者之和,并與新生兒出生體重進行對照分析。結果:胎兒肝臟長度與厚度之和與胎兒出生體重密切相關(r=0.861)。回歸方程Y=104X+641,P<0.01。胎兒體重2 500~4 000 g,FLLand FLT預測敏感性89%、特異性90%;胎兒體重>4 000 g,敏感性90%、特異性92%;胎兒體重<2 500 g,敏感性86%、特異性87%。結論:用超聲測量胎兒肝臟長度與厚度之和預測胎兒體重的方法簡便、數值準確,為臨床選擇分娩方式提供了可靠依據。     

A rare case of pleuropulmonary blastoma detected in fetus

Pleuropulmonary blastoma (PPB) is among the rarest malignant tumors diagnosed in children. PPBs can be histopathologically classified into 3 types: cystic tumor (type I), mixed cystic and solid tumor (type II), and pure solid tumor (type III). We describe a case of type III PPB that was detected in a prenatal fetus, confirmed using histopathological methods. To the best of our knowledge, this is the first case describing a type III PPB detected in a fetus. Prenatal ultrasonography is an excellent tool for detecting pulmonary lesions during the diagnostic phase, and the possibility of PPB should be considered when solid tumors are detected. Early detection can allow for the performance of full resection, leading to a better prognosis for this cancerous tumor.     

Diagnostic accuracy of computed tomography and ultrasound for the diagnosis of acute appendicitis: A systematic review and meta-analysis

IntroductionThe diagnosis of acute appendicitis remains challenging. This review determined the current diagnostic accuracy of CT and ultrasound for suspected acute appendicitis in adults.MethodsThis systematic review adhered to the PRISMA for diagnostic test accuracy guidelines. A systematic search was undertaken in appropriate databases. Screening of potential titles and abstracts, full-text retrieval, methodological quality assessment using QUADAS, and data extraction was performed. Meta-analyses were performed for relevant subgroups, and sensitivity analysis was completed to account for outliers. GRADE was utilized to assess the certainty of findings.Results31 studies evaluating CT, 10 evaluating US, and six evaluating both were included. Pooled sensitivity and specificity for CT was 0.972 [0.958, 0.981] and 0.956 [0.941, 0.967] respectively, and 0.821 [0.738, 0.882] and 0.859 [0.727, 0.933] for US, respectively. When analyzing subgroups based on the use of contrast enhancement, sensitivity and specificity was highest for CT with intravenous and oral contrast (0.992 [0.965, 0.998], 0.974 [0.936, 0.99]), compared to CT with intravenous contrast (0.955 [0.922, 0.974], 0.942 [0.916, 0.960]). Low-Dose CT produced comparable values (0.934 [0.885,0.963], 0.937 [0.911, 0.955]) relative to these subgroups and standard dose non-contrast CT (0.877 [0.774,0.937], 0.914 [0.827, 0.959]). US studies which excluded equivocal findings demonstrated significantly greater values than the remainder of US studies (p < 0.0001).ConclusionThe updated diagnostic test accuracies of CT, US and relevant subgroups should be implemented in light of factors such as dose, cost, and timing.Implications for practiceFor diagnosis of adult acute appendicitis:? CT with intravenous plus oral contrast enhancement yields statistically significantly greater diagnostic accuracy than CT with intravenous contrast alone.? Low-dose CT yields comparable sensitivity and specificity to standard-dose CT.? Ultrasound studies which exclude equivocal results may overinflate sensitivity and specificity.     

Correlations between renal function and the total kidney volume measured on imaging for autosomal dominant polycystic kidney disease: A systematic review and meta-analysis

PurposeTo provide a systematic summary of total kidney volume (TKV) as an imaging biomarker in clinical trials for autosomal dominant polycystic kidney disease (ADPKD), focusing on the correlation between TKV and renal function.MethodsA computerized literature search was performed using MEDLINE and EMBASE databases for studies that evaluated the correlation between TKV and the glomerular filtration rate (GFR) and between the TKV growth rate and GFR decline rate. A meta-analysis was performed to generate the summary correlation coefficient (r). A qualitative review was performed to evaluate the characteristics of TKV as an imaging biomarker.ResultsEighteen articles including a total sample size of 2835 patients were retrieved. Meta-analysis revealed substantial correlations between TKV and GFR [r, −0.520; 95% confidence interval (CI), −0.60 to −0.43] and between the TKV growth rate and GFR decline rate [r, −0.320; 95% CI, −0.54 to −0.10]. The quantitative review revealed that baseline TKV can affect the TKV growth rate and GFR decline rate, such that patients with a higher baseline TKV showed faster TKV growth and GFR decline. There was significant variability in image acquisition and analysis methods.ConclusionThere were significant negative correlations between TKV and GFR as well as between TKV growth and GFR decline rates, suggesting that TKV imaging is a useful biomarker in clinical trials. However, standardization—or at least trial-specific standardization—of image acquisition and analysis techniques is required to use TKV as a reliable biomarker.