三维超声诊断胎儿肢体畸形的临床应用

目的探讨三维超声在产前诊断胎儿肢体畸形中的临床应用价值。方法对1526例孕妇进行三维超声检查,并与引产及生产结果对照。结果16例胎儿肢体畸形的孕妇产前三维超声准确诊断14例,诊断不全1例,漏诊1例。本组产前三维超声诊断的准确率为93．75％,漏诊率6．25％。结论三维超声可以明显提高胎儿肢体畸形产前诊断的准确性,其图像生动逼真,有利于临床医师及患者全面了解胎儿肢体的解剖结构及畸形状况,为临床处置方案的制定提供较为客观的依据。     

三维超声对胎儿体表畸形的诊断价值

目的:探讨三维超声成像在胎儿体表畸形诊断的临床价值。方法:利用三维超声仪对在我院进行产前检查的妊娠20~41周的3241例孕妇、共3277个胎儿进行二维及三维超声检查,统计并比较超声诊断与随访结果。结果:140例各种发育异常胎儿,其中体表畸形胎儿34例,二维超声诊断正确者21例,9例体表畸形胎儿二维超声检查不能作出明确诊断;三维超声进一步检查诊断正确者共30例;二维及三维超声检查误诊1例胎儿足内翻,生后证实正常,漏诊1例耳廓缺失、2例多指畸形,生后随访证实。三维超声对胎儿体表畸形检出的敏感性、特异性及准确性分别为90.91%、99.97%、99.88%;二维超声对胎儿体表畸形检出的敏感性、特异性及准确性分别为63.64%、99.97%、99.60%。结论:三维超声能直观显示胎儿体表结构,三维超声检查诊断胎儿体表畸形的敏感性、特异性及准确性高,是二维超声检查的重要补充,与二维超声联合应用,可提高胎儿体表畸形的检出率。     

应用三维超声对胎儿体表畸形诊断的价值

目的:探讨胎儿体表畸形三维超声成像的诊断价值.方法:利用具有实时三维容积成像功能的超声诊断仪对7241名孕龄18～41周的胎儿进行二维和三维超声对照检查,统计两种超声成像胎儿体表畸形的检出率,与引产结果进行比对,分析三维超声成像的优势.结果:发现胎儿体表畸形42例,二维超声诊断正确者32例,三维超声进一步检查诊断正确者共39例,7例体表畸形胎儿二维超声检查不能作出明确诊断,二维及三维超声检查漏诊1例右手六指畸形,1例单纯腭裂畸形,1例小耳畸形.二维及三维超声对畸形诊断正确率分别为76.2%(32/42),92.9%(39/42).结论:三维超声图像立体、直观,对胎儿体表畸形的诊断优于单纯使用二维超声,有较高的临床应用价值,是提高产前诊断水平的一个可靠的技术手段.     

三维超声在胎儿畸形产前筛查中的应用价值

随着临床围产医学的发展,超声检查由于其图像清晰,对胎儿无致畸和创伤等优点越来越受到人们的重视,被广泛应用于中晚期妊娠胎儿畸形的产前筛查。胎儿出生缺陷干预能够有效降低围产儿死亡率,探讨二维和三维超声成像技术在胎儿畸形产前筛查中的临床应用价值,     

三维超声表面模式在胎儿唇腭裂诊断中的应用

在围生期医学中,胎儿畸形的产前诊断是提高出生人口素质的重要环节。唇腭裂是最常见的胎儿颜面部先天性畸形,我国的发病率为0.182%[1],唇腭裂畸形已上升为胎儿畸形的第四位。唇腭裂不仅造成患儿的容貌畸形,而且影响患儿吸吮、吞咽、语言及面部发育等功能。产前正确诊断唇腭裂并明确其类型对提高人口素质具有重要意义。     

超声三维成像模式在筛查胎儿肢体畸形中的应用

超声三维成像是一项新兴的诊断技术,可以帮助医生加深对病变部位解剖结构的理解,唐河县人民医院应用该项技术成功筛查出胎儿肢体畸形14例,现将结果报道如下。1材料和方法1.1一般资料收集2007-09～2009-11,唐河县人民医院应用超声三维成像模式进行产前畸形筛查不同孕龄的胎儿1318例,平均筛查次数为1～3次,孕周14～40周,年龄18～49岁。对有胎儿肢体畸形的孕妇筛查结果进行存档、记录,并与引产     

应用三维超声成像评价胎儿畸形的初步临床应用研究

目的：评价三维超声成像技术在诊断胎儿畸形中的应用价值。方法：所有患者先常规作二维超声检查。之后再由同一操作者行三维超声检查。并将二维及三维超声检查结果相对照。结果：６６例孕妇６７例胎儿中,共检查出胎儿异常１７例,其中３例为胎儿宫内发育迟缓,１４例为胎儿畸形,余５０例未发现异常。在１４例胎儿畸形中,有８例（５７％）三维超声可提供更多的诊断信息;有６例（４３％）二维超声即能诊断,三维超声未能提供更丰富     

三维彩色多普勒超声在胎儿畸形诊断中的应用分析

近几年来,我国雾霾、沙尘暴等恶劣的生态环境影响,还有我国目前的食品安全问题的问题集中出现,畸形胎儿的被诊断出的概率大大提高,而先天畸形胎儿目前对于一个家庭、社会和国家来说都是一个比较大的负担。因此,对畸形胎儿的诊断对家庭和社会国家来说都是具有一定意义的意向措施。而目前孕妇对畸形胎儿的主要诊断手段就是彩色多普勒超声技术。现针对我院2013—2014年在我院进行孕检并在我院生产的2 861名孕妇进行结果分析,结果如下。     

胎儿三维超声在临床中的应用价值

目的 研究胎儿三维超声在临床中的应用,并与二维超声进行比较.方法使用的仪器为三维超声工作站和三维彩超机容积探头.用扇形或平行自由扫查方式匀速采集图像,或用容积探头自动采集图像.图像采集后,根据研究的需要进行表面或透明三维重建.结果 220例中有205例三维图像显示满意,成功率93.2%;查出无脑儿、脑积水、内脏外翻、死胎各1例,胚胎停育5例;与二维图像比较,三维图像更能清楚地显示胚胎发育过程中三维形态的演变,能清楚地显示胎儿头面、体表结构及脊柱肋骨结构,图像直观,立体感强.结论胎儿三维超声明显优于二维超声,能直观显示胎儿头面、体表结构及先天畸形,具有极高的临床应用价值.     

分时段系统超声检查对筛查胎儿形态结构异常的意义

目的评价分时段系统超声检查对筛查胎儿形态结构异常及提高人口出生质量的意义。方法自2004年1月至2009年10月，我院超声科利用分时段系统超声检查对5173例胎儿于3个重要的孕周时段：孕10～14周，22～24周及30-32周进行了形态结构异常的筛查。结果在5173例接受了分时段系统超声检查的胎儿中，共检出形态结构异常者299例，检出率为5．78％，与2004年的检出率2．43％（46／1890）比较，提高了3．35％。随后，大多数形态结构异常胎儿得到包括终止妊娠在内的临床干预措施，有效地降低了缺陷儿的出生率。结论分时段系统超声检查是筛查胎儿形态结构异常的一种敏感的影像技术，对提高人口出生质量有重要意义。     

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.     

产前常规彩色多普勒超声筛查胎儿畸形的临床价值

目的:探讨产前常规彩色多普勒超声筛查胎儿畸形的临床价值。方法:利用彩色多普勒超声对2007年1月~2009年12月对所有自愿来本院要求行超声筛查的孕妇4680例进行了检查,并进行了追踪随访。结果:4680例孕妇中检出胎儿畸形68例,诊断符合率为92.3%(63/68),其中神经管畸形最多,占61.2%。结论:产前超声对畸形胎儿的检出具有重要的临床价值,无创无痛,可重复性强,结果可靠。     

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.).     

Fetal MRI of the central nervous system: State-of-the-art

Prenatal ultrasonographic (US) examination is considered as the first tool in the assessment of fetal abnormalities. However, several large-scale studies point out that some malformations, in particular central nervous system (CNS) anomalies, are not well characterized through US. Therefore, the actual malformation severity is not always related to prenatal ultrasound (US) findings.Over the past 20 years, ultrafast Magnetic Resonance Imaging (MRI) has progressively increased as a prenatal 3rd level diagnostic technique with a good sensitivity, particularly for the study of fetal CNS malformations. In fact, CNS anomalies are the most common clinical indications for fetal MRI, representing about 80% of the total examinations.This review covers the recent literature on fetal brain MRI, with emphasis on techniques, safety and indications.     

胎儿畸形产前超声筛查在基层医院开展的可行性研究

目的按照产前超声检查技术规范的标准,探讨基层医院胎儿畸形产前超声筛查可行性及其意义。方法收集2004年3月至2009年4月,10 630例孕妇接受胎儿畸形产前超声检查资料,以产后最终诊断为标准,评估产前超声诊断的价值。结果超声诊断胎儿先天性畸形共266例,畸形的发生率约为2.50%(266/10 630),畸形检出率88.96%(266/299),单发畸形228例,复合畸形38例;漏诊33例,其中小畸形和复杂畸形漏诊29例。结论基层医院在严格执行产前超声筛查技术规程同时,加强自身技术和服务能力,能有效地降低畸形儿的出生率及漏诊率。     

Evaluation of fetal kidney growth using ultrasound: A systematic review

PurposeTo determine the role of ultrasound imaging in evaluating fetal kidney growth.MethodsMEDLINE, CINAHL and EMBASE databases were electronically searched for studies between 1996 and January 2017 and limited to English language. Studies were included if they reported on an ultrasound technique to assess fetal kidney growth and they were not a case report or case series. There was independent selection of studies by two reviewers in consensus with one other reviewer. Data were extracted by one reviewer in consensus with two other reviewers.ResultsA total of 1785 articles were identified. The full text of 39 of these were assessed for eligibility for inclusion. Twenty-eight studies were then included in the review. Standard two dimensional (2D) fetal renal measurements are easy to perform, however, this review identified that most studies had some methodological limitations. The disadvantage with 2D and three dimensional (3D) fetal renal volumes are that they include the entire kidney and good reproducibility of 3D volumes has not yet been demonstrated. Currently there is limited research on fetal kidney growth in the setting of abnormal fetal growth. Research focussing directly on fetal kidney parenchyma and blood flow is scarce.ConclusionsSome nomograms of 2D and 3D fetal kidney size and volume have been developed. Kidney length is the most popular single fetal kidney measurement; however, it does not seem to be a good indicator of growth. In IUGR fetuses, kidney length remained similar to appropriately grown fetuses whereas AP and TS dimensions were significantly decreased. New ultrasound techniques focusing on the parenchyma of the kidney and perfusion to the kidney should be explored as they may provide more meaningful information on kidney development in the fetus and future kidney function.     

超声检查在异常双胎妊娠中的应用价值

目的：探讨产前超声检查在异常双胎妊娠中的诊断价值与意义。方法：回顾性分析2006-01～2009-06于四川大学华西第二医院及2009-08～2011-05于航空总医院行产前超声检查中发现的异常双胎143例,并进行连续观察与产后追踪随访。结果：超声检查出异常双胎143例,其中各系统单发畸形69例,多发畸形16例,单绒毛膜囊双胎特殊并发症31例,双胎之一死亡22例,双胎均死亡5例。结论：异常双胎妊娠发生率高,尤其是单绒毛膜囊双胎。产前超声检查能及早、准确的发现胎儿异常,提示临床做相应的处理。     

分时段系统超声检查对筛查胎儿畸形的临床意义

目的探讨分时段系统超声检查对筛查胎儿畸形的临床价值。方法根据胎儿生长发育特点,对12380例孕11～40周的胎儿进行分时段系统超声筛查,对畸形胎儿作出诊断。结果12380例胎儿中,经产后证实胎儿畸形223例,产前超声筛查诊断胎儿畸形212例,检出率95．07％,漏诊11例,漏诊率4．93％。结论分时段系统产前超声筛查,能较清晰地显示胎儿各时期的形态结构,是产前及时发现胎儿畸形,及时终止妊娠,确保出生质量的重要手段。     

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。