Loss of Echogenicity and Onset of Cavitation from Echogenic Liposomes: Pulse Repetition Frequency Independence

Echogenic liposomes (ELIP) are being developed for the early detection and treatment of atherosclerotic lesions. An 80% loss of echogenicity of ELIP has been found to be concomitant with the onset of stable and inertial cavitation. The ultrasound pressure amplitude at which this occurs is weakly dependent on pulse duration. It has been reported that the rapid fragmentation threshold of ELIP (based on changes in echogenicity) is dependent on the insonation pulse repetition frequency (PRF). The study described here evaluates the relationship between loss of echogenicity and cavitation emissions from ELIP insonified by duplex Doppler pulses at four PRFs (1.25, 2.5, 5 and 8.33 kHz). Loss of echogenicity was evaluated on B-mode images of ELIP. Cavitation emissions from ELIP were recorded passively on a focused single-element transducer and a linear array. Emissions recorded by the linear array were beamformed, and the spatial widths of stable and inertial cavitation emissions were compared with the calibrated azimuthal beamwidth of the Doppler pulse exceeding the stable and inertial cavitation thresholds. The inertial cavitation thresholds had a very weak dependence on PRF, and stable cavitation thresholds were independent of PRF. The spatial widths of the cavitation emissions recorded by the passive cavitation imaging system agreed with the calibrated Doppler beamwidths. The results also indicate that 64%–79% loss of echogenicity can be used to classify the presence or absence of cavitation emissions with greater than 80% accuracy.     

中孕期胎儿肠管超声回声增强临床意义分析

目的探讨中孕期胎儿肠管回声增强(EB)在产前诊断中的临床意义。方法对我院2008年-2009年中孕期EB胎儿进行分析,部分行侵入性检查,继续妊娠者追踪至分娩后。结果发现EB胎儿210例(1.32%);合并其它超声异常114例(54.3%),其中胎儿水肿58例(27.6%);引产74例,胎死宫内7例,感染性腹膜炎3例,肠梗阻2例,早产7例,宫内发育迟缓10例;单纯EB 96例中,86例(90.2%)正常;79例行侵入性检查,发现α-纯合子地中海贫血16例,非整倍体9例,巨细胞病毒感染2例。结论中孕胎儿EB为非特异性的指标,与多种胎儿异常相关;单纯EB胎儿大部分预后良好。当发现EB时,应全面观察并定期复查,必要时行侵入性检查以确定病因。     

Outcomes for fetal echogenic bowel during the second trimester ultrasound

Objective.?To investigate the association between fetal echogenic bowel (FEB) during the second trimester and perinatal outcome.

Methods.?A retrospective chart review of FEB during the second trimester over 3 years.

Results.?A total of 56 women were identified of 9067 screened (0.6%) women. Forty-seven agreed to genetic counseling (84%). Of those, 22 (39%) agreed to an amniocentesis. There were three cases of trisomy 21, one case of trisomy 18 and one case of fetal CMV infection. Twelve fetuses had an adverse outcome (21%), with only three of them having an echogenic bowel as the only finding.

Conclusions.?In our study, almost 80% of the fetuses had an uncomplicated perinatal outcome. FEB was present as the only finding in only 5% of the fetuses with an adverse outcome. A potential association with placental abnormalities and a low prevalence of viral infections was observed. These findings may be of use in counseling parents.     

胎儿心内强回声病灶出现的临床意义探讨

目的探讨胎儿心内强回声病灶出现的意义和临床处理原则。方法对产前超声检查发现的163例胎儿心内强回声病灶（EIF）孕妇进行临床追踪随访（其中,存在其他染色体异常高危因素的孕妇为43例）。对自愿选择并愿意承担羊膜腔或脐静脉穿刺风险的孕妇,行产前染色体核型分析。对同时存在其他胎儿异常而选择终止妊娠放弃胎儿,在家属知情同意情况下行尸体解剖和病理检查。对继续妊娠者,在新生儿期至2岁内行心脏结构和功能复查。结果 1.163例胎儿EIF中,124例EIF仅存在于左心室（76.1%）,34例EIF仅存在于右心室（20.9%）,5例EIF同时存在于两左右心室（3.1%）。2.163例胎儿EIF中,3例合并心脏畸形（1.8%）,3例合并染色体异常（1.8%）。其中1例为法洛四联征伴发21-三体;1例为伴发室间隔膜部缺损伴发21-三体,1例为三尖瓣下移畸形（染色体正常）,另1例为18-三体。此4例患者行引产放弃胎儿,胎儿病理解剖结果显示EIF为心室乳头肌钙化灶。3.其他159例仅存在EIF而不伴其他超声异常者,21例选择孕期行羊膜腔或脐静脉穿刺（19例存在高危因素）,染色体核型分析结果提示染色体均正常。余138例中,114例（82.6%）分娩时取脐带血行染色体核型分析,1例9号染色体臂间倒位,其余染色体均正常。另1例伴发左手6指畸形。4.在临床随访中发现11例（6.9%）EIF消失,其中2例于妊娠晚期消失,9例于2岁内消失。其余148例EIF在随访期内与胎儿期表现相同,但没有任何不良临床表现。结论 1.当胎儿存在EIF时,其发生心脏畸形的风险略高于正常人群。2.孤立存在的胎儿EIF没有病理意义,没有明显增加胎儿染色体异常风险,胎儿临床结局良好。3.对于伴发胎儿其他结构异常或存在染色体异常高危因素的胎儿心内EIF,其存在染色体异常的风险较高。     

Can “Tumor-to-Cortex Echogenicity Ratio” Differentiate Angiomyolipomas from Other Hyper-Echoic Renal Masses

A retrospective study was performed to evaluate the diagnostic value of tumor-to-cortex echogenicity ratio (TCER) in the characterization of hyper-echoic renal masses. The radiology database was queried between 2012 and 2014 for hyper-echoic renal masses on the basis of defined exclusion and inclusion criteria. Each included mass was characterized as either an angiomyolipoma (AML) or a non-AML based on pre-defined criteria. The ratio of renal mass echogenicity to that of adjacent renal cortex (TCER) was calculated for each mass using commercially available software. A total of 70 masses in 65 patients were identified, including 49 AMLs. TCER values >2.26 were associated with a sensitivity and specificity of 81.6% and 71.4%, respectively, for diagnosis of AML. Moreover, TCER values >3.98 resulted in 100% specificity for AML diagnosis with a sensitivity of 28.6%. These findings suggest that the TCER may be a valuable tool for the characterization of hyper-echoic renal masses.     

糖尿病孕妇胎儿心脏超声检查的临床意义探讨

目的探讨糖尿病孕妇引起胎儿心脏畸形发生率及胎儿心脏检查的意义。方法选自197例糖尿病孕妇（Ⅰ型糖尿病6例，Ⅱ型糖尿病19例，妊娠期糖尿病172例）。应用Yagel等描述的胎儿心脏检查方法进行胎儿心脏结构检查，并对产前诊断为先天性心脏畸形要求引产的胎儿进行尸体解剖核对产前诊断的正确性，并进行胎儿染色体分析；对未引产或产前诊断未发现明显异常胎儿进行临床随访，胎儿出生后进行新生儿或婴儿心脏超声检查，判定产前诊断的正确性。结果1．197例糖尿病孕妇中，5例（2．54％）被发现胎儿心脏畸形，其中1例来自于Ⅰ型糖尿病患者（1／6，16．7％），2例来自于Ⅱ型糖尿病患者（2／19，10．5％），2例来自于妊娠期糖尿病患者（2／172，1．16％）。2．5例胎儿心脏畸形具体类型及染色体核型如下：2例为法洛四联症（其中1例为21三体，1例染色体正常），1例为右室双出口（染色体正常），1例为室间隔缺损（21三体），1例为左心发育不良（染色体正常）。3．192例产前未发现胎儿心脏畸形胎儿，在分娩后的随访中，发现1例为室间隔缺损（直径为3mm，染色体正常）；1例为动脉导管未闭。4．在胎儿心脏异常中，染色体异常发生率为28．6％。结论1．糖尿病孕妇具有导致子代心脏的高风险，建议对糖尿病孕妇进行胎儿心脏检查，进一步排除胎儿心脏畸形。2．Ⅰ型糖尿病和Ⅱ型糖尿病引起后代出现胎儿先天性心脏畸形的几率明显高于妊娠期糖尿病孕妇，在围孕期和妊娠早期进行良好的血糖控制。3．对糖尿病同时合并胎儿心脏畸形患者，如果需要继续妊娠，建议行羊膜腔穿刺或脐静脉穿刺排除胎儿染色体病变。     

Acoustic Characterization of Echogenic Polymersomes Prepared From Amphiphilic Block Copolymers

Polymersomes are a class of artificial vesicles prepared from amphiphilic polymers. Like lipid vesicles (liposomes), they too can encapsulate hydrophilic and hydrophobic drug molecules in the aqueous core and the hydrophobic bilayer respectively, but are more stable than liposomes. Although echogenic liposomes have been widely investigated for simultaneous ultrasound imaging and controlled drug delivery, the potential of the polymersomes remains unexplored. We prepared two different echogenic polymersomes from the amphiphilic copolymers polyethylene glycol–poly-DL-lactic acid (PEG-PLA) and polyethylene glycol–poly-L-lactic acid (PEG-PLLA), incorporating multiple freeze-dry cycles in the synthesis protocol to ensure their echogenicity. We investigated acoustic behavior with potential applications in biomedical imaging. We characterized the polymeric vesicles acoustically with three different excitation frequencies of 2.25, 5 and 10?MHz at 500?kPa. The polymersomes exhibited strong echogenicity at all three excitation frequencies (about 50- and 25-dB enhancements in fundamental and subharmonic, respectively, at 5-MHz excitation from 20?µg/mL polymers in solution). Unlike echogenic liposomes, they emitted strong subharmonic responses. The scattering results indicated their potential as contrast agents, which was also confirmed by clinical ultrasound imaging.     

不同孕周胎儿肠管超声回声增强病因及其临床意义分析

目的回顾分析不同孕周胎儿肠管超声回声增强的原因及其临床意义。方法对2003年4月至2005年12月间我院行产前超声检查发现胎儿腹腔内肠管回声增强的79例病例进行随访,分析不同孕周中超声检查结果以及引产者胎儿尸检结果。结果79例胎儿中因合并其他严重畸形引产者10例,因合并染色体异常引产3例,妊娠进程中自行消失51例,肠管强回声延续至出生而新生儿无异常6例,进一步发展为肠管异常扩张5例,胎儿感染性腹膜炎的3例。结论胎儿腹腔内肠管超声回声增强预示多种病理改变,有着重要的临床意义。     

肠管强回声胎儿伴发结构异常及染色体异常超声图像分析

目的探讨肠管强回声合并染色体异常胎儿的产前超声声像图特征。方法选取2009年9月至2013年6月在南京医科大学附属苏州医院产前超声检出的80例肠管强回声胎儿行染色体核型分析并随访至产后,产前超声与产后检查结果对照分析。结果 80例肠管强回声胎儿产前超声及染色体检查结果：（1）单纯肠管强回声胎儿58例（72.5%,58/80,均无染色体异常）,产前超声筛查无其他异常发现。（2）合并超声软指标异常11例（13.8%,11/80,均无染色体异常）,超声显示脉络丛囊肿8例,单脐动脉1例,鼻骨偏短1例,心室点状强回声1例。（3）合并严重结构异常或复合结构畸形但无染色体异常5例,超声显示心脏结构畸形3例,心衰1例,中枢神经系统畸形2例。其中1例为复合畸形,表现为右心室发育不良综合征伴发小脑发育不良及单脐动脉,其余4例均为单发畸形,且无其他软指标异常。（4）合并染色体异常6例（7.5%,6/80）,3例染色体结构异常,3例染色体数目异常（21-三体1例,18-三体1例,双胎之一三倍体1例）,均合并严重结构畸形及软指标异常;超声显示严重心脏畸形2例,中枢神经系统畸形2例,心包腔积液合并腹腔积液1例,胎盘绒毛膜多发性血管瘤1例。其中1例双胎输血综合征胎儿合并全前脑（输血儿）宫内死亡;伴发的软指标异常包括颈项软组织层（NF）增厚、脉络丛囊肿,脐带囊肿,单脐动脉,胎盘绒毛膜血管瘤等。结论单纯肠管强回声胎儿预后良好,临床随访过程中部分肠管强回声可消失;合并严重结构畸形和染色体异常的胎儿预后差,产前超声检出肠管强回声应行系统超声检查并提示临床对胎儿行染色体核型分析。