To summarize the characteristics of pernicious placenta previa (PPP) disease complex with placenta implantation, and analyze the reason of ultraound misdiagnosis and missed diagnosis in placenta implantation proved by surgical pathology and clinically follow-up.

Fifty-one cases clinically diagnosed PPP disease patients were examined by both transabdominal and transperineal ultrasounography.

Out of 51 PPP patients, 42 cases (82.4%, 42/51) were proved as placenta increta disease and 9 cases were confirmed with no placenta implantation complication. By transabdominal ultrasound (TAS) combined transperineal ultrasound (TPS) method: 40 cases were correctly diagnosed with placenta implantation (78.4%, 40/51), while 7 cases (13.3%, 7/51) were confirmed without placenta increta, 2 cases (3.9%, 2/51) were mis-diagnosed, 2 cases (3.9%, 2/51) were missed diagnosed. The goup of abdominal ultrasound findings: the placental thickening, diffuse or focal placenta essence lacuna in 25 cases, the gap disappeared after the placenta and placental uterine muscle layer becomes thin (less than or equal to 2 mm) 44 cases, uterine flesh layer arcuate artery arranged in disorder in 34 cases, placental uterine serosa layer bladder junction rich in blood vessels at 18 cases of disorder. Perineal sonography of performance: swelling of lower uterine segment lung, placenta thickening in 25 cases, cervical enlargement, placenta local to the cervical extends into the 6 cases, lower uterine segment and cervical tube placenta cover flow was rich in 8 cases.

PPP disease complex with placenta implantation can be prenatally diagnosed by characteristic ultrasonic features. The combination of TAS and TPS can further improve the diagnostic accuracy of PPP.

To analyze the ultrasound features of ultrasonograpy-false-positive benign thyroid nodules in 37 cases.

With pathology results as the golden standard, thirty-seven patients with forty-six nodules were misdiagnosed as thyroid cancer by ultrasonography. The pre-operative diagnosis of ultrasonography were retrospectively reviewed and analyzed.

Among forty-six thyroid nodules, twenty-one nodules had a diameter of 10.0 mm or smaller, while the other twenty-five nodules had a diameter of larger than 10.0 mm. In all forty-six thyroid nodules, the pre-operative ultrasonography found the majority of nodules with 3 or more than 3 malignant signs. The forty-six thyroid nodules showed solid (89.1%, 41/46), cystic-solid (10.9%, 5/46), marked hypoechogencity (87.0%, 40/46), ill-defined margin (56.5%, 26/46), calcification (76.1%, 35/46), microcalcification and macrocalcification), and taller-than-wide shape (30.4%, 14/46). The thyroid imaging reporting and data system (TI-RADS) lexicon was introduced to describe the lesions: forty-one nodules were categorized as TI-RADS 4c and 5 nodules were categorized as TI-RADS 5. On histology, these misdiagnosed thyroid nodules revealed severe fibrosis, hyalinization and calcification. The ultrasonic images were complicated and difficult to be differentiated from thyroid cancer.

Benign thyroid nodules with fibrosis, hyalinization, hemorrhage and calcification will lead to the significant change on lesions' morphology, echo intensity and internal structure. When the benign and malignant signs ultrasound co-existed in a single thyroid nodule, benign thyroid nodules might be easily misdiagnosed as thyroid cancer.

To summarize the clinical significance of ultrasonic screening of fetal structural anomalies at 11-13⁺⁶ weeks.

We conducted a retrospective study of 4853 cases of nuchal translucency screening at 11-13⁺⁶ weeks in Maternal and Child Health Hospital of Bao′an of Shenzhen City from September 2011 to May 2014. The screening ultrasound planes included the median sagittal plane, neck sagittal section, cerebral transverse section, cardiac four-chamber view, three-vessel-trachea view, abdominal transverse section, bladder section, upper limb section and lower limb section of the fetuses. All the cases then underwent the ultrasonic structural screening in the second trimester (20-24 weeks) and the third (28-32 weeks) trimester and were followed up until 6 weeks after birth or the biopsy after abortion.

Eighty-five fetal structural anomalies were detected among the 4853 pregnant women at 11-13⁺⁶ weeks of gestation with the detection rate of 1.75% (85/4853), including central nervous system abnormalities (28 cases), anterior abdominal wall anomalies (9 cases), cardiac anomalies (6 cases), urinary system malformation (3 cases), skeletal system malformation (2 cases), multilocular cystic tumor and dropsy embryo (35 cases), and abnormal twins (2 cases). Among above abnormal fetuses, 6 cases showed normal structure in the screening after 14 weeks and were born without malformations, while the rest 79 cases were taken artificial abortion (73 cases in the first trimester and 6 cases in the second trimester). Only 9 cases were taken chorionic puncture or amniocentesis, including normal karyotypes (3 cases), 47, XN, +18 (3 cases) and 45, X (3 cases). The False negative rate in the first trimester was 23% (25/110). Supplementary detection of fetal structural abnormalities in the second and third trimester were found in 22 cases (20%, 22/110). Two cases of VSD and 1 case of microtia were identified after birth.

The fetal malformation can be detected in the earlier gestation with the ultrasonic screening at 11-13⁺⁶ weeks, which provide the earlier termination to the abnormal fetus. It has important clinical significance in effectively reducing fetal births with structural abnormalities.

To evaluate the value of superb mircovascular imaging (SMI) for differentiating benign from malignant thyroid nodules by observing the flow distribution characteristics of thyroid solid nodules.

From May to June 2014, patients, come from Huadong Hospital of Fudan University, with 68 thyroid nodules were preoperatively evaluated with color Doplor flow image (CDFI) and SMI. All the thyroid nodules were confirmed by pathology. The flow pattern and the color characteristics of thyroid nodule were observed and compared between those two flow imaging technology. The Chi-square test was used to compare the distribution of nodules blood flow patterns between CDFI and SMI and the results were compared with the pathology results. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value were calculated and analyzed.

For 68 nodules, 41 were benign and 27 were malignant. Both CDFI and SMI showed that malignant nodules were mostly central type vascularization (Ⅲ), whereas the benign nodules were mainly peripheral (Ⅱ) and mixed type vascularization (Ⅳ). SMI is more sensitively in display the nodules blood flow. For benign solid nodules with blood flow distribution type Ⅱ and malignant type Ⅲ, the display rates of SMI are higher than those of the CDFI [68.3% (28/41) vs 46.3% (19/41), 77.8% (21/27) vs 37.0% (10/27)], the differences were statistically significant (χ²=4.04, P<0.05; χ²=9.16, P<0.01). For benign solid nodules with blood flow distribution type Ⅰ, Ⅲ and Ⅳ and malignant solid nodules with blood flow distribution type Ⅰ, Ⅱ and Ⅳ, there were no significant differences between SMI and CDFI. In this study, pathological diagnosis was used as gold standard, nodules with blood flow type Ⅱ and Ⅳ were diagnosed as benign and nodules with blood flow type Ⅲ diagnosis were diagnosed as malignant. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of SMI and CDFI in the diagnosis of thyroid solid nodules were 63.0% vs 88.9%, 80.5% vs 95.1%, 73.5% vs 92.9%, 68.0% vs 92.6%, 76.7% vs 92.3%, respectively.

SMI is more sensitive to show the real flow and contribute a certain value in differential diagnosis of benign and malignant thyroid nodules.

To investigate the characteristic sonographic and pathological features of breast ductal carcinoma in situ (DCIS) without microcalcifications on mammography (MG).

Forty cases of DCIS without microcalcifications on MG were retrospectively reviewed. The 40 lesions were classified into mass and non-mass groups according to their sonographic findings. The pathological subtypes and nuclear grades of these cases were also analyzed. Fisher exact test was used to compare the differences of the sonographic accuracy rate, sonographic microcalcification rate, pathological nuclear grade and subtype rate between mass and non-mass groups.

No abnormal finding was found in sixteen cases (40.0%) on MG and only one case (2.5%) on ultrasonography (US), respectively. The most common sonographic feature of DCIS without microcalcifications on MG were masses (75.0%, 30/40), and other sonographic findings were round/oval and irregular shape, microlobulated margin, heterogeneous hypoechogenicity and isoechogenicity, and posterior acoustic feature. Ductal dilatations and heterogeneous isoechogenicity were present in most non-mass lesions of DCIS without microcalcifications on MG (22.5%, 9/40). The ultrasonographic microcalcifications were found in 5 cases of DCIS without microcalcifications on MG. The common pathological features of DCIS without microcalcifications on MG were medium-low nuclear grade (85.0%, 34/40) and noncomedo (87.5%, 35/40). The difference of US accuracy rate in mass and non-mass groups was statistically significant [73.3% (22/30) vs 33.3% (3/9), P=0.047]. The differences of US microcalcification rate, pathological subtype and nuclear grade were not significant (P=1.000, 0.070).

The mass appearance and medium-low nuclear grade were most common sonographic findings and pathological features of DCIS without microcalcifications on MG. Ultrasonography should be an helpful tool for improving the diagnostic sensitivity of mammography in breast DCIS.