Objective

To explore the correlation between contrast-enhanced ultrasound (CEUS)characteristics and pathology of highly vascularized uterine leiomyoma, in order to provide a reliable imaging basis for the selection of clinical treatment.

Methods

A total of 78 patients who were hospitalized and underwent surgical treatment for uterine leiomyoma in the Women’s Hospital School of Medicine Zhejiang University from June 2021 to October 2023 were collected.Finally, 97 lesions were diagnosed as highly vascularized uterine leiomyoma by color/energy Doppler ultrasonography, all of which underwent contrastenhanced ultrasound before surgery.According to pathology, the 97 lesions were divided into common uterine leiomyomas, common uterine leiomyomas with degeneration, special types of uterine leiomyomas,and uterine sarcoma for comparison.The edematous uterine leiomyomas and uterine leiomyomas with hyaline degeneration in the common leiomyomas with degeneration group, and the cellular leiomyomas in the special leiomyoma group were also compared with the common uterine leiomyomas group.Fisher exact probability method was used to compare the overall difference between groups, and Bonferroni test was used for pairwise comparisons.The contrast-enhanced ultrasound mode features, arrival time, time to peak,and late enhancement features were also compared among the groups.

Results

Ninety-three (95.9%) of 97 highly vascularized uterine leiomyomas diagnosed by color/energy Doppler ultrasonography were eventually diagnosed as benign leiomyoma by histopathology, and four (4.1%) were diagnosed as uterine sarcomas.The arrival time (P=0.004), the degree of enhancement at the peak (P=0.013), the uniformity of internal contrast distribution (P＜0.001), the speed of wash-out (P＜0.001), and the degree of lesion enhancement (P=0.005)differed significantly among the common uterine leiomyomas group (51 lesions), the uterine leiomyomas with degeneration group (23 lesions), the special type of uterine leiomyomas group (19 lesions), and the uterine sarcomas group (4 lesions).There were significant differences in the arrival time (P=0.001), the degree of enhancement (P=0.014), the uniformity of internal contrast distribution (P＜0.001), and the speed of washout (P＜0.001) among common leiomyoma (51 lesions), edematous uterine leiomyomas (11 lesions) and uterine leiomyomas with hyaline degeneration (11 lesions) in the common leiomyomas with degeneration group, and cellular leiomyomas (11 lesions) in the special type of leiomyomas group, though there was no significant difference in the degree of enhancement in the late stage of enhancement (P=0.329).The contrastenhanced ultrasound patterns of different pathology classifications of highly vascularized uterine leiomyoma were as follows: (1) The enhanced mode such as synchronous uniformity and equal enhanced ratio was higher in the common leiomyomas group; (2) The time to peak and inhomogeneity enhancement ratio was higher in the common leiomyomas with degeneration group.The fast-in hyperenhancement pattern was the main pattern of edematous degeneration, “honeycomb-like” hypoperfusion areas were seen internally,and hyaline degeneration was dominated by synchronous equal enhancement or low enhancement patterns;(3) The uterine sarcomas group had the highest proportion fast wash-out and inhomogeneity enhancement,and 3 lesions (75.0%) showed non-perfusion areas of “map pattern”; and (4) The proportion of cellular leiomyomas in the special type of leiomyomas group with fast-in and high enhancement was high, but lower than that of the uterine sarcoma group.

Conclusion

There are differences in contrast-enhanced ultrasound patterns between different pathologic types of highly vascularized uterine leiomyomas and uterine sarcomas.These differences can help to infer the pathology classification before surgery and provide an imaging basis for clinical decision-making.

Objective

To summarize the prenatal and postnatal sonographic features of congenital cystic neuroblastoma in order to improve the accuracy of prenatal ultrasound diagnosis.

Methods

A retrospective analysis was conducted on five cases of cystic neuroblastoma confirmed by pathology, which were detected by prenatal ultrasound at Maternal and Child Health Hospital of Hubei Province from June 2016 to December 2021.

Results

All the five cases were singleton pregnancies (three males and two females), with gestational weeks at the time of prenatal ultrasound detection ranging from 30⁺⁶ to 37⁺² weeks.The lesions were located in the left adrenal gland in three cases and the right adrenal gland in two.Prenatal ultrasound made a definitive diagnosis in one case, failed to make a clear diagnosis in three, and misdiagnosed one case as a right adrenal cyst.Postnatal ultrasound follow-up revealed the following characteristic changes: tumor enlargement (maximum diameter increased from 12-42 mm prenatally to 27-63 mm postnatally); increased thickness of the cyst wall (maximum thickness increased from 1.0-4.6 mm prenatally to 2.2-5.0 mm postnatally,with the number of cases with uneven thickness increasing from two to five); changes in cyst cavity echoes (echo penetration deteriorated from two cases to five cases, with all showing punctate and flocculent echoes); increased number of septa (from three cases to five cases); increased calcification (no calcification echoes prenatally, but calcification echoes appeared in three cases postnatally); and increased cyst wall blood flow (blood flow in the cyst wall was visible in one case prenatally, but in four postnatally).All the five patients underwent surgical resection of the cystic mass in the neonatal period without chemotherapy, and postoperative pathology indicated undifferentiated neuroblastoma with low mitotic and karyorrhexis indices.Follow-up after surgery for 6-36 months showed no recurrence.

Conclusion

Cystic neuroblastoma is prone to occur in the adrenal glands and can be detected early by prenatal ultrasound.Ultrasound can provide timely observation and efficient prenatal consultation, and provide an important basis for early clinical diagnosis and treatment.

Objective

To assess the diagnostic accuracy of ultrasound in detecting fetal cystic malformations of the posterior fossa in order to further enhance their diagnostic recognition and differential diagnosis.

Methods

Data of 281 fetuses (abnormal group) diagnosed with cystic malformations of the posterior fossa via ultrasound at Hubei Maternal and Child Health Hospital from August 2020 to 2023 were retrospectively analyzed.All cases were confirmed by MRI or postpartum pathological examination and compared with 2000 normal pregnant women (normal group) in the same period.The ultrasound diagnostic features of cystic malformations of the posterior fossa were summarized, the diagnostic concordance rate was calculated, the distribution of malformation types was examined, and the imaging features and causes of misdiagnosed cases were analyzed.

Results

Among all fetal posterior fossa malformation cases, ultrasound and MRI diagnoses showed concordant results in 268 cases (95.37%) and discordant results in 13.Most pregnant women in both the abnormal (74.3%, 199/268) and normal (79.9%, 1598/2000) groups were aged 25-34 years, with no significant difference between the two groups (P=0.104).Most ultrasonographic diagnoses of cystic malformations of the posterior fossa were made in late pregnancy (30-34⁺⁶ weeks, 67.5%,181/268).These malformations often coexisted with nervous system malformations or other congenital abnormalities.In contrast, normal pregnant women mainly had check-ups at 20-22 and 30-32 weeks (two systematic checks), with a significant difference in peak timing of check-ups compared to the abnormal group (P＜0.001).The posterior fossa cisterna malformations detected by ultrasound included 255 cases of mega cisterna magna, 8 cases of Dandy-Walker malformation, 3 cases of Blake’s pouch cysts, and 2 cases of cerebellar vermis hypoplasia.Among 13 misdiagnosed cases, 2 arachnoid cysts were misdiagnosed as Blake's pouch cysts, and 1 case each of arachnoid cyst, Blake's pouch cyst, and cerebellar vermis hypoplasia was missed.Approximately 22.8% (61/268) of the cases had malformations in other systems.The abnormality rate was 24.8% (34/137) in the posterior cranial fossa width ≥1.20 cm group, higher than the 13.6% (16/118) in the＜1.20 cm group.

Conclusion

Ultrasound is valuable for prenatal screening of cystic malformations of the posterior fossa but has a misdiagnosis rate for complex malformations like cerebellar vermis hypoplasia and Blake’s pouch cysts.Late pregnancy (30-34⁺⁶ weeks) is the critical time point for confirming these diagnoses.For suspicious cases, a comprehensive neurological assessment, multi-system screening, and multi-modality imaging verification are recommended to enhance diagnostic accuracy.

Objective

To evaluate the clinical value of real-time dynamic three-dimensional painless tubal contrast-enhanced ultrasonography.

Methods

One hundred and sixty-three women who had suspected tubal infertility at Hangzhou Hospital of Traditional Chinese Medicine from June 2021 to March 2024 were selected as the study subjects.They were divided into a control group, an experimental group,and an observation group by the random number table method, involving 59 women in the control group with 117 fallopian tubes, 54 women in the experimental group with 103 fallopian tubes, and 50 women in the observation group with 100 fallopian tubes.The control group underwent X-ray hysterosalpingography,and real-time dynamic three-dimensional painless (performed under anesthesia) tubal contrast-enhanced ultrasonography was used in the experimental group.Real-time dynamic three-dimensional tubal contrastenhanced ultrasonography was used in the observation group.The three groups of patients were statistically analyzed for the excellent rate of contrast images obtained, the accuracy of diagnosis of tubal patency, and the rate of adverse reactions.The comparison of continuous variables within the group was performed using multifactorial repeated-measures analysis of variance, and categorical variables between groups were compared using the χ² test.

Results

The excellent rate of contrast images in the experimental group was higher than that of the control group (91.26% vs 81.2%; χ²=4.585, P＜0.001).In terms of the diagnosis of tubal patency,the rate of impatency in the experimental group was significantly higher than that of the control group and the observation group (89.32% vs 77.00%, χ²=5.892, P=0.015; 89.32% vs 76.92%, χ²=5.523, P=0.019).In terms of adverse reactions, the rate of pain in the control group and observation group was significantly higher than that of the experimental group (20.34% vs 0, χ²=12.288, P＜0.001; 20.00% vs 0, χ²=11.949, P＜0.001),and the rate of nausea and vomiting in the control group and observation group was significantly higher than that of the experimental group (11.86% vs 0, χ²=4.941, P=0.026;10.00% vs 0, χ²=5.673, P=0.023).

Conclusion

Real-time dynamic three-dimensional painless tubal contrast-enhanced ultrasonography is more effective in asessing tubal patency, with images having higher quatlity, and it can improve the diagnostic accuracy and effectively reduce the rate of adverse reactions.

Objective

To investigate the incidence， associated characteristics， and postnatal follow-up results of ventricular septal defect （VSD） detected in a national ultrasound screening program for fetal congenital heart defects （CHDs） in China.

Methods

From January 1， 2011 to December 31，2013， a ultrasound screening for CHDs was investigated in 92 hospitals across 31 provinces/municipalities/autonomous regions in China.A total of 759 physicians in these hospitals， who had undergone standardized prenatal ultrasound training and obtained qualiflcations for prenatal diagnosis， participated in this research project.Fetal ultrasound screening was performed in accordance with relevant practice guidelines and hierarchical referral criteria.Data on fetuses with CHDs and their mothers were collected and uploaded using a “data investigation software” system developed by the research group.The incidence， associated characteristics， and follow-up outcomes of VSD was analyzed based on the aggregated data from 92 hospitals during the fetal cardiac screening.

Results

A total of 18 171 fetal CHD cases were identified from 2 452 249 pregnancies.Among these cases， 4345 fetuses were diagnosed with ventricular septal defect（VSD）， accounting for 23.9% of all CHD cases （4345/18 171）.The incidence of VSD was 17.72 per 10 000（4345/2 452 249； 95% confldence interval：17.20-18.25）， which was the highest among the 36 subtypes of CHD.The 31 provinces， municipalities， and autonomous regions in China were divided into six geographical regions.The highest incidence of fetal VSD was found in the eastern region （20.59 per 10 000； 854/414 815），while the lowest incidence occurred in the northwestern region （8.85 per 10 000； 109/123 189）.There was a statistically signiflcant difference in incidence among the six geographical regions （χ² = 166.71， P＜0.01）.Among the 4345 VSD cases， isolated VSD was identifled in 3171 cases （72.98%）， while 1015 cases （23.36%）were associated with extracardiac malformations.The top three extracardiac malformations were central nervous system anomalies （427 cases）， single umbilical artery and umbilical cord cysts （241 cases）， and craniofacial anomalies （219 cases）.A total of 534 VSD fetuses underwent genetic study for chromosomal abnormality， with 142 cases （27%） showing chromosomal abnormalities.The most common abnormalities were trisomy 21 （31 cases） and trisomy 18 （59 cases）.Postnatal follow-up was carried out for the fetal VSD cases， with 2835 fetuses born alive， 674 cases terminated， and 836 cases lost to follow-up.The concordance rate between prenatal screening results and postnatal veriflcation was 89.60% （3144/3509）.

Conclusion

This study provides the incidence of VSD in China， including the regional incidence in the six geographical regions， as well as types of extracardiac malformations associated with VSD， the incidence of chromosomal abnormalities， and the concordance rate between prenatal screening results and postnatal veriflcation.These flndings offer valuable foundational data for further research on fetal VSD.

Objective

To assess the value of fetal heart quantiflcation （fetal HQ） in evaluating heart morphology and function in fetuses with simple complete transposition of the great arteries （D-TGA）.

Methods

Thirty-one fetuses with simple D-TGA （D-TGA group） diagnosed by fetal echocardiography who visited Sir Run Run Shaw Hospital， Zhejiang University School of Medicine from May 2020 to December 2023 were retrospectively analyzed， and 171 normal fetuses with matched gestational weeks were used as controls （control group）.Fetal standard 4-chamber views （4CV） were collected， and fetal HQ software was applied to measure end diastolic basal apical length， transverse width， and area， and calculate the global spherical index （GSI）.Measurements of left and right ventricular functional changes were also performed，including left ventricular ejection fraction （EF）， and left and right ventricular fraction area change （FAC）.Left and right ventricular end-diastolic areas were analyzed by speckle tracking imaging （STI）， and longitudinal diameter and 24-segment end-diastolic diameter （ED）， spherical index （SI）， fractional shortening （FS），and global longitudinal strain （GLS） of the left and right ventricles were analyzed by STI.The great artery parameters of the fetuses in both groups were analyzed， including aortic diameter （AO）， pulmonary artery diameter （PA）， main pulmonary artery diameter （MPA）， and their Z-scores.

Results

The differences in GSI， left and right ventricular FAC， left and right ventricular GLS， left ventricular end-diastolic area， and left ventricular length were signiflcant between the D-TGA group and the control group （all P＜0.05）.There were statistically signiflcant differences in ED of left ventricular segments 20-24 ED and right ventricular segments 8-24 （all P＜0.05）， in FS of left ventricular segments 20-24 and right ventricular segments （all P＜0.05）.and in SI of left ventricular segments 1-4， 10-17， and 19， and right ventricular segments 1-9 （all P＜0.05）between the two groups.The difference between fetal AO Z-score and PA Z-score in the D-TGA group was statistically significant （1.32±0.70 vs -0.22±1.09， P＜0.05）.

Conclusion

Quantitative assessment of fetal cardiac morphology and function using the fetal HQ technique provides a reference basis for analyzing ventricular remodeling in D-TGA fetuses.

Objective

To evaluate the predictive value of fetal craniofacial ultrasound markers for open spina bifida (OSB) during early pregnancy (gestational weeks 11-13⁺⁶).

Methods

The medical data of 13 fetuses with OSB and 60 normal fetuses that underwent prenatal examinations at Beijing Obstetrics and Gynecology Hospital, Capital Medical University from December 2018 to November 2023 were retrospectively reviewed and analyzed. Based on prenatal ultrasound quality control standards, standard sections of early pregnancy ultrasound were selected. The mid-sagittal section of the craniofacial region was assessed for morphology of the interbrain,midbrain, brainstem, fourth ventricle, and posterior fossa cistern. Measurements included brain stem width(BSW) and the distance from the brainstem posterior edge to the occipital bone (BSOB). The BS/BSOB ratio was calculated, and the frontomaxillary facial angle (FMFA) was evaluated. Qualitative indicators such as the maxilla-occipital line (MO line) in relation to the junction of the thalamus and midbrain (J-TM) were observed.Measurements on the lateral ventricle transverse section included the ratio of choroid plexus length to occipitofrontal diameter (CP-L/OFD), choroid plexus area, and the ratio of choroid plexus area to lateral ventricle plane brain area(CP-A/HA). The t-test or rank sum test was used to compare the differences in the above indexes. Lasso regression was used to screen the indexes to establish a prediction model. Receiver operating characteristic (ROC) curves of each index and the prediction model were drawn to evaluate the predictive value of each index for OSB in fetuses.

Results

In the mid-sagittal plane of the head and face, the diencephalon and mesencephalon of 60 normal fetuses exhibited an “8-shaped” morphology. The brainstem, fourth ventricle, and posterior fossa structures were clearly visible, appearing as three nearly parallel cavities. The J-TM was located above the MO line. In 13 OSB fetuses,the diencephalon and mesencephalon were distorted, the brain stem was displaced downward and widened, the BSOB was narrowed, and the fourth ventricle was compressed and reduced in size. Among these fetuses, the fourth ventricle disappeared in 10 cases (76.9%), leading to the presence of two cavities. In 11 cases (84.6%), the J-TM was below the MO line. Compared to the normal group, the OSB group showed a statistically significant increase in BSW/BSOB [1.26 (0.79, 1.49) vs 0.57 (0.52, 0.65); Z=18.09, P＜0.001] and a statistically significant decrease in the FMFA [77.60° (67.05°, 84.22°) vs 85.09° (80.15°, 89.03°); Z=6.48, P=0.009]. Lasso regression analysis showed that BSW/BSOB, FMFA, and CP-A/HA were significant variables for predicting OSB. Based on these variables, a regression model was established, and the regression equation was log(P/1-P) =2.043BSW/BSOB-0.026FMFA+1.251CP-A/HA-12.414. The ROC curves of each index and the regression model were plotted, and the area under the curve of the predictive model was 0.928, indicating good diagnostic performance compared to other indexes.

Conclusion

Ultrasound markers obtained from routine sections in fetuses at 11-13⁺⁶ gestational weeks can effectively predict fetal OSB. BSW/BSOB, FMFA, and CP-A/HA are significant variables for predicting OSB, and their combination provides better diagnostic value for OSB.

Objective

To investigate the ultrasonographic imaging and clinical features of pelvic nerve sheath tumors in female patients, in order to improve their recognition.

Methods

From March 2019 to October 2023, patients with pelvic nerve sheath tumors who underwent gynecological ultrasound, surgical treatment, and pathological examination at the Gynecologic Center Ultrasound Department of Nanjing Drum Tower Hospital Affiliated to Nanjing University were included. Their ultrasound findings and clinical data were reviewed retrospectively.

Results

A total of 11 cases were included, including 9 cases of schwannom and 1 case each of neurofibroma and neurofibromatosis, age of onset: 29-68 years old. Most of them were asymptomatic or found by physical examination. The size of the tumors varied (maximum diameter 29-105 mm), the masses were well-defined, the internal echo was mainly solid-cystic, the shape was mainly regular, and the presence of a hyperechogenic rim was mainly detected in schwannoa. Color Doppler showed that the blood flow in the lesions was mainly grade I.

Conclusion

Pelvic never sheath tumors in female patients have the characteristics of benign tumors on ultrasonographic images and lack typical imaging features. Sonographers should improve their understanding of pelvic never sheath tumors to further improve the accuracy of preoperative diagnosis.

Objective

To summarize the echocardiographic characteristics of intracardiac total anomalous pulmonary venous connection (TAPVC), in order to provide prenatal screening institutions with some rapid screening ideas for this condition.

Methods

This retrospective study included 54 cases of fetuses with intracardiac TAPVC diagnosed by prenatal echocardiography in our hospital from January 2017 to January 2024. The analysis focused on prenatal ultrasound characteristics, concomitant malformations, and follow-up. Descriptive statistical analysis was utilized for this purpose.

Results

Among the 54 fetuses with intracardiac TAPVC included, all (100%) exhibited no detection of pulmonary vein openings in the left atrium on the four-chamber view, 23 (42.59%) had a common pulmonary venous chamber observed between the left atrium and the descending aorta, 22 (40.74%) showed abnormal four-chamber proportions, 22 (40.74%) had a dilated coronary sinus, and 48 (88.89%) had a left atrium posterior space index greater than 1.0. Among the 54 cases, 34 (62.96%) had other complex cardiovascular malformations, of which right-sided heterogeneous syndrome was the most common concomitant abnormality (n=23, 42.59%). Among the 54 fetuses who were followed, 41 underwent induced labor, 7 were born (6 confirmed by postnatal surgery and 1 by postnatal ultrasound, with ongoing observation and follow-up), 1 was stillborn (one of the twins), and 5 were lost to follow-up. Among the 41 cases of induced labor, 3 were confirmed by autopsy.

Conclusion

Fetal prenatal echocardiography with two-dimensional and low-velocity flow imaging can diagnose intracardiac TAPVC and associated malformations. When prenatal ultrasound findings show a smooth posterior wall of the left atrium, abnormal cardiac chamber proportions, increased spacing between the left atrium and descending aorta, and dilated coronary sinus, the possibility of intracardiac pulmonary venous anomalous connection should be considered.

Objective

To evaluate the value of fetal heart quantitation （fetal HQ） combined with other multiple fetal echocardiographic quantitative parameters in evaluating heart structure and function in fetuses with coarctation of the aorta （CoA）.

Methods

Fifty fetuses suspected of having CoA who underwent fetal echocardiography at the Department of Diagnostic Ultrasound & Echocardiography， Sir Run Run Shaw Hospital， Zhejiang University College of Medicine from January 2022 to January 2023 were selected as the study subjects. The fetuses diagnosed with CoA in the outpatient follow-up after delivery were included in a CoA group （18 cases）， and those with false-positive results as demonstrated during outpatient follow-up were included in a control group （32 cases）. Overall cardiovascular parameters of the two groups of fetuses were compared， including left ventricular fractional area change （LVFAC）， LVFAC Z-score， left ventricular global longitudinal strain （LVGLS）， right ventricular global longitudinal strain （RVGLS）， right ventricular area （RVA）/left ventricular area （LVA） ratio， aortic isthmus inner diameter （AI） and its Z score （AI Z-score），aortic isthmus inner diameter/descending aorta inner diameter ratio （AI/DAO ratio）， main pulmonary artery inner diameter/ascending aorta inner diameter ratio （MPA/AAO ratio）. The end diastolic transverse diameter（ED）， ED Z-score， short axis shortening rate （FS）， FS Z-score， sphericity index （SI）， and SI Z-score of the 24 segments of the left and right ventricle were also compared between the two groups. Multivariate Logistic regression analysis was performed to identify risk factors for CoA. Receiver operating characteristics（ROC） curve analysis was performed to test the diagnostic efficacy of LVFAC， LVFAC Z-score， AI， and the combination of the three for fetal CoA. Within-group correlation coefficients （ICCs） were used to judge the consistency of measured parameters within and between observers.

Results

LVFAC， LVFAC Z-score，LVGLS， RVGLS， AI， AI Z-score， and AI/DAO ratio were significantly lower in the CoA group than in the control group， while RVA /LVA ratio and MPA/AAO ratio of fetuses in the CoA group were significantly higher than those of the control group （P＜0.05）. The ED Z-score of the first segment of the left ventricle in the CoA group was significantly lower than that of the control group （P＜0.05）， and the FS Z-scores of the fourth to eighth segments of the left ventricle were significantly higher than those of the control group （P＜0.05）. LVFAC， LVFAC Z-score， and AI were identified to be risk factors for CoA （P＜0.05）. The area under the ROC curve values of LVFAC， LVFAC Z-score， AI， and their combination for diagnosing fetal CoA were 0.989 （0.969 ～ 1.000）， 0.966 （0.922 ～ 1.000）， 0.785 （0.731 ～ 0.859）， and 0.997 （0.987 ～ 1.000），respectively. The ICCs for intra-observer and inter-observer measurements of various fetal parameters ranged from 0.90 to 0.99.

Conclusion

Fetal HQ combined with other multiple fetal echocardiographic quantitative parameters can effectively evaluate the changes of heart structure， size， and function in fetuses with CoA，providing reference information for improving prenatal detection of CoA.

胎儿颈部淋巴水囊瘤是胎儿颈后软组织内的囊状无回声区，以内部分隔型多见。单胎妊娠早孕期淋巴水囊瘤常合并染色体非整倍体异常、心脏畸形、胎儿水肿、其他结构异常等，常预后不良。单绒毛膜囊双胎妊娠由于其胎盘绒毛板存在连接两个胎儿循环的吻合血管，其发生淋巴水囊瘤的机制与单胎妊娠可能不尽相同。本研究回顾性分析北京协和医院产前超声诊断的4例单绒毛膜双胎妊娠早孕期颈部淋巴水囊瘤病例的声像图特征及临床结果，并进行漏误诊病例分析，以期提高超声医师对该病的认识。