Contrast-enhanced US to Improve Diagnostic Performance of O-RADS US Risk Stratification System for Malignancy.

Background The Ovarian-Adnexal Reporting and Data System (O-RADS) has limited specificity for malignancy. Contrast-enhanced US can help distinguish malignant from benign lesions, but its added value to O-RADS has not yet been assessed. Purpose To establish a diagnostic model combining O-RADS and contrast-enhanced US and to validate whether O-RADS plus contrast-enhanced US has a better diagnostic performance than O-RADS alone. Materials and Methods This prospective study included participants from May 2018 to March 2021 who underwent contrast-enhanced US before surgery and had lesions categorized as O-RADS 3, 4, or 5 by US, with a histopathologic reference standard. From April 2021 to July 2022, participants with pathologically confirmed ovarian-adnexal lesions were recruited for the validation group. In the pilot group, the initial enhancement time and enhancement intensity in comparison with the uterine myometrium, contrast agent distribution pattern, and dynamic changes in enhancement of lesions were assessed. Contrast-enhanced US features were used to calculate contrast-enhanced US scores for benign (score ≤2) and malignant (score ≥4) lesions. Lesions were then re-rated according to O-RADS category plus contrast-enhanced US scores. Receiver operating characteristic curves were constructed and compared using the DeLong method. The combined system was validated in an independent group. Results The pilot group included 76 women (mean age, 44 years ± 13 [SD]), and the validation group included 46 women (mean age, 42 years ± 14). Differences in initial enhancement time (P < .001), enhancement intensity (P < .001), and dynamic changes in enhancement (P < .001) between benign and malignant lesions were observed in the pilot group. Contrast-enhanced US scores were calculated using these features. The O-RADS risk stratification was upgraded one level for contrast-enhanced US scores of 4 or more and downgraded one level for contrast-enhanced US scores of 2 or less. In the validation group, the diagnostic performance of O-RADS plus contrast-enhanced US score was higher (area under the receiver operating characteristic curve [AUC] = 0.93) than O-RADS (AUC = 0.71, P < .001). Conclusion Contrast-enhanced US improved the diagnostic performance for malignancy of the O-RADS categories 3-5. © RSNA, 2023 Supplemental material is available for this article. See also the editorial by Grant in this issue.

Spontaneous renal hemorrhage secondary to choriocarcinoma in a man with congenital hypospadias and cryptorchidism: a case report and literature review.

BACKGROUND: Choriocarcinoma is a rare malignant germ-cell tumour, most commonly found in adult women. It infrequently presents as spontaneous renal haemorrhage (SRH). Genital malformation and SRH secondary to choriocarcinoma has previously been only reported in females. We present what we believe to be the first case of a male patient with genital malformation (hypospadias and cryptorchidism) and SRH at presentation of choriocarcinoma. CASE PRESENTATION: A 25-year-old man presented to the department with intense pain in the right flank region and lower back. Initial investigations showed spontaneous renal haemorrhage, for which an emergency partial nephrectomy was performed. Clinical, radiological, and pathological investigations suggested a diagnosis of testicular choriocarcinoma with metastases to the right kidney, both lungs, and brain. Initial treatment was with a chemotherapy regimen of cisplatin, etoposide and bleomycin and whole brain radiotherapy; however, 6 months after diagnosis the patient developed liver metastasis, after which time the BEP protocol was switched to ITP with oral apatinib. Despite best efforts, the liver and lung metastasis continued to grow and a decision was made to discontinue active treatment and provide only palliative care until the patient passed away. CONCLUSION: Choriocarcinoma is a difficult cancer to diagnose pre-operatively. In male patients with early metastasis, prognosis may be much poorer than in the commoner gestational choriocarcinoma. A multidisciplinary with comprehensive post-surgical intervention is of great importance in the treatment of these patients.

Clinical Outcomes after Selective Fetal Reduction of Complicated Monochorionic Twins with Radiofrequency Ablation and Bipolar Cord Coagulation.

AIMS: To review pregnancy outcomes, complication rates and neonatal neural development of selective termination procedures for complicated monochorionic (MC) twins. METHODS: This was a retrospective review of the pregnancies that underwent selective reduction with radiofrequency ablation (RFA) and bipolar cord coagulation (BCC) in our institution. RESULTS: Forty-eight cases underwent selective reduction with BCC and the remaining 45 with RFA. Overall survival was not statistically different between the RFA and BCC groups (71.1 and 62.5%, p = 0.379). With regard to the indications, the survival rates were not significantly different for twin to twin transfusion syndrome, twin reversed arterial perfusion, discordant anomalies and selective intrauterine growth restriction. Preterm premature rupture of membrane was not statistically different between the BCC and RFA groups (47.9 and 33.3%, p = 0.153). Five foetuses presented with abnormal middle cerebral artery-peak systolic velocity in the BCC group and 4 in the RFA group (p = 0.829). In the BCC group, neurological injury was detected in 2 neonates, presenting with cerebral dysplasia on MR scanning. In the RFA group, intracranial haemorrhage Grade III was detected in one neonate with cranial ultrasound (p = 0.607). CONCLUSIONS: Overall survival and complication rates following selective reduction in complicated MC twin pregnancies is similar irrespective of whether the reduction was performed using RFA or BCC. Key Message: It seems that selective reduction in MC pregnancies with RFA does not carry a significant decrease in the overall survival and complication rates than the cases with BCC. According to our data, neurodevelopmental impairment of the co-twins is relatively seldom after selective reduction.

Date-independent parameters: an innovative method to assess fetal cerebellar vermis.

The objectives of this paper were to identify gestational age-independent parameters for cerebellar vermis (CV) evaluation and examine their use in CV integrity assessments. Using three-dimensional ultrasonography, we obtained the following measurements from 217 pregnant women carrying 18-37-week-old fetuses: the largest area of the CV, vermal craniocaudal distance (VCC), vermal anterior to posterior diameter, and vermal perimeter (VP). In addition, fetal growth parameters (biparietal diameter, head circumference femoral length [FL], humeral length, transverse cerebellar diameter, and abdominal circumference) were evaluated. The ratios of the CV dimensions to each other and to the fetal growth parameters were calculated. Ratios showing no significant correlation with gestational age and acceptable internal validity in subsequent bootstrap analyses were chosen. The normal ranges of the specific parameters were compared with cases identified with posterior fossa anomalies (PFA). The ratios VP/FL (mean 1.20, SD 0.09), VCC/FL (mean 0.36, SD 0.03), and VCC/VP (mean 0.3, SD 0.03) were chosen using our protocol. These parameters were not significantly different between normal fetuses and those with PFA and an intact vermis. However, VP/FL and VCC/FL values were abnormal in cases of hypoplastic vermis or vermian agenesis, while the VP/VCC value was abnormal only in cases of vermian agenesis. The VP/FL, VCC/FL, and VCC/VP ratios are gestational age-independent parameters in evaluation of CV integrity.

Hepatoprotective effect of ulinastatin in a rat model of major hepatectomy after obstructive jaundice.

BACKGROUND: To date, major hepatectomy with obstructive jaundice is still a highly risky and difficult surgery because of the high rate of complications. An excessive inflammatory response may be the primary hindrance to postoperative recovery of liver function. AIMS: Recent research has demonstrated that ulinastatin blocks the release of inflammatory factors and prevents the cytokine cascade reaction. This study was conducted to investigate the effect of ulinastatin on major hepatectomy after obstructive jaundice and to explore the potential mechanisms of this effect. METHODS: Male Sprague-Dawley rats were divided into three groups: sham, control and treated groups. In the control and treated groups, obstructive jaundice was induced, and a 70 % major hepatectomy was performed with implementation of ulinastatin treatment in the treated group but not the control group. The rats were sacrificed after hepatectomy on day 1, day 3, day 5 and day 7. The survival time, liver function, inflammatory cytokine expression and the indices of proliferation activities were examined. Kupffer cells were isolated, and the mRNA and protein levels of CD14 and NF-κB P65 in the Kupffer cells were determined. RESULTS: Compared to the control group, the survival rates, postoperative liver function, and the indices of proliferation activities were better in the treated group; in the treated group serum TNF-α and IL-6 levels were lower whereas serum IL-10 levels were higher. The expression of CD14 and NF-κB P65 in Kupffer cells at both the mRNA and protein levels was significantly higher in the control group than in the treated group. CONCLUSIONS: Ulinastatin has a protective effect in major hepatectomy with obstructive jaundice by inhibiting Kupffer cell activation and modulating the hepatic cytokine response.

Fetal persistent left superior vena cava in cases with and without chromosomal anomalies.

OBJECTIVES: The objectives of this study are to determine and compare the prevalence of persistent left superior vena cava (PLSVC) in chromosomally normal and abnormal fetuses and to evaluate the potential of PLSVC as a screening marker for chromosomal abnormalities. METHODS: Women undergoing routine fetal sonographic examinations were evaluated once for the presence of PLSVC. PLSVC was diagnosed on the basis of the identification of an additional vessel in the left of the pulmonary artery in a three-vessel trachea view. Associated abnormalities, karyotypes, and outcomes were analyzed. RESULTS: A total of 164 (0.7%, 164/25 171) cases of PLSVC were detected and successfully followed-up. The detection rates were 0.5% (81/17 535) and 1.1% (83/7636) in the low-risk and high-risk cases, respectively. The incidence of PLSVC was lower among the chromosomally or clinically normal (0.4%, 110/24 914) compared with chromosomally abnormal fetuses (7.8%, 20/257, p < 0.001). Additional defects were identified in 90% (18/20) of the PLSVC fetuses with chromosomal anomalies, a rate that was higher than those fetuses with chromosomal normal (61.8%, 68/110). CONCLUSIONS: Persistent left superior vena cava is more common among chromosomally abnormal than normal fetuses, and PLSVC fetuses with other defects are more highly associated with chromosomal disorders than isolated PLSVC fetuses. Isolated PLSVC is a benign vascular anomaly and may not affect outcomes.

Prenatal diagnosis of prevalence of the right heart: associated anomalies and outcome predictors.

OBJECTIVES: To analyze the characteristics, associations, and outcomes of prevalence of the right heart and to evaluate the use of sonography to predict the risk of a poor prognosis in fetuses with this condition. METHODS: We conducted a retrospective cohort study of 182 fetuses with prevalence of the right heart. At the initial evaluation, the left ventricle (LV) and right ventricle (RV) sizes, left atrium and right atrium sizes, great artery diameters, appearance of the aortic arch and ductus arteriosus arch, and flow direction across the foramen ovale and aortic arch were documented. Malformations were documented in fetuses with intracardiac anomalies, who were divided into groups with and without coexisting extracardiac defects. The RV-LV diameter ratio and main pulmonary artery-to-aortic root diameter ratio were calculated and compared. The following variables were analyzed: coexisting intracardiac anomalies, associated extracardiac anomalies, diagnosis before 24 gestational weeks, fetal growth restriction, reversed flow across the foramen ovale, reversed flow in the aortic arch, and RV-LV ratio greater than 2.0. Relationships between these sonographic findings and the prognosis were evaluated by multivariable logistic regression. RESULTS: Of the 182 fetuses, 1 (0.5%) had intrauterine death, and 25 (13.7%) had neonatal death; 1 (0.5%) had selective reduction, and 106 (58.2%) underwent termination of pregnancy; 49 (26.9%) survived at this writing. The mean RV-LV ratio was 1.67. Multivariable logistic regression revealed that only 2 sonographic parameters, coexisting intracardiac anomalies (odds ratio, 17.75; 95% confidence interval, 4.18-75.26) and diagnosis before 24 weeks (odds ratio, 17.26; 95% confidence interval, 1.80-165.39) were significantly associated with a poor prognosis. CONCLUSIONS: The sonographic parameters of coexisting intracardiac anomalies and diagnosis before 24 gestational weeks are significant independent predictors of a poor prognosis in fetuses with prevalence of the right heart. Combinations of these risk factors may be useful in prenatal consultation.

[Association between fetal ventricular septal defects and chromosomal abnormalities].

OBJECTIVE: To evaluate the association between fetal ventricular septal defects (VSD) and chromosomal abnormalities. METHODS: The 214 fetuses diagnosed VSD in the First Affiliated Hospital of Sun Yat-sen University from January 2008 to September 2011 were included. The VSD were categorized into 3 types: perimembranous, muscular and mixed (the defect could not be classified because the dimensions were larger than 5 mm) type. The perimembranous defect was subdivided into inlet and outlet subtypes. Complicated with other cardiac abnormalities/extracardiac abnormalities or not, the cases were divided into isolated VSD group,VSD complicating cardiac anomalies group (other cardiac and/or great vessels malformation),VSD complicating extracardiac anomalies group (include organ malformation and sonographic soft markers) and VSD with both cardiac and extracardiac anomalies group.G-banding chromosome analysis was advised for all cases.In cases that no karyotype was obtained, the phenotype of the newborns was examined by the pediatricians. And those appeared normal were defined as normal karyotype. RESULTS: (1) There were 134 (62.6%, 134/214) perimembranous defects, including 91 (42.5%, 91/214) inlet lesions and 43 (20.1%, 43/214) outlet lesions. There were 35 (16.4%, 35/214) muscular defects and 45 (21.0%, 45/214) mixed type lesions. (2) Among the 214 VSD fetuses, 46 (21.5%) were isolated VSD, 34 (15.9%) were cases with other cardiac anomalies, 87 (40.6%) were cases with extracardiac anomalies and 47 (22.0%) were cases with both cardiac and extracardiac anomalies. (3) The chromosomal karyotypes were obtained in 105 cases, and 21 cases were considered as normal according to the phenotype.Of all these 126 cases, 46 (36.5%, 46/126) had chromosomal abnormalities. (4) Inlet defects had the highest risk of chromosomal abnormalities (28/55, 50.9%), while the muscular defects had the lowest risk (2/25, 8.0%). The incidence of chromosomal abnormalities in outlet and mixed type was 33.3% (9/27) and 7/19, respectively. The types of VSD were significantly correlated with chromosomal defects (P < 0.01).(5) The incidence of chromosomal abnormalities in the 4 groups were 3.4% (1/29), 2/14, 53.6% (30/56) and 48.1% (13/27), respectively. The risk of chromosomal abnormalities in the cases complicating extracardiac or both extracardiac and cardiac anomalies was significantly higher than the isolated VSD group (P < 0.01). CONCLUSION: Fetal VSD had a highest risk of chromosomal abnormalities, especially the inlet type and VSD with extracardiac abnormalities, and then the fetal karyotype should be recommended.

Accuracy, agreement, and reliability of fetal cardiac measurements using 4-dimensional spatiotemporal image correlation.

OBJECTIVES: The purpose of this study was to evaluate the accuracy, agreement, and reliability of 4-dimensional sonography using spatiotemporal image correlation (STIC) in fetal cardiac measurements during the second and third trimesters. METHODS: Four-dimensional cardiac STIC volumes were acquired from 150 low-risk singleton pregnancies at gestational ages of 18 to 38 weeks. A total of 11 dimensions of the fetal heart and great vessels were analyzed by two different observers. Accuracy was assessed by comparing the measurements acquired by 4-dimensional STIC with those determined by 2-dimensional echocardiography by calculating the mean error and mean percent error and depicted by Bland-Altman plots. Absolute agreement and reliability of STIC-based measurements were evaluated on the basis of an intraclass correlation coefficient (ICC). RESULTS: For STIC-based measurements of cardiac dimensions, good accuracy was achieved by the two experienced observers (mean percent error, -3.10% to 0.87% for observer A; -2.49% to -0.33% for observer B), and absolute agreement was almost perfect (ICC, 95% confidence interval, 0.916-0.993 for observer A; 0.957-0.990 for observer B). Interobserver ICCs among the two observers were between 0.909 and 0.990 (95% confidence interval), whereas intraobserver ICCs for observer A were between 0.894 and 0.989, and those for observer B were between 0.893 and 0.985, showing no significant differences in the reliability of SITC with regard to observers. CONCLUSIONS: Four-dimensional sonography with STIC is a feasible and accurate method for fetal cardiac dimension measurements in the second and third trimesters. It is in good agreement with 2-dimensional echocardiography and can be performed by different observers.

Four-dimensional sonography with spatiotemporal image correlation and tomographic ultrasound imaging in the prenatal diagnosis of anomalous pulmonary venous connections.

OBJECTIVES: To determine whether the use of 4-dimensional (4D) sonography with spatiotemporal image correlation (STIC) and tomographic ultrasound imaging (TUI) can provide additional information with respect to 2-dimensional (2D) echocardiography in the prenatal diagnosis of anomalous pulmonary venous connections. METHODS: The study population consisted of 10 cases that were initially suspected to have total or partial anomalous pulmonary venous connections by prenatal 2D echocardiography between January 2008 and April 2011. All 10 cases were further examined and analyzed by 4D sonography with STIC-TUI. Detailed postnatal surgery or autopsy was performed on all 10 fetuses. RESULTS: Total anomalous pulmonary venous connections were found in 5 cases, and a partial connection was diagnosed in 1 fetus postnatally. The remaining 4 cases were confirmed to have normal pulmonary venous connections. Four of the 5 fetuses with anomalous pulmonary venous connections had an additional major cardiac defect; 1 fetus had an isolated connection. Anomalous drainage was supracardiac to the superior vena cava in 2 cases, cardiac to the coronary sinus in 3, and partially infracardiac to the portal vein in remaining case. The pulmonary venous connections were completely and correctly visualized with 2D echocardiography in 2 of the 10 cases, partially identified in 4, and not distinguished completely in 4. Four-dimensional sonography imaging with STIC-TUI clearly visualized the connections in 9 of the 10 cases, and the remaining case was partially identified. CONCLUSIONS: Four-dimensional sonography with STIC-TUI facilitates visualization of pulmonary venous connections, thus supplying additional information with respect to 2D echocardiography in the prenatal diagnosis of anomalous pulmonary venous connections.

Feasibility of Transabdominal Real-time CDFI and HDFI Techniques for Fetal Pulmonary Vein Display in the First Trimester.

OBJECTIVE: This study aimed to assess the feasibility and usefulness of transabdominal color Doppler flow imaging (CDFI) technology and the high-definition flow imaging (HDFI) technique in detecting fetal pulmonary veins (PVs) in the first trimester (11-13+6 weeks). METHODS: From December 2018 to October 2019, 328 pregnant women with 328 normal singleton fetuses (crown-rump length: 45-84 mm) who had undergone CDFI and HDFI scans for fetal heart and vessel examination were enrolled in this study. The cases were divided into three groups according to the gestational age: group A, 11+0 -11+6 weeks; group B, 12+0 -12+6 weeks; and group C, 13+0 -13+6 weeks. Baseline sonograms and CDFI and HDFI images were analyzed by two senior radiologists independently and blindly. The abilities of CDFI and HDFI to display PVs were compared. RESULTS: Successful PV display rates via CDFI and HDFI were 2.3% and 68.2% (P<0.01), 22.4% and 82.4% (P<0.01), 41.5% and 91.2% (P<0.01) for group A, group B, and group C, respectively. The total successful display rates for the two methods were 28.9% (CDFI) and 84.8% (HDFI) (P<0.01). CONCLUSIONS: The HDFI technique is more valuable than CDFI for detecting PVs in early pregnancy (11-13+6 weeks). HDFI can detect at least one PV in all cases and may be used to detect pulmonary venous anomalies early.

[Prenatal diagnosis of trisomy 18 syndrome with sonogram index scoring system].

OBJECTIVE: To explore the value of sonogram index scoring system in the prenatal diagnosis of trisomy 18 syndrome. METHODS: Neonates who had prenatal sonographic screening in our tertiary center were followed up from January 2004 to December 2009. The fetuses who were suspected with abnormalities received karyotype analysis. All fetuses were divided into case group (trisomy 18 group) and the control group (non-trisomy 18 group). The latter group was constituted of fetuses with trisomy 21, trisomy 13, other chromosomal abnormalitis and fetuses with normal karyotype. Logistic regression analysis was done to decide the individual sonographic features of trisomy 18. A score was assigned for ultrasound markers according to their likelihood ratios for trisomy 18 syndrome. A score of 3 was assigned for the sonographic features with likelihood ratio over 200, 2 for those with likelihood ratio between 100 and 200, and 1 for those with likelihood ratio less than 100. The diagnostic efficacy of the ultrasound index scoring system was evaluated by diagnostic test. The optimal cutoff value was determined by receiver operating characteristic (ROC) curve. RESULTS: The study group included 59 fetuses with trisomy 18. And 26 486 fetuses did not have trisomy 18 syndrome, including 93 fetuses with trismoy 21, 19 fetuses with trisomy 13, 134 fetuses with other chromosomal abnormalities, 3739 fetuses with normal karyotype and 22 501 fetuses with normal appearance after birth. Two or more structural defects were observed in each trisomy 18 fetus. The highest incidence of sonogram abnormalities was extremities abnormalities (85%, 50/59), followed by cardiac defects (83%, 49/59) and central nervous system (CNS) malformations (75%, 44/59). Overlapping fingers, ventricular septal defect and strawberry-shaped skull were the most common abnormalities in extremities abnormalities, cardiac defects and CNS malformations, respectively. Logistic regression identified 16 markers, including choroid plexus cyst, strawberry-shaped skull, enlarged cisterna magna, holoprosencephaly, low-set ears, ventricular septal defect, hypoplastic left heart syndrome, etc. Different scores were assigned according to the likelihood ratios of these markers. In trisomy 18 group, fetuses with the sonographic score of 1, 4, 9, 10 to 16 were 2% (1/59), 9% (5/59), 10% (6/59) and 32% (19/59) respectively, whereas in non-trisomy 18 group they were 2.549% (675/26 486), 0.215% (57/26 486), 0.004% (1/26 486) and zero, respectively. When a score of 4 was used as the cutoff value for diagnosing fetal trisomy 18, the sensitivity and specificity were 0.966 and 0.997, respectively. The area under ROC curve was 0.999. CONCLUSIONS: The ultrasound index scoring system may help to quantify the ultrasound features and has a good diagnostic value for fetal trisomy 18 syndrome. The cutoff value of 4 has the best diagnostic efficacy.

Prenatal surveillance of bronchopulmonary sequestration using 3-dimensional ultrasonography.

OBJECTIVE: The purpose of this study was to assess the growth of fetal lung lesions using 3-dimensional ultrasonography (3DUS) and to note the clinical outcomes of infants with congenital bronchopulmonary sequestration (BPS) diagnosed prenatally. METHODS: Twenty-two cases of intrathoracic BPS diagnosed prenatally occurred between May 2005 and September 2008. The volume of the BPS lesion (V(mass)) and the volume of the fetal chest (V(chest)) were measured with the 3DUS software Virtual Organ Computer-Aided Analysis (VOCAL; GE Healthcare, Kretztechnik, Zipf, Austria). The clinical outcomes of all cases were recorded. RESULTS: Among 22 cases with fetal BPS, 8 were terminated, and 2 were lost to follow-up. The growth pattern of the BPS lesions was assessed in 12 live-born cases with 2 or 3 3DUS measurements per case. There was no statistically significant difference between the V(mass) (P = .859) and V(mass)/V(chest) (P = .078) at 19 to 24 weeks' gestational age (WGA) and greater than 24 to 30 WGA, but there was a statistically significant difference between the V(mass) (P = .010) and V(mass)/V(chest) (P = .008) at greater than 24 to 30 WGA and greater than 30 to 39 WGA. The lung lesion resolved spontaneously before birth in 4 fetuses and postnatally in 2 infants. All 12 fetuses survived to term without any prenatal intervention, were born without any evidence of neonatal respiratory impairment, and did not undergo surgical resection of the mass. CONCLUSIONS: Our data showed that fetuses with BPS had a favorable clinical outcome, and the pulmonary mass decreased during late pregnancy and resolved spontaneously. Three-dimensional ultrasonography with VOCAL provides a useful method for assessing the growth of pulmonary lesions.

[Ultrasonographic fetal nasal bone assessment in prenatal screening for Down syndrome].

OBJECTIVE: To investigate the clinic value of ultrasonographic fetal nasal bone examination as a screening marker for Down syndrome (DS). METHODS: The study was conducted in the First Affiliated Hospital of Sun Yat-sen University from Oct 2004 to Mar 2007. Two-dimensional ultrasound was used to assess the fetal nasal bone of 1863 normal pregnancies (normal group) and 25 cases with DS fetus (study group) during their second and third trimesters. The incidence of nasal bone absence or short nasal bone in two groups was determined. The fetal nasal bone absence should be confirmed in three orthogonal planes of the fetal face, and the short nasal bone included the cases that the fetal nasal bone was shorter than the 2.5th percentile of normal according to the gestational week. The diagnostic test index was used for assessing the value of fetal nasal bone abnormality as a marker in prenatal screening for DS. RESULTS: (1) 1761 fetuses of normal group were successfully examined for the nasal bone and the detection rate was 94.5% (1761/1863). 102 fetuses failed examination because of inconvenient intra-uterine position. (2) The nasal bone length grew in a linear fashion throughout pregnancy and the growth pattern correlated well with gestational age (r = 0.605, P < 0.05) in normal group. The nasal bone was absent in 3 normal fetuses (0.2%, 3/1761) and short nasal bone was found in 44 normal fetuses (2.5%, 44/1761). (3) The nasal bone was absent in 7 DS fetuses (28.0%, 7/25) and short nasal bone was found in 15 DS fetuses (60.0%, 15/25). (4) When the absence of nasal bone was used as a cut-off, the sensitivity for DS was 28.0%, the specificity was 99.8%, the positive likelihood ratio was 164.45 (95% CI: 45.11-599.60), and the negative likelihood ratio was 0.72 (95% CI: 0.57-0.92). When short nasal bone was used as a cut-off, the sensitivity was 60.0%, specificity was 97.5%, the positive likelihood ratio was 24.03 (95% CI: 7.15-80.71), and the negative likelihood ratio was 0.41 (95% CI: 0.29-0.59). CONCLUSION: Fetal nasal bone hypoplasia at the second and third trimester scan is associated with a high risk for Down syndrome and it can be used as a screen marker for this chromosomal abnormality.

[Quantitative analysis of cerebellar vermis in fetuses with Dandy-Walker syndrome with three-dimensional ultrasonography].

OBJECTIVE: To evaluate the third plane image of the three-dimensional sonography (3D US) for the quantitative analysis of the cerebellar vermis in normal and Dandy-Walker syndrome (DWS) fetuses. METHODS: The cerebellar vermis was scanned with trans-abdominal 3D US in the second and third trimesters in 571 normal fetuses and 39 fetuses with Dandy-Walker syndrome. The surface area of the vermis in the mid-sagittal view was measured and calculated. The correlation between the vermian area and the pregnant week was analyzed. The data of vermian area between normal and DWS fetuses was compared. RESULTS: The vermian area was measured in 529 normal fetuses in the third plane of 3D US. The vermis grew in a linear fashion throughout pregnancy and the growth pattern positively correlated with the gestational age (r2 = 0. 854, P < 0.05). In 39 fetuses with DWS, including 14 with Dandy-Walker malformation (DWM) and 25 with Dandy-Walker variant (DWV), no vermian structure was showed in the mid-sagittal plane in 12 fetuses with DWM and 2 fetuses with DWV, whereas a small vermis appeared in other DWSs. CONCLUSIONS: The third plane image obtained by 3D US is valuable in studying the fetal cerebellar vermis during the middle and late pregnancy. Knowledge of normal and abnormal vermian appearance may help identify developmental anomalies. Measurement of vermian area in the third plane with 3D US provide a quantitative indicator for prenatal diagnosis of DWS.