Prenatal ultrasound diagnosis of complete cryptophthalmos, congenital aphakia, and corneal vascularization in a fetus: A case report and literature review.

BACKGROUND: Complete cryptophthalmos, congenital aphakia, and corneal vascularization are relatively uncommon congenital eye malformations during the fetal period. Herein, we report a case of a fetus with complete cryptophthalmos, congenital aphakia, and corneal vascularization in both eyes and review previous prenatal reports of related cases. CASE PRESENTATION: The patient was a 27-year-old pregnant woman, gravida 2, para 1, who was referred to our hospital for consultation at 23 weeks of gestation due to a diagnosis of fetal right renal agenesis at an external hospital. The ultrasound system of our hospital diagnosed the fetus with complete cryptophthalmos, congenital aphakia, and corneal vascularization, which was verified under the postnatal water basin test, anatomical and pathological sections. CONCLUSIONS: Fetal ocular malformations are often associated with malformations of other organs, and if ultrasound findings are associated with such malformations, attention should be paid to the ocular examination to avoid missing the diagnosis.

Automatic segmentation of 15 critical anatomical labels and measurements of cardiac axis and cardiothoracic ratio in fetal four chambers using nnU-NetV2.

BACKGROUND: Accurate segmentation of critical anatomical structures in fetal four-chamber view images is essential for the early detection of congenital heart defects. Current prenatal screening methods rely on manual measurements, which are time-consuming and prone to inter-observer variability. This study develops an AI-based model using the state-of-the-art nnU-NetV2 architecture for automatic segmentation and measurement of key anatomical structures in fetal four-chamber view images. METHODS: A dataset, consisting of 1,083 high-quality fetal four-chamber view images, was annotated with 15 critical anatomical labels and divided into training/validation (867 images) and test (216 images) sets. An AI-based model using the nnU-NetV2 architecture was trained on the annotated images and evaluated using the mean Dice coefficient (mDice) and mean intersection over union (mIoU) metrics. The model's performance in automatically computing the cardiac axis (CAx) and cardiothoracic ratio (CTR) was compared with measurements from sonographers with varying levels of experience. RESULTS: The AI-based model achieved a mDice coefficient of 87.11% and an mIoU of 77.68% for the segmentation of critical anatomical structures. The model's automated CAx and CTR measurements showed strong agreement with those of experienced sonographers, with respective intraclass correlation coefficients (ICCs) of 0.83 and 0.81. Bland-Altman analysis further confirmed the high agreement between the model and experienced sonographers. CONCLUSION: We developed an AI-based model using the nnU-NetV2 architecture for accurate segmentation and automated measurement of critical anatomical structures in fetal four-chamber view images. Our model demonstrated high segmentation accuracy and strong agreement with experienced sonographers in computing clinically relevant parameters. This approach has the potential to improve the efficiency and reliability of prenatal cardiac screening, ultimately contributing to the early detection of congenital heart defects.

An Easy and Effective Method for Evaluating the Position of Conus Medullaris: Counting the Number of Vertebral Ossification Center Below the End of Conus Medullaris.

OBJECTIVE: This study aimed to ascertain the conus medullaris position by counting the number of ossification centers in the vertebral bodies below the conus medullaris endpoint (N) and assess its utility in screening for closed spinal dysraphism and tethered cord syndrome. METHODS: A total of 900 normal fetuses and 146 fetuses with closed spinal dysraphism or tethered cord syndrome were included in this study. The N values were tallied and compared along the spinal longitudinal plane. The receiver operating characteristic curve was utilized, and the cut-off value of N was analyzed. RESULTS: The counting of N was successfully performed in 856 normal and 146 abnormal fetuses. In the normal group, an increase in N with gestational age was observed. Specifically, in the subgroup of 17-20 wk fetuses, N was ≥6 in 117 out of 131 cases. This figure increased to 211 out of 213 in 21-24 wk and 512 out of 512 in 25-41 wk, respectively. Cases with N ≥7 accounted for 715 out of 856 fetuses in the 17-41 wk range. In the abnormal group, N was less than 7 in 152 out of 163 fetuses, showing statistical differences between the two groups. With a cut-off value of 6.5, specificity and sensitivity reached 93.3% and 83.5%. CONCLUSIONS: The counting of N was found to be a straightforward and efficient method for evaluating the position of the conus medullaris.

Sonographic demonstration of the sulci and gyri on the convex surface in normal fetuses using 3D-ICRV rendering technology.

PURPOSE: To demonstrate morphological alteration of the sulci and gyri on the convex surface in normal fetuses using innovative three-dimensional inversion and Crystalvue and Realisticvue (3D-ICRV) rendering technology. MATERIALS AND METHODS: 3D fetal brain volumes were collected from low-risk singleton pregnancies between 15+0 and 35+6 gestational weeks. Volumes were acquired from the transthalamic axial plane by transabdominal ultrasonography and were then post-processed with Crystalvue, Realisticvue rendering software and inversion mode. Volume quality was assessed. The anatomic definition of the sulci and gyri was determined according to location and orientation. The morphology alteration and sulcus display rates were recorded in sequential order of gestational weeks. Follow-up data were collected in all cases. RESULTS: 294 of 300 fetuses (294 brain volumes) (98%) with qualified fetal brain volumes were included (n=294, median 27 gestational weeks). 6 fetuses with unsatisfactory 3D-ICRV image quality were excluded. The morphology of the sulci and gyri on the brain convex surface could be demonstrated clearly on 3D-ICRV images. The Sylvian fissure was the first structure to be recognized. From 25 to 30 weeks, other sulci and gyri became visible. An ascending trend in the display rate of the sulci was found in this period. Follow-up showed no detectable anomalies. CONCLUSION: 3D-ICRV rendering technology is different from traditional 3D ultrasound. It can provide vivid and intuitive prenatal visualization of the sulci and gyri on the brain surface. Moreover, it may offer new ideas for neurodevelopment exploration.

A New Parameter to Evaluate Fetal Sylvian Fissure by Transabdominal 2-D Ultrasound.

OBJECTIVE: Evaluation of the inclination direction and degree of the Sylvian fissure plateau has not been reported. We aimed to evaluate the Sylvian fissure plateau by Sylvian fissure plateau angle (SFPA) in axial views at 23-28 wk gestation. METHODS: A prospective ultrasound evaluation of 180 normal and 3 abnormal singleton pregnant women was conducted at 23-28 wk gestation. All cases were assessed in three axial planes of the fetal brain (the transthalamic, transventricular and transcerebellar plane) using transabdominal 2-D images. The SFPAs of all cases were measured between the brain midline and a line drawn along the Sylvian fissure plateau. Intraclass correlation coefficients (ICCs) were used to assess the intra- and inter-observer repeatability of SFPA measurements. RESULTS: The SFPAs in normal cases in the transthalamic, transventricular and transcerebellar planes were all above y = 0, while in abnormal cases were below y = 0. However, there was no major difference between the angles measured on the transthalamic and transventricular planes (p = 0.365). There was a major difference between the SFPAs on the transcerebellar plane and transthalamic/transventricular plane (p < 0.05). The intra- and inter-observer ICCs were excellent at 0.971 (95% confidence interval [CI]: 0.945-0.984) and 0.936 (95% CI: 0.819-0.979), respectively. CONCLUSION: The SFPAs of the normal cases in three axial views were stable at 23-28 wk gestation, suggesting that 0° may be a good cut-off value for evaluating abnormal SFPA. Findings offer a potential method by which the SFPA < 0°, as shown in three abnormal cases described herein, can be evaluated prenatally and thus serve as another tool for malformations of cortical development assessment, especially for frontoobitalopercula dysplasia. We recommend use of SFPA of the transthalamic plane to evaluate the Sylvian fissure in clinical work.

Effect of Compound Polyethylene Glycol Electrolyte Powder on the Quality of Gastrobowel Preparation before Enteroscopy Intervention.

Objective: To study the effect of compound polyethylene glycol electrolyte powder (PGEP) on the quality of gastrobowel preparation before enteroscopy intervention. Methods: From March 2021 to January 2022, among the patients who needed enteroscopy in our hospital, 280 patients who volunteered for this study were randomly selected as the research objects. All the subjects were randomly divided into the control group (140 cases) and the observation group (140 cases). Both groups received routine treatment before enteroscopy intervention. On this basis, patients in the control group were given 9 g of senna every day before operation, and 250 ml of 20% mannitol and 2500 ml of water were taken orally from 9:00 am to 11:00 am on the day of examination. Patients in the observation group took PGEP orally from 9:00 am to 11:00 am. The effective rate of bowel cleaning, the frequency of defecation and duration of diarrhea, the levels of blood electrolyte indexes such as Na+, K+, and Cl- before and after the intervention, and the incidence of adverse reactions were compared between the two groups. Results: The effective rate of bowel cleaning in the observation group was significantly higher than that in the control group (P < 0.05). The frequency of defecation and duration of diarrhea in the observation group were significantly lower than those in the control group (P < 0.05). Compared with the control group, the levels of blood electrolyte indexes in the observation group after the intervention were not statistically significant (P > 0.05). The incidence of adverse reactions in the observation group was significantly lower than that in the control group (P < 0.05). Conclusion: Using PGEP for gastrobowel preparation before enteroscopy intervention can achieve high bowel cleaning efficiency, short bowel preparation time, and low incidence of adverse reactions, which does not affect the water-electrolyte balance of patients, and the psychological state of patients before enteroscopy intervention is more stable. This program is worthy of clinical promotion.

Which fetal growth charts should be used? A retrospective observational study in China.

BACKGROUND: The fetal growth charts in widest use in China were published by Hadlock >35 years ago and were established on data from several hundred of American pregnant women. After that, >100 fetal growth charts were published around the world. We attempted to assess the impact of applying the long-standing Hadlock charts and other charts in a Chinese population and to compare their ability to predict newborn small for gestational age (SGA). METHODS: For this retrospective observational study, we reviewed all pregnant women ( n  = 106,455) who booked prenatal care with ultrasound measurements for fetal biometry at the Shenzhen Maternity and Child Healthcare Hospital between 2012 and 2019. A fractional polynomial regression model was applied to generate Shenzhen fetal growth chart ranges for head circumference (HC), biparietal diameter (BPD), abdominal circumference (AC), and femur length (FL). The differences between Shenzhen charts and published charts were quantified by calculating the Z -score. The impact of applying these published charts was quantified by calculating the proportions of fetuses with biometric measurements below the 3rd centile of these charts. The sensitivity and area under the receiver operating characteristic curves of published charts to predict neonatal SGA (birthweight <10th centile) were assessed. RESULTS: Following selection, 169,980 scans of fetal biometry contributed by 41,032 pregnancies with reliable gestational age were analyzed. When using Hadlock references (<3rd centile), the proportions of small heads and short femurs were as high as 8.9% and 6.6% in late gestation, respectively. The INTERGROWTH-21st standards matched those of our observed curves better than other charts, in particular for fat-free biometry (HC and FL). When using AC<10th centile, all of these references were poor at predicting neonatal SGA. CONCLUSIONS: Applying long-standing Hadlock references could misclassify a large proportion of fetuses as SGA. INTERGROWTH-21st standard appears to be a safe option in China. For fat-based biometry, AC, a reference based on the Chinese population is needed. In addition, when applying published charts, particular care should be taken due to the discrepancy of measurement methods.

A Study on the Impact of Perioperative Pain Care Management on Pain, Comfort, and Defecation of Patients in Anorectal Surgery.

Purpose: The aim of the study is to explore the impact of perioperative pain care management on patients' pain, comfort, and defecation in anorectal surgery. Methods: From January to December 2021, 126 patients who underwent anorectal surgery in our department were selected for the study and were randomly divided into a study group and a control group of 63 patients each after consent was obtained from the patients. The control group was given the usual care protocol and the study group was given the perioperative pain care management on top of the usual care. The two groups of patients were compared in terms of postoperative anal pain rating, comfort score, time to first bowel movement and time spent in bowel movement, the Pittsburgh sleep quality index (PSQI) scores at night, related complications, and satisfaction with care. Results: ① Postoperative anal pain was less severe in the study group than in the control group (P < 0.05). ② Postoperative comfort scores were higher in the study group than in the control group (P < 0.05). ③ The time to first bowel movement and its duration after surgery were shorter in the study group than in the control group (P < 0.05). ④ Patients in the study group had lower postoperative night-time PSQI scores than the control group (P < 0.05). ⑤ Patients in the study group had a lower rate of postoperative complications than the control group (P < 0.05). ⑥ Patients in the study group had higher postoperative care satisfaction scores than the control group (P < 0.05). Conclusion: The application of perioperative pain care management to patients undergoing anorectal surgery plays an important role in reducing anal pain, improving treatment comfort, and relieving difficult defecation symptoms, with significant improvement in postoperative sleep quality and reduction in complications. It is worthy of clinical reference and promotion.

In silico analysis and experimental validation to exhibit anti-nasopharyngeal carcinoma effects of plumbagin, an anti-cancer compound.

BACKGROUND: Nasopharyngeal carcinoma (NPC) is publicly known as a malignant tumor. Our previous study reported that plumbagin exhibits potent anti-cancer actions. Nevertheless, more mechanical details of plumbagin against NPC remain unknown. The present study aimed to unmask the core targets/genes and anti-NPC mechanisms involved in the signaling pathways of plumbagin prior to biochemical validation. METHODS: A network pharmacology approach was employed to respective identification of mutual and core targets/genes in plumbagin and/treating NPC. Molecular docking determination was used to identify core target proteins for biochemical validation using human and cell line samples. RESULTS: In total, 60 anti-NPC genes of plumbagin were screened out, and then nine core target genes of plumbagin against NPC were identified accordingly. The enrichment findings revealed detailed biological functions and pharmacological pathways of plumbagin against NPC. Moreover, in silico analysis using molecular docking had determined the core targets for further experimental validation, comprising protein kinase B (AKT1) and sarcoma gene (SRC). In human sample validation, clinical NPC sections showed increased positive expression of AKT1 and SRC. Additionally, plumbagin-treated NPC cells resulted in inactivated protein expression of AKT1 and SRC. CONCLUSION: The re-identified core targets/genes in the molecular docking report may function as plumbagin-related pharmacological targets for treating NPC via experimental validation. Furthermore, additional anti-NPC molecular mechanisms of plumbagin action were disclosed on the basis of enrichment findings. © 2022 Society of Chemical Industry.

Prenatal Diagnosis of Congenital Cataract: Sonographic Features and Perinatal Outcome in 41 Cases.

PURPOSE: To describe the prenatal ultrasonographic characteristics and perinatal outcomes of congenital cataract. MATERIALS AND METHODS: We analyzed congenital cataract diagnosed prenatally at four referral centers between August 2004 and February 2019. The diagnosis was confirmed by postnatal ophthalmologic evaluation of liveborn infants or autopsy for terminated cases. Maternal demographics, genetic testing results, prenatal ultrasound images, and perinatal outcomes were abstracted. RESULTS: Total of 41 cases of congenital cataract diagnosed prenatally among 788 751 women undergoing anatomic survey. Based on the sonographic characteristics, 16/41 (39.0 %) had a dense echogenic structure, 15/41 (36.6 %) had a hyperechogenic spot and 10/41 (24.4 %) had the "double ring" sign. 17/41 (41.5 %) were isolated, and 24/41 (58.5 %) had associated intraocular and extraocular findings. Microphthalmia, cardiac abnormalities, and central nervous system abnormalities were the most common associated abnormalities. Regarding potential etiology, 6 cases had a known family history of congenital cataract, 4 cases had confirmed congenital rubella infection, and 2 cases had aneuploidy. 31/41 (75.6 %) elected termination and 10/41 (24.4 %) elected to continue their pregnancy. Among the 10 cases, one case died, one case was lost to follow-up, and the remaining 8 cases were referred for ophthalmologist follow-up and postnatal surgery. CONCLUSION: Once fetal cataracts are detected, a detailed fetal anatomy survey to rule out associated abnormalities and a workup to identify the potential etiology are recommended. Prenatal diagnosis of congenital cataracts provides vital information for counseling and subsequent management.

A new classification of congenital abnormalities of UPVS: sonographic appearances, screening strategy and clinical significance.

The umbilical-portal venous system (UPVS) plays an important role in embryonic development, as well as a significant blood circulation system to ensure the normal blood supply of fetal heart and brain and other vital organs. Congenital anomalies of UPVS contain many subtypes with a broad spectrum of manifestations and prognoses. Furthermore, because of fetal small lumen of UPVS, the sonographic evaluation remains difficult in utero. Appreciation of normal embryology and anatomy of UPVS is essential to an understanding of sonographic characteristics of anomalies of UPVS and fetal sequential changes. Through reviewing previous references and our experience with congenital abnormalities of UPVS, a new comprehensive classification is proposed. The new classification identifies three types of congenital abnormalities of UPVS based on morphological abnormalities and shunts. The embryology and etiology, sonographic, clinical and prognostic characteristics of each subtype of the new classification are described in detail. Knowledge of congenital abnormalities of UPVS can give sonographers a clue and aid prenatal sonographic diagnosis. The purpose of this article is to help the sonographers to understand the new classification of congenital abnormalities of UPVS, master the sonographic characteristics of each subtype and prenatal ultrasonographic screening strategy, and guide subsequent appropriate counseling and management.

A Prenatal Ultrasound Scanning Approach: One-Touch Technique in Second and Third Trimesters.

This study was aimed at evaluating the performance of the innovative technique Smart Fetus (SF) developed to recognize the planes and obtain the basic biometric measurements of fetuses automatically. This prospective study included 1005 uncomplicated singleton pregnancies undergoing routine examinations. For every pregnancy, planes, including the transverse section of the thalami, transverse section of the abdomen and longitudinal section of the femur, were acquired, and standard biometric measurements, including biparietal diameter, head circumference, abdominal circumference and femur length, were obtained using SF and traditional ultrasound technique (TUT). The accuracy, reproducibility and time required for the analysis of SF were compared with those of TUT. In 998 of 1005 cases (99.30%), SF successfully acquired the sections and made all measurements. The agreement between the techniques was high for all measurements. The time to obtain sections and measure biometric parameters or solely measure biometric parameters was significantly shorter with SF than with TUT. No significant differences were found in SF repeated measurements obtained by two independent observers. The SF technique helped in the acquisition of reliable standard sections and biometric measurements and saved time. It might serve as a novel ultrasound scanning approach and improve workflow efficiency.

Routine first-trimester ultrasound screening using a standardized anatomical protocol.

BACKGROUND: First-trimester ultrasound scans were introduced to China for nearly 20 years. The ability of first-trimester ultrasound screening to detect different malformations was variable. A recent systematic review concluded that the use of a standardized anatomic protocol was the most crucial factor to improve the sensitivity of first-trimester ultrasound screening for anomalies. Standardized sectional scans have long been used for routine anatomy screening during the second trimester. However, during the first trimester, most of the previous studies have described the observation of anatomic structures but have not specified clearly the standard sectional views. OBJECTIVE: We aimed to determine the performance of routine first-trimester scans using a standardized anatomic protocol for detecting structural abnormalities in China. STUDY DESIGN: This was a large retrospective study involving 59,063 sequential unselected pregnancies. Scans at 11 to 13+6 weeks were performed in a single center during a 7-year span. All fetuses were examined following a predefined protocol for standardized views. RESULTS: From October 2008 to December 2015, first-trimester scans were performed in 53,349 pregnant women with available outcome. Of these, there were 1578 (3%) pregnancies that presented with at least 1 fetal structural abnormality. The detection rate for first-trimester screening was 43.1% (95% confidence interval, 40.6%-45.5%). Routine first-trimester scans detected 95.6% of abdominal wall defects, 66.3% of nervous system defects, 33.8% of limbs and skeleton malformations, 30.8% of facial abnormalities, 21.2% of urogenital abnormalities, 18.4% of thoracic and lung abnormalities, and 4.1% of gastrointestinal tract abnormalities. During the first trimester, 37.7% of cardiac defects were identified and included 57.9% of major cardiac defects and 2.6% of mild cardiac defects. A robust high detection rate for anencephaly, exencephaly, cephalocele, holoprosencephaly, exomphalos, gastroschisis, Pentalogy of Cantrell, sirenomelia, and body stalk anomaly was achieved during routine first-trimester scans. CONCLUSION: A standardized anatomic protocol is advised when performing routine first-trimester ultrasound screening. It is recommended that screening for severe structural abnormalities should be extended to the first trimester.

Fetal Open and Closed Spina Bifida on a Routine Scan at 11 Weeks to 13 Weeks 6 Days.

OBJECTIVES: This study aimed to determine the sensitivity of a first-trimester routine scan in detecting spina bifida (SB) and evaluating the first-trimester intracranial signs. METHODS: This retrospective study was a review of a prospectively collected database. All cases of SB diagnosed in a tertiary center from 2008 to 2015 were identified. The ultrasound images and medical records were reviewed. All cases of SB diagnosed prenatally were confirmed at birth or autopsy. RESULTS: A total of 24 cases of SB were diagnosed from 53,349 pregnancy cases. Except for 10 cases with a body stalk anomaly, craniorachischisis, or iniencephaly, 7 cases with open spina bifida (OSB) and 7 cases with closed spina bifida (CSB) were analyzed. The first-trimester detection rates were 100% (7 of 7) for OSB and 28.5% (2 of 7) for CSB. Eight cases were highly suspected of SB in the first trimester because of an abnormal appearance of the posterior brain; 3 were false-positive cases. Two isolated cases of OSB had first-trimester intracranial signs. An obliterated cisterna magna (CM) showed the highest sensitivity for OSB but low specificity. Two cases of OSB had no discernible landmark of intracranial translucency and the CM, and 4 showed normal intracranial translucency with an obliterated CM. All CSB cases were coupled with a normal hind brain except for 2 cases. CONCLUSIONS: A first-trimester routine scan has high sensitivity in screening for OSB. The CM may be the most sensitive intracranial sign.

A novel technique to assess fetal corpus callosum by two-dimensional axial plane.

OBJECTIVE: The definition of new normal values of the corpus callosum (CC) in axial sonographic scans and evaluation of their feasibility in diagnosing abnormal CC. METHODS: A cross-sectional study assessed CC from 20-gestational-week to full-term. CC observations across three axial planes (the largest CC length plane, trans-genu-and-splenium plane, and trans-body plane) were developed. The largest CC length, genu and splenium thickness, and body width and thickness were compared with compound scatter plots. Ultrasonographic features of normal and abnormal CC were described and the feasibility of the new approach studied. Intra-class correlation coefficient (ICC) was used for assessing the intra- and inter-observer agreements. RESULTS: Six hundred seventy normal and 42 abnormal fetuses from 20-gestational-week to full-term were studied. The mean normal and abnormal group maternal ages were 30.46 ± 4.36 years and 29.69 ± 4.49 years (p = 0.269). The success rate in obtaining satisfactory axial planes reached 100% but only 13.9% for sagittal plane in the normal group. The success rate of abnormal cases obtaining satisfactory axial planes was 100% and 59.5% by sagittal plane (p < 0.05). The compound scatter plots of abnormal and normal groups showed that the largest CC length and body width were significantly lower in normal fetuses, and the thickness of the genu and splenium with CC hypoplasia was significantly lower than normal fetuses. The intra- and inter-observer agreements were reproducible (all ICC > 0.850). CONCLUSIONS: The feasibility of incorporating an evaluation of CC into routine anatomical screening was demonstrated. Additionally, a focused examination of the craniocerebral axial planes exploring CC at the time of central nervous system scanning might facilitate CC anomaly detection. KEY POINTS: • Three axial planes with direct CC measurements can detect CC anomalies more accurately compared with indirect CC signs. Besides, this method is simpler, more convenient, and time-saving compared with the sagittal plane. • Assessing fetal CC on the axial plane helps clinicians to diagnose fetuses with abnormal CC. • A prospective single-center study showed that our new technique provides enough diagnostic confidence.

A Generic Quality Control Framework for Fetal Ultrasound Cardiac Four-Chamber Planes.

Quality control/assessment of ultrasound (US) images is an essential step in clinical diagnosis. This process is usually done manually, suffering from some drawbacks, such as dependence on operator's experience and extensive labors, as well as high inter- and intra-observer variation. Automatic quality assessment of US images is therefore highly desirable. Fetal US cardiac four-chamber plane (CFP) is one of the most commonly used cardiac views, which was used in the diagnosis of heart anomalies in the early 1980s. In this paper, we propose a generic deep learning framework for automatic quality control of fetal US CFPs. The proposed framework consists of three networks: (1) a basic CNN (B-CNN), roughly classifying four-chamber views from the raw data; (2) a deeper CNN (D-CNN), determining the gain and zoom of the target images in a multi-task learning manner; and (3) the aggregated residual visual block net (ARVBNet), detecting the key anatomical structures on a plane. Based on the output of the three networks, overall quantitative score of each CFP is obtained, so as to achieve fully automatic quality control. Experiments on a fetal US dataset demonstrated our proposed method achieved a highest mean average precision (mAP) of 93.52% at a fast speed of 101 frames per second (FPS). In order to demonstrate the adaptability and generalization capacity, the proposed detection network (i.e., ARVBNet) has also been validated on the PASCAL VOC dataset, obtaining a highest mAP of 81.2% when input size is approximately 300 × 300.

Multi-task learning for quality assessment of fetal head ultrasound images.

It is essential to measure anatomical parameters in prenatal ultrasound images for the growth and development of the fetus, which is highly relied on obtaining a standard plane. However, the acquisition of a standard plane is, in turn, highly subjective and depends on the clinical experience of sonographers. In order to deal with this challenge, we propose a new multi-task learning framework using a faster regional convolutional neural network (MF R-CNN) architecture for standard plane detection and quality assessment. MF R-CNN can identify the critical anatomical structure of the fetal head and analyze whether the magnification of the ultrasound image is appropriate, and then performs quality assessment of ultrasound images based on clinical protocols. Specifically, the first five convolution blocks of the MF R-CNN learn the features shared within the input data, which can be associated with the detection and classification tasks, and then extend to the task-specific output streams. In training, in order to speed up the different convergence of different tasks, we devise a section train method based on transfer learning. In addition, our proposed method also uses prior clinical and statistical knowledge to reduce the false detection rate. By identifying the key anatomical structure and magnification of the ultrasound image, we score the ultrasonic plane of fetal head to judge whether it is a standard image or not. Experimental results on our own-collected dataset show that our method can accurately make a quality assessment of an ultrasound plane within half a second. Our method achieves promising performance compared with state-of-the-art methods, which can improve the examination effectiveness and alleviate the measurement error caused by improper ultrasound scanning.

Congenital abnormalities of the aortic arch: revisiting the 1964 Stewart classification.

The traditional classification of congenital aortic arch abnormalities was described by James Stewart and colleagues in 1964. Since that time, advances in diagnostic imaging technology have led to better delineation of the vasculature anatomy and the identification of previously unrecognized and unclassified anomalies. In this manuscript, we review the existing literature and propose a series of modifications to the original Stewart classification of congenital aortic arch abnormalities to incorporate this new knowledge. In brief, we propose the following modifications: (1) In Group I, we further divide subgroup B into left arch atretic and right arch atretic; (2) In Group II, we add three more subgroups, including aberrant right innominate artery, "isolated" right innominate artery (RIA), "isolated" right carotid artery with aberrant right subclavian artery; (3) In Groups I, II, and III, we add a subgroup of absence of both ductus arteriosus; and (4) In Group IV, we add three subgroups, including circumflex retro-esophageal aorta arch, persistent V aortic arch, and anomalous origin of pulmonary artery from ascending aorta.

Routine screening for fetal limb abnormalities in the first trimester.

OBJECTIVE: We aim to determine the accuracy of first-trimester ultrasonography in detecting fetal limb abnormalities. METHODS: This is a retrospective study of all women undergoing fetal nuchal translucency (NT) assessment and detailed fetal anatomic survey in the first trimester at a single tertiary-care referral center in China. Fetal anatomy scans were repeated in the second trimester. Detection of fetal limb abnormalities was compared between first and second trimester anatomy scans and confirmed at delivery or at autopsy. RESULTS: Analyzed were 9438 fetuses from 9197 women (241 twin pairs). The incidence of fetal limb abnormalities was 0.38% (36/9438). Of these, 28 (77.8%) were diagnosed prenatally: 23 (63.9%) on first trimester scan and 5 (13.9%) on second trimester scan. Limb reduction defects (usually transverse limb deficiencies) were the most common limb defects identified in the first trimester (n = 12), followed by clubfoot (n = 4), skeletal dysplasia (n = 3), sirenomelia (n = 1), limb dysplasia (n = 1), malposition (n = 1), and syndactyly (n = 1). Nine fetuses with isolated limb abnormalities had normal NT, while 74.1% (20/27) of limb abnormalities that were associated with other abnormalities had increased NT. CONCLUSIONS: This study demonstrates that the majority of limb abnormalities detected prenatally [23/28 (82%)] can be identified in the first trimester, especially major limb defects; however, our numbers are small and still need larger cases for further investigation.