Establishment of a risk model of placental accreta spectrum by ultrasound combined with clinical high risk factors / 中华超声影像学杂志

Objective:To establish a risk model of placenta accreta spectrum(PAS) based on the clinical risk factors and ultrasound signs of patients with placenta accreta, and identify severe placenta accreta prenatal.Methods:A retrospective analysis was performed on 121 PAS patients admitted to Beijing Obstetrics and Gynecology Hospital Affiliated to Capital Medical University from January 2018 to June 2022 who were clinically classified or pathologically diagnosed during delivery. The two groups were divided into light and severe groups according to the implantation type. The clinical risk factors and ultrasound signs between the two groups were compared. A risk model of PAS was established based on the clinical risk factors and ultrasound signs to predict the perinatal complications.Results:A total of 130 cases of PAS were clinically diagnosed or pathologically diagnosed with placenta, 9 cases with incomplete clinical data or irregular ultrasound images were excluded, and the remaining 121 cases were included in the study. Among the 121 patients, 64 cases were placental accreta, 39 cases were placental increta, and 18 cases were placenta percreta. The placental accreta was defined as mild group, and the combination of placental increta and placenta percreta were referred to as severe group. There were no significant differences in placenta previa, and the number of uterine cavity operations (all P>0.05). There were significant differences in the number of cesarean section, myometrium thinning, placental lacunae, abnormal vascularization at the utero-bladder junction, bridging vessels at the utero-bladder junction, placental protuberance and cervical involvement (all P<0.05). Binary logistic regression analysis showed that placental lacunae, abnormal vasculization of the utero-bladder interface and the number of cesarean sections were independent risk factors for severe PAS. Based on this, a risk model was established and the ROC curve of each independent risk factor and risk model was plotted respectively. The AUC of the risk model was 0.826, which had better diagnostic efficacy than other independent risk factors. Conclusions:In the prenatal ultrasound classification diagnosis of high-risk patients with PAS, the placental lacunae, abnormal vascularization of utero-bladder interface and the number of cesarean section are combined to establish the risk model of PAS, which has a good diagnostic efficacy for severe placenta accreta.

Predictive value of ultrasound signs of the involvement of the cervix in the adverse pregnancy outcomes of placenta accreta spectrum / 中华超声影像学杂志

Objective:To explore the the predictive value of ultrasound signs of the involvement of the cervix in the clinical grade diagnosis of placenta accreta spectrum(PAS) with placenta previa and adverse pregnancy outcomes.Methods:A retrospective analysis was performed on PAS patients with placenta previa diagnosed during delivery or by cesarean section in Beijing Obstetrics and Gynecology Hospital Affiliated to Capital Medical University from January 2018 to March 2021. According to the signs of cervical involvement on prenatal ultrasound, the patients were divided into cervical involvement group and cervical non-involvement group. Logistic analysis was performed on clinical data between the two groups. The clinical data, hysterectomy rate, intraoperative blood loss and clinical diagnosis were compared between the two groups.Results:There were 1 455 patients with PAS diagnosed by clinical diagnosis or placental pathology, of which 170 were with placenta previa, 24 with incomplete clinical data or non-standard ultrasound images, and the remaining 146 patients were included. In the cervical involvement group, all of 6 cases had placenta percreta. Of the 140 cases in the unaffected cervical group, 89 cases (63.6%) had placental accreta, 48 cases (34.3%) had placental increta, and 3 cases (2.1%) had placenta percreta. There were no significant differences of the age and uterine operation history between the two groups. There was significant difference in the number of cesarean sections between the two groups ( P<0.05). There were significant differences in intraoperative blood loss, hysterectomy rate and placenta accreta grade diagnosis between the two groups(χ 2/ Z=4.203, 11.165, 95.248, all P<0.05). Conclusions:The ultrasonographic signs of cervical involvement have a good predictive value for the pregnancy outcome of PAS.

The distribution of abdominal and pelvic adipose tissue in malignant gynecologic tumor and benign gynecologic diseas / 重庆医学

Objective To study the abdominal and pelvic adipose tissue volume and distribution in patients with malignant gynecologic tumor and benign gynecologic disease prospectively .Methods Eighty patients with malignant gynecologic tumor and eighty patients with benign gynecologic disease were underwent abdominal and pelvic CT scan by 64‐slice spiral CT and QCT cali‐bration phantom .The area and the volume of TAT ,VAT ,SAT of abdomen and(or) pelvis(TFV ,VFV ,SFV and VFV/SFV) were measured and calculated .The differences between the malignant gynecologic tumor group and the benign gynecologic disease group and between the different stages or types of malignant gynecologic tumor groups were compared ,then the distribution of AT was analyzed .Results (1)Except the VFV of abdomen and pelvis ,there were differences in TFV ,VFV and SFV between the malignant gynecologic tumor group and the benign gynecologic disease group(P0 .05) .There were differences in VFV/SFV between the early‐stage and the benign gynecologic disease group and between the advanced‐stage and the benign gynecologic dis‐ease group(P0 .05) .(3)There was no difference in abdominal and pelvic TFV ,VFV ,SFV ,VFV/SFV between the en‐dometrial carcinoma and the cervical carcinoma group(P>0 .05) .(4)There were positive correlations between abdominal or pelvic VFV ,SFV and abdominal and pelvic TFV ,the abdominal SFV was the highest .Conclusion The patients with malignant gyneco‐logic tumor ,especially in the early‐stage ,were much fatter than the patients with benign gynecologic disease .In malignant gyneco‐logic tumor patients ,the SAT increased more significantly than the VAT ,and had the highest correlation with TAT ,and was the mainly composition of obesity .

Feasibility Study of Radiation Dose Reduction in Adult Female Pelvic CT Scan with Low Tube-Voltage and Adaptive Statistical Iterative Reconstruction

OBJECTIVE: To evaluate image quality of female pelvic computed tomography (CT) scans reconstructed with the adaptive statistical iterative reconstruction (ASIR) technique combined with low tube-voltage and to explore the feasibility of its clinical application. MATERIALS AND METHODS: Ninety-four patients were divided into two groups. The study group used 100 kVp, and images were reconstructed with 30%, 50%, 70%, and 90% ASIR. The control group used 120 kVp, and images were reconstructed with 30% ASIR. The noise index was 15 for the study group and 11 for the control group. The CT values and noise levels of different tissues were measured. The contrast to noise ratio (CNR) was calculated. A subjective evaluation was carried out by two experienced radiologists. The CT dose index volume (CTDIvol) was recorded. RESULTS: A 44.7% reduction in CTDIvol was observed in the study group (8.18 +/- 3.58 mGy) compared with that in the control group (14.78 +/- 6.15 mGy). No significant differences were observed in the tissue noise levels and CNR values between the 70% ASIR group and the control group (p = 0.068-1.000). The subjective scores indicated that visibility of small structures, diagnostic confidence, and the overall image quality score in the 70% ASIR group was the best, and were similar to those in the control group (1.87 vs. 1.79, 1.26 vs. 1.28, and 4.53 vs. 4.57; p = 0.122-0.585). No significant difference in diagnostic accuracy was detected between the study group and the control group (42/47 vs. 43/47, p = 1.000). CONCLUSION: Low tube-voltage combined with automatic tube current modulation and 70% ASIR allowed the low CT radiation dose to be reduced by 44.7% without losing image quality on female pelvic scan.

The diagnostic value of magnetic resonance imaging in different planes for uterine septum malformation / 实用放射学杂志

Objective To explore the value of magnetic resonance imaging (MRI)different planes in the diagnosis of uterine sep-tum.Methods The MR images of 28 cases with hysteroscopy surgery proved congenital uterine septum were analyzed retrospective-ly.The MRI findings in different planes of uterine septum were compared.Results 28 cases of congenital uterine septum malforma-tion were shown by magnetic resonance imaging in different planes.The sensitivity of oblique coronal for the uterine septum was not only higher than the conventional axial and oblique axial,but also higher than normal coronal (P <0.05).The oblique coronal was the most sensitive MRI imaging position for diagnosis of uterine septum,especially for complete uterine septum malformation.The uterine septum morphology and signal characteristics was fully visualized and accurately measured by the oblique coronal T2 WI.The oblique axial T2 WI displayed a continuous cross-sectional image of uterine septum and played a complementary role on the diagnosis of uterine septum.In contrast,a poor display was observed for uterine septum on sagittal plane.Conclusion Congenital uterine sep-tum can be clearly demonstrated by MRI oblique coronal and oblique axial joint application.

Laparoscopic cholecystectomy for acute cholecystitis: report of 280 cases / 中国医师进修杂志

Objective To summarize clinical experience of laparoscopic cholecystectomy (LC) for acute cholecystitis.Methods Two hundred and eighty patients with acute cholecystitis underwent LC in our hospita1.Results The LC was successfully completed in 268 cases,the other 12 patients were converted to open surgery because of massive adhesion at the Calot triangle (5 cases),severe hemorrhage (2 cases),Mirizzi syndrome (3 cases),Common bile duct injury (2 cases) were exectuted by bile duct repair and T tube drainage' and were Roux-en-Y chole-enterostomy).None of the patients had intra-abdominal hemorrhage,biliary leakage,or subphrenic abscess after the operation.Conclusions LC is safe and feasible in the treatment of acute cholecystitis,and successful surgery should be based on the skilled techniques and the knowledge of key points in the operation.Conversion to open surgery is necessary when LC is difficult.