Ultrasound assessment of twin reversed arterial perfusion sequence for the prediction of adverse pregnancy outcomes in the first trimester.

OBJECTIVE: To investigate twin reversed arterial perfusion (TRAP) sequence for the prediction of TRAP-related adverse pregnancy outcomes at the gestational age of 11-14 weeks. METHODS: Pregnant women in the first trimester diagnosed with TRAP were recruited at West China Second University Hospital from January 2015 to June 2018. Systematic screening for the pump twin's crown-rump length (CRL) and acardiac twin's upper pole-rump length (URL) was conducted using ultrasonic detection. The (CRL - URL)/CRL and URL/CRL ratios were used to assess the pregnancy outcomes for the pump twin. Twenty-one pregnant women aged 21-39 years with a gestation of 11-14 weeks were recruited. RESULTS: TRAP was diagnosed on average (± standard deviation (SD)) at pregnancy week 13.1 ± 0.18. The pump twins' mean (± SD) CRL was 6.65 ± 1.1 cm. The incidence of intrauterine death for the pump twins was 19.0% (n = 4), the miscarriage rate was 14.3% (n = 3), and the live birth rate was 66.7% (n = 14). The (CRL - URL)/CRL ratios between the nonsurvival (intrauterine death and miscarriage) and survival groups significantly differed (0.33 ± 0.08 vs. 0.58 ± 0.08, p < 0.05). Similarly, the URL/CRL ratios between the nonsurvival and survival groups significantly differed (0.67 ± 0.08 vs. 0.42 ± 0.08, p < 0.05). CONCLUSION: The (CRL - URL)/CRL and URL/CRL ratios were valuable indicators for determining pregnancy outcomes of pump twins with TRAP at an early gestational age.

Chinese fetal biometry: reference equations and comparison with charts from other populations.

OBJECTIVE: This study aimed to construct new reference charts and equations for fetal biometry from Chinese fetuses at 15-40 weeks and to compare them with previous references. METHOD: This was a prospective, cross-sectional study of singleton pregnancies in patients with a confirmed gestational age who underwent ultrasound examinations between the 15th and 40th weeks of gestation. Each woman was selected only once for this study. Biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC), and femur length (FL) were recorded. For each measurement, separate regression models were fitted to estimate the mean and standard deviation at each menstrual age. Z-scores were calculated with our reference equations for comparison with other references. RESULTS: New charts and reference equations involving 7553 Chinese women were created for BPD, HC, AC, and FL. Reference equations were cubic models. Prediction intervals for the new reference charts were similar to those of previous references, but with some slight differences. The main difference in our fetal biometric measurements compared with those of Korea and Hong Kong was the FL. CONCLUSIONS: We report new Chinese reference charts and equations for fetal biometry. These reference charts and equations are available for clinical use in obstetric ultrasound studies for the Chinese population.

Early diagnosis of trisomy 21, trisomy 18 and trisomy 13 using nuchal translucency thickness and ductus venosus blood flow waveform in West China.

Abnormal nuchal translucency (NT) thickness and ductus venosus (DV) blood flow have been associated with trisomy 21, 18 and 13. However, the association of abnormal DV with these aneuploidies varies among clinical studies. The present study examined the possibility of using NT combined with DV for the early diagnosis of the three aforementioned aneuploidies in the Western Chinese population, focusing on three aspects: Biological pathway analysis, theoretical statistical analysis and clinical data analysis from 1,962 first­trimester pregnant women from Western China. The pathway and statistical analyses performed suggested the reliability of integrating NT and DV in the prediction of the three aneuploidies. The clinical data analysis suggested that integrating NT and DV, compared with NT alone, resulted in increased predictive power (34.09 vs. 22.45%), better rejection probability (0.21 vs. 0.44%), increased specificity (96.71 vs. 94.07%) and increased sensitivity (89.47 vs. 80.49%). The present results suggested the reliability of integrating NT and DV for the early diagnosis of trisomy 21, 18 and 13 for the Western Chinese population. The present results provided novel statistical analyses to the field of prenatal diagnosis in the Western Chinese population.

[Perfusion Imaging of Ovarian Masses with Contrast-enhanced Ultrasonography].

OBJECTIVE: To determine the perfusion features of ovarian masses and their diagnostic value. METHODS: Contrast-enhanced ultrasonography (CEUS) of 81 ovarian masses were confirmed by surgical pathology. Time-intensity curves of perfusion were obtained for the interest areas of ovarian mass. CEUS perfusion parameters were estimated, including rise time (RT), time to peak (TTP), peak intensity (PI), time from peak to one half (TTH) and area under the curve (AUC). Repeatability of those parameters was tested. Differences in the perfusion parameters were tested between benign and malignant masses, between tumor and non-tumor masses, between different differentiated and stages of ovarian cancers, between cancers with and without lymph-node metastases, and between primary and metastatic cancers. Receive operating characteristic (ROC) curve analyses were performed to determine the cutoff values of perfusion parameters for discriminating cancer from benign ovarian masses. RESULTS: Good intra-observer repeatability was reached in the five perfusion parameter measurements. PI, TTH and AUC increased significantly in ovarian cancer and tumor compared with benign and non-tumor masses (P<0.05) . PI, TTH and AUC were effective parameters in diagnosing ovarian cancer. AUC had the highest diagnostic effectiveness, with a sensitivity of 87.3% and a specificity of 80.8% at the cutoff value of 877 dB?s. There were no differences in the parameters between different differentiated and stages of ovarian cancers, between cancers with and without lymph-node metastases, and between the primary and metastatic cancers. CONCLUSION: Malignant ovarian cancer has higher PI, TTH and AUC values in CEUS. AUC has certain value in diagnosing ovarian cancer.

[Value of Fetal Frontomaxillary Facial Angle in Diagnosing Fetal Chromosomal Aneuploidy at 11+0 to 13+6 Weeks of Gestation].

OBJECTIVE: To determine the value of fetal Frontomaxillary facial angle (FMFA) in diagnosing chromosomal aneuploidy at 11+0-13+6 weeks of pregnancy. METHODS: Singleton pregnancies were randomly selected from January 2015 to August 2016 in our hospital. The crown-rump length (CRL), nuchal translucency (NT) and FMFA of the fetuses were measured and recorded, followed by chromosomal tests. FMFA and NT of the euploid fetuses were compared with those of the aneuploidy fetuses. A linear regression model was established between FMFA and CRL. The specificity and sensitivity of FMFA for diagnosing aneuploidy were assessed using the receiver operating characteristic (ROC) curve. RESULTS: The euploid fetuses had 80.61° (79.94°-81.28°) FMFA, compared with 91.24° (90.21°-92.25°) in the aneuploidy fetuses. The euploid fetuses had 1.63 mm (0.90-2.43 mm) NT, compared with 4.18 mm (3.12-5.44 mm) NT in the aneuploid fetuses. The differences were statistically significant (P<0.01). A negative correlation between CRL and FMFA was found in the euploid fetuses (y=-0.320 8x+100.32) . FMFA had a sensitivity of 90.5% and a specificity of 94.3% for diagnosing chromosomal aneuploidy with a cut-off value of 87.5° and 0.960 of the area under the curve. CONCLUSION: Aneuploid fetuses have significantly greater FMFA than euploid fetuses at 11+0 to 13+6 weeks of gestation.

Visualization and quantitation of fetal movements by real-time three-dimensional ultrasound with live xPlane imaging in the first trimester of pregnancy.

AIM: To prove whether real-time three-dimensional (3D) ultrasound with live xPlane imaging is better in observing fetal movements than standard ultrasound imaging. METHODS: 50 healthy women with singleton pregnancies (22-43 years old) at 11 to 14 weeks of gestation underwent real-time 3D ultrasound examination with live xPlane imaging from July 2014 to February 2015. The incidence and frequency of 10 fetal movement patterns in 10 minutes were evaluated, including general movements (GMs), isolated arm movements, isolated leg movements, hiccup, stretching, breathing, startle, jaw opening, isolated head retroflexion, and isolated head anteflexion. The correlation between gestational age and frequency of each fetal movement pattern was analyzed. RESULTS: GM had the highest incidence (100%), followed by startle (84%) and isolated arm movements (68%). Their median frequency was 5 (IQR 3-6), 5 (IQR 1.75-11.5), and 1 (IQR 0-2), respectively. GM (Z=5.875, P<0.001) and startle (Z=5.302, P<0.001) had significantly higher frequency than isolated arm movements. The other 7 fetal movement patterns had much lower incidence and frequency. The frequency of GM was positively correlated with gestational age (r=0.360, P=0.010). CONCLUSION: Real-time 3D ultrasound with live x Plane imaging was shown to be a feasible tool for observing fetal movements.

Fetus in fetu: From Prenatal Sonographic Diagnosis to Postnatal Confirmation.

A case of prenatal sonographic diagnosis of fetus in fetu is described. Postnatal laparotomy was performed and the diagnosis was confirmed by pathological examination.

[Preliminary study of contrast-enhanced ultrasonography in the evaluation of angiogenesis in ovarian tumors].

OBJECTIVE: To investigate the role of contrast-enhanced ultrasonography (CEUS) with pulsed inversion harmonic imaging in the evaluation of angiogenesis in ovarian tumors. METHODS: Forty-two patients of ovarian tumor received CEUS examination, in which the rise time (RT), peak intensity (PI), area under the curve (AUC), time from peak to one half (TTH) and time to peak (TTP) of ovarian tumors were measured. The post- surgical specimens of ovarian tumors were analysed by the stain with polyclonal antibodies against vascular endothelial growth factor (VEGF) and CD34. Correlations between the index of VEGF, microvessel density (MVD) and ultrasonic perfusion parameters were studied. RESULTS: MVD and VEGF index of ovarian tumors were significantly correlated with CEUS perfusion parameters including PI, AUC and TTH. The correlation coefficients of MVD with PI, AUC and TTH were 0. 569, 0. 623 and 0. 585 respectively; and the correlation coefficients of VEGF with PI, AUG and TTH were 0. 516,0. 640 and 0. 591 respectively. There were significant differences of the perfusion parameters between high and low MVD group. CONCLUSION: The perfusion parameters PI, AUC and TTH in CEUS were correlated with MVD and VEGF in ovarian tumors, which may be useful in the evaluation of tumors angiogenesis.

[Diagnostic value of contrast-enhanced ultrasonography in ovarian tumors].

OBJECTIVE: To determine the value of contrast-enhanced ultrasonography (CEUS) in diagnosing ovarian tumors. METHODS: Both conventional ultrasonography (CUS) and CEUS were performed in 86 patients with ovarian masses. A total of 106 ovarian masses from those patients were examined for pathological changes. The blood flow and color scores determined by CUS and CEUS and the contrast intensity determined by CEUS were analyzed and compared with the pathological results. RESULTS: Blood flow was detected in 91 ovarian masses by CUS, with 27 diagnosed as benign and 79 as malignant. Blood flow was detected in 106 ovarian masses by CEUS, with 33 diagnosed as benign and 73 as malignant. CUS had 84.9% diagnostic accuracy, 92.0% sensitivity, 67.7% specificity, 87.3% positive predictive value, and 77.8% negative predictive value. CEUS had 92.5% diagnostic accuracy, 93.3% sensitivity, 90.3% specificity, 95.9% positive predictive value, and 84.8% negatvie predictive value. CONCLUSION: CEUS is a better instrument than CUS for diagnosing ovarian tumors through blood flow detection.

Prenatal sonographic diagnosis of mature renal teratoma: a case report.

Renal teratoma is an extremely rare condition found in adolescents and young adults. Here, we report a case in which renal teratoma was diagnosed by fetal ultrasound examination. To our knowledge, this is the first report to describe the imaging manifestation of renal teratoma in prenatal diagnosis.

[Comparative study of ultrasonography and magnetic resonance imaging in midline structures of fetal brain].

OBJECTIVE: To evaluate the accuracy of ultrasonography (US) and magnetic resonance imaging (MRI) in midline structures of fetal brain. METHODS: Thirty-two fetuses underwent US and MRI examinatiom. Imagings acquired from US and MRI were analysed, the results were compared with the final outcomes which were obtained after fetal birth or pathological study after induction of labor. RESULTS: There were 20 cases found abnormal in prenatal CNS ultrasonography (18 cases involving midline structures ). Among these 20 cases, 12 cases were normal in MRI and the fetuses were born in full-term without special problem, 8 cases were abnormal in MRI and fetal autopsy confirmed their abnormalities. Diagnostic accuracy rate of US was 93.8%, sensitivity was 100%, specificity was 87.5%, positive predictive value was 88.9%, negatvie predictive value was 100%. Diagnostic accuracy rate of MRI was 100%, modifying the US results in 4 cases. CONCLUSION: US and MRI examinations are important in fetal central nervous system. US could be the first line examination, and MRI is an important supplement because of the high diagnostic accuracy, especially in the image study of midline structures of fetal brain.

[Diagnostic value of power Doppler ultrasonography for Sirenomelia Seguence in prenatal].

OBJECTIVE: To study and discuss the diagnostic value and ultrasonographic characteristics of power doppler ultrasound in the prenatal diagnosis of Sirenomelia Seguence. METHODS: The abdominal aorta in two fetuses with sirenomelia seguence fetuses and in ten with nomal was reviewed and compared with two-dimensional power doppler ultrasound and three-dimensional power doppler ultrasound in prenatal. RESULTS: The abdominal aorta were showed to divid into renal arteries in the kidney level while two common iliac arteries in the pelvis in nomal fetuses with two-dimensional power doppler ultrasound and three-dimensional power doppler ultrasound; compared with the nomal, the abdominal aorta and whose branches in sirenomelia seguence were demonstrated as follows: 1) a large and deformed vascular coming from the high abdominal aorta, which was found to act as a umbilical artery by careful examination; 2) no bifurcation of renal arteries identified; 3) no bifurcation of two common iliac arteries identified; 4) the abdominal aorta changing into a narrow vascular after one deformed vascular separating from. CONCLUSIONS: Sirenomelia seguence fetuses has a characteristic change in two-dimensional power doppler ultrasound and three-dimensional power doppler ultrasound, which is helpful to improve the prenatal diagnosis of sirenomelia seguence.

[Value of prenatal diagnosis of placenta previa with placenta increta by transabdominal color Doppler ultrasound].

OBJECTIVE: To assess the value of prenatal diagnosis of placenta previa with placenta increta by transabdominal color Doppler ultrasound. METHODS: Two hundred and fourteen patients with persistent placenta previa underwent transabdominal color Doppler ultrasound for the prenatal diagnosis of placenta increta in our hospital from June 2002 to June 2005. We prospectively followed up their clinical and pathological results. The main color Doppler imaging criteria used included a loss of the normally visible retroplacental hypoechoic zone and/or a lacunar flow pattern showing marked or turbulent blood flow distributed within the subplacenta or intraparenchymal placenta area and extended into the surrounding tissues. RESULTS: (1) The sensitivity of color Doppler ultrasound in diagnosis of placenta previa increta was 77.3% (17/22) and the specificity was 98.4% (189/192). The positive and negative predictive values were 85.0% (17/20) and 97.4% (189/194) respectively. (2) The morbidity of placenta increta in women with placenta previa was 10.3% (22/214). The average amount of peripartum hemorrhage of placenta previa with increta (2494 ml) was higher than that of placenta previa without increta (505 ml). The morbidity of cesarean hysterectomy among women with placenta previa increta was 40.9% (9/22). CONCLUSION: Placenta previa is a high-risk factor of placenta increta. Placenta previa increta threatens the lives of the mother and the fetus because of massive hemorrhage. Prenatal color Doppler ultrasound has a high sensitivity and specificity for the identification of placenta previa increta. It has a positive impact on the peripartum clinical management of the affected patients through reducing the death of the mother and the fetus because of unpredictive bleeding while terminating the pregnancy.

[Estimation of fetal weight on the basis of neural network].

The ultrasonic estimation of fetal weight at delivery is of important prognostic significance in obstetrical practice. The convertional regression formulas used for estimating fetal weight have the disadvantage of less reliability. In this study, we used the back propagation neural network (BP) to estimate Fetal Weight. Some input variables were adopted in constructing the BP model: biparietal diameter (BPD), cerebellum transverse diameter (TCD), abdominal circumference (AC), liver length (LL), femur length (FL), fetal thigh soft tissue thickness (FSTT), and gestational age (GA). The fetal weights of 109 singleton fetuses were estimated. In the training group and validation group, coincidence rates were 89.77% and 76.19% respectively. The results show that the estimation based on neural network is more accurate than that by regression method. GA, its unit is not week but day in our formulas, is very valuable in combination with other ultrasonic parameters on estimation.