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Objective To explore the feasibility of real-time three-dimensional ultrasound Xplane imaging in quantifying left and right atrial diastolic maximal volume (LAVmax,RAVmax) and evaluating cardiac diastolic function in fetuses with cardiac disease in second and later trimesters.Methods One hundred and forty-four fetuses with abnormal heart morphology at 16-34 weeks of gestational age were included and divided into 3 groups according to the influence of pathological changes on atrial volume:group A with symmetrical left and right atrial volume,group B with decreased left atrial volume and increased right atrial volume and group C with increased left atrial volume and decreased right atrial volume,and the fetus were also divided into 2 groups according to the law of fetal development:the middle pregnancy group (16-27+6 weeks) and the late pregnancy group (28-34+6 weeks).Using the "Xplane" mode of volume probe,the maximal atrial volume was calculated automatically by tracing method and three-path line method.The correlation between the two methods in quantitative LAVmax was validated by paired sample t test and Pearson correlation analysis.The correlation between LAVmax,RAVmax and gestational age were analyzed by curve fitting.The volumes of bilateral chambers and the average weekly growth rates of E peak,A peak and E/A value of mitral and tricuspid orifices were calculated and compared.Results There was no significant statistical difference between the maximal volume of the left atrium obtained by the tracing method and the three-diameter line method (P ＞0.05),and there was high correlation between the two methods in the comparison of the maximal volume of the left atrium (r =0.90,0.88,0.85;all P ＜0.01).The data of group A,B and C showed that LAVmax and RAVmax could increase with the increase of gestational weeks in a certain period of abnormal state,and had a good correlation with them(LAVmax:r =0.78,0.74,0.78,all P ＜0.005;RAVmax:r =0.79,0.77,0.78,all P ＜0.005).The average weekly growth rate of RAVmax showed an advantage in group A,B and C.Especially in group C with reduced right atrium,the growth rate of right atrium was 8.15 ％,which was higher than that of group B with decreased left atrium by 5.06％.The weekly growth rates of E peak and E/A in tricuspid orifice were also higher than those in mitral orifice.The E peak and E/A values of tricuspid orifice in group C were 4.05％ and 0.60％,respectively,higher than those in group B,which were 2.58％ and 0.02％.Peak A showed an increase in growth rate in group B and group C with decreased atria,peak A values in group B and group C increased by 4.01 ％ and 2.19％,respectively.Conclusions The right ventricular dominance of fetal heart can still be reflected in certain stages of disease,and the atrial active systolic may play a regulatory role in the filling of cardiac blood flow.Real-time three-dimensional ultrasound Xplane imaging could be used to quantify the atrial volume of fetuses with abnormal heart morphology in second and later trimesters and to preliminary assess atrial function combined with the changes of atrioventricular valve orifice hemodynamics.Real-time three-dimensional ultrasound Xplane imaging technology has obvious advantages of simple,safe,non-invasive,simultaneous and high repeatability in measuring fetal atrial volume.
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Objective@#To explore the feasibility of real-time three-dimensional ultrasound Xplane imaging in quantifying left and right atrial diastolic maximal volume (LAVmax, RAVmax) and evaluating cardiac diastolic function in fetuses with cardiac disease in second and later trimesters.@*Methods@#One hundred and forty-four fetuses with abnormal heart morphology at 16-34 weeks of gestational age were included and divided into 3 groups according to the influence of pathological changes on atrial volume: group A with symmetrical left and right atrial volume, group B with decreased left atrial volume and increased right atrial volume and group C with increased left atrial volume and decreased right atrial volume, and the fetus were also divided into 2 groups according to the law of fetal development: the middle pregnancy group (16-27+ 6 weeks) and the late pregnancy group (28-34+ 6 weeks). Using the " Xplane" mode of volume probe, the maximal atrial volume was calculated automatically by tracing method and three-path line method. The correlation between the two methods in quantitative LAVmax was validated by paired sample t test and Pearson correlation analysis. The correlation between LAVmax, RAVmax and gestational age were analyzed by curve fitting. The volumes of bilateral chambers and the average weekly growth rates of E peak, A peak and E/A value of mitral and tricuspid orifices were calculated and compared.@*Results@#There was no significant statistical difference between the maximal volume of the left atrium obtained by the tracing method and the three-diameter line method (P>0.05), and there was high correlation between the two methods in the comparison of the maximal volume of the left atrium (r=0.90, 0.88, 0.85; all P<0.01). The data of group A, B and C showed that LAVmax and RAVmax could increase with the increase of gestational weeks in a certain period of abnormal state, and had a good correlation with them(LAVmax: r=0.78, 0.74, 0.78, all P<0.005; RAVmax: r=0.79, 0.77, 0.78, all P<0.005). The average weekly growth rate of RAVmax showed an advantage in group A, B and C. Especially in group C with reduced right atrium, the growth rate of right atrium was 8.15%, which was higher than that of group B with decreased left atrium by 5.06%. The weekly growth rates of E peak and E/A in tricuspid orifice were also higher than those in mitral orifice. The E peak and E/A values of tricuspid orifice in group C were 4.05% and 0.60%, respectively, higher than those in group B, which were 2.58% and 0.02%. Peak A showed an increase in growth rate in group B and group C with decreased atria, peak A values in group B and group C increased by 4.01% and 2.19%, respectively.@*Conclusions@#The right ventricular dominance of fetal heart can still be reflected in certain stages of disease, and the atrial active systolic may play a regulatory role in the filling of cardiac blood flow. Real-time three-dimensional ultrasound Xplane imaging could be used to quantify the atrial volume of fetuses with abnormal heart morphology in second and later trimesters and to preliminary assess atrial function combined with the changes of atrioventricular valve orifice hemodynamics. Real-time three-dimensional ultrasound Xplane imaging technology has obvious advantages of simple, safe, non-invasive, simultaneous and high repeatability in measuring fetal atrial volume.
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Objective To explore the correlation between injection peak pressure and tubal patency during real-time three-dimensional hysterosalpingo-contrast sonography(RT 3D-HyCoSy).Methods One hundred and seven patients who were scheduled to undergo transvaginal RT 3D-HyCoSy with SonoVue contrast agent were included in the study.They were injected with contrast agent by an YLD-YZ-800 auto contrast agent injection device. The patients were divided into tubal patency included bilateral patency group,one side patency group and bilateral positive group according to imaging results. During the examination,the injection peak pressure was recorded to analyze whether there were significant differences among the three groups.Results The contrast agent injection peak pressures of bilateral patency group,one side patency group and bilateral positive group were (34.58 ± 8.25)kPa,(44.85 ± 10.05)kPa and (54.26 ± 11.65)kPa,respectively. The differences of injection pressure among the three groups were statistically significant ( F = 38.732; P = 0.000,0.000,0.033). The peak pressure was negatively correlated with tubal patency ( r = -0.653,P =0.000).Conclusions Contrast agent injection peak pressure is associated with tubal patency in RT 3D-HyCoSy,and can be quantitatively measured to help for assessing fallopian tube patency.
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Objective To discuss the possible reasons of contrast agent reflux during transvaginal real-time three-dimensional hysterosalpingo-contrast sonography (TVS RT-3D-HyCoSy),and in order to provide scientific evidences for reducing the contrast agent reflux.Methods The sonographic features of contrast reflux were observed in the images of 167 infertile patients who underwent TVS RT-3D-HyCoSy, and the association of the incidence rate of the reflux with tubal patency,the types of infertility,endometrial thickness,menstrual clean days,abnormal uterine cavity,the history of intrauterine operations,pelvic operations and ectopic pregnancies were analyzed.Results The incidence rate of the reflux during TVS RT-3D-HyCoSy was 41 .3%.The incidence rates of reflux in unilateral patency and bilateral obstruction were 4.929 and 9.21 5 times of that of bilateral patency respectively.The incidence rate of reflux in the secondary infertility cases was significantly higher than that of primary ones(P <0.05).Logistic regression analysis demonstrated that the reflux is associated with the tubal patency,the endometrial thickness and the history of intrauterine operations,and none of the other factors.Conclusions TVS RT-3D-HyCoSy could differentiate the images of reflux better;the proper timing of the contrast examination and avoiding the damage of endometrium would reduce the incidence of the reflux.
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Objective To evaluate the feasibility and accuracy of the transvaginal real-time three-dimensional hysterosalpingo-contrast sonography(RT 3D-HyCoSy) with SonoVue in the assessment of tubal patency.Methods Tubal patency was investigated by RT 3D-HyCoSy in 96 unselected infertile patients (a total of 191 tubes).The image quality of RT 3D-HyCoSy was evaluated.Laparoscopy was performed in 35 cases (a total of 70 tubes) of them.The efficacy of the procedure was compared with laparoscopy.Results The mean score of image quality of RT 3D-HyCoSy in ninety-six cases was 2.94 ± 0.26.The accordance between RT 3D-HyCoSy and laparoscopy was good,with the Kappa value was 0.802.Sensitivity,specificity,positive predictive value,negative predictive value and accuracy in diagnosing tubal patency by using RT 3D-HyCoSywas 87.5％ (14/16),94.4％ (51/54),82.3％ (14/17),96.2％ (51/53),92.9％ (65/70),respectively.Conclusions Transvaginal RT 3D-HyCoSy is a good imaging technique which can display the morphological character of fallopian tube and assess the patency.
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Objective To evaluate the value of real time three-dimensional ultrasound in differentiating benign and malignant breast tumors. Methods One hundred and fifty-three patients with breast tumors were examined with real time three-dimensional ultrasound. The results were compared with post-operative pathological results. Results A sign of malignancy on the coronal plane was observed by three-dimensional ultrasonography,named “sun-like symptom”,because the sign looked like a shining sun:striated hyperechoic or iso-echoic images scattered radially around cancers,together with the distortion of normal tissue.The accuracy of the sign in differentiating benign and malignant breast tumors was 86.93 %( 133/153 ), the sensitivity was 78.38 %( 58/74 ), and the specificity was 94.94 %( 75/79 ). Conclusions Real time three-dimensional ultrasound is a valuable and new technique in differentiating benign and malignant breast tumors.