ABSTRACT
Objective:To explore the causes of misdiagnosis and missed diagnosis of fetal liver, hemangioma by prenatal ultrasound, aimed at improving the diagnostic rate of fetal liver hemangioma by prenatal ultrasound.Methods:Six cases of misdiagnosed fetal liver hemangioma in Hunan Province Maternal and Child Health Hospital between January 2016 and October 2018 were selected. In these cases, live births were tracked until they were 6-24 months old, while autopsy was carried out on induced fetuses. These failed cases were analyzed retrospectively, in terms of their scanning methods, ultrasonographic features and pregnancy outcomes.Results:Three cases were misdiagnosed by perinatal ultrasound: the time for the first discovery of masses in these cases was 37 + 3 weeks, 39 + 5 weeks and 37 + 4 weeks respectively. All of these tissues appeared as mixed echogenic masses and were misdiagnosed as hepatoblastoma. The other three cases were categorized as prenatal ultrasound missed diagnosis: in one case, prenatal ultrasound examination failed to detect the disease in question during the whole pregnancy, while ultrasound examination revealed lesions 2 days after birth; the other case didn′t see the detection of hepatic hemangioma was not detected until the 40th week of pregnancy by ultrasound in another case, as prenatal ultrasound at 31 + 6 weeks and 37 + 4 weeks showed nothing abnormal; yet prenatal ultrasound examination of the third case showed no findings in which at 26 + 6 weeks pregnant, but ultrasound performed at 33 weeks into gestation suspected slightly hypoechoic area in the liver, which was indicated hepatic hemangioma by MRI. Among the 6 cases, 2 of the induced fetuses were confirmed as hepatic capillary tumor by autopsy and pathological examination by with the consents of their family; four live births were confirmed to be hepatic hemangioma by contrast-enhanced CT scan and clinical follow-up observation. Conclusions:Multi-angle and multi-section scanning technique should be adopted in prenatal ultrasound examination of fetal liver. Mean while observations must also be made of any changes in the hepatic vein and any displacement of the peripheral organs of the liver, while ultrasonic images and color Doppler flow imaging features of the lesions are further analyzed. These actions lead to an improvement in the diagnostic accuracy of fetal liver hemangioma, which serves as a useful clinical guide to active and effective intervention measures.
ABSTRACT
Objective To explore the diagnostic value of ultrasonography and magnetic resonance imaging (MRI) in placenta accreta.Methods Totally 150 pregnancy women in Hunan Provincial Maternal and Child Health Care Hospital from January 2015 to December 2016 were selected into the clinical data.According to the location of the placenta in the uterus,150 pregnancy women were divided into the anterior (n =80) and posterior (n =70) groups.The sensitivity,specificity,positive predictive value and negative predictive value of ultrasound and MRI were calculated.The sonographic and MRI features between placenta implantation and non placental implantation were compared.Results There were no statistically significant difference for ultrasound and MRI sensitivity (96.43％ vs 85.71％,P =0.89),specificity (88.46％ vs 96.15％,P =0.37),positive predictive value (81.82％ vs 92.31％,P =0.95) and negative predictive value (97.87％ vs 92.59％,P =0.42) in anterior group.The MRI sensitivity (96.67％ vs 66.67％,P＜0.01),positive predictive value (96.67％ vs 83.33％,P ＜ 0.01) and negative predictive value (97.50％ vs 78.26,P ＜0.01) in the posterior group were higher than those in the ultrasound.Ultrasound showed that the incidence of localexpansion of the uterus and the increased placental vessels in placenta accreta was higher than that in non placental accreta (x2 =26.92,26.83,and 63.77,P ＜ 0.01).MRI showed that the incidence of local swelling,increased placental vascularity and low T2 signaling rates in placenta accreta was higher than that in non placental accrete (x2 =23.75,17.46,18.86,P ＜ 0.01).Conclusions Ultrasonography and MRI has high diagnostic value in placenta accreta.MRI is superior in the diagnosis of placenta accreta in the posterior uterus than in the anterior uterus.