The clinical research of Z-scores in assessing fetal coarctation of aorta / 中华超声影像学杂志

Objective:To develop Z-scores for the aortic arch in normal fetuses as a reference for fetuses with suspected coarctation of aorta(CoA).Methods:The aortic arch inner diameters of 610 normal fetuses and 59 CoA fetuses from May 2010 to March 2015 in the Second Xiangya Hospital of Central South University were measured at the long axis of the aortic arch view. Gestational age(GA), femur length(FL) as the independent variable, the aortic arch inner diameters as the dependent variable, Z-scores were created relating the aortic arch inner diameters to the GA and FL. Z-score=[ln(measured diameter)-ln(predicted diameter)]/root MSE. Z-scores of the CoA fetuses were calculated with the above regression, and compared with the Z-scores of the control group.Results:A simple linear regression model was the best description of the data in each case and correlations between FL and the aortic arch inner diameters were excellent ( P<0.001). There was no significant difference in Z-scores calculated with FL or GA as independent variables ( P>0.05). Z-scores of the control group was between -2 and + 2, Z-scores of the CoA group was significantly lower and below -2( P<0.001). Conclusions:Z-scores of fetal aortic arch are sensitive indicators of fetal coarctation, and are of clinical importance for the diagnosis and follow-up study of CoA.

Prenatal echocardiographic diagnosis and differential diagnosis of fetal double outlet ventricle / 中华超声影像学杂志

Objective To investigate the clinical value of prenatal diagnosis of fetal double outlet ventricle . Methods T he data of double outlet ventricle from fetal echocardiography in Second Xiangya Hospital of Central South University and Changde Women and Children Health Hospital of Hunan Province from January 2000 to August 2018 were collected . T he statistical method was used to analyze characteristics of echocardiography ,related‐intracardiac and extracardiac abnormalities ,postnatal echocardiography ,surgery and autopsy findings . Results Ninety‐four fetuses were diagnosed with double outlet ventricle ,including 84 cases of double outlet right ventricle ( DORV ) and 10 cases of double outlet left ventricle ( DOLV ) . T he pregnancy was terminated in 45 cases . Autopsy was offered to all patients after termination of pregnancy ,42 cases were consistent with prenatal diagnosis ,1 case was tetralogy of fallot ,2 cases were transposition of great artery . Forty‐nine cases were decided to continue the pregnancy ,32 cases of them were confirmed by postpartum surgery ,17 cases were confirmed by postnatal echocardiography . Echocardiographic findings of fetal double outlet ventricle was characterized by the origin of the both great arteries arising predominantly or completely( ＞50% ) from the same ventricle . Conclusions Prenatal ultrasound diagnosis of double outlet ventricular has important clinical value ,facilitate appropriate prenatal counseling and postnatal management and it should be differentiated with transposition of the great arteries ,tetralogy of fallot and ventricular septal defect .

Echocardiographic diagnosis for ventricular non-compaction cardiomyopathy in foetus and the pathologically comparative study / 中南大学学报(医学版)

OBJECTIVE@#To evaluate the echocardiographic diagnosis for ventricular non-compaction cardiomyopathy (NCCM) in foetus and to analyze the pathologic features of NCCM.
@*METHODS@#A total of 9 patients with fetal NCCM were examined by prenatal echocardiography from 2004 to 2013, which was compared with postnatal echocardiography or autopsy to analyze the fetal characteristic of myocardial ultrastructure.
@*RESULTS@#The results of echocardiography displayed an excessive muscle trabecular meshwork and muscle trabecular crypt, and the ventricular myocardium and non-compaction/compaction ratio was ≥2.0. Among the 9 fetuses of NCCM, 6 fetuses were involved in left ventricle, 2 in both left and right ventricles and 1 in right ventricle. Two fetuses were confirmed by postnatal echocardiography, the remaining 7 patients were chosen to terminate their pregnancies, which were confirmed by autopsy later. Muscle biopsies revealed the abnormal myocardial mitochondria, sarcomeres and myocardial fibrosis.
@*CONCLUSION@#It is feasible to accurately diagnose NCCM by prenatal echocardiography. Fetal NCCM most often involves the left ventricle, but it can involve the right ventricle or both, too. The myocardial ultrastructure of fetal NCCM possesses certain unique characteristics, such as the low maturation of the mitochondria, sarcomeres and myocardial fibers.

Four-dimensional reconstruction by inversion mode of spatio-temporal image in prenatal diagnosis of congenital heart diseases / 中南大学学报(医学版)

OBJECTIVE@#To investigate the value of 4-dimensional reconstruction by inversion mode of spatio-temporal image correlation (STIC) in prenatal diagnosis of congenital heart diseases.@*METHODS@#Cardiac volume images of 30 normal fetuses and 22 fetuses with congenital heart diseases were obtained by STIC gray-scale 2-dimensional imaging technique. Under the guidance of cross-sectional display, the images were collected by inversion mode.@*RESULTS@#A total of 53 and 38 qualified volume images were obtained in the 30 normal fetuses and 22 fetuses with congenital heart diseases respectively. All volume images were inverted successfully and showed the spacial position of the heart and blood vessel directly.@*CONCLUSION@#Four-dimensional reconstruction by inversion mode of STIC is feasible. This new method can provide more morphologic information, and may be used for prenatal diagnosis of congenital heart diseases.

Combination of B-flow imaging and spatio-temporal image correlation in prenatal diagnosis of congenital heart diseases / 中华超声影像学杂志

Objective To investigate the value of combination of B-flow imaging and spatio-temporal image correlation in prenatal diagnosis of congenital heart diseases. Methods Volume images of 50 normal fetuses and 14 fetuses with congenital heart diseases were recruited in the study. Surface mode was used to reconstruct the volume images. Results Sixty-three and twenty-six qualified volume images were obtained in 50 normal fetuses and 14 fetuses with congenital heart diseases respectively. All volume images were reconstructed successfully and showed the spacial relationship of cardiac blood vessel directly. Conclusions The combination of B-flow imaging and spatio-temporal image correlation was feasible and useful in prenatal diagnosis of congenital heart diseases.

Quantitative assessment of myocardial segmental systolic function in patients with coronary disease by velocity vector imaging / 中华超声影像学杂志

Objective To investigate the clinical significance of velocity vector imaging(VVI)in evaluating the left ventricular(LV)segmental longitudinal systolic function in patients with coronary artery disease(CAD).Methods In 25 patients with myocardial ischemia,28 patients with myocardial infarction,26 patients with coronary lumen stenosis＜50%,according to coronary arteriography and electrocardiogram,the myocardial segments of LV were divided into 4 groups:ischemic segments group,infarcted segments group,non-ischemic segments group and normal segments group.Twenty-eight healthy subjects were selected as control group.Dynamic imaging of all subjects were collected,the systolic peak strain(Smax)and strain rate(SRmax),the time to peak strain(PTs)and the time to peak strain rate(PTsr)were measured respectively.Results Smax and SRmax of the ischemic segments and infracted segments were significantly lower than those of the control group respectively,PTs and PTsr of the ischemic segments and infracted segments were significantly longer than those of the control group respectively.Smax and SRmax of infarcted segments were significantly lower than those of the ischemic segments,there were no differences of PTs and PTsr between ischemic segments and infracted segments.Smax and SRmax cutoff of -14.08%,-0.83 s-1 for detecting ischemic segments and cutoff of -6.65%,-0.38 s-1 for detecting infracted segments,respectively,gave an optimal sensitivity and specificity.Conclusions VVI is a kind of novel noninvasive-tool to quantitatively assess LV regional systolic function in CAD patients.It is competent to differentiate between the ischemic segments and infarcted segments.

The characteristic of left ventricular twist changed from infancy to the elder assessed by speckle tracking echocardiography / 中华超声影像学杂志

Objective To assess the characteristic of left ventricular(LV) twist changed from infancy to the elder,in order to determine the normal value of LV twist in different age group.Methods After acquired basal and apical LV short-axis images in 293 healthy volunteers (aged 15 days to 72 years) by 2-dimensional echocardiography, speckle tracking echocardiography was used to analysis LV twist motion offline.The peak apical rotation (PAr), peak basal rotation (PBr), peak LV twist (Ptw), peak LV twist normalized by LV length ( PtwN), peak untwisting velocity ( PutwV), isovolumic untwisting% ( Iutw% ) in different group were compared.Results Reliable LV twist measurements were obtained in 274 volunteers.Different LV twist values were noted according to age.Ptw increased gradually with advancing age, when normalized by LV length, PtwN showed higher values before 3 years old and 25 to 45 years old.PutwV increased with aging from infancy to 25 years old, and leveled off from 25 to 45 years old, then decreased with advancing age.Iutw% was lowest before 3 years old,and increased gradually from 25 to 45 years old,then decreased with aging.Conclusions speckle tracking echocardiography can be used to noninvasively and exactly assess LV twist with high feasibility.The effect of aging on LV twist may reflect the process of maturational and adaptive modulation of LV torsional biomechanics from infancy to the elder.

Evaluation of regional left ventricular longitudinal function in 151 normal fetuses using velocity vector imaging / 中华超声影像学杂志

Objective To investigate the clinical value of VVI assessment normal fetal segmental myocardial performance and to establish a nomogram of normal fetus.Methods Digital dynamic fourchamber imaging of 151 healthy fetus(divided 5 groups according to gestation)were collected,then the longitudinal velocity,strain and strain rate of interventricular septal and left lateral wall were measured in systolic and diastolic period respectively.Results Normal systolic and diastolic values for tissue velocitv.strain,and strain rate were established.Tissue velocity was age dependent,whereas strain and strain rate were stable throughout gestation(P＞0.05).Tissue velocity was gradually decreased from the base segment to the apical segment(P＜0.01),whereas strain and strain rate were stable among all segments in every group(P＞0.05).Conclusions Fetal myocardial velocity,strain,and strain rate measuraments are easy to obtain and reproducible,VVI is a novel noninvasive tool to assess quantitatively and objectivelv regional systolic and diastolic function in fetal heart,it is providing another useful modality for evaluating cardiac function.

Intrahepatic Peripheral Cholangiocarcinoma:Comparative Study on Imaging Findings and Pathology / 实用放射学杂志

Objective To evaluate the imaging findings and its pathologic basis of intrahepatic peripheral cholangiocarcinoma(IHPCC).Methods 25 patients with pathologically proven IHPCC were reviewed retrospectively.B-ultrasonic scanning (BUS) was performed in allpatients.CT(including conventional unenhanced and enhanced scan) was done in 21 patients.11 patients received MRI with dynamicscannings.9 patients underwent digital subtraction angiography(DSA).Results 15 patients were hypoecho and 10 patients were brieflyhyperecho or hyperecho in BUS, homogeneous or heterogeneous. On unenhanced CT, the lesions were of low density with ill-definedborder. The lesions were low intensity on T1WI and moderately high intensity with low intensity in central area on T2WI . Dynamic CT and MRI showed gradually enhancement from the periphery toward the center of the lesion in most patients. Focal dilatation and calculus of the intrahepatic bile ducts around the tumor could be seen and retraction of liver capsule could also be seen in imaging appearance of IHPCC. On selective DSA ,the lesions were resemble to the tumors with rare blood vessels ,on superselective DSA, tumor vascular plexus were tiny and like “flocculus” in arterial period, obvious staining with ill-defined during parenchymal phase in 9 patients. Pathologically,tumor vessels were rare, these were plenty of interstitial fibrous tissue between tumor cells. Conclusion The imaging features of intrahepatic peripheral cholangiocarcinoma are of certain characteristic.