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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.
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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 .
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Objective To evaluate the renal peripheral inflow perfusion in patients with liver cirrhosis by region of interest ( ROI) quantification of color Doppler technique . Methods Fifty-eight patients with cirrhosis with normal renal function were selected as the case group ,and classified into A grade ( 10 cases) , B grade (23 cases) and C grade ( 25 cases) according to Child-Pugh classification criteria . Thirty healthy volunteers were selected as the control group .Resistance index ( RI) of interlobar artery and interlobular artery were measured in all groups . The blood flow of renal cortical was analyzed using ROI quantification in the corresponding region ,and vascular index ( VI) ,flow index ( FI) ,vascularization flow index ( VFI) were obtained . Results ① Patients of B grade group and C grade group in the cirrhosis group showed sparser corical blood flow and slender blood vessels . ②No statistical difference were found in the resistance index of the renal interlobaries and interlobular arteries between A grade group and control group ( P ＞0 .05) ,the RI of renal interlobar arteries and interlobular arteries in B grade group and C grade group were significantly higher ( P ＜0 .01) . Compared with the A grade group ,the RI of renal interlobar arteries and interlobular arteries in B grade group and C grade group increased evidently ( P ＜ 0 .01).The RI of renal interlobar arteries and intralobular arteries between B grade groupand C grade group showed no statistical difference (P＞0 .05).③Compared with the control group ,the VI ,FI ,and VFI of A ,B ,and C grade groups declined obviously ( P ＜ 0 .05).With the increase of cirrhosis grade ,VI ,FI and VFI gradually decreased ,and the difference among the three groups were statistically significant ( P ＜ 0 .05 ).Conclusions Patients with cirrhosis have showed a reduction in renal peripheral vascular bed and blood perfusion earlier than laboratory tests for renal dysfunction .ROI quantification of Color Doppler technique can sensitively assess changes of early renal peripheral blood perfusion in patients with cirrhosis .
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Objective To assess the clinical value of ultrasound shear wave elastography (SWE) guided biopsy for diagnosis of tuberculous peritonitis.Methods Clinical data of 25 tuberculous peritonitis patients who underwent SWE guided biopsy (SWE guided group) and other 25 tuberculous peritonitis patients who underwent conventional ultrasound guided biopsy (conventional ultrasound guided group) were retrospectively analyzed.The successful rate of biopsy and the complication occurrence were compared between the two groups.Results The success rate of SWE guided group was 100％(25/25),and the rate of complication occurrence was 8.00％ (2/25).The successful rate and complication occurrence in conventional ultrasound guided group was 84.00％ (21/25) and 32.00％ (8/25),respectively.There were statistical differences of success rate of biopsy (x2=4.348,P=0.037) and the complication occurrence (x2=4.500,P=0.034) between the two groups.Conclusion Compared with conventional ultrasound,SWE guidance can improve the success rate and reduce the complication occurrence of biopsy.
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Objective To investigate the clinical application valve of prenatal ultrasound in diagnosis of fetal isolated levocardia ( IL ) . Methods Thirty-eight IL fetuses diagnosed in three prenatal diagnosis centers from 2000 to 2016 were reviewed with their prenatal ultrasound features and cardiac and extracardiac malformations . Results Thirty-eight IL cases included 19 cases of left isomerism ( LI) ,14 cases of right isomerism( RI) and 5 non-classified cases . The overall incidence of malformations in IL patients was 97 .4％with 94 .7％ in LI patients and 100％ in RI patients . The incidence of cardiac malformations was 92 .1％with 84 .2％ in LI patients and 100％ in RI patients . The most common congenital heart diseases were:right ventricle outlet obstruction , univentricular physiology and atrioventricular septal defect . Anomalous pulmonary venous connection was more commonly seen in LI patients than in RI patients . The most common extracardiac malformation was duodenal obstruction( 86 .9％ ) . Inferior vena cava interruption and polysplenia were more commonly seen in LI patients .Juxtaposition of aorta and inferior vena cava and asplenia were more commonly seen in RI patients . Conclusions IL is very rarely seen in population with high incidence of congenital heart diseases and extracardiac malformations .
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Objective To investigate the clinical outcome and prenatal diagnosis feasibility of fetal congenital cardiac diventiculum.Methods The data of 12 fetuses with congenital cardiac diventiculum were retrospectively reviewed.The prenatal and postnatal medical records,including the characteristics of diverticulum,presence of abnormalities,karyotype and the outcomes of each pregnancy were collected.Results The overall incidence of cardiac diventiculum was 0.03％ (12/40 564) and the rate of incidence between left and right ventricle was 2 ∶ 1.Mean size of diventiculum was (69.75 ± 28.73)mm2,mean diameter of the diventiculum neck was (3.58 ± 0.80) mm and mean thickness of diventiculum wall was (1.54± 0.29)mm.Seven cases (58.4％) as an isolated malformation,5 cases (41.6％) combined with cardiac defect and extracardiac abnormalities,2 cases (16.7 ％) with chromosomal abnormalities.Five cases underwent termination of pregnancy,1 case died in uterus and 6 cases were born live.The mean follow-up periods was (62.33±-36.52)month.Of the 6 follow-up cases,4 cases (66.7％) remained asymptomatic,one case underwent drug therapy because of arrhythmia and one case combined with VSD underwent operation.Conclusions Echocardiography could be an useful tool to demonstrate and monitor congenital cardiac diventiculum prenatally and postnatally.The outcome of cardiac diventiculum depends on the size,progression,and the combined abnormalities and complications.
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Objective To investigate global cerebral blood flow perfusion in fetuses with congenital heart disease (CHD)by three-dimensional power Doppler ultrasound (3D PD).Methods The vascular index (VI),flow index (FI)and vascular/flow index (VFI)in the global cerebral were prospectively compared in 1 12 fetuses with CHD and 1 12 normal fetuses using 3D PD.Correlations between the 3D PD indices and neurodevelopment scores were assessed.Results Compared with the controls,the VI,FI and VFI of the global brain were significantly increased in fetuses with hypoplastic left heart syndrome (HLHS) and left sided obstructive lesions (LSOLs)(P <0.001).The mean psychomotor development index (PDI) and mental development index (MDI)scores were significantly lower than normal (P < 0.001 ).FI was positively correlated with PDI (r =0.342,P =0.029)and MDI (r =0.339,P =0.030).Conclusions Global cerebral blood flow perfusion was significantly increased in most fetuses with CHD and had association with neurodevelopment scores.3D PD ultrasound might help to identify cases of brain vasodilatation earlier and inform parental counseling.
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Objective To investigate the regional cerebral blood flow perfusion in fetuses with congenital heart disease (CHD)by three-dimensional power Doppler ultrasound (3D PD).Methods The vascular index (VI),flow index (FI)and vascular/flow index (VFI)in the main arterial territories [middle cerebral artery (MCA ),anterior cerebral artery (ACA ) and posterior cerebral artery (PCA )] were prospectively compared in 1 12 fetuses with CHD and 1 12 normal fetuses using 3D PD.Correlations between the 3D PD indices and neurodevelopment scores were assessed.Results Compared with the controls,the VI,FI and VFI of the three main arteries were significantly increased in fetuses with hypoplastic left heart syndrome (HLHS)and left sided obstructive lesions (LSOL)(P < 0.001 ).The mean psychomotor development index (PDI)and mental development index (MDI)scores were significantly lower than normal (P <0.001).ACA VI and ACA VFI were positively correlated with PDI (r =0.377,P =0.01 5 and r =0.389,P = 0.012,respectively)but were not correlated with MDI.Conclusions Cerebral blood flow perfusion in three main arteries was significantly increased in fetuses with HLHS/LSOL,and blood flow perfusion in ACA area was significantly increased in fetuses with TGA.ACA-VI,ACA-FI had association with neurodevelopment scores.3D PD ultrasound might help to identify cases of brain vasodilatation earlier and inform parental counseling.
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OBJECTIVE@#To evaluate the superiority, feasibility and clinical signifi cance of the four-dimensional spatio-temporal image correlation (STIC) in detection of the right ventricle function of fetus.@*METHODS@#Th e STIC dynamic images of 180 normal fetal hearts at 24+0 to 37+6 weeks of gestation were obtained by the three-dimensional (3D) probe. Th e post-process evaluation was done off -line with the virtual organ computer-aided analysis (VOCAL) software. The computer recorded the right ventricular end-diastolic volume (RVEDV), right ventricular end-systolic volume (RVESV), and then calculated the right stroke volume (RSV), the right cardiac output (RCO) and the right ejection fraction (REF). RCO was standardized by biometric measurements obtained at prenatal screening, including head circumference (HC), abdominal circumference (AC), femur length (FL) and estimated fetal weight (EFW).@*RESULTS@#The overall successful rate in image acquisition was 83.89% and the repeatability was favorable. After the standardization of fetal biometric parameters (HC, AC, FL) and the right ventricle function indexes (RVEDV, RVESV, RSV), RCO was increased with the gestational age while the REF and RCO/EFW fluctuated within a certain range.@*CONCLUSION@#STIC technique can accurately and objectively measure the fetal ventricular volume and it might be a potential strategy in the clinical assessment of the fetal cardiac function.
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Female , Humans , Pregnancy , Biometry , Fetal Heart , Diagnostic Imaging , Physiology , Gestational Age , Stroke Volume , Ultrasonography, Prenatal , Ventricular Function, RightABSTRACT
OBJECTIVE@#To discuss the value of fetal pulmonary venous Doppler flow patterns in hypoplastic left heart syndrome (HLHS).@*METHODS@#Forty-six HLHS and 180 normal singleton fetuses at 24+0 to 37+6 weeks of gestation were enrolled in this study. The blood flow of pulmonary vein (PV) was detected by color Doppler ultrasound. The systolic wave of ventricle (S-wave), diastolic wave of ventricle (D-wave), atrial contraction wave (A-wave) and S/D ratio of PV were measured. The statistical difference in the above parameters between HLHS and normal fetuses was compared. The diagnosis was also confirmed by autopsy in still birth or postnatal follow-up when the baby was alive.@*RESULTS@#The PV blood flow in HLHS fetuses had a high possibility of reversed A wave, and the velocity of S wave and S/D ratio were higher than the matched normal controls (P<0.001). There were 3 types of PV blood flow patterns among all fetuses with HLHS. Both the cases with right to left shunt through foramen ovale (FO) and the cases with restricted left to right shunt at FO showed the triphasic patterns of PV with antegrade S wave, D wave and retrograde A wave. However, the latter had a higher velocity of retrograde A wave (P<0.001), lower D wave (P<0.001), and obviously elevated S wave and S/D ratio (P<0.001). The cases with intact interatrial septum showed short and apparent pulsatile back and forth blood flow in the PV, which displayed as absence of D wave.@*CONCLUSION@#The 3 types of PV blood flow patterns in the fetuses with HLHS reflect the severity of hypertension in the left atrium, which is extremely vital for the prognosis and the perinatal treatment plan.
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Female , Humans , Pregnancy , Diastole , Echocardiography, Doppler , Fetus , Heart Atria , Heart Ventricles , Hypoplastic Left Heart Syndrome , Diagnosis , Pulmonary Veins , Systole , Ultrasonography, PrenatalABSTRACT
OBJECTIVE@#To investigate the clinical significance of 3-vessel subsequence view in prenatal screening and diagnosis of fetal congenital heart disease.@*METHODS@#The 3-vessel subsequence view of 231 fetuses with congenital heart disease was obtained with Sequoia 512, Voluson 730 and E8 color Doppler ultrasonographic diagnostic system.@*RESULTS@#Of the 231 consecutive fetuses with congenital heart defects (CHD), 169 (73%) had at least 1 abnormality on the 3-vessel subsequence view. When ventricl septal defects and so on were excluded, the detection rate increased to 91%. Some defects had several abnormalities visualized at the 3-vessel subsequence view.@*CONCLUSION@#The 3-vessel subsequence view has high detection rate in identifying the presence of CHD.
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Female , Humans , Pregnancy , Fetal Diseases , Diagnostic Imaging , Fetus , Heart Defects, Congenital , Diagnostic Imaging , Ultrasonography, PrenatalABSTRACT
OBJECTIVE@#To assess the left ventricular (LV) longitudinal systolic and diastolic function in patients treated by epirubicin by velocity vector imaging (VVI) and to discuss the important clinical value of VVI in quantitatively evaluating the regional longitudinal function.@*METHODS@#Thirty patients with breast cancer treated with epirubicin chemotherapy and 30 normal controls were included in the study. Dynamic images of apical long axis, four-chamber and two chamber view were obtained in all subjects, and the longitudinal systolic and diatolic parameters were measured in all subjects, including systolic maximum velocity (Vs), systolic maximum strain (SS), systolic maximum strain rate (SSR), diastolic maximum velocity (Vd), and diastolic maximum strain rate (DSR). The parameters were compared between the 2 groups. The conventional echcardiographic parameters were also obtained.@*RESULTS@#There was no significant change in all baseline parameters before the chemotherapy in 30 breast cancer patients compared with the normal controls (P>0.05). After the second chemotherapy cycle, DSR was lower in every segment, Vd was lower in the free wall, mainly the lateral, anterior and inferior wall (P0.05). After the third chemotherapy cycle, Vd, DSR and SSR decreased significantly in all segments (P0.05).@*CONCLUSION@#VVI can monitor the epirubicin cardiotoxicity early and is more sensitive than echocardiograph.
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Adult , Female , Humans , Middle Aged , Antineoplastic Combined Chemotherapy Protocols , Therapeutic Uses , Blood Flow Velocity , Breast Neoplasms , Drug Therapy , Carcinoma, Ductal, Breast , Drug Therapy , Cardiac Volume , Case-Control Studies , Echocardiography , Elasticity Imaging Techniques , Epirubicin , Ventricular Dysfunction, Left , Diagnostic ImagingABSTRACT
Objective To investigate the clinical value of velocity vector imaging (VVI) in the assessment of cardiac torsion in fetuses with gestational diabetes mellitus(GDM).Methods Digital dynamic four-chamber views of 98 fetuses with gestational diabetes mellitus and 135 normal fetuses were collected and analyzed using VVI.Left ventricular(LV) peak apical rotation of endocardium and epicardium at basal and apical level were measured,LV peak torsion was calculated.Results 140 of 233 cases were analyzed successfully.Direction of LV peak apical and basal rotation of endocardium and epicardium in fetus could be clockwise or counter clockwise,however apical and basal level was opposite.LV peak apical and basal rotation of endocardium and epicardium in fetus were stable throughout gestation ( P ＞ 0.05).LV peak rotation of endocardium was higher than that of epicardium in both apical and basal level.The peak rotation in apical level of endocardium and epicardium was higher than that in basal level( P ＜0.05).LV peak torsion of endocardium was significantly higher than that of epicardium( P ＜0.05).Compared with normal group,LV peak rotation of endocardium and LV peak torsion in fetus with GDM were higher( P ＜0.05). Conclusions VVI can measure the LV rotation and torsion parameters,and evaluate the cardiac function of GDM fetus.
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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.
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Adult , Female , Humans , Pregnancy , Echocardiography, Four-Dimensional , Methods , Heart Defects, Congenital , Diagnostic Imaging , Image Processing, Computer-Assisted , Ultrasonography, Prenatal , MethodsABSTRACT
Objective To investigate the clinical value of velocity vector imaging in the assessment of regional left ventricular longitudinal myocardial function in fetuses with gestational diabetes mellitus (GDM). Methods Digital dynamic four-chamber views of 98 fetuses with GDM and 135 normal fetuses were collected and analyzed using velocity vector imaging. The regional tissue velocity, strain and strain rate of the interventricular septum and left lateral wall were measured in systole and diastole. Results Two hundred and seven of 233 cases were analyzed successfully. Systolic velocity(Vs) and diastolic velocity(Vd)were age-dependent, Vs and Vd were both gradually decreased from the basal segment to the apical segment in the left ventricle( P ＜0. 05). The Va after 32+0 weeks and Vd after 28+0 weeks and systolic strain(S),systolic strain rate(SRs) and diastolic strain rate(SRd) in left ventricle of fetuses with GDM after 24+0weeks were obviously lower than the corresponding parameters of normal fetuses ( P ＜0. 05). Conclusions Velocity vector imaging can evaluate the fetal regional left ventricular longitudinal myocardial function.
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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.
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Objective To evaluate regional right ventricular longitudinal function in fetus using velocity vector imaging(VVI),and establish nomogram of right ventricle,Methods One hundreed and seventy healthy fetuses were divided into 5 groups according to the gestational age.Dynamic digital views of four chamber view were collected and analyzed offline.Velocity,strain and strain rate were calculated in systolic and diastolic period,respectively.Results Normal systolic and diastolic values for velocity,strain and strain rate were established.Tissue velocity gradually decreased from the base segment to the apical segment(P＜0.05),whereas strain and strain rate were stable(P＞0.05).Tissue velocity was gestationalage dependent(P＜0.05),whereas strain and strain rate were stable throughout gestation (P＞0.05).Conclusions Fetal myocardial velocity,strain and strain rate measurements are easy to obtain and reproducible.Increase in tissue velocity throughout gestation probably reflects the growth of the fetal heart,whereas intrinsic myocardial properties as measured by strain and strain rate do not change.
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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.
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Objective To evaluate the clinic value of five different ultrasonographic fetal parameters for prenatal diagnosis of pulmonary hypoplasia.Methods Two hundred and seventy-one normal singleton pregnancies with well-established dates between 20 and 40 weeks of gestation were studied to establish normal reference range of five different ultrasonographic fetal parameters.The five parameters,which could reflect fetal lung mass,were as follows:lung area/body weight ratio,lung area,thoracic circumference/abdominal circumference ratio,lung area/thoracic area ratio and lung area/head circumference.Thirty pregnancies with risk factors for pulmonary hyperplasia were studied for the usefulness of five parameters.Two or more standard deviations below the mean control group measurement were considered abnormal.The prenatal ultrasonic diagnoses of pulmonary hyperplasia were confirmed at neonatal follow-up examinations,on autopsy and by pathologic findings.Results Lung area and lung area/head circumference increased with gestational age,lung area/body weight ratio decreased with gestational age.The relationships among the two ratios(thoracic circumference/abdominal circumference ratio,lung area/thoracic area ratio)and gestational age were relatively constant. Abnormal lung area/body weight ratio had a higher diagnostic accuracy than other parameters.Sensitivity of the parameters,including lung area,lung area/body weight ratio,thoracic circumference/abdominal circumference ratio,lung area/thoracic area ratio and lung area/head circumference were 83%,97%,50%,70% and 87%,respectively.Sensitivity of the lung area/bedy weight ratio was 95%(20/21 fetuses);specificity,9/9 fetuses;positive predictive value,100% (20/20fetuses);negative predictive value,9/10;and accuracy 97% (29/30 fetuses).Conclusion Lung area/body weight ratio is a good predictor of pulmonary hypoplasia.
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Objective To assess the left ventricular(LV)segmental function by velocity vector imaging(VVI)in uremic patients with diffferent quantity of parathyroid hormone(PTH).Methods Sixty patients with uremia were divided into 2 groups according to the value of PTH:group A with PTH less than 3 times of upper normal limit,group B with PTH more than 3 times of upper normal limit.Normal control group was 30 healthy subj ects.All people were evaluated by VVI.The parameters,including the longitudinal systolic strain rate(SSR),diastolic strain rate(DSR),were analysed among the three groups.Results Compared with normal group,in group A and B,SSR,DSR in all segments were lower.Compared with group A,in group B,DSR were all significantly lower(P＜0.05),SSR in apex of laternal wall,medium of anterior septum wall,posterior wall,medium and apex of posterior septum wall and superior wall,base,medium and apex of anterior wall were significantly lower(P＜0.05).There was no statistically significant difference of left ventricular ejection fraction between the two groups(P＞0.05).Conclusions VVI is a viable objective tool to quantitatively assess LV segmental function damaged by different quantity of PTH.