Prenatal ultrasonography of craniofacial abnormalities

Craniofacial abnormalities are common. It is important to examine the fetal face and skull Epub ahead of print during prenatal ultrasound examinations because abnormalities of these structures may indicate the presence of other, more subtle anomalies, syndromes, chromosomal abnormalities, or even rarer conditions, such as infections or metabolic disorders. The prenatal diagnosis of craniofacial abnormalities remains difficult, especially in the first trimester. A systematic approach to the fetal skull and face can increase the detection rate. When an abnormality is found, it is important to perform a detailed scan to determine its severity and search for additional abnormalities. The use of 3-/4-dimensional ultrasound may be useful in the assessment of cleft palate and craniosynostosis. Fetal magnetic resonance imaging can facilitate the evaluation of the palate, micrognathia, cranial sutures, brain, and other fetal structures. Invasive prenatal diagnostic techniques are indicated to exclude chromosomal abnormalities. Molecular analysis for some syndromes is feasible if the family history is suggestive.

Clinical value of transvaginal three-dimensional ultrasonography in the differential diagnosis of benign and malignant endometrial diseases after menopause / 中国基层医药

Objective@#To investigate the clinical value of transvaginal three-dimensional ultrasonography in the differential diagnosis of benign and malignant endometrial diseases after menopause.@*Methods@#From April 2015 to April 2017, the imaging data of transvaginal three-dimensional ultrasonography of 184 patients with benign and malignant breast tumors in the Second People's Hospital of Yuhang District were retrospectively analyzed.The peak systolic flow velocity, resistance index, peak systolic velocity, intimal arterial resistance index and blood flow display rate of uterine artery of benign and malignant endometrial diseases were compared.@*Results@#The accuracy, sensitivity and specificity of transvaginal three-dimensional ultrasonography in the diagnosis of endometrial diseases were 91.30%(168/184), 92.00%(46/50), 91.04%(122/134), respectively.There were no statistically significant differences in the peak systolic flow velocity, resistance index, peak systolic velocity of patients with benign and malignant endometrial diseases by transvaginal three-dimensional ultrasonography(t=1.17, 0.88, 0.51, all P>0.05). The intimal arterial resistance index of patients with malignant endometrial diseases by transvaginal three-dimensional ultrasonography was significantly lower than patients with benign endometrial diseases(t=2.59, P<0.05). The blood flow display rates of uterine artery of patients with malignant endometrial diseases by transvaginal three-dimensional ultrasonography were 19.40%(26/134), 92.00%(46/50). The blood flow display rate of uterine artery of patients with malignant endometrial diseases by transvaginal three-dimensional ultrasonography was significantly higher than patients with benign endometrial diseases(χ2=7.26, P<0.05).@*Conclusion@#Transvaginal three-dimensional ultrasonography in the differential diagnosis of benign and malignant endometrial diseases after menopause has higher accuracy, sensitivity and specificity.

Comparison of Two- and Three-dimensional Ultrasonography in the Evaluation of Lesion Level in Fetuses with Spina Bifida / Comparação entre a ultrassonografia bidimensional e a ultrassonografia tridimensional na avaliação do nível da lesão nos fetos com espinha bífida

Purpose To evaluate the precision of both two- and three-dimensional ultrasonography in determining vertebral lesion level (the first open vertebra) in patients with spina bifida. Methods This was a prospective longitudinal study comprising of fetuses with open spina bifida who were treated in the fetal medicine division of the department of obstetrics of Hospital das Clínicas of the Universidade de São Paulo between 2004 and 2013. Vertebral lesion level was established by using both two- and three-dimensional ultrasonography in 50 fetuses (two examiners in each method). The lesion level in the neonatal period was established by radiological assessment of the spine. All pregnancies were followed in our hospital prenatally, and delivery was scheduled to allow immediate postnatal surgical correction. Results Two-dimensional sonography precisely estimated the spina bifida level in 53% of the cases. The estimate error was within one vertebra in 80% of the cases, in up to two vertebrae in 89%, and in up to three vertebrae in 100%, showing a good interobserver agreement. Three-dimensional ultrasonography precisely estimated the lesion level in 50% of the cases. The estimate error was within one vertebra in 82% of the cases, in up to two vertebrae in 90%, and in up to three vertebrae in 100%, also showing good interobserver agreement. Whenever an estimate error was observed, both two- and three-dimensional ultrasonography scans tended to underestimate the true lesion level (55.3% and 62% of the cases, respectively). Conclusions No relevant difference in diagnostic performance was observed between the two- and three-dimensional ultrasonography. The use of three-dimensional ultrasonography showed no additional benefit in diagnosing the lesion level in the fetuses with spina bifida. Errors in both methods showed a tendency to underestimate lesion level.

Objetivo Avaliar a precisão da ultrassonografia bidimensional e tridimensional para a determinação do nível da lesão vertebral em casos de fetos portadores de espinha bífida. Métodos Estudo prospectivo longitudinal, compreendendo fetos portadores de espinha bífida assistidos no setor de medicina fetal de hospital de ensino do Sudeste do Brasil, entre os anos de 2004 e 2013. Foram incluídos 50 fetos portadores de espinha bífida pela ultrassonografia bidimensional e tridimensional (dois examinadores em cadamétodo) comrelação ao nível da lesão. O nível exato da lesão foi verificado usando radiografia após o nascimento. Resultados A ultrassonografia bidimensional estimou corretamente o nível de espinha bífida em 53,0% dos casos. Em 80,0% dos casos a estimativa ocorreu com erro de uma vértebra; 89,0% em até duas vértebras e de 100,0% em até três vértebras. A ultrassonografia tridimensional estimou corretamente o nível de espinha bífida em 50,0% dos casos. Em 82,0% dos casos, a estimativa ocorreu com erro de uma vértebra; 90,0% em até duas vértebras e de 100,0% em até três vértebras. Nos casos em que houve erro na estimativa do nível da lesão, tanto na avaliação bidimensional quanto na tridimensional, observou-se tendência a subestimar o nível da lesão vertebral (55,3% na avaliação bidimensional e 62,0% na tridimensional), ou seja, colocando o nível ultrassonográfico mais baixo que o observado no pós-natal. Conclusões Não houve diferenças relevantes entre o desempenho diagnóstico da ultrassonografia bidimensional e tridimensional para determinação do nível da lesão vertebral nos casos de fetos portadores de espinha bífida. Tendência a subestimação do nível de lesão nos casos em que houve erro tanto na ultrassonografia bidimensional quanto na tridimensional.

Comparison of two- and three-dimensional sonography for the prediction of the extrathyroidal extension of papillary thyroid carcinomas

BACKGROUND/AIMS: The purpose of this study was to compare the diagnostic validity of two-dimensional (2D) and three-dimensional (3D) ultrasonography (US) when predicting the extrathyroidal extension of papillary thyroid cancer. METHODS: All 2D data were interpreted in real time and 3D data were stored, rendered using tomographic ultrasound imaging (TUI), and then reviewed retrospectively. RESULTS: Extrathyroidal extension was present in 17 papillary thyroid cancers(24.3%) on pathology reports. The presence of contact was significantly associated with extrathyroidal extension on both 2D and 3D US (p = 0.007 and p = 0.003), and the sensitivity and specificity were not significantly different between 2D and 3D US (p = 1.000 and p = 0.754). The coexistence of protrusion and contact was not significantly associated with extrathyroidal extension on either 2D or 3D sonogram. CONCLUSIONS: Three-dimensional images rendered with TUI algorithms alone do not seem to be markedly superior to real-time 2D US in predicting the extrathyroidal extension of papillary thyroid cancer.

Assessment of embryo/fetus during pregnancy by threedimensional ultrasonography using the HD live software: iconographic essay / Avaliação do embrião/feto ao longo da gestação por meio da ultrassonografia tridimensional com o software HD live: ensaio iconográfico

Fetal development is studied since the advent of two-dimensional ultrasonography. However, a detailed assessment of structures and surfaces improved with three-dimensional ultrasonography. Currently, it is possible to identify embryonic components and fetal parts with greater detail, at all pregnancy trimesters, using the HD live software, where the images gain realistic features by means of appropriate control of lighting and shadowing effects. In the present study, the authors utilized this resource to follow-up, by means of images, the development of a normal pregnancy along all trimesters.

O desenvolvimento fetal é estudado desde o advento da ultrassonografia bidimensional. Entretanto, a avaliação pormenorizada de estruturas e superfícies ganhou maior qualidade com a ultrassonografia tridimensional. Atualmente, é possível identificar componentes embrionários e partes do feto com maior riqueza de detalhes, em todos os trimestres da gestação, utilizando o software HD live, no qual a imagem ganha características realísticas mediante controle adequado de luz e sombreamento. Neste estudo utilizamos este recurso, por meio de imagens, para acompanhar a evolução de uma gestação normal em todos os seus trimestres.

Prenatal diagnosis of epignathus with multiple malformations in one fetus of a twin pregnancy using three-dimensional ultrasonography and magnetic resonance imaging

Epignathus is an extremely rare type of congenital teratoma arising in the oral cavity. Although it is a benign tumor, it is associated with high mortality and morbidity rates because of severe airway obstruction and other malformations. We present a case of epignathus affecting one fetus in a twin pregnancy. The tumor was associated with multiple congenital malformations including cleft palate, bifid tongue, bifid uvula, congenital heart defect, and bilateral inguinal hernias. The diagnostic value of three-dimensional ultrasonography and magnetic resonance imaging was explored with respect to antenatal counseling and peripartum management.

Intervalos de referência para o volume da cisterna magna fetal por meio do método bidimensional usando o modo multiplanar da ultrassonografia tridimensional / Reference intervals of fetal cisterna magna volume by two-dimensional method using the multiplanar mode of three-dimensional ultrasonography

Objetivo: Determinar intervalos de referência para o volume da cisterna magna fetal por meio do método bidimensional (2D) usando o modo multiplanar da ultrassonografia tridimensional. Materiais e Métodos: Estudo de corte transversal com 224 gestantes normais entre a 17ª e 29ª semanas. O volume foi obtido automaticamente pela multiplicação dos três maiores eixos nos planos axial e sagital pela constante 0,52. Regressão polinomial foi realizada para obter correlação entre o volume 2D da cisterna magna e a idade gestacional, sendo os ajustes realizados pelo coeficiente de determinação (R2). Confiabilidade e concordância foram obtidas pelo coeficiente de correlação intraclasse (CCI) e limites de concordância. Resultados: A média do volume da cisterna magna 2D variou de 0,71 ± 0,19 cm3 para 4,18 ± 0,75 cm3 entre a 17ª e 29ª semanas, respectivamente. Observou-se boa correlação do volume da cisterna magna fetal 2D e a idade gestacional (R2 = 0,67). Observou-se excelente confiabilidade e concordância intraobservador com CCI = 0,89 e limites de concordância 95% (-52,0; 51,8), respectivamente. Observou-se baixa confiabilidade e concordância interobservador com CCI = 0,64 e limites de concordância 95% (-110,1; 84,6), respectivamente. Conclusão: Intervalos de referência para o volume 2D da cisterna magna fetal usando o modo multiplanar da ultrassonografia tridimensional foram determinados e apresentaram excelente confiabilidade e concordância intraobservador. .

Objective: To establish reference intervals for the fetal cisterna magna volume by means of two-dimensional (2D) method using the multiplanar mode of three-dimensional ultrasonography. Materials and Methods: Cross-sectional study with 224 healthy pregnant women between the 17th and 29th gestational weeks. The volume was automatically obtained by multiplying the three major axes in axial and sagittal planes by the constant 0.52. Polynomial regression was utilized to establish the correlation between fetal cisterna magna volume and gestational age, with adjustments by coefficient of determination (R2). Reliability and agreement were obtained by intraclass correlation coefficient (ICC) and limits of agreement, respectively. Results: Mean fetal cisterna volume with the 2D method ranged from 0.71 ± 0.19 cm3 to 4.18 ± 0.75 cm3 at the 17th and 29th weeks, respectively. The authors observed a good correlation between fetal cisterna magna volume and gestational age (R2 = 0.67), excellent intraobserver reliability and agreement with ICC = 0.89 and limits of agreement 95% (-52.0; 51.8), respectively, and low interobserver reliability and agreement with ICC = 0.64 and limits of agreement 95% (-110.1; 84.6), respectively. Conclusion: Reference intervals for fetal cisterna magna volume by means of 2D method using the multiplanar mode of three-dimensional ultrasonography were established and presented excellent intraobserver reliability and agreement. .

Correlation between Ultrasonography Findings and Electrodiagnostic Severity in Carpal Tunnel Syndrome: 3D Ultrasonography

BACKGROUND AND PURPOSE: To determine the correlation between the cross-sectional area (CSA) of the median nerve measured at the wrist using three-dimensional (3D) ultrasonography (US) and the electrophysiological severity of carpal tunnel syndrome (CTS). METHODS: We prospectively examined 102 wrists of 51 patients with clinical CTS, which were classified into 3 groups according to the electrodiagnostic (EDX) findings. Median nerve CSAs were measured using 3D US at the carpal tunnel inlet and at the level of maximal swelling. RESULTS: Ten wrists were negative for CTS. Of the 92 CTS-positive wrists, 23, 30, and 39 were classified as having mild, moderate, and severe CTS, respectively. The median nerve CSA differed significantly between the severe- and moderate-CTS groups (p=0.0007 at the carpal tunnel inlet and p<0.0001 at the maximal swelling site). There was a correlation between median nerve CSA and EDX parameters among those wrists with severe and mild CTS (p<0.0001 at both sites). CONCLUSIONS: The median nerve CSA as measured by 3D US could provide additional information about the severity of CTS, as indicated by the strong correlation with standard EDX findings.

Prenatal diagnosis of Beckwith-Wiedemann syndrome by two- and three-dimensional ultrasonography / Diagnóstico pré-natal da síndrome de Beckwith-Wiedemann pela ultrassonografia bidimensional e tridimensional

Beckwith-Wiedemann syndrome is a genetic syndrome characterized by macroglossia, omphalocele, fetal gigantism and neonatal hypoglycemia. The authors report a case of Beckwith-Wiedemann syndrome diagnosed in a 32-year-old primigravida in whom two-dimensional ultrasonography revealed the presence of abdominal wall cyst, macroglossia and polycystic kidneys. Three-dimensional ultrasonography in rendering mode was of great importance to confirm the previous two-dimensional ultrasonography findings.

Radiologic Findings of Inguinoscrotal Bladder Herniation Including 3D Ultrasonography: A Case Report

Inguinoscrotal bladder hernia is relatively common in obese males over 50 years old, especially patients with benign prostate hyperplasia. Various imaging modalities are used for diagnosis of inguinoscrotal bladder hernia. In particular, ultrasonography has many benefits, including non-invasiveness, and the fact that it does not require exposure to radiation; however, no domestic cases of ultrasonographic diagnosis of inguinoscrotal bladder hernia have been reported. The authors report on a case of a 67-year-old male patient with right scrotal swelling diagnosed as inguinoscrotal bladder hernia by ultrasonography, including three-dimensional imaging. Findings on ultrasonography showed a sacular lesion in the scrotum, which was connected to the urinary bladder through the inguinal canal; additional findings on CT, PET, and cystography showed that the entire lesion had a dumbbell shape.

Qual é o valor da ultrassonografia 3D em ginecologia / What is the value of 3D ultrasound in gynecology

A ultrassonografia (US) 3D tem sido cada vez mais utilizada, nas diversas áreas da Ginecologia, por oferecer de forma mais objetiva e reprodutível as medidas do volume e vascularização da região de interesse, melhor avaliação da normalidade ou patologia dos órgãos estudados, reduzir o tempo de varredura e permitir o armazenamento de imagens para reavaliação posterior. Para a realização deste estudo, efetuou-se uma pesquisa no banco de dados PubMed/Medline compreendendo os estudos publicados entre os anos de 1966 a 2010. Os resultados da pesquisa mostram que, embora a US 3D tenha uma utilização crescente em ginecologia, são necessários mais estudos prospectivos de maior consistência para validar a técnica.

Three-dimensional ultrasound (US 3D) has been increasingly used in various gynecologic areas. It offers more objective and reproducible measurements of volume and vascularization in the region of interest, better evaluating the normality or pathology aspects of the organs, reducing scanning time and allowing storage of images for later review. We searched the PubMed/Medline database including in this review the studies published between the years of 1966 to 2010. The results show that although the US 3D has an increasing application in gynecology, we need more prospective studies of greater consistency to validate this technique.

Reprodutibilidade do volume de membros fetais pela ultrassonografia tridimensional utilizando o método XI VOCAL / Reproducibility of fetal limbs volume by three-dimensional ultrasonography utilizing the XI VOCAL method

OBJETIVO: Avaliar a reprodutibilidade do volume do braço e coxa fetais aferido pela ultrassonografia tridimensional utilizando o método eXtended Imaging Virtual Organ Computer-aided AnaLysis (XI VOCAL). MATERIAIS E MÉTODOS: Realizou-se estudo de reprodutibilidade com 43 fetos normais entre 20 e 37 semanas. Para o cálculo do volume do braço e coxa fetais utilizou-se o método XI VOCAL com delimitação de 10 planos consecutivos. Para o cálculo da variabilidade interobservador, um examinador realizou uma medida do volume do braço e coxa dos 43 fetos, enquanto um segundo examinador, sem o conhecimento prévio dos resultados do primeiro examinador, realizou uma segunda medida dos mesmos volumes. Utilizaram-se, para os cálculos estatísticos, o coeficiente de correlação intraclasse (ricc), gráficos de Bland-Altman e teste t-Student pareado (p). RESULTADOS: Observou-se alta reprodutibilidade interobservador. Para o volume do braço, obtiveram-se ricc = 0,996 (intervalo de confiança [IC] 95 por cento: 0,992; 0,998) e média das diferenças = 0,13 ± 1,29 por cento (95 por cento limites de concordância: -2,54; +2,54 por cento). Para o volume da coxa, obtiveram-se ricc = 0,997 (IC 95 por cento: 0,995; 0,999) e média das diferenças = 0,24 ± 7,60 por cento (95 por cento limites de concordância: -7,6; +7,6 por cento). CONCLUSÃO: O volume do braço e coxa fetais aferido pela ultrassonografia tridimensional utilizando o método XI VOCAL apresentou elevada reprodutibilidade interobservador.

OBJECTIVE: To assess the reproducibility of fetal thigh and upper arm volumes measurement by threedimensional ultrasonography utilizing the eXtended Imaging Virtual Organ Computer-aided AnaLysis (XI VOCAL) method. MATERIALS AND METHODS: This reproducibility study enrolled 43 pregnant women with healthy singleton pregnancies between 20 and 37 gestational weeks. The XI VOCAL 10 planes was the method utilized for volumetric measurement of the fetal limbs. The calculation of the interobserver reproducibility was based on blind volumetric measurements of fetal thighs and upper-arms performed by two observers in 43 fetuses. Intraclass correlation coefficient (ICC), Bland-Altman plots and paired Student's t-test (p) were utilized in the statistical analysis. RESULTS: A high interobserver reproducibility was observed. For the upper arm volume ICC was 0.996 (confidence interval [CI] 95 percent: 0.992; 0.998) and mean difference = 0.13 ± 1.29 percent (95 percent limits of agreement: -2.54; +2.54 percent). For the thigh volume, ICC was 0.997 (CI 95 percent: 0.995; 0.999) and mean difference = 0.24 ± 7.60 percent (95 percent limits of agreement: -7.6; +7.6 percent). CONCLUSION: Fetal thigh and upper arm volumes measured by three-dimensional ultrasonography with the XI VOCAL method presented a high interobserver reproducibility.

Prenatal assessment of normal fetal pulmonary grey-scale and lung volume by three-dimensional ultrasonography / 西安交通大学学报·英文版

Objective: To quantitatively analyze the fetal lung echo and right lung volume in the third trimester by real-time three-dimensional ultrasound (3-D US) and evaluate the feasibility of fetal lung maturity. Methods: A total of 732 women with normal singleton pregnancies between 28 and 42 weeks of gestation underwent ultrasound examination. The 3-D US equipment with a 3.5-5 MHz transabdominal transducer was used for the fetal biometric measurement. The echogenicity ratio between fetal lung and liver was compared. The fetal lung volume was calculated by the rotational multiplanar technique for volume measurement (VOCAL). Results: The right fetal lung volume increased with the increase of gestational age with a linear positive correlation (r = 0.884, P<0.01). After 34 weeks, the echogenicity ratio of fetal lung to liver was more than 1.1. Conclusion: The echogenicity of lung/liver and fetal lung volume could be used as normal fetal predictable indicators for fetal lung maturity.

Thoraco-omphalopagus conjoined twins diagnosed at 14 weeks of gestation / 대한산부인과학회지

Conjoined twins are very rare and the mortality rate of the fetus is extremely high. Early prenatal diagnosis is crucial, as it provides the opportunity for the mother and father to help in recognizing the conjunction of the twins and to help medical team in defining the prognosis of conjoined twins. We present a case of thoraco-omphalopagus conjoined twins diagnosed by two-dimensional and three-dimensional transabdominal sonography at 14(+2) weeks of gestation.

Prenatal assessment of normal fetal pulmonary grey-scale and lung volume by three-dimensional ultrasonography / 药物分析学报

Objective To quantitatively analyze the fetal lung echo and right lung volume in the third trimester by real-time three-dimensional ultrasound (3-D US) and evaluate the feasibility of fetal lung maturity. Methods A total of 732 women with normal singleton pregnancies between 28 and 42 weeks of gestation underwent ultrasound examination. The 3-D US equipment with a 3.5-5MHz transabdominal transducer was used for the fetal biometric measurement. The echogenicity ratio between fetal lung and liver was compared. The fetal lung volume was calculated by the rotational multiplanar technique for volume measurement (VOCAL). Results The right fetal lung volume increased with the increase of gestational age with a linear positive correlation (r=0.884, P<0.01). After 34 weeks, the echogenicity ratio of fetal lung to liver was more than 1.1. Conclusion The echogenicity of lung/liver and fetal lung volume could be used as normal fetal predictable indicators for fetal lung maturity.

Preoperative Three Dimensional Ultrasonographic Evaluation of the Rotator Cuff Tear

PURPOSE: We wanted to determine if preoperative three dimensional (3D) ultrasonographic evaluation for rotator cuff tear is useful to measure the real size of a torn rotator cuff for performing an operation MATERIALS AND METHODS: This study included 15 cases (7 males and 8 female), and these patients were confirmed to have a full thickness tear of the rotator cuff by 3D ultrasonography and the operative findings, as well as on the magnetic resonance imaging (MRI). The average age of the patients was 55.4yrs. RESULTS: The average difference between the 3D ultrasonographic and operative measurements of the full thickness tear of the rotator cuff was 0.7 mm in the transverse length and 2.0 mm in the longitudinal length. CONCLUSION: The low error between the 3D ultrasonographic and intraoperative measurements of rotator cuff tear shows the usefulness of preoperative 3D ultrasonographic evaluation for rotator cuff tear.

Prenatal diagnosis of thrombocytopenia-absent radius syndrome using three-dimensional ultrasound / 대한산부인과학회지

We describe a case of thrombocytopenia-absent radius syndrome suspected by ultrasonography, later confirmed by fetal blood analysis. From this case we confirmed the usefulness of three-dimensional ultrasonography in diagnosing abnormalities in the fetal skeletal system and genetic counseling.

A case of thoraco-omphalopagus with omphalocele with 3D ultrasonography and MRI / 대한산부인과학회지

One of the most interesting congenital malformations is a conjoined twin. Conjoined twins are a rare occurrence in obstetric practice. More commonly known as Siamese twins, this phenomenon is shrouded in mystery and considered a curiosity by general public. Current technology is providing a basis for earlier diagnosis and a better prognosis. Frequently, the twins are born dead, but there are a few cases in which the twins survive. We present a case of thoraco-omphalophagus with omphalocele in 35 years old woman at 25weeks 5 days gestation by 3-D ultrasonography and MRI.