RESUMEN
Objective:To analyze the fetal ultrasonographic features of malformation of cortical development (MCD) during the second trimester, and explore and summarize the relevant diagnostic clues, so as to improve the ability of diagnosis and differential diagnosis of fetal MCD.Methods:A total of 313 fetuses with brain abnormalities suspected on ultrasound in Chengdu Women′s and Children′s Central Hospital from April 2018 to August 2022 were retrospectively analyzed. The fetuses were examined using MRI. The ultrasonographic characteristics of fetal MCD were summarized, and the fetal ultrasound and MRI imaging data were compared for fetal MCD.Results:Nineteen fetuses were diagnosed with MCD from 313 fetuses(6.07%, 19/313). Seventeen cases of MCD were identified by ultrasonography and subsequently validated by fetal MRI, including 6 cases of schizencephaly, 2 cases of hemimegalencephaly(HMEG), 3 cases of periventricular nodular heterotopia(PVNH), 3 cases of lissencephaly, 2 cases of microcephaly and 1 case of polymicrogyria(PMG). There were 3 cases with two concurrent MCD, 1 case of HMEG, and MRI increased the diagnosis of left parietal PMG; 1 case of lissencephaly, and MRI increased the diagnosis of PVNH. The other case was PMG, and MRI increased the diagnosis of lissencephaly. Two cases of fetal MCD were not indicated by ultrasonography, one of which was diagnosed as tuberous sclerosis and another one as schizencephaly by MRI, both due to ventriculomegaly.Conclusions:Various types of MCD in the second trimester have ultrasonographic characteristics. Abnormal lateral ventricles, intracranial structural changes such as sulci and gyrus can provide reliable ultrasound diagnostic clues for fetal MCD.
RESUMEN
Objective:To evaluate the characteristics of cervical hardness and softness in the second trimester, and to explore the predictive value of the combination of cervical elastographic parameters and cervical length(CL) in spontaneous preterm birth (sPTB).Methods:The clinical data of 147 women with full-term birth(full-term birth group) and 24 women with sPTB(sPTB group) who received prenatal examination in Chengdu Women′s and Children′s Central Hospital from January 2018 to December 2019 were reviewed. Multiple parameters were measured between 16-28 gestational weeks by the transvaginal ultrasound E-cervix technique. CL, elasticity contrast index(ECI), hardness ratio(HR), mean strain at internal os(IOS), mean strain at external os(EOS), the ratio of IOS to EOS(IOS/EOS) were obtained.Elastographic parameters and CL were compared between the two groups. Furthmore, binary regression was established, while the area under ROC curve(AUC) was used to evaluate the predictive efficiency of elastographic parameters and CL in sPTB, both alone and in combination with other parameters.Results:The elastographic parameters IOS and IOS/EOS in the sPTB group were higher than those in the full-term birth group, while HR and CL were lower than those in the full-term birth group (all P<0.05). There were no statistical differences of ECI and EOS between the two groups(both P>0.05). The AUCs of predicting sPTB with single IOS, IOS/EOS were 0.684 and 0.625, higher than the AUCs of HR, CL. The combination of IOS/EOS and CL, IOS and CL showed higher AUCs than elastographic parameters alone, with the AUC 0.788 of IOS/EOS combined with CL. The sensitivity was 70.8%, and the specificity was 87.3% corresponding to the optimum cutoff value(IOS/EOS was 1.22, CL was 3.46 cm). Conclusions:In the second trimester, sPTB has a lower hardness cervix than that of full-term women, especially the internal os of cervix. The combination of IOS/EOS and CL tends to improve the ability of predicting sPTB in pregnant women.