Journal of Clinical Ultrasound最新文献

Objective

To investigate the adaptation of the anterior cerebral artery (ACA) in fetuses with fetal growth restriction (FGR) and assess if forebrain and midbrain structures are affected by vascular adaptations.

Methods

A prospective case–control study involving normally developed fetuses and those with late-onset FGR (estimated fetal weight < 3rd percentile and/or abdominal circumference < 3rd percentile). Doppler indices of the middle cerebral artery (MCA), ACA and umbilical artery (UA) were determined between 32 + 0 and 37 + 0 weeks. Neurosonography assessed the depth of the insula, the sylvian fissure, and the antero-posterior diameter of the frontal lobes (FAPD).

Results

The cerebral-placental ratio (CPR) and cerebro-placental-uterine ratio (CPUR) were lower in FGR cases. ACA PI percentile values were significantly lower in the FGR group (p = 0.020). Sylvian fissure depth was significantly lower in FGR fetuses.

Conclusion

The ACA may be the first cranial vascular structure affected in fetuses with FGR. This may be related to the impact on postnatal cognitive functions in FGR patients.

Trial Registration: NCT06215690

Purpose

This study aimed (1) to determine the degree of correlation between 2D and 3D estimated fetal weight (EFW) and neonatal birth weight (BW) among borderline small fetuses and (2) to compare the accuracy and precision of 2D and 3D EFW in BW prediction.

Methods

A retrospective cohort study evaluated fetuses who had an ultrasound performed between January 2017 and September 2021 at a tertiary maternal center. All singleton pregnancies with 3D EFW within 4 weeks of delivery were included. Fetuses with known structural or genetic abnormalities were excluded. Pearson's correlation coefficients were determined for both 2D and 3D EFW to BW then compared using Williams' test and Fisher r to z transformation, where applicable. Mean percent difference and standard deviation were used to assess the accuracy and precision, respectively, of 2D and 3D EFWs in BW prediction.

Results

Two hundred forty-eight pregnancies were included. Ultrasound studies were performed with a median interval of 2 weeks (IQR 1, 3) between ultrasound and delivery. Both 2D and 3D estimated fetal weights showed a significant correlation with birth weight (r = 0.74 and r = 0.73, respectively), indicating similar accuracy between the two techniques.

Conclusion

Two-dimensional and three-dimensional EFWs performed similarly in the prediction of BW in borderline small fetuses.

Objective

To summarize the ultrasound characteristics, diagnostic experiences, and pregnancy outcomes of gravid uterine incarceration.

Methods

A retrospective analysis was conducted on the data of pregnant women diagnosed with gravid uterine incarceration by prenatal ultrasound at the Ultrasound Department of the Third Affiliated Hospital of Zhengzhou University from January 2020 to December 2023. Clinical data, ultrasound features, and pregnancy outcomes were analyzed.

Results

In this study, a total of 23 pregnant women were included. Of these, eight were diagnosed in early pregnancy, and 15 were diagnosed in mid-pregnancy. Seven participants had concurrent uterine fibroids, 10 had a history of abdominal or pelvic surgery, and two had ovarian cysts. A total of 13 cases presented with symptoms of urethral obstruction, three with rectal pressure symptoms, five cases with tight and stiff lower abdomen and two cases without special discomfort. Seventeen cases exhibited cervical compression with thinning and elongation, measuring approximately 39 to 73 mm. All 23 cases underwent manual or knee-chest positioning repositioning, with one case requiring surgical intervention. Ultimately, 22 cases resulted in full-term live births, one case experienced fetal demise at 24 weeks and one case experienced gravid uterine incarceration again in the third week after successful manual reduction, and manual reduction was performed again.

Conclusion

Early diagnosis is critical for obstetric management and clinical prognosis, facilitating the successful release of the incarcerated uterus. The earlier the diagnosis, the higher the likelihood of successfully releasing the incarcerated uterus.

Objective

We aimed to investigate how combining myocardial contrast echocardiography (MCE) with dobutamine stress echocardiography (DSE) could help evaluate myocardial perfusion in coronary heart disease patients and understand changes in microcirculation across different levels of coronary artery blockage.

Methods

We conducted MCE and DSE tests on 53 coronary heart disease patients, categorizing ischemic myocardium into four groups: A (<50%), B (50%–69%), C (70%–89%), and D (≥90%). Dynamic myocardial perfusion images were captured during rest and peak dobutamine stress from various angles, analyzing parameters like plateau value A, slope β, and the product A × β, reflecting different aspects of myocardial blood flow.

Results

Parametric values of myocardial perfusion (PVMPs) were significantly lower in group D at rest compared with other groups (p < 0.001). PVMPs increased notably at peak dobutamine stress in groups A, B, and C (p < 0.001). Groups A and B had higher PVMPs than groups C and D, with group D significantly lower (p < 0.001). β reserve values decreased gradually from group A to D, with significantly lower values of A and A × β in groups C and D compared with A and B (p < 0.001). Sensitivity and specificity for predicting >70% coronary artery blockage was 80%, 66%, and 74%, 80%, respectively, using specific thresholds.

Conclusion

Combining MCE with DSE is highly sensitive and accurate in diagnosing obstructive coronary artery blockages. It also helps assess myocardial microcirculation perfusion and left ventricular reserve function, which decline with increasing severity of coronary artery blockage.

Purpose

To evaluate superb microvascular imaging for measuring puerperal myometrial microvascular blood flows at incisional sites following cesarean delivery.

Methods

Twenty postpartum women (singleton births) were studied: 10 with cesarean and 10 with transvaginal deliveries. All cesarean cases were first operational delivery with lower uterine incision, repaired with double-layer suture. At 1 and 4 weeks postpartum, the uterus was delineated using transvaginal ultrasonography with superb microvascular imaging. Separate regions of interest were created for anterior myometrium of the isthmus and the body. The microvascular flow profile in three circular sampling points placed in a region of interest was quantified and expressed as vascular density. The vascular density ratio of the uterine isthmus to the body was compared between one and four weeks for both groups. Wilcoxon's signed-rank test was used to assess statistical significance (set at p < 0.05).

Results

In cesarean deliveries, the vascular density ratio of the uterine isthmus to the body increased from 1 (median: 0.51, range: 0.30–0.68) to 4 weeks (0.99, 0.85–1.60), whereas no changes were noted in transvaginal deliveries.

Conclusion

Superb microvascular imaging can effectively measure myometrial microvascular blood flow recovery at cesarean incision sites, indicating its potential as a tool for monitoring postpartum wound healing.

Objectives

Pubertal gynecomastia (PG) is defined as benign proliferation of male breast tissue. Ultrasonography is frequently used for follow-up of symptomatic gynecomastia. Shear wave elastography (SWE) is an auxiliary tool for the diagnosis of breast disorders. Our aim is to evaluate SWE properties of breast tissue in PG.

Methods

Fifty consecutive adolescents, aged 10–18 with a diagnosis of gynecomastia were prospectively included in the study. Following clinical and laboratory evaluation, participants underwent B-mode ultrasound and classified as nodular, dendritic, and diffuse pattern. SWE and hormonal values of all groups were recorded. Then, statistical analysis was performed.

Results

Briefly, 92 breasts (43 left and 49 right; 42 bilateral and 8 unilateral) were included in the analyses. There were no significant differences in clinical parameters including age, BMI-SDS, estradiol (E2), testosterone (T), and E₂/T levels within groups (p > 0.05). Breast volume and SWE levels were significantly different in all groups (p < 0.05). SWE values were significantly lower for those of dendritic pattern than in nodular pattern (p < 0.05). ROC analysis revealed that for the best the cut-off value of 13.7 kPa, area under the curve value was 0.922 with 84% sensitivity and 87% specificity.

Conclusions

SWE values were significantly lower in patients with dendritic gynecomastia than those with nodular gynecomastia. Knowledge of the SWE values for the initial diagnosis and follow-up values could help avoid unnecessary interventions.