二维联合三维超声在中晚孕期宫腔内条索状回声诊断中的临床价值

Clinical value of two-dimensional combined with three-dimensional ultrasound in the diagnosis of intrauterine cord-like echo during the second and third trimester of pregnancy

目的 分析中晚孕期宫腔内异常条索状回声的二维及三维超声表现,提高超声医师对其的认识和诊断水平。方法 回顾性分析224例中晚孕期超声检查发现宫腔内异常条索状回声病例的临床资料,收集并记录正常分娩后或术中所见子宫纵隔、宫腔粘连带及胎盘情况,随访妊娠结局,结合病理组织学检查结果与声像图表现,总结不同类型疾病的二维及三维超声特征。结果 224例中晚孕期宫腔内发现异常条索状回声的病例中,以宫腔粘连带最多见,共170例,二维超声表现为条索状回声,可出现在宫腔任意地方,形成羊膜腔的不全分隔;三维超声可清晰显示宫腔粘连带的数目、厚度和形态。单纯羊膜皱褶19例,二维超声示羊膜边缘向羊膜腔内延伸形成条索状回声,远端呈游离状;三维超声示单纯羊膜皱褶呈薄膜状。不全纵隔子宫12例,分隔均位于宫腔底部或上段,三维超声示其分隔较厚,并可显示胎盘附着的位置关系。轮廓胎盘11例,二维超声示条索状回声位于胎盘边缘部;三维超声示胎盘边缘呈环状突起或局部山脊状突起。绒毛膜羊膜分离4例,二维超声示羊膜呈可飘动的线形回声,与绒毛膜分离;三维超声示羊膜似“薄纱”样膜状结构。斜隔4例,二维超声表现类似不完全纵隔子宫,但斜隔的基底部均位于宫腔侧壁;三维超声可清晰显示宫腔内斜行分隔回声。羊膜带综合征2例,二维超声示宫腔内多条纤细杂乱光带回声,与胎儿肢体分界不清;三维超声示胎儿肢体表面杂乱的膜状结构。结论 二维联合三维超声可全面观察中晚孕期宫腔内异常条索状回声,分析其不同的影像学表现,有利于提高超声医师对中晚孕期宫腔内异常条索状回声的诊断水平。

Objective To analyze the two-dimensional and three-dimensional ultrasound manifestations of abnormal intrauterine cord-like echo during the second and third trimester of pregnancy,and to improve the understanding and diagnostic level of ultrasound physicians for this kind of disease.Methods The clinical data of 224 cases with abnormal intrauterine cord-like echo detected by ultrasound in the second and third trimester of pregnancy were retrospectively analyzed.The uterine septum,intrauterine adhesions and placenta were collected and recorded after normal delivery or during operation.The pregnancy outcomes were followed up.Combined with the results of histopathological examination and sonographic findings,the two-and three-dimensional ultrasound characteristics of different types of those diseases were summarized.Results Among the 224 cases with intrauterine cord-like echo during the second and third trimester of pregnancy,the most common one was intrauterine adhesions(totally 170 cases),which can appeard anywhere in the uterine cavity and could be revealed cord-like echos by two-dimensional ultrasound,forming incomplete separations of the amniotic cavity.The number,thickness and shape of intrauterine adhesions could be demonstrated by three-dimensional ultrasound.There were 19 cases of amniotic sheet,two-dimensional ultrasound showed that the edge of the amniotic membrane extended into the amniotic cavity to form a strip like echo,with free distal end.Three-dimensional ultrasound showed that the amniotic sheet were reflective membrane.There were 12 cases of incomplete mediastinal uterus,which septum always located at the bottom or upper part of the uterine cavity.The thick septum and its position relationship with placenta attachment could be identified by three-dimensional ultrasound.There were 11 cases of circumvallate placenta,which cord-like echo was detected at the margin of the placenta by two-dimensional ultrasound and ring-shaped protrusions or local ridge shaped protrusions at the edge of the placenta by three-dimensional pattern.There were 4 cases of chorioamniotic separation,two-dimensional ultrasound showed that amniotic membrane exhibits a flapping linear echo,separated from the chorion.Three-dimensional ultrasound showed that the membrane like structure of amnion.There were 4 cases of oblique septum,two-dimensional ultrasound showed that the echo was similar to that of incomplete mediastinal uterus,but the base of oblique septum was located in the lateral wall of uterine cavity.Three-dimensional ultrasound showed that the oblique separated echo in the uterine cavity.There were 2 cases of amniotic cord syndrome,which showed multiple thin and disordered light band echo in uterine cavity,and with unclear boundary with the fetal limbs by two-dimensional ultrasound.Three-dimensional ultrasound showed a disordered membranous structure on the surface of fetal limbs.Conclusion Two-dimensional combined with three-dimensional ultrasound can comprehensively observe intrauterine cord-like echo in the second and third trimester of pregnancy,and analyze its different ultrasound imaging characteristics,which is conducive to improving diagnostic accuracy of ultrasound physicians of intrauterine cord-like echo in the second and third trimester of pregnancy.