Three-dimensional endoanal ultrasound for diagnosis of perianal fistulas: reliable and objective technique

AIM: To evaluate accuracy of three-dimensional endoanal ultrasound(3D-EAUS) as compared to 2D-EAUS and physical examination(PE) in diagnosis of perianal fistulas and correlate with intraoperative findings. METHODS: A prospective observational consecutive study was performed with patients included over a two years period. All patients were studied and operated on by the Colorectal Unit surgeons. The inclusion criteria were patients over 18, diagnosed with a criptoglandular perianal fistula. The PE, 2D-EAUS and 3D-EAUS was performed preoperatively by the same colorectal surgeon at the outpatient clinic prior to surgery and the fistula anatomy was defined and they were classified in intersphincteric, high or low transsphincteric, suprasphincteric and extrasphincteric. Special attention was paid to the presence of a secondary tract, the location of the internal opening(IO) and the site of external opening. The results of these different examinations were compared to the intraoperative findings. Data regarding location of the IO, primary tract, secondary tract, and the presence of abscesses or cavities wasanalysed.RESULTS: Seventy patients with a mean age of 47years(range 21-77), 51 male were included. Low transsphincteric fistulas were the most frequent type found(33, 47.1%) followed by high transsphincteric(24,34.3%) and intersphincteric fistulas(13, 18.6%). There are no significant differences between the number of IO diagnosed by the different techniques employed and surgery(P > 0.05) and, there is a good concordance between intraoperative findings and the 2D-EAUS(k= 0.67) and 3D-EAUS(k = 0.75) for the diagnosis of the primary tract. The ROC curves for the diagnosis of transsphincteric fistulas show that both ultrasound techniques are adequate for the diagnosis of low transsphincteric fistulas, 3D-EAUS is superior for the diagnosis of high transsphincteric fistulas and PE is weak for the diagnosis of both types.CONCLUSION: 3D-EAUS shows a higher accuracy than 2D-EAUS for assessing height of primary tract in transsphincteric fistulas. Both techniques show a good concordance with intraoperative finding for diagnosis of primary tracts.

Utility of trans-vaginal ultrasound in diagnosis and follow-up of non-pregnant sexually active females with lower ureteric calculi

objective:To assess the utility of trans-vaginal ultrasonography in evaluation of non-pregnant sexually active female patients with lower ureteric calculi.Methods:A prospective study was done from January 2015 to December 2017 including non-pregnant sexually active females with suspected ureteric calculus.Trans-abdominal ultrasound was initially done in all patients.In those patients in whom trans-abdominal ultrasound was inconclusive or there was indirect evidence of lower ureteric calculus in form of ureteral dila-tion but no calculus was evident,trans-vaginal ultrasound was done.The patients with ureteric calculi detected on trans-vaginal ultrasound and kept on conservative management were also followed up with trans-vaginal ultrasound.Non-contrast computed tomography was done in patients with inconclusive trans-vaginal ultrasound.Results:As per the study protocol,156 out of the total 468 patients evaluated by trans-abdominal ultrasound were eligible for trans-vaginal ultrasound.Trans-vaginal ultrasound was done in 149 patients,as seven patients did not give consent.Seventy-nine patients were detected with a lower ureteric calculus on trans-vaginal ultrasound and 27 patients had gyne-cologic or other cause for their symptoms.Forty-three patients had an inconclusive trans-vaginal ultrasound of which 36 underwent non-contrast computed tomography,among them only one patient had a lower ureteric calculus.Stone free status could be easily demonstrated on follow-up trans-vaginal ultrasound.

Detection of Congenital Uterine Malformation by Using Transvaginal Three-dimensional Ultrasound

This study assessed the clinical application of transvaginal three-dimensional ultrasound （3D TVUS） in the diagnosis of congenital uterine malformation. A retrospective study was performed on 62 patients with congenital uterine malformation confirmed hysteroscopically and/or laparoscopically. The patients were subjected to transvaginal two-dimensional ultrasound （2D TVUS） and 3D TVUS. The accuracy rate was compared between the two methods. The accuracy rate of 3D TVUS was （98.38%, 61/62）, higher than that of 2D TVUS （80.65%, 50/62）. 3D TVUS coronal plane imaging could demon- strate the internal shape of the endometrial cavity and the external contour of the uterine fundus. It al- lowed accurate measurement on the coronary plane, and could three-dimensionally show the image of cervical tube, thereby providing information for the diagnosis of some complex uterine malformation. 3D TVUS imaging can obtain comprehensive information of the uterus malformation, and it is superior to 2D TVUS for the diagnosis of congenital uterine malformations, especially complex uterine anomaly.

Prenatal Diagnosis of Sirenomelia by Two-Dimensional and Three-Dimensional Skeletal Imaging Ultrasound

Summary： This study sought to evaluate the contribution of two-dimensional ultrasound （2D-US） and three-dimensional skeletal imaging ultrasound （3D-SUIS） in the prenatal diagnosis of sirenomelia. Be- tween September 2010 and April 2014, a prospective study was conducted in a single referral center using 3D-SU1S performed after 2D-US in 10 cases of sirenomelia. Diagnostic accuracy and detailed findings were compared with postnatal three-dimensional helical computed tomography （3D-HCT）, radiological findings and autopsy. Pregnancy was terminated in all 10 sirenomelia cases, including 9 singletons and I conjoined twin pregnancy, for a total of 5 males and 5 females. These cases of sirenomelia were deter- mined by autopsy and/or chromosomal examination. Initial 2D-US showed that there were 10 cases of oligohydranmios, bilateral renal agenesis, bladder agenesis, single umbilical artery, fusion of the lower limbs and spinal abnormalities; 8 cases of dipus or monopus; 2 cases of apus; and 8 cases of cardiac abnormalities. Subsequent 3D-SUIS showed that there were 9 cases of scoliosis, l0 cases of sacrococ- cygeal vertebra dysplasia, 3 cases of hemivertebra, 1 case of vertebral fusion, 3 cases of spina bifida, and 5 cases of rib abnormalities. 3D-SUIS identified significantly more skeletal abnormalities than did 2D-US, and its accuracy was 79.5% （70/88） compared with 3D-HCT and radiography. 3D-SUIS seems to be a useful complementary method to 2D-US and may improve the accuracy of identifying prenatal skeletal abnormalities related to sirenomelia.

Sequential transcatheter arterial chemoembolization,three-dimensional conformal radiotherapy,and high-intensity focused ultrasound treatment for unresectable hepatocellular carcinoma patients

The purpose of this study was to evaluate the outcome of patients with unresectable hepatocellular carcinoma（HCC） treated by sequential therapy of transcatheter arterial chemoembolization（TACE）,three-dimensional conformal radiotherapy（3-DCRT） and high-intensity focused ultrasound（HIFU）.From October,2005 to September,2010,120 patients with unresectable HCC received the sequential treatments of several courses of TACE followed in 2-4 weeks by 3-DCRT and then a single session of HIFU with a curative intent.The median tumor irradiation dose was 40 Gy.Tumor response,toxicity and overall survival rate were analyzed.Clinicopathologic factors affecting the primary technique effectiveness and overall survival rates were investigated by univariate analysis or multivariate analysis.All 120 HCC patients were followed up by the last follow-up time.Among these patients,hepatic toxicities due to treatment were notable in 9 cases.Gastrointestinal bleeding after the overall treatment occurred in 2 cases,leukopenia of grade III was detected in 1 case,radiation-induced liver disease（RILD） was observed in 2 patients,and first-and second-degree skin burn around the HIFU treatment zone were observed in 2 patients and 1 patient,respectively.Among 120 patients,23,83 and 14 cases achieved partial response,stable disease and progressive disease,respectively.The overall survival rates at 1 year,3 years and 5 years were 70%,35% and 15%,respectively,with a median survival time of 26 months.Both Child-Pugh liver function grading and radiation dose were determined to be independent predictors for overall survival revealed by the multivariate analysis.It is concluded that the sequential therapy of TACE,3-DCRT and HIFU is a promising therapeutic regimen for unresectable HCC.

Assessment of Sub-Endometrial Junction Zone by 3-Dimensional Transvaginal Ultrasound in Unexplained Recurrent Implantation Failure and Its Effect on ICSI Outcomes

BACKGROUND: Sub-endometrial junction zone (JZ) plays an important role in most of reproductive functions. OBJECTIVE: To find out the effect of the sub-endometrial JZ thickness assessment by 3-D trans-vaginal ultrasound (TVUS) on intracytoplasmic sperm injection (ICSI) outcomes in patients with unexplained recurrent implantation failure (RIF). SETTING: ART Unit of Obstetrics and Gynecology Department, Faculty of Medicine, South Valley University, Qena, Egypt. DURATION: From April 2016 to October 2018. STUDY DESIGN: A prospective observational study. METHDS: Fifty couples with history of unexplained RIF in previous ICSI cycles and prepared for another ICSI cycle (group I) and fifty couples with unexplained infertility prepared for ICSI for the first time (group II) had been included in this study. At time of ovum pick up, 3-DTVUS was done for all cases in both groups for assessment of sub endometrial junction zone thickness and correlated with ICSI outcome. RESULTS: There were statistically significant differences between group I and group II in JZ thickness in the 3 uterine regions (fundus, anterior and posterior walls) with p 0.001, but there were mildly statistically significant differences between both groups in chemical and clinical pregnancy rates with p < 0.01. CONCLUSIONS: The thickness of JZ in patients with history of unexplained RIF was higher than those with unexplained infertility scheduled for ICSI. The JZ thickness was inversely correlated with increased embryo implantation rates in ICSI procedures, the thinner the JZ thickness was associated with higher pregnancy rates (both chemical and clinical pregnancy rates).

Application of three dimensional conformal radiation therapy combined with high-intensity focused ultrasound for prostate cancer

Objective:Prostate cancer is a form of cancer that develops in the prostate,a gland in the male reproductive system.Prostate cancer tends to develop in men over the age of fifty;it is one of the most prevalent types of cancer in men.This article introduced a new method of prostate cancer treatment with the combination of three dimensional conformal radiation therapy (3D-CRT) and high-intensity focused ultrasound (HIFU),its efficacy was evaluated.Methods:From January 2004 to December 2009,95 patients were diagnosed with prostate cancer,among them,48 patients were received combined therapy with total irradiation of TD 60 Gy/30 Fx and 5 fractions of HIFU treatment,while 47 patients were received with pure 3D-CRT with total irradiation of TD (66-72) Gy/(33-36) Fx.Various indicators were evaluated,such as the local control rate and distant metastasis rate,the changes in blood PSA and fPSA,changes in T-lymphocyte subsets and NK cells,as well as acute adverse reaction of normal tissue.Results:The local response rate difference between the two groups had statistical significance (P < 0.05);the changes in blood PSA and fPSA were significant (P < 0.05);CD3+,CD4+,CD8+,CD4+/CD8+ and NK cells of the combined group increased obviously (P < 0.01),while the latter group had no increase (P > 0.05);the combined group had lower blood cells reduction and II-level acute adverse reaction of rectum,bladder and caput humeri than the pure group,but the II-level acute adverse reaction of urogenital canal in the combined group was higher (P < 0.05).Conclusion:The combined therapy with 3D-CRT and HIFU is a good way for the treatment of aged-related prostate cancer.It can ease the symptoms,control the disease and lengthen the survival time.

Non-invasive assessment of liver fibrosis using twodimensional shear wave elastography in patients with autoimmune liver diseases

AIM To determine the diagnostic accuracy of two-dimensional shear wave elastography(2D-SWE) for the noninvasive assessment of liver fibrosis in patients with autoimmune liver diseases(AILD) using liver biopsy as the reference standard.METHODS Patients with AILD who underwent liver biopsy and 2D-SWE were consecutively enrolled. Receiver operating characteristic(ROC) curves were constructed to assess the overall accuracy and to identify optimal cut-off values.RESULTS The characteristics of the diagnostic performance were determined for 114 patients with AILD. The areas under the ROC curves for significant fibrosis, severe fibrosis, and cirrhosis were 0.85, 0.85, and 0.86, respectively, and the optimal cut-off values associated with significant fibrosis(≥ F2), severe fibrosis(≥ F3), and cirrhosis(F4) were 9.7 k Pa, 13.2 k Pa and 16.3 k Pa, respectively. 2D-SWE showed sensitivity values of 81.7% for significant fibrosis, 83.0% for severe fibrosis,and 87.0% for cirrhosis, and the respective specificity values were 81.3%, 74.6%, and 80.2%. The overall concordance rate of the liver stiffness measurements obtained using 2D-SWE vs fibrosis stages was 53.5%.CONCLUSION2D-SWE showed promising diagnostic performance for assessing liver fibrosis stages and exhibited high cut-off values in patients with AILD. Low overall concordance rate was observed in the liver stiffness measurements obtained using 2D-SWE vs fibrosis stages.

超声评估在子宫内膜容受性判定中的应用

目的 探讨经阴道三维超声在子宫内膜容受性判定中的应用价值。方法 回顾性选取昆明市妇幼保健院2022年4月至2023年6月106例拟行辅助生殖者,所有辅助生殖者在妊娠前均接受经阴道三维超声检测,根据临床妊娠与否分为妊娠组(n=48)和未妊娠组(n=58),运用经阴道三维容积探头,记录2组子宫内膜类型、子宫内膜血流分型、子宫内膜容积、妊娠率、子宫内膜及内膜下血流参数[血流指数(flow index,FI)、血管化指数(vascularization index,VI)、及血管-血流指数(vascular fiow index,VFI)]情况。结果 2组在子宫内膜类型、子宫内膜血流分型、子宫内膜容积方面比较,差异有统计学意义(P <0.05);子宫内膜形态A型妊娠率高于C型,子宫内膜血流分型Ⅲ级妊娠率高于型Ⅰ级,差异有统计学意义(P <0.05);2组在子宫内膜及内膜下FI、VI以及VFI方面比较,差异有统计学意义(P <0.05)。结论 经阴道三维超声技术能够有效评估子宫内膜容受性,预测妊娠结局,为临床治疗方案提供重要依据。

经阴道二维超声对子宫内膜息肉及子宫内膜息肉病变诊断的应用价值

目的探讨经阴道二维超声对子宫内膜息肉及子宫内膜息肉病变诊断的应用价值。方法选取2019年1月至2022年1月在本院就诊的患者46例,据病理检查结果将其分为息肉组和病变组。记录两组患者临床资料、BMI、超声指标(子宫内膜厚度、病灶最大直径、病灶回声不均匀、血流丰富),并以病理检查为金标准,分析经阴道二维超声诊断价值。结果依据病理检查检查显示,息肉组30例,病变组16例。两组患者年龄、产次0次占比比较差异无统计学意义(P>0.05),两组患者BMI≥24kg/m^(2)、绝经后出血比较差异具有统计学意义(P<0.05);病变组子宫内膜厚度、病灶最大直径、病灶回声不均匀占比、血流丰富占比均显著高于息肉组,差异均具有统计学意义(P<0.05);以病理结果作为金标准,灵敏度为67.50%(27/40),特异度为16.67%(1/6),阳性预测值为84.38%(27/32),阴性预测值为7.14%(1/14),符合率为60.87%(28/46)。结论经阴道二维超声可作为辅助手段用于子宫内膜息肉及其病变的早期诊断和鉴别诊断。

胎儿闭合性脊柱裂的影像诊断与病理诊断的一致性研究

目的研究超声评价脊柱情况的影像学改变对胎儿闭合性脊柱裂的诊断及与病理诊断的一致性。方法选择2017年1月至2021年12月在保定市第一中心医院收治的产检孕妇505例,年龄20~40岁,平均年龄30.59岁;孕周6~12周,平均孕周8.93周;身体质量指数21.72~32.98 kg/m^(2),平均身体质量指数27.35 kg/m^(2);初中及以下学历157例,中专或高中学历213例,大专及以上学历135例。根据分娩结局将胎儿分成正常组472例和闭合性脊柱裂组33例。使用四维超声和MRI等影像学技术评估胎儿脊柱发育情况,以病理诊断为金标准,评估二者对闭合性脊柱裂的诊断效能;单因素和多因素Logistic分析确定闭合性脊柱裂的影响因素。结果33例闭合性脊柱裂胎儿均进行引产或剖宫产,所有胎儿的脊髓和脊柱都有不同程度的畸形。脊柱裂范围从骶椎到颈椎不等,其中21例胎儿的闭合性脊柱裂范围在腰椎以下,9例在胸椎以上,3例在腰椎到胸椎之间。所有胎儿的脊髓都有不同程度的损伤。超声显示:椎体变形、缺损等,经过胎儿脊柱冠状背面扫查,脊柱背侧椎弓呈现平行串珠状,为强回声,间距变宽;横切面表示,椎管外围由椎弓和椎体构成的闭合性三角形;包块型中有脊膜膨出、脂肪脊髓裂及脂肪脊髓脊膜膨出;无包块型中存在脊髓纵裂、尾端退化综合征、皮毛窦、终丝脂肪瘤和脊膜膨出合并脊髓纵裂。MRI:可清晰显示腰骶部畸形的各类形态,矢状位可清晰显示高信号,脊髓和脊膜向背部膨出;T1和T2为高信号,脊髓圆锥和背部软组织粘连,椎管突出和膨出。根据受试者工作特性(ROC)曲线,四维超声诊断的灵敏度为81.82%,特异度为87.71%,ROC曲线下面积(AUC)为0.814(95%CI 0.735~0.893);MRI诊断的灵敏度为90.91%,特异度为89.83%,AUC为0.877(95%CI 0.817~0.937);联合诊断的灵敏度为96.97%,特异度为87.08%,AUC为0.908(95%CI 0.867~0.948),联合检测的灵敏度和AUC明显高于单独检测(P<0.05)。两组孕妇身体质量指数、胎儿位置、羊水量、前置胎盘及双顶径、腹围和股骨长等指标差异有统计学意义(P<0.05)。Logistic回归分析显示,胎儿位置[比值比(OR)=1.351,95%CI 1.113~1.641]、前置胎盘(OR=1.575,95%CI 1.058~2.344)、双顶径(OR=1.831,95%CI 1.021~3.284)及孕妇身体质量指数(OR=1.504,95%CI 1.229~1.840)等是闭合性脊柱裂的影响因素。结论四维超声可应用于闭合性脊柱裂的预测和诊断,且联合MRI影像学可提高闭合性脊柱裂的阳性检出率,以达到优生优育的目的。

三维能量多普勒超声参数联合胎盘生长因子对早发型胎儿生长受限的预测价值

目的探讨三维能量多普勒超声参数联合胎盘生长因子(PLGF)对早发型胎儿生长受限(FGR)的预测价值。方法选取早发型FGR孕妇80例为FGR组,另选取同期产检健康孕妇50例为对照组。在孕11~13周+6对所有研究对象进行三维能量多普勒超声检查,收集胎盘容积(PV)、血管化指数(VI)、血流指数(FI)、血管化-血流指数(VFI)等指标。在孕14~16周+6检测所有研究对象血清PLGF水平。结果FGR组的PV、VI、FI、VFI以及血清PLGF水平均低于对照组,差异有统计学意义(P<0.05)。多元Logistic回归方程分析显示,PV、VI、FI、VFI以及血清PLGF水平过低是早发型FGR的危险因素(P<0.05)。受试者工作特征(ROC)曲线分析显示,PV、VI、VFI以及血清PLGF均对早发型FGR有一定的预测价值,曲线下面积分别为0.723(95%CI:0.629~0.817)、0.776(95%CI:0.693~0.860)、0746(95%CI:0.653~0.839)、0.799(95%CI:0.713~0.884),FI对早发型FGR的预测价值一般,曲线下面积为0.625(95%CI:0.524~0.725)。经分析显示,PLGF联合VI以及PLGF联合VFI对早发型FGR的预测价值较好,PLGF联合VI的敏感度、特异度和约登指数分别为86.25%、76.00%、0.623,PLGF联合VFI的敏感度、特异度和约登指数分别为81.25%、80.00%、0.613。结论三维能量多普勒超声参数联合PLGF对早发型FGR有一定的预测价值,可用于临床筛查早发型FGR高风险人群。

超声三维容积成像联合剪切波弹性成像诊断子宫内膜病变的价值

目的探讨超声三维容积成像联合剪切波弹性成像(SWE)诊断子宫内膜病变的价值。方法选取郑州人民医院2019年8月至2022年7月接收的100例子宫内膜病变患者,所有患者均在入院后接收超声三维容积成像、SWE检查,以术后病理结果为金标准,比较超声三维容积成像、剪切波弹性成像及联合诊断子宫内膜病变的价值。结果经活检或术后病理检查结果证实,100例子宫内膜病变患者中共有75例良性病变,25例恶性病变。其中子宫良性病变中子宫内膜息肉33例、子宫内膜增生不伴不典型增生18例,子宫黏膜下平滑肌瘤12例、其他(子宫腺肌病、子宫腺肌瘤、子宫内膜炎等)12例。恶性病变均为子宫内膜样腺癌;联合诊断的灵敏度及准确度最高,其次为SWE、超声三维容积成像,3种方式诊断效能比较,差异有统计学意义(P<0.05);Kappa一致性检验,超声三维容积成像联合SWE诊断不同子宫内膜病变的与活检或术后病理检查结果的一致性较好(P<0.05)。结论超声三维容积成像联合SWE在子宫内膜病变诊断中具有较高的临床价值,可提高对不同类型子宫内膜病变的诊断价值。

彩色多普勒超声与四维超声对胎儿肢体畸形的诊断及漏诊分析

目的:探讨彩色多普勒超声(CDUS)与四维超声(4D-US)对胎儿肢体畸形的诊断及漏诊情况。方法:选取2021年1月至2022年12月在保定市第一中心医院产检的201例孕妇,以引产后病理结果或出生结果为“金标准”,其中确诊为胎儿肢体畸形52例,并在产前均予以CDUS和4D-US检查,采用四格表法计算阳性、阴性预测值,采用受试者工作特征(ROC)曲线模型分析CDUS、4D-US诊断胎儿肢体畸形的ROC曲线下面积(AUC)值、灵敏度及特异度。结果:201例行胎儿肢体畸形筛查的孕妇经CDUS检查后,阳性预测值为64.15%,阴性预测值为85.53%,与“金标准”相比一致性一般(Kappa=0.532,P<0.001)。经4D-US扫描后,阳性预测值为84.31%,阴性预测值为94.00%,与“金标准”相比一致性较好(Kappa=0.778,P<0.001)。CDUS与4D-US的准确率相比,差异具有统计学意义(x^(2)=8.557,P<0.05)。201例行胎儿肢体畸形筛查的孕妇经4D-US诊断检出的人鱼序列综合征、裂手畸形、多指畸形、桡骨缺失并伴有或不伴有钩状手、长骨短小、足内翻、手掌缺如、胎儿股骨短小、并指畸形以及缺指畸形的总检出率(82.69%)高于CDUS的总检出率(65.38%),差异具有统计学意义(x^(2)=4.514,P<0.05)。ROC曲线分析显示,CDUS、4D-US诊断胎儿肢体畸形的AUC值分别为0.767和0.892;灵敏度分别为66.70%和84.30%;特异度分别为86.70%和94.00%;CDUS与4D-US的AUC比较,差异有统计学意义(Z=2.367,P<0.016)。结论:CDUS与4D-US在胎儿肢体畸形筛查中具有一定价值,其中以4D-US诊断效能更高。

宫颈刮片BHLHE22/CDO1和COL2A1基因甲基化检测在早期子宫内膜癌筛查中的作用

目的探讨宫颈刮片BHLHE22/CDO1和COL2A1基因甲基化检测在早期子宫内膜癌筛查中的作用。方法选取徐州市妇幼保健院2022年2月—2024年5月行宫腔镜下诊断性刮宫排除子宫内膜病变的患者78例,妇科检查时进行宫颈刮片细胞采集,并进行BHLHE22/CDO1和COL2A1基因甲基化检测。同时收集患者的基本临床资料及三维能量多普勒超声下子宫内膜血流指数(FI)、血管化指数(VI)、血管化-血流指数(VFI)等资料。以宫腔镜手术获得的组织病理学结果为金标准,利用单因素logistic回归模型分析子宫内膜癌的影响因素,采用受试者工作特征(ROC)曲线下面积(AUC)分析相关基因甲基化检测联合或不联合子宫内膜血流指标对早期子宫内膜癌的筛查价值。结果患者年龄、体重指数、VI、FI、VFI、BHLHE22/CDO1基因甲基化高风险是子宫内膜癌的影响因素(P<0.05)。宫颈刮片相关基因甲基化检测筛查子宫内膜癌的AUC为0.926(0.846~1.000),其敏感度和特异度分别为90.48%、94.74%。子宫内膜血流指标VFI联合宫颈刮片相关基因甲基化检测可提高敏感度至100%,但特异度降至68.42%。结论宫颈刮片BHLHE22/CDO1和COL2A1基因甲基化检测筛查子宫内膜癌的准确性较高,联合子宫内膜血流指标可以增加筛查的敏感度,但也降低了筛查的特异度,增加了有创操作的风险。

3D-PDU对宫腔粘连术后妊娠结局的预测

目的探讨经阴道三维能量多普勒超声(three-dimensional power Doppler ultrasound,3D-PDU)对轻、中度宫腔粘连松解术(transcervical resection of adhesion,TCRA)后妊娠结局的预测价值。方法选取2020年1月至2021年12月于浙江省立同德医院行TCRA治疗并有生育要求的66例轻、中度宫腔粘连(intrauterine adhesions,IUA)患者,其中31例成功妊娠患者纳入妊娠组,35例未成功妊娠患者纳入非妊娠组。患者于术前及术后3个月行3D-PDU检测,获得子宫内膜厚度(endometrial thickness,ED)、宫腔容积(uterine volume,EV)、子宫内膜血管生成指数(vasculogenesis index,VI)、血流指数(blood flow index,FI)、血管生成-血流指数(vasculogenesis-blood flow index,VFI)。随访术后1年患者的受孕情况,观察上述相关指标对术后妊娠结局的预测价值。结果术后患者的ED、EV、VI、FI、VFI较术前明显改善(P<0.05),且妊娠组患者的改善情况优于非妊娠组(P<0.05);受试者操作特征曲线下面积分别为0.80、0.84、0.68、0.65、0.88。结论3D-PDU通过测量轻、中度IUA患者手术前后的ED、EV、VI、FI、VFI可有效预测TCRA术后患者的妊娠结局,为疗效评估及指导后续治疗提供参考依据。

二维超声与彩色多普勒超声在诊断乳腺结节患者中的应用价值

目的:探究二维超声及彩色多普勒超声技术在乳腺结节诊断中的诊断效能。方法:选择2019年11月—2020年11月厦门大学附属第一医院杏林分院接收的88例乳腺结节患者,对其开展二维超声、彩色多普勒超声及手术病理活检。以病理活检结果为诊断金标准,比较上述两种影像学检查手段单独及联合诊断的效能,并以声像图为基准对比不同性质结节血流情况。结果:病理活检结果显示,88例乳腺结节包括30例恶性结节及58例良性结节。二维超声联合彩色多普勒超声诊断符合率为96.59%,高于二维超声的85.23%及彩色多普勒超声的82.95%(P<0.05)。彩色多普勒超声影像显示良性结节动脉血流收缩期峰值流速(PSV)、搏动指数(PI)、阻力指数(RI)、血管指数(VI)均低于恶性结节(P<0.05)。良性结节血流分级为0级、Ⅰ级者占比均高于恶性结节(P<0.05)。良性与恶性结节形态规则病灶占比、结节纵横比、出现粗钙化及微钙化灶、腋窝淋巴结组织形态异常,差异均有统计学意义(P<0.05)。结论:联合分析二维超声及彩色多普勒超声对乳腺结节的诊断结果,可获取关于结节性质及血流状况的信息,便于临床准确判定结节性质。

超声评分法联合三维能量多普勒血流灌注参数对胎盘植入性疾病的诊断价值

目的探讨超声评分法联合三维能量多普勒超声(3D power doppler ultrasonography,3D-PDU)诊断胎盘植入性疾病(placenta accreta,PAS)不同病理分型的应用价值。方法分析112例疑似PAS的孕妇,术前进行超声评分,并进行3D-PDU检查,测量血管指数(vascularization index,VI)、血流指数(flow index,FI)和血管-血流指数(vascularization flow index,VFI)。以病理诊断为金标准将样本分为不同组别,比较组间血流灌注参数的差异性。结果112例疑似PAS患者病理证实92例,PAS组VI、FI及VFI均高于无PAS组(P均<0.05)。92例PAS中未侵入肌层即粘连型24例,侵入肌层包括植入型和穿透型68例,侵入肌层组的VI、FI及VFI均高于非侵入肌层组(P均<0.05)。而植入型与穿透型比较时,穿透型的VI、VFI均高于植入型(P均<0.05)。采用超声评分法联合3D-PDU诊断粘连型、植入型以及穿透型胎盘植入的Kappa值分别为0.724、0.856和0.892。结论超声评分法与3D-PDU联合使用可定量分析胎盘血流灌注情况,为产前诊断PAS的精准分型提供量化评估依据。

3种方法单独及联合诊断甲状腺微小结节的价值比较

目的 比较二维高频超声、声脉冲辐射力成像(ARFI)-声触诊组织定量(VTQ)技术及应变弹性成像3种方法单独及联合诊断甲状腺微小结节良恶性的价值。方法 回顾性分析2021年6月—2023年6月在陕西省宝鸡市人民医院就诊的99例(107个甲状腺微小实性结节)结节直径≤10.0 mm患者的临床资料,均采用二维高频超声、ARF-VTQ技术及应变弹性成像进行检查,获得超声资料评分及数据,以穿刺活检和手术病理结果为诊断“金标准”,比较3种超声检查方法单独及联合应用对甲状腺微小结节的诊断效能。结果 62例患者(共68个结节)选择FNAB,37例患者(共39个结节)选择手术。107个甲状腺微小结节中,诊断为恶性微小结节45个,良性微小结节62个。恶性微小结节与良性微小结节相比,结节内回声(等回声和高回声、极低回声和低回声)、边界、微钙化、纵横比>1及血供情况和供血动脉阻力指数(RI)比较,差异均有统计学意义(P<0.05)。二维高频超声诊断甲状腺微小结节C-TIRADS积分临界值≥2分(C-TIRADS 4b)时,诊断灵敏度为73.33%,特异度为79.03%,曲线下面积[AUC(95%CI)]为0.762(95%CI:0.670~0.839);ARFI-VTQ技术中,107个甲状腺微小结节SWV测值为0.52~7.55 m/s,平均(2.62±0.61)m/s,其中24个实性结节多次出现×.××m/s,最后测值以7.55 m/s记录。恶性微小结节SWV均值为(5.24±2.23) m/s,高于良性微小结节的(2.11±0.70) m/s,差异有统计学意义(t=10.258,P<0.05);当SWV临界值为3.19 m/s时,诊断灵敏度为77.78%,特异度为80.65%,AUC(95%CI)为0.792(95%CI:0.703~0.865);应变弹性成像检查中,当评分临界值≥3分时,诊断的灵敏度为75.56%,特异度为77.42%,AUC(95%CI)为0.765(95%CI:0.673~0.841)。三者联合应用诊断的阳性微小结节为44个,阴性微小结节63个,诊断灵敏度为93.33%,特异度为96.77%,AUC(95%CI)为0.951(95%CI:0.891~0.983)。三者联合诊断效能与二维高频超声检查、ARFI-VTQ、应变弹性成像单独检测比较,差异均有统计学意义(Z=4.861、4.393、4.842,P<0.05)。结论 二维高频超声联合ARFI-VTQ技术及应变弹性成像可提高甲状腺微小结节良恶性的诊断准确性。

三维超声在不同中医证型不孕症患者卵泡监测中的应用

目的围绕不同中医证型不孕症患者,采用三维超声对其卵泡进行监测,评定其临床价值。方法选取2021年1月至2023年6月江西省妇幼保健院收治的80例不同中医证型不孕症患者作为研究对象,用三维超声评定其排卵类型及窦卵泡计数(AFC),并剖析不同证型患者相对应的卵泡监测特征。结果在不孕症患者中,肾虚证为最常见、最主要的一种中医证型;AFC预测卵巢储备功能,其中瘀滞胞宫者的卵巢储备功能下降最明显,痰湿阻滞者下降最少;肾阳亏虚者小卵泡排卵的例数最多;肝气郁滞者无论是正常排卵型、小卵泡排卵型还是无排卵型,均有较多例数。结论经三维超声检测得知,不孕症的证型主要为肾虚证,其与排卵障碍、卵泡发育之间存在紧密联系;肝郁气滞证与排卵障碍的发生紧密相关,具体表现为小卵泡排卵与卵泡黄素化不排卵;瘀滞胞宫证与卵巢储备功能的异常下降之间存在紧密联系;痰湿阻滞证通常与多囊卵巢综合征所致不孕有关联。