Predictive value of the trans-perineal three-dimensional ultrasound measurement of the pubic arch angle for vaginal delivery

BACKGROUND Numerous variables are linked to the success of vaginal delivery,including the subpubic arch angle(SPAA)during labor,the importance of which has not yet been fully elucidated.AIM To examine the SPAA distributional characteristics and to ascertain SPAA’s ability to predict the type and duration of labor.METHODS We determined the SPAA and analyzed the corresponding data.We also evaluated the relationship between the SPAA and the mode of delivery and the duration of labor by regression.The present study comprised a total of 301 pregnant women who had given birth at Beijing Tiantan Hospital of the Capital Medical University between January and December of 2021.RESULTS Our analysis of 301 pregnant women revealed that the SPAA measured using three-dimensional trans-perineal ultrasound had a minimum angle of 81°and a maximum angle of 122.2°.The angle in the normal vaginal delivery group was greater than that in the labor cesarean group(P=0.000).The SPAA was a highly significant positive predictor of normal vaginal delivery(P=0.000)with an area under the curve of 0.782(P=0.000;95%CI:0.717-0.848).We found the length of the second stage of labor to be positively influenced by the SPAA using linear regression analysis(P=0.045).CONCLUSION The SPAA was a highly significant positive predictor of normal vaginal delivery.The length of the second stage of labor and normal vaginal birth were predicted by SPAA.

Differentiation of focal liver lesions using three-dimensional ultrasonography: Retrospective and prospective studies

AIM: To differentiate focal liver lesions based on enhancement patterns using three-dimensional ultrasonography (3D US) with perflubutane-based contrast agent.METHODS: Two hundred and eighty two patients with focal liver lesions,including 168 hepatocellular carcinomas (HCCs),63 metastases,40 hemangiomas and 11 focal nodular hyperplasias (FNHs),were examined by 3D US with perflubutane-based contrast agent.Tomographic ultrasound images and sonographic angiograms were reconstructed.Among 282 lesions,enhancement patterns of 163 lesions between January 2007 and October 2007 were analyzed retrospectively.Then from November 2007 to May 2008,compared with contrast-enhanced (CE) 2D US,CE 3D US was performed on 119 lesions for prospective differential diagnosis.Sensitivity,specificity,area under receiver operating characteristic curve (Az) and inter-reader agreement were assessed.RESULTS: With the tridimensional view,dominant enhancement patterns were revealed as diffuse enhancement or peripheral ring-like enhancement,followed with washout change for HCCs or metastases,respectively,and peripheral nodular enhancement or diffuse enhancement with spoke-wheel arteries,followed by persistent enhancement for hemangiomas or FNHs,respectively.At CE 3D US,the prospective differentiation of lesions showed sensitivity 92% (mean for two readers),specificity 91% and Az value 0.95 for HCCs,84%,97%,and 0.95 for metastases,91%,98%,and 0.98 for hemangiomas and 80%,99%,and 0.99 for FNHs,respectively,while good to excellent inter-reader agreement was achieved.No significant difference exists between prospective diagnosis accuracy at CE 3D US and that at CE 2D US.CONCLUSION: CE 3D US provides a spatial perspective for liver tumor enhancement,and could help in differentiating focal liver lesions.

Prenatal assessment of normal fetal pulmonary grey-scale and lung volume by three-dimensional ultrasonography

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.

Prenatal diagnosis of isolated lateral facial cleft by ultrasonography and three-dimensional printing:A case report

BACKGROUND Lateral facial clefts are atypical with a low incidence in the facial cleft spectrum.With the development of ultrasonography(US)prenatal screening,such facial malformations can be detected and diagnosed prenatally rather than at birth.Although three-dimensional US(3DUS)can render the fetus'face via 3D reconstruction,the 3D images are displayed on two-dimensional screens without field depth,which impedes the understanding of untrained individuals.In contrast,a 3D-printed model of the fetus'face helps both parents and doctors develop a more comprehensive understanding of the facial malformation by creating more interactive aspects.Herein,we present an isolated lateral facial cleft case that was diagnosed via US combined with a 3D-printed model.CASE SUMMARY A 31-year-old G2P1 patient presented for routine prenatal screening at the 22nd wk of gestation.The coronal nostril-lip section of two-dimensional US(2DUS)demonstrated that the fetus'bilateral oral commissures were asymmetrical,and left oral commissure was abnormally wide.The left oblique-coronal section showed a cleft at the left oral commissure which extended to the left cheek.The results of 3DUS confirmed the cleft.Furthermore,we created a model of the fetal face using 3D printing technology,which clearly presented facial malformations.The fetus was diagnosed with a left lateral facial cleft,which was categorized as a No.7 facial cleft according to the Tessier facial cleft classification.The parents terminated the pregnancy at the 24th wk of gestation after parental counseling.CONCLUSION In the diagnostic course of the current case,in addition to the traditional application of 2D and 3DUS,we created a 3D-printed model of the fetus,which enhanced diagnostic evidence,benefited the education of junior doctors,improved parental counseling,and had the potential to guide surgical planning.

Clinical Application of Surface Mode on Three-dimensional Ultrasonography: A Preliminary Study

To investigate the methodology and evaluate the clinical value of surface mode on three- dimensional ultrasonography (3DUS) in static anatomical structures, 62 patients with various diseases were studied. The equipment used here was Voluson 530D 3DUS imaging system and 3D volume trahsducer with frequency being 3. 0-5. 0 MHz. The 3DUS rendering method was surface mode. The results showed that: 1 ) Surface mode of 3DUS could demonstrate clearly the anatomical characteristics of the region-of-interest (ROI) and the inner wall of lesions or organs that contained fluid. The anatomic details, such as location, size, shape, and number of the ROI, could be visualized intuitively; 2) The outer anatomic features (e. g. contour, edge, configuration, etc. ) of some organs or lesions surrounded by fluid could be displayed clearly. It could be concluded that surface mode on 3DUS could provide more diagnostic information than two-dimensional ultrasonography (2DUS) in some cases and could served as a beneficial supplement to ZDUS in clinical practice.

Endoanal ultrasonography in fecal incontinence: Current and future perspectives

Fecal incontinence has a profound impact in a patient's life, impairing quality of life and carrying a substantial economic burden due to health costs. It is an underdiagnosed condition because many affected patients are reluctant to report it and also clinicians are usually not alert to it. Patient evaluation with a detailed clinical history and examination is very important to indicate the type of injury that is present. Endoanal ultrasonography is currently the gold standard for sphincter evaluation in fecal incontinence and is a simple, well-tolerated and non-expensive technique. Most studies revealed 100%sensitivity in identifying sphincter defect. It is better than endoanal magnetic resonance imaging for internal anal sphincter defects, equivalent for the diagnosis of external anal sphincter defects, but with a lower capacity for assessment of atrophy of this sphincter.The most common cause of fecal incontinence is anal sphincter injury related to obstetric trauma. Only a small percentage of women are diagnosed with sphincter tears immediately after vaginal delivery, but endoanal ultrasonography shows that one third of these women have occult sphincter defects. Furthermore, in patients submitted to primary repair of these tears, ultrasound revealed a high frequency of persistent sphincter defects after surgery. Three-dimensional endoanal ultrasonography is currently largely used and accepted for sphincter evaluation in fecal incontinence, improving diagnostic accuracy and our knowledge of physiologic and pathological sphincters alterations. Conversely,there is currently no evidence to support the use of elastography in fecal incontinence evaluation.

TACC diagnosed by transoesophageal endoscopic ultrasonography:A case report

BACKGROUND Primary adenoid cystic carcinoma in the trachea(TACC)is a rare tumour.Tracheal bronchoscopy is always chosen as a routine approach to obtain a pathological diagnosis,but it can be associated with an increased risk of asphyxia.CASE SUMMARY We describe a case of TACC in a patient evaluated by chest computed tomography(CT)with three-dimensional reconstruction imaging and diagnosed by transoesophageal endoscopic ultrasonography.The pathological diagnosis confirmed tracheal adenoid cystic carcinoma.CONCLUSION We highlight the importance of CT and provide a successful exploration of transoesophageal biopsy as a safe alternative approach.

360°腔内三维超声在阴道周围囊性病变诊断中的价值

目的:探讨经阴道360°腔内三维超声在阴道周围囊性病变中的应用价值。方法:常规经阴道超声检查发现阴道周围囊性病变42例,先利用二维超声观察阴道周围囊性病变大小、位置及与阴道、尿道和直肠的关系,再利用经阴道360°腔内三维超声获取矢状切面、横切面、冠状切面、任意切面图像,不同视角观察阴道周围囊性病变的空间关系,从而进行定位诊断。结果:常规经阴道超声检查发现阴道周围囊性病变42例,经手术病理、尿道镜、肾盂输尿管造影证实阴道壁囊肿21例、尿道旁腺囊肿13例、尿道憩室3例、先天性输尿管异位开口2例、骶尾部囊性畸胎瘤3例。经阴道360°腔内三维超声检查诊断符合率为95.23%(40/42),经阴道常规二维超声检查诊断符合率为71.42%(30/42),经阴道360°腔内三维超声检查与经阴道常规二维超声检查诊断符合率比较,差异具有统计学意义(P<0.05)。结论:经阴道360°腔内三维超声是准确、方便、快捷诊断阴道周围囊性病变的影像学手段,具有重要的应用价值。

阴道超声在子宫内膜疾病中的诊断价值分析

目的研究阴道超声运用于子宫内膜疾病中的诊断效能。方法选取2017年1月—2023年1月西安市北方医院收治的80例疑似子宫内膜疾病患者为研究对象,所有患者均接受腹部、阴道超声诊断,以宫腔镜病理诊断作为金标准,分析不同诊断方法的诊断效能及诊断符合率。结果80例疑似子宫内膜疾病患者的病理诊断结果显示,阳性74例,阴性6例。腹部超声检出阳性64例,阴性16例。阴道超声检出阳性72例,阴性8例。阴道超声的灵敏度[94.59%(70/74)]、特异度[66.67%(4/6)]、准确度[92.50%(74/80)]均高于腹部超声[81.08%(60/74)、33.33%(2/6)、77.50%(62/80)],差异有统计学意义(χ^(2)=17.515、5.166、22.279,P均<0.05)。阴道超声对子宫内膜息肉及黏膜下子宫肌瘤的诊断符合率高于腹部超声,差异有统计学意义(P均<0.05)。结论临床在开展子宫内膜疾病诊断时可选择阴道超声,诊断价值较高。

阴道彩超联合经腹超声对输卵管妊娠与妊娠黄体囊肿的诊断价值

目的分析阴道彩超联合经腹超声对输卵管妊娠与妊娠黄体囊肿的诊断价值。方法选取2019年1月至2022年9月在周口市中心医院接受诊疗的54例输卵管妊娠患者纳入观察组,将同期诊疗的50例妊娠黄体囊肿患者纳入对照组,两组均经阴道彩超和经腹超声检查,对比两组包块相关超声参数、血流动力学参数及血流频谱形态,并对比体位改变后包块与同侧卵巢位置变化。结果观察组包块高回声和不均质包块占比高于对照组(P<0.05),两组包块直径、环壁厚度差异无统计学意义(P>0.05)。观察组包块血流分布以点/线居多,对照组包块以环状居多,差异有统计学意义(P<0.05),观察组动脉收缩期峰值流速(PSV)低于对照组,血管阻力指数(RI)高于对照组(P<0.05)。观察组包块中高阻、低阻型血流频谱低于对照组,极低阻型血流频谱高于对照组(P<0.05)。观察组包块与同侧卵巢相对位置变化率低于对照组(P<0.05)。结论阴道彩超联合经腹超声可观察包块血流分布情况、频谱形态和同侧卵巢相对位置改变,对输卵管妊娠与妊娠黄体囊肿的鉴别诊断价值较高,值得推广应用。

腔内三维超声联合临床指标对剖宫产术后子宫切口憩室致子宫异常出血的价值

目的 探讨腔内三维超声联合临床指标在剖宫产术后子宫切口憩室致子宫异常出血的价值。方法 收集2017年1月~2023年4月在石河子市人民医院行阴道超声检查的126例剖宫产术后合并子宫切口憩室的患者资料。根据患者剖宫产术后出血情况分为组1(无异常出血,n=72)、组2(异常出血,n=54),所有患者均行阴道超声(二维超声及三维超声)检查。分析比较两组间临床特征(子宫位置、剖宫产次数以及剖宫产缝线方式等)以及子宫切口憩室超声特征(憩室形态、憩室容积、憩室长度、憩室深度以及残余肌层厚度等)的差异,建立基于临床及超声特征的预测模型,探索剖宫产术后合并子宫切口憩室患者子宫异常出血的独立危险因素,并评价此模型的预测价值。结果 两组间剖宫产次数、子宫位置、子宫内膜厚度、憩室深度、憩室长度、憩室容积、憩室比以及残余肌层厚度的差异均有统计学意义(P<0.05);多因素回归分析显示,子宫位置、剖宫产次数、憩室容积、憩室比以及残余肌层厚度是子宫异常出血的独立危险因素(OR=0.087、10.385、4.658、12.892、0.001,P<0.05),与各单因素相比,此模型预测子宫异常出血的AUC为0.936,高于各单因素(AUC=0.567、0.705、0.836、0.895、0.870,P<0.05),该联合预测模型以-6.28为截断值时,敏感度为87.04%,特异性为91.67%,准确度为89.68%,且与临床诊断结果有良好一致性(Kappa=0.789,P<0.001)。结论 子宫位置、剖宫产次数、憩室容积、憩室比以及残余肌层厚度是剖宫产术后子宫切口憩室合并子宫异常出血的独立危险因素,超声及临床特征对预测剖宫产术后子宫切口憩室致子宫异常出血有重要预测价值。

经直肠双平面超声诊断儿童先天性阴道尿道瘘1例

女性患儿,14岁,不自主漏尿10余年、憋尿后明显,近半年症状加重;无特殊家族史。查体及实验室检查均未见明显异常。下腹部纵切面超声:膀胱充盈,双侧输尿管均开口于膀胱三角区,膀胱与阴道、宫颈间未见异常通道;阴道内见5.63cm×1.85cm梭形无回声区。

阴道斜隔综合征的超声评估:附8例报告并文献复习

目的探讨超声检查在诊断阴道斜隔综合征(OVSS)及术后随访中的应用价值。方法回顾性分析2018—2022年收治的8例OVSS患者的临床资料和超声检查资料,总结OVSS的超声特征。结果8例OVSS患者表现为进行性痛经(7例)、月经期间阴道分泌物有恶臭(3例)、月经延长(3例)、下腹疼痛伴肛门隆起(3例)。其中Ⅰ型2例(25%),Ⅱ型5例(62.5%),Ⅲ型1例(12.5%);7例为双子宫双宫颈畸形,1例为完全纵隔子宫;斜隔位置在右侧和左侧各4例;宫颈阴道积液6例,宫腔积液1例;8例均伴斜隔侧肾脏缺如。所有病例均经手术病理证实。术后随访均未发现宫腔、宫颈管及阴道积液,临床症状明显缓解,其中1例正常妊娠分娩。结论OVSS的首选诊断方法是超声检查,可以为该病的治疗及术后随访提供重要价值。

早期经阴道彩超检查子宫内膜厚度联合血清β-HCG检测在宫外孕临床诊断中的应用

目的:探讨早期经阴道彩超检查子宫内膜厚度联合血清β-人绒毛膜促性腺激素(β-human chorionic gonadotropin,β-HCG)检测在宫外孕临床诊断中的应用。方法:选取2018年3月至2021年3月收治的156例宫外孕患者作为宫外孕组,另同期选取在本院行体检的健康孕妇156例作为对照组。收集两组的临床资料,两组均行早期经阴道彩超检查记录子宫内膜厚度、收缩期最大血流速度(Peak systolic velocity,VS)、舒张末期流速(Enddiastolic velocity,VD)和阻力指数(Resistance index,RI),采用化学发光免疫法检测血清β-HCG水平。对比两组上述指标差异,并采用受试者工作曲线(Receiver operating characteristic,ROC)分析上述指标联合检测对宫外孕的诊断价值。结果:宫外孕组患者VS、VD和RI水平均高于对照组(P<0.05),子宫内膜厚度和血清β-HCG水平均低于对照组(P<0.05)。ROC分析显示,子宫内膜厚度、VS、VD、RI、血清β-HCG及其联合检测的曲线下面积(Receiver operating characteristic,AUC)分别为0.780、0.743、0.733、0.746、0.793和0.934,(P均<0.05)。结论:早期经阴道彩超检查子宫内膜厚度联合血清β-HCG检测可以提高宫外孕诊断的准确度,有助于及时发现异常并治疗。

对照分析阴式与腹部彩色多普勒超声对子宫切口妊娠的诊断价值

目的 比较阴式与腹部彩色多普勒超声在子宫切口妊娠诊断中的应用价值。方法 选取102例疑似子宫切口妊娠患者作为研究对象,患者均接受阴式与腹部彩色多普勒超声检查。以手术病理检查结果作为金标准,观察阴式与腹部彩色多普勒超声对于子宫切口妊娠的诊断结果 ,比较阴式与腹部彩色多普勒超声诊断子宫切口妊娠的敏感度、特异度、符合率,以及不同子宫切口妊娠分型诊断准确率。结果 102例疑似子宫切口妊娠患者经手术病理检查诊断阳性75例(73.53%),其中混合型28例(37.33%)、单纯妊娠囊型32例(42.67%)、嵌入型15例(20.00%);阴式彩色多普勒超声检出阳性75例(73.53%),腹部彩色多普勒超声检出阳性74例(72.55%)。阴式彩色多普勒超声对子宫切口妊娠诊断敏感度98.67%、特异度96.30%与符合率98.04%均高于腹部彩色多普勒超声的86.67%、66.67%、81.37%(P<0.05)。阴式与腹部彩色多普勒超声对混合型、单纯妊娠囊型、嵌入型子宫切口妊娠的诊断准确率对比,结果未见差异性(P>0.05)。结论 相较于腹部彩色多普勒超声,阴式彩色多普勒超声对子宫切口妊娠的诊断价值更高,为临床诊疗工作提供了可靠的参考依据。

经阴道彩超用于宫外孕破裂及卵巢黄体破裂鉴别诊断的临床价值

目的:分析阴道彩超的诊断价值。方法:选取2020年2月到2023年8月90例宫外孕破裂患者以及90例卵巢黄体破裂患者,均行阴道彩超检查,分析阴道彩超检查的鉴别诊断价值,并比较两组超声检查结果的差异。结果:(1)阴道超声在宫外孕破裂与卵巢黄体破裂诊断准确率的差异无意义(P>0.05);(2)两组血流表现、血流频率特征相比,差异有意义(P<0.05);(3)两组血流动力学指标相比,差异有意义(P<0.05)。结论:阴道超声在宫外孕破裂与卵巢黄体破裂的鉴别诊断准确率高,可推广使用。

经阴道二维与三维超声评估子宫内膜-肌层结合带对子宫腺肌病的诊断价值分析

目的对比经阴道二维(2D-TVS)与三维超声(3D-TVS)评估子宫内膜-肌层结合带对子宫腺肌病(AM)的诊断价值。方法选取2023年1月至12月广东省英德市人民医院60例疑似AM患者,均给予2D-TVS、3D-TVS检查,比较不同检查方法对AM的诊断结果,分析子宫内膜-肌层结合带异常量化评分对不同分型AM的诊断结果。结果3D-TVS诊断AM患者40例,2D-TVS诊断AM患者37例,两种方法诊断AM的灵敏度分别为92.31%、76.92%,特异度分别为80.95%、66.67%,差异有统计学意义(P<0.05);受试者工作特征曲线显示,3D-TVS诊断AM的曲线下面积(AUC)为0.866,2D-TVS诊断AUC为0.718,差异有统计学意义(P<0.05);3D-TVS诊断AM的Kappa值为0.741,而2D-TVS的Kappa值仅为0.427。子宫内膜-肌层结合带异常量化评分(>2分)对不同分型AM的灵敏度为91.67%、特异度为93.33%,AUC为0.925(95%CI:0.827~1.000),Kappa值为0.840。结论与2D-TVS比较,3D-TVS应用于AM的诊断可提高其诊断效能,且子宫内膜-肌层结合带异常量化评分对AM分型诊断具有积极的指导意义,可推广应用。

阴道彩色超声与磁共振成像诊断子宫内膜癌分期的价值比较

目的探讨阴道彩色超声与磁共振成像(MRI)诊断子宫内膜癌分期的应用价值。方法选取2021年2月至2023年12月蒙阴县人民医院的49例子宫内膜癌患者为研究对象,均进行MRI检查以及阴道彩色超声检查,采用Kappa检验比较两种诊断方法与病理学诊断结果的一致性。结果MRI、阴道彩色超声与病理学检查的Kappa值分别为0.765、0.702,MRI与病理学检查的一致性更高。结论MRI诊断子宫内膜癌分期的应用价值较高。

腹腔镜检查不孕症398例分析

目的应用腹腔镜诊断技术探讨不孕症的病因,评价腹腔镜对不孕症的诊断价值。方法应用腹腔镜对398例不孕症妇女的盆腔疾病和不孕的影响因素进行分析。结果腹腔镜检查发现盆腔器质性病变359例,检查阳性率为90.20%。慢性盆腔炎、子宫内膜异位症和多囊卵巢是引起不孕的主要盆腔疾病,分别占54.52%、18.34%和10.30%;慢性盆腔炎患者中91.70%有1侧或双侧输卵管梗阻;子宫内膜异位症患者中20.55%有输卵管梗阻。本资料398例中,有156例病人术前进行了输卵管碘油检查,96例与腹腔镜检查结果一致,两者符合率为61.53%;术前227例患者进行阴道超声检查,经腹腔镜证实159例,符合率70.04%(159/227)。结论应用腹腔镜技术对不孕症的病因诊断有重要价值,盆腔炎输卵管梗阻率在继发不孕患者中的发病率高于原发不孕患者;在原发不孕患者中,以子宫内膜异位症、多囊卵巢多见;对怀疑有盆腔疾病或原因不明的不孕患者应尽早腹腔镜诊治。

实时三维超声鉴别诊断阴道后壁膨出病变

目的探讨经会阴实时三维超声鉴别诊断阴道后壁膨出病变的价值。方法对91例临床确诊为阴道后壁膨出的患者应用经会阴实时三维超声进行检查,评价图像质量,并分析其声像图特点。结果 91例患者均能配合并完成检查。图像质量评分均为3分。超声诊断直肠膨出38例,会阴体过度运动48例,肠疝5例。直肠膨出及会阴体过度运动均表现为直肠壶腹部不同程度下移至参考线以下,但只有前者膨出物突向阴道内;肠疝表现为疝出物位于直肠壶腹部与阴道间。结论经会阴实时三维超声可用于阴道后壁膨出病变的鉴别诊断,可为临床治疗提供更多有价值的信息。