Objective This study aimed to provide a clinical reference for prenatal diagnosis by summarizing the ultrasound manifestations and classifications of fetal limb-body wall complex (LBWC).Methods We retrospectively reviewed cases of LBWC diagnosed through prenatal ultrasound examination at Peking Union Medical College Hospital and Xuzhou Maternal and Child Health Hospital between 2012 and 2023. The primary prenatal ultrasound imaging features and associated malformations were recorded and classified into two categories based on the presence (type I) or absence (type II) of craniofacial anomalies.Results Among 37 fetuses with LBWC, 4 were classified as type I, 31 were classified as type II, and 2 exhibited features of both type I and type II concurrently. All fetuses had varying degrees of thoracoschisis or gastroschisis with visceral herniation. A total of 35 fetuses had limb abnormalities, and 11 had craniofacial abnormalities. All fetuses showed varying degrees of spinal curvature, and 23 had umbilical cord abnormalities. In addition, 32 fetuses had other abnormalities, including a persistent extraembryonic coelom in 12 fetuses, an amniotic band in 9 fetuses, nuchal translucency thickening in 5 fetuses, nuchal cystic hygroma in 3 fetuses, an invisible bladder in 2 fetuses, and external genital anomalies in 1 fetus. All cases resulted in induced termination.Conclusion Fetal LBWC has characteristic ultrasonographic features and can be diagnosed in the first trimester. An accurate prenatal ultrasound assessment is essential to enable clinicians to offer future parents the necessary information and counseling concerning the prognosis of this type of anomaly.

INTRODUCTION:To evaluate the association between longitudinal changes in Observed-to-Expected Lung-to-Head Ratio (O/E LHR) measured by ultrasound and postnatal survival in fetuses with Congenital Diaphragmatic Hernia (CDH). METHODS:A total of 74 pregnant women carrying fetuses with CDH were retrospectively analyzed. The change in O/E LHR (ΔO/E LHR) was assessed as a continuous variable using univariate and multivariate logistic regression analyses. Hernia lateralization and liver herniation were combined into a single categorical variable to account for their clinical and statistical correlation. Receiver Operating Characteristic (ROC) analysis was performed to evaluate the discriminative ability of ΔO/E LHR for survival. RESULTS:The majority of patients (86% and 74% according to the first and last ultrasound examinations, respectively) in this cohort had mild CDH, with an overall survival rate of 73.0%. ΔO/E LHR differed significantly between survivors and non-survivors (13.32±22.09 vs. -13.93±17.59, p < 0.001). In multivariate analysis, ΔO/E LHR (OR = 1.089, 95% CI 1.024-1.158; p = 0.007), gestational age at diagnosis (OR = 1.462, 95% CI 1.041-2.053; p = 0.029), and the combined variable of hernia lateralization and liver herniation (p = 0.011) were associated with survival. ROC analysis of ΔO/E LHR yielded an AUC of 0.836 (95% CI 0.725-0.948). CONCLUSION:In this single-center cohort of fetuses with predominantly mild CDH, ΔO/E LHR was associated with postnatal survival and showed good discriminative performance. Gestational age at diagnosis and the combined variable of hernia lateralization and liver herniation were also associated with outcomes. However, estimates for individual anatomical subgroups were imprecise because of the limited number of cases and should not be used for individual risk prediction. These findings suggest that longitudinal assessment of O/E LHR may be more informative than a single measurement in this specific population. Further validation in larger cohorts is warranted.

This study aimed to develop a new ultrasonographic dating formula to estimate gestational age (GA) based on fetal crown–rump length (CRL) in a Chinese population, evaluate model accuracy and compare its performance with established dating formulas. A prospective, multicenter study was conducted across mainland China. Participants included healthy, low-risk women with spontaneously conceived singleton pregnancies and a regular menstrual cycle in the preceding year. Ultrasonography was performed between 11 and 14 weeks of gestation, with GA determined based on the last menstrual period. Participants were randomly assigned to a development or validation cohort in a 7:3 ratio. A best-fit regression model was constructed for GA estimation based on CRL in the development cohort. For validation, mean differences between the new estimated GA and menstrual age were calculated and compared with those obtained using five established CRL-based dating formulas in the validation cohort. All participants were followed through to delivery. The study recruited 4,710 women with singleton pregnancies, with 3,297 in the development cohort and 1,413 women in the validation cohort. The mean and standard deviation values of CRL changed linearly with GA during 11–14 weeks. CRL demonstrated a linear relationship with GA between 11 and 14 weeks, yielding the regression equation GA = 59.590085 + 0.458539×CRL (R2 = 0.8042). The mean difference between estimated GA and menstrual age was 0.32 days (95

Although many studies have validated the diagnostic performance of Ovarian-Adnexal Reporting and Data Systems ultrasound (O-‎RADS US), most have been observed by experienced sonologists, and relatively few by junior sonologists. The purpose of this study was to compare the diagnostic performance of the O-RADS US and the International Ovarian Tumor Analysis (IOTA) Simple Rules (SRs) in senior and junior sonologists to determine a more suitable assessment model for general clinical use. We prospectively recruited 228 patients diagnosed with adnexal masses (AMs). Two senior sonologists acquired images and evaluated them following the O-RADS US and IOTA guidelines, and two junior sonologists reviewed and analyzed images and evaluated them following the same guidelines. In this research, pathological findings were used as the reference standard. Comparisons of categorical variables were made using the chi-square test, and comparisons of continuous variables were made using the two independent-samples t-test. The diagnostic performance of the models was compared by analyzing the receiver operating characteristic (ROC) curve. The kappa value (κ) was used to compare the interobserver agreement between the senior and junior sonologists and the agreement between each ultrasound method and the reference standard. Of 228 AMs, 176 were benign and 52 malignant. The junior adjusted O-RADS US (> O-RADS 4a represents malignancy) had the highest diagnostic validity, with a sensitivity, specificity, and accuracy of 94.23

Background:Rectal endometriosis is a complex condition requiring multidisciplinary treatment. Accurate preoperative assessment is critical for selecting the appropriate surgical technique, with transvaginal ultrasound (TVS) and endorectal ultrasound (ERUS) being key diagnostic tools. While TVS is effective in detecting ovarian endometriosis and pelvic deep infiltrating endometriosis, it has limitations in assessing bowel involvement. ERUS, however, provides detailed imaging of the rectal wall and depth of invasion. Materials and methods:A single-center prospective cohort study included 23 patients suspected of rectal endometriosis between August 2023 and September 2024. Perioperative findings and questionnaires, including Endometriosis Health Profile-30 and Gastrointestinal Quality of Life Index (GIQLI), were assessed. Results:Preoperative ERUS revealed that 82.6% of patients had a single rectal nodule, with a mean size of 2.1 ± 0.7 cm in length and 1.1 ± 0.6 cm in width. Luminal stenosis was found in two patients, and 100.0% of nodules extended into the muscular layer. TVS detected ovarian endometriosis and adenomyosis in 47.8% of patients and identified single rectal nodules in 60.9%, with a mean nodule length of 2.7 cm. Surgical approaches included rectal shaving (12 patients), disc excision (8 patients), and segmental resection (3 patients). Luminal stenosis was absent in the shaving and disc excision groups but present in 66.7% of segmental resection cases. The segmental resection group had significantly larger nodules (3.4 ± 0.5 cm length, 2.1 ± 0.8 cm width, 56.8 ± 0.4 cm2 area). Postoperative complications were generally mild, with only one patient experiencing Grade II rectal bleeding. Significant improvements were observed in pain (P = 0.004), control and powerlessness (P = 0.004), emotional well-being (P = 0.035), work-related issues (P = 0.030), and sexual relationship quality (P = 0.044). Conclusion:Our study highlights that combining preoperative ERUS with TVS improves the accuracy of assessments, enabling a more tailored surgical approach that enhances surgical outcomes and optimizes the management of rectal endometriosis.

OBJECTIVES:Cesarean scar pregnancy (CSP) refers to a special type of pregnancy with a variable prognosis. We aimed to establish a prognostic classification system using ultrasound and clinical features to provide a reference for management strategies. METHODS:Exactly 230 patients with CSP were included and categorized into three groups based on treatment and prognosis: Group A (favorable prognosis), Group B (moderate prognosis), and Group C (poor prognosis). A total of 26 ultrasound features and 8 clinical features were collected for further analysis. Machine learning and traditional scoring models were then constructed for Group A and Group C and integrated to predict CSP prognosis using the significant features. RESULTS:In the univariate analysis, 26 variables were significantly correlated with Group C, while 21 variables were significantly correlated with Group A. For Group C, a linear scoring model was established using three key features: the criteria length of the implantation portion (IMPL) ≥2.43 cm, the height of the gestational sac or mass protruding above the uterine cavity line (GSUCL) ≥1.4 cm, and absent residual myometrial thickness (RMT), achieving an area under the curve (AUC) of 0.939 (0.872, 1.000), which demonstrated comparable performance to the machine learning model (P = .814). For Group A, 13 significant univariate variables were utilized to construct the machine learning model with an AUC of 0.917 (0.842, 0.993). CONCLUSION:Multiple features were associated with CSP prognosis, such as GSUCL, IMPL, RMT, and the anterior-posterior diameter of the gestational sac at the level of the niche (GSSH). The CSP prognostic prediction can be achieved by integrating machine learning and linear scoring models to balance performance and interpretability, which can assist clinicians in treatment decisions.

Objective:The purpose of this study was to assess the quality of 11-14-week fetal ultrasound images and physician scanning performance in a large general hospital to inform future quality improvement initiatives. Methods:A retrospective audit of ultrasound scans of normal fetuses at 11-14 weeks was conducted from November 2021 to March 2023 at a large tertiary general hospital in Beijing, China. Ten anatomical views were analyzed by two experienced assessors. Scan completeness and view completeness rates ≥ 70%, and logbook quality scores ≥ 42 (i.e., ≥ 70% of the maximum possible score), were considered acceptable. Results:The overall scan completeness of 256 logbooks was 77.4%. The scan completeness of 189 logbooks (73.8%) was acceptable. The median image quality score for the 256 logbooks was 37 (interquartile range, 28-46), and 96 logbooks (37.5%) had acceptable image quality, with a score ≥ 42. The scan completeness of 23 sonographers (63.9%) was > 70%. Sonographers with intermediate titles performed a higher average number of fetal ultrasound scans than those with senior titles (148 vs. 115 scans), and their scan completeness and logbook image quality scores were also superior (87% vs. 69% and 43.24 ± 6.38 vs. 31.62 ± 11.28, respectively; both p < 0.05). Conclusion:The majority of sonographers met the expectations of the audit. Sonographers performing more fetal ultrasound scans may have an advantage in terms of scan completeness and image quality.

Objective:This study retrospectively analyzed the prenatal ultrasound features and outcomes of fetal neck masses to improve the understanding of fetal neck masses and provide evidence for prenatal consultation, prognosis assessment, delivery mode selection, and clinical intervention. Methods:From January 2018 to November 2023, 18 patients who underwent routine prenatal ultrasonography in the ultrasound department of Peking Union Medical College Hospital or who were referred to our hospital for the diagnosis of a fetal neck mass were retrospectively identified. Their prenatal ultrasound characteristics and pregnancy outcomes were examined and follow-up was conducted. Results:There were 18 cases of fetal neck masses. The mean gestational age at which the fetal neck mass was first detected was 27 ± 6 weeks (range 17-38 weeks). There were seven (39%) male fetuses, nine (50%) female fetuses, and two (11%) fetuses of undetermined sex. The clinical diagnosis was lymphangioma in 14 cases (78%), hemangioma in two (11%), teratoma in one (6%), and congenital goiter in one (6%). The maximum diameter of the fetal neck mass at the first ultrasound examination was 1.8-8.6 cm, and the median diameter was 4.3 (2.5, 6.5) cm. The median mass volume was 17.0 (3.5, 59.0) cm3 (range 1.0-219.0 cm3). The neck mass was cystic in nine cases, a cystic solid mass with compartmentalization in five cases, and a solid mass with a blood flow signal in four cases. Sixteen fetuses were delivered by elective cesarean section, while two were born via induced labor. The average postnatal follow-up time was 27 months, and the longest follow-up was 6 years. There were 13 cases (72%) with a favorable outcome and five (28%) with an unfavorable outcome. Conclusion:A fetal neck mass is a rare benign lesion. Accurate evaluation of the size and location of the cervical mass by prenatal ultrasound, auxiliary examinations such as magnetic resonance imaging, and assessments of clinical manifestations and related complications are crucial for appropriate prenatal consultation, prognosis assessment, delivery mode selection, and postpartum management. Multidisciplinary treatment is essential for the successful management of fetal cervical masses.

Background:Ultrasonography of the uterine artery (UtA) in the first and second trimesters of pregnancy can assess uterine-placental blood perfusion and guide early clinical prevention. Establishing normal ranges of the UtA pulsatility index (UtA-PI) at 11-14 weeks of pregnancy is helpful for the early identification of high-risk pregnant women and improving the prognosis. This study aimed to establish a reference range of UtA-PI based on crown-rump length (CRL) for spontaneous and in vitro fertilization (IVF) singleton pregnancy during 11-14 weeks, respectively.Methods:A prospective study was performed at Peking Union Medical College Hospital. Healthy, low-risk women with a singleton pregnancy at 11-14 gestational weeks were consecutively recruited for this study from December 2017 to December 2020. All participants underwent routine prenatal ultrasound examination. The CRL of the fetus and the UtA-PI were measured in both uterine arteries, and average values were calculated. The LMS method was used to fit the percentile (P)5, P10, P25, P50, P75, P90, and P95 curves of the UtA-PI value of spontaneous and IVF singleton pregnancy with CRL changes, respectively.Results:A total of 1,962 pregnant women with normal fetuses were included in this study, including 1,792 pregnancies conceived naturally and 170 IVF fetuses. The UtA-PI reference range in the spontaneous pregnancy group was consistently higher than that in the IVF group during 11-14 weeks, and showed a statistically significant difference in UtA-PI for spontaneous and IVF pregnancies (P<0.001). According to the LMS method, each percentile curve of UtA-PI decreased with the increase of CRL in both the natural pregnancy group and the IVF group. The P95 range of UtA-PI for pregnant women with naturally conceived and IVF pregnancy was 2.74 to 2.11 and 2.50 to 1.94, respectively. The overall change of UtA-PI differentials of the two groups showed a downward trend and decreased slightly with the increase of CRL.Conclusions:This study provided a single-center, large sample of data and constructed a CRL-based reference value of UtA-PI for spontaneous and IVF singleton pregnancy, which provides a reliable basis for early UtA evaluation and early clinical decision-making during 11-14 gestational weeks.

The aim of this study was to validate the performance of the Ovarian-Adnexal Reporting and Data Systems (O-RADS) series models proposed by the American College of Radiology (ACR) in the preoperative diagnosis of adnexal masses (AMs). Two experienced sonologists examined 218 patients with AMs and gave the assessment results after the examination. Pathological findings were used as a reference standard. Of the 218 lesions, 166 were benign and 52 were malignant. Based on the receiver operating characteristic (ROC) curve, we defined a malignant lesion as O-RADS > 3 (i.e., lesions in O-RADS categories 4 and 5 were malignant). The area under the curve (AUC) of O-RADS (v2022) was 0.970 (95% CI 0.938–0.988), which wasn’t statistically significantly different from the O-RADS (v1) combined Simple Rules Risk (SRR) assessment model with the largest AUC of 0.976 (95% CI 0.946–0.992) ( p = 0.1534), but was significantly higher than the O-RADS (v1) (AUC = 0.959, p = 0.0133) and subjective assessment (AUC = 0.918, p = 0.0255). The O-RADS series models have good diagnostic performance for AMs. Where, O-RADS (v2022) has higher accuracy and specificity than O-RADS (v1). The accuracy and specificity of O-RADS (v1), however, can be further improved when combined with SRR assessment.

To assess the consistency of Ovarian-Adnexal Reporting and Data System (O-RADS) lexicon interpretation between senior and junior sonologists and to investigate its impact on O-RADS classification and diagnostic performance. We prospectively studied 620 patients with adnexal lesions, all of whom underwent transvaginal or transrectal ultrasound performed by a senior sonologist (R1) who selected the O-RADS lexicon description and O-RADS category for the lesion after the examination. Meanwhile, the junior sonologist (R2) analyzed the images retained by R1 and divided the lesion in the same way. Pathological findings were used as a reference standard. kappa (к) statistics were used to assess the interobserver agreement. Of the 620 adnexal lesions, 532 were benign and 88 were malignant. When using the O-RADS lexicon, R1 and R2 had almost perfect agreement regarding lesion category, external contour of solid lesions, presence of papillary inside cystic lesions, and fluid echogenicity (к: 0.81–1.00). Substantial agreement in solid components, acoustic shadow, vascularity and O-RADS categories (к: 0.61–0.80). Consistency in classifying classic benign lesions in the O-RADS category was only moderate (к = 0.535). No significant difference in diagnostic performance between them using O-RADS (P = 0.1211). There was good agreement between senior and junior sonologists in the interpretation of the O-RADS lexicon and in the classification of O-RADS, except for a moderate agreement in the interpretation and classification of classic benign lesions. Differences in O-RADS category delineation between sonologists had no significant effect on the diagnostic performance of O-RADS.

PURPOSE:Carotid ultrasound allows noninvasive assessment of vascular anatomy and function with real-time display. Based on the transfer learning method, a series of research results have been obtained on the optimal image recognition and analysis of static images. However, for carotid plaque recognition, there are high requirements for self-developed algorithms in real-time ultrasound detection. This study aims to establish an automatic recognition system, Be Easy to Use (BETU), for the real-time and synchronous diagnosis of carotid plaque from ultrasound videos based on an artificial neural network. MATERIALS AND METHODS:445 participants (mean age, 54.6±7.8 years; 227 men) were evaluated. Radiologists labeled a total of 3259 segmented ultrasound images from 445 videos with the diagnosis of carotid plaque, 2725 images were collected as a training dataset, and 554 images as a testing dataset. The automatic plaque recognition system BETU was established based on an artificial neural network, and remote application on a 5G environment was performed to test its diagnostic performance. RESULTS:The diagnostic accuracy of BETU (98.5%) was consistent with the radiologist's (Kappa = 0.967, P < 0.001). Remote diagnostic feedback based on BETU-processed ultrasound videos could be obtained in 150ms across a distance of 1023 km between the ultrasound/BETU station and the consultation workstation. CONCLUSION:Based on the good performance of BETU in real-time plaque recognition from ultrasound videos, 5G plus Artificial intelligence (AI)-assisted ultrasound real-time carotid plaque screening was achieved, and the diagnosis was made.

Objective:To analyze the quality of cervical ultrasound during pregnancy among ultrasound physicians with different working experience and professional training.Methods:All 624 cervical ultrasound reports [transperineal ultrasound (TPU) and transvaginal ultrasound (TVU)] from January 1 to December 31, 2019 at Peking Union Medical College Hospital were derived from the ultrasound medical imaging workstation. The examiners were divided into first-year residents (G1), second- or third-year residents (G2), and professional doctors (G3). According to the guidelines published by the Society of Obstetricians and Gynaecologists of Canada Maternal-Fetal Medicine Committee, the above reports were evaluated and classified as true or false by two ultrasound physicians with more than 10 years of experience. Chi-square test or Fisher's test was used to compare the difference between groups.Results:A total of 624 cervical examinations were recruited, 507 (81.2%, 507/624) by TPU and 117 (18.8%, 117/624) by TVU. The number of physicians in G1, G2, and G3 was 16, 33, and 13, respectively. By TPU, the total number of reports in G1, G2, and G3 was 90, 326, and 91, and the accuracy was 74.4% (67/90), 85.9% (280/326), and 86.8% (79/91), respectively; the difference between G1 and G2 and between G1 and G3 was significant (χ2=6.678, P=0.010; χ2=4.438, P=0.035), but the difference between G2 and G3 was not significant (P＞0.05). By TVU, the total number of reports in G1+G2 and G3 was 44 and 73, and the accuracy was 75.0% (33/44) and 91.8% (67/73), respectively; the difference was significant (χ2=6.225, P=0.013). The difference between TPU and TVU was not significant (P＞0.05).Conclusion:The accuracy of TVU among physicians in the professional group is higher, and the accuracy of TPU increases with the increase of seniority. Case accumulation and standardized professional training are effective ways to improve pregnant cervical ultrasonography.

例1患者女性,29岁,孕1产0,宫内孕15+5周,因发现盆腔囊性包块近1个月就诊,查体:腹软,轻度隆起,孕15周大小.辅助检查:血清甲胎蛋白(alpha fetoprotein,AFP)50.03 ng/ml,绒毛膜促性腺激素 195 842.07 mIU/ml,其他肿瘤标志物均在正常范围.超声所见:子宫增大,宫腔内可见一成形胎儿,可见胎心搏动.在子宫右后方可见混合回声,大小11.5cmX8.5cmX6.4cm,内见团块状中等回声,大小约6.0cmX4.0cm,内见数个分隔,彩色多普勒血流成像示:中等回声内见少许散在短条状血流(图1).超声提示:宫内中孕,子宫右后方囊实性肿物,考虑妊娠合并卵巢肿瘤.行全身麻醉下腹腔镜右卵巢附件切除术.术中所见:右侧卵巢增大,呈直径11.0 cm囊实性肿物,外表光滑,其中一囊腔已自发破裂,破口 1.0 cm.囊内液淡黄色清亮,吸净囊内液后见囊内生乳头,右侧输卵管外观未见明显异常.术后病理诊断:(右附件)卵巢未成熟畸胎瘤(Ⅲ级).免疫组织化学染色结果:细胞角蛋白(AE1/AE3)阳性,CD99阴性,上皮细胞膜抗原(EMA)阳性,胶质纤维酸性蛋白(GFAP)阳性,细胞增殖Ki-67指数50％,生殖细胞肿瘤标志物SALL-4部分阳性,神经纤维来源肿瘤局灶阳性,S-100蛋白阳性.术后未予化疗,后足月妊娠至40周剖宫产一健康活男婴,现已规律随访5年,未见明确转移及复发征象.

目的 探讨基于线上自主学习和考核的产科超声教学模式对规范化培训学员识别产科超声标准切面能力的效果.方法 2021年3月纳入21名在北京协和医院超声医学科参加住院医师规范化培训的学员,应用调查问卷收集学员对产科超声的教学需求,以胎儿颅脑、胸腹腔和心脏3个部位的标准切面及标志性结构为培训内容录制讲课视频.学员通过线上自主学习形式,完成标准切面强化培训及考核.应用x2检验对比培训前后学员答题正确率的差异.结果 大部分学员(95.2％,20/21)认为产科超声培训非常重要并且非常愿意参加;考核题目包含胎儿颅脑、胸腹腔、心脏3个部位标准切面的标志性结构识别共22题.培训前学员答题总正确率为79.9％(369/462),培训后学员答题总正确率提高为88.7％(410/462),其中,学员对心脏标志性结构识别的正确率提高11.5％(87.7％vs 76.2％),培训前后答题正确率比较,差异具有统计学意义(x2=11.28,P=0.001).结论 基于线上自主学习和考核的标准切面强化培训,提高了规范化培训学员对胎儿颅脑、胸腹腔和心脏系统标准切面中标志性结构的识别能力,可作为产科超声培训的有效手段.

We aimed to assess the associations of large artery stenosis(LAS) and cerebral small vessel disease(CSVD) with the risk of ischemic stroke and to investigate their respective and combined contributions. In the prospective population-based Shunyi Study, 1,082 stroke-free participants aged 55.9±9.1 years were included. Participants were followed for incident stroke throughout the study period(2013–2019). Total small vessel disease score was used to measure CSVD burden. Cervico-cerebral large artery stenosis was evaluated via brain magnetic resonance angiography and carotid ultrasound. We estimated the risk of ischemic stroke in relation to LAS and CSVD with Cox regression models. During a mean follow-up of 4.2 years, 34 participants(3.1%) experienced at least one ischemic stroke. Severe LAS(≥50% stenosis versus no stenosis: HR=3.27(95% CI: 1.31–8.18))and high CSVD burden(total small vessel disease score 2–4 versus 0 point: HR=12.73(4.83–33.53)) were associated with increased stroke risk independently. In multivariate models, CSVD burden(7.72%) explained a larger portion of the variation in stroke risk than severity of LAS(3.49%). Our findings identified that both LAS and CSVD were associated with future ischemic stroke in asymptomatic subjects, while those with high CSVD burden deserve more attention in primary prevention of stroke.

目的 观察静脉内平滑肌瘤病(IVL)的临床、超声与CT特征表现.方法 回顾性分析55例经术后病理证实的IVL患者的临床及影像学特征,对比超声、CT诊断IVL的准确率.结果 Ⅰ期IVL超声多表现为子宫肿物呈“蠕虫”或条索串珠样向宫旁延伸,血流信号丰富;CT多表现为子宫或盆腔低密度肿物,伴子宫静脉或卵巢静脉内肿物.Ⅱ～Ⅳ期IVL超声表现为生殖静脉、髂静脉、下腔静脉、右心甚至肺动脉内条索状肿物沿静脉走行,内见血流信号;增强CT肿物呈“丝瓜络”样不均匀强化.超声与CT诊断IVL的准确率分别为49.09％和58.18％,CT诊断准确率高于超声(P＜0.05);超声和CT诊断Ⅱ～Ⅳ期IVL的准确率均高于Ⅰ期(P均＜0.05).超声与CT联合诊断IVL准确率达74.55％.结论 IVL影像学表现具有一定特征性,联合超声与CT可显著提高诊断IVL的准确率.

Objective To observe the lacunar-like changes in cesarean scar pregnancy (CSP) ultrasonography in first trimester and to explore its relationship with clinical outcome in early pregnancy termination. Methods This is a retrospective case-control study. Patients who were diagnosed as CSP and chose to terminate pregnancy from January 2017 to April 2020 were enrolled. According to occurrence of lacunar-like change in chorion membrane, patients were divided into case and control group. The clinical manifestation, laboratory test, ultrasound data, and outcome were compared. Results Fifty-five CSP patients were enrolled with 20 (36.4%) in case group and 35 (63.6%) in control group. As for ultrasound features, the maximum outer diameter of gestational mass (5.6 +/- 2.5 cm vs. 3.9 +/- 1.5 cm), the maximum thickness of the chorion membrane (median number 1.1 cm vs. 0.7 cm), the longitudinal diameter of the implanting part of gestational mass in uterine lower segment (3.3 +/- 1.8 cm vs. 1.2 +/- 0.5 cm), uterine lower segment protrusion incidence (12, 60% vs. 2, 5.7%), and the crown-rump length of fetus (median number 1.7 cm vs. 0.7 cm) were bigger or higher in case group than that of the control group; the minimum thickness of the uterine lower segment myometrium (median number 0.08 cm vs. 0.20 cm) was significantly thinner in case group. CDFI grading of case group was different from control group with more cases in higher grades. As for clinical outcome, the patients of case group showed more frequency of CSP lesion resection under open surgery or laparoscopy (7, 35% vs. 1, 2.86%) rather than suction curettage, more blood loss in surgery (median number 35 ml vs. 20 ml) and more hospitalization days (median number 7.5 d vs. 3.5 d) than control group. Conclusions Lacunar-like change of chorion can be detected in early gestation and may act as a predictor of complicated and worse clinical outcome.

OBJECTIVES:As a rare malformation of the female reproductive system, Herlyn-Werner-Wunderlich syndrome (HWWS) was categorized into 3 classifications. It was recommended recently that, on the basis of the past classification, cervicovaginal atresia without communicating uteri should be newly added as classification 4. The surgical intervention will differ by type. To better optimize patient counseling as well as the preoperative evaluation and planning, our objective was to describe the ultrasound characteristics of each type of HWWS, including the new type.METHODS:From January 1995 to November 2015, 37 cases of HWWS in with complete ultrasound information confirmed by surgery in the Peking Union Medical College Hospital were reviewed. We analyzed their ultrasound features, including hematometra, hematocervix, hematocolpos, and an ovarian chocolate cyst.RESULTS:All of the ultrasound images of the 37 patients showed uterus didelphys with ipsilateral renal agenesis. Compared with the other 3 types, classification 4 showed distinctive ultrasound characteristics. Most cases of classification 4 showed hematometra (5 of 7 [71.4%]) and an ipsilateral ovarian chocolate cyst (6 of 7 [85.7%]), which was significantly higher than in the other 3. A rudimentary uterine horn was also a distinctive characteristic in this type. Meanwhile none of the classification 4 cases showed hematocervix or hydrocolpos, which were common signs of the other 3.CONCLUSIONS:According to this new classification criteria for HWWS, ultrasound characteristics of the new classification 4 differ from the others. As classification 4 was suggested to have a different surgical option, we should pay attention to its ultrasound characteristics, which might help in providing more information about the treatment and prognosis to the gynecologist.