Hydatid disease is a parasitic disease with a high incidence in pastoral areas in Tibet. The heart is an uncommon location of echinococcosis, and involvement of the interventricular septum is even rarer. This disease can remain asymptomatic for a long time, but may result in cardiac tamponade and sudden death. We report a 58-year-old woman who was diagnosed with a giant cardiac hydatid cyst involving the interventricular septum associated with complete right bundle branch block. However, owing to insufficient treatment, spontaneous rupture of the cardiac hydatid cyst occurred 6 months after diagnosis, which caused sudden death of the patient.

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.

To evaluate the incidence and progression of thyroid nodules and cancers in acromegaly and the necessity for increased surveillance. This retrospective study identified 1075 acromegaly patients who underwent thyroid ultrasounds from 1830 consecutive cases between 2013 and 2022 at a single center. Thyroid nodules were assessed using the American College of Radiology Thyroid Imaging Reporting and Data System. Control data were from 17839 individuals who received thyroid ultrasounds at a health screening center during the same period. In 1830 acromegaly patients, 80 thyroid cancers (4.4, 82.5

Reliable methods for the non-invasive monitoring of placental status are essential for the management of preeclampsia. This study investigates the feasibility of multimodal photoacoustic-ultrasound (PA-US) imaging for the longitudinal assessment of placental oxygenation (sO2) and microvascular perfusion in a rat model. Our findings demonstrate that multimodal PA-US imaging parameters illustrate alterations in placental status non-invasively, which correlate strongly with histopathological markers, including hypoxia-inducible factor 1α (HIF-1α) and microvascular density (MVD). Besides, a characteristic inverted trajectory of imaging parameters during early gestation day 10–12 is observed. By enabling the simultaneous evaluation of oxygen and blood supply dynamics, multimodal PA-US imaging yields a more comprehensive view of placental function. Ultimately, these results suggest that multimodal PA-US imaging serves as a non-invasive and viable tool for detecting placental dysfunction and monitoring therapeutic responses in real time, laying a solid experimental foundation for advanced maternal-fetal care.

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.

OBJECTIVE:To evaluate the clinical utility of serial foetal echocardiographic surveillance, specifically atrioventricular interval (AVI) monitoring, in managing anti-SSA/Ro-SSB/La-Positive SLE pregnancies. METHODS:SLE pregnancies with positive anti-SSA/Ro-SSB/La antibodies were retrospectively included (n = 50). Pregnancies were stratified into two groups based on whether optimal pre-gestational conditions were met. All pregnancies underwent serial foetal echocardiography, including structural assessment and precise AVI measurement. RESULTS:The overall incidence of foetal cardiac conduction abnormalities was 12% (6/50). The incidence was significantly higher in the suboptimal-conditions group (Group 2, 26% [5/19]) compared with the optimal-conditions group (Group 1, 3% [1/31]) (P = 0.024). Through close monitoring, one foetus with persistent AVI prolongation received dexamethasone and intravenous immunoglobulin, successfully preventing progression to advanced heart block; the other five cases normalized spontaneously upon short-term follow-up, avoiding overtreatment. CONCLUSION:SLE pregnancies with anti-SSA/Ro-SSB/La antibodies and suboptimal gestational conditions constitute a distinct high-risk subgroup. A management strategy through risk-stratified serial foetal AVI monitoring allows for precise treatment identification, significantly improving neonatal outcomes while avoiding unnecessary interventions.

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

ObjectiveTo evaluate the role of prenatal ultrasound and three-dimensional ultrasound in the diagnosis of fetal congenital auricular malformations.MethodsThe ultrasonographic features of 14 fetuses diagnosed with auricular malformations at Peking Union Medical College Hospital between May 2019 and May 2024 were retrospectively reviewed, and pregnancy outcomes were followed up.ResultsThe median gestational age at which congenital auricle deformities were detected by ultrasound was 24 weeks 5 days. Of the 14 cases, 5 had bilateral deformities, 5 had right-sided deformities, and 4 had left-sided deformities. The auricular abnormalities detected included microtia, low set ears, accessory auricles, abnormal ear helix and question mark ear, all of which were confirmed by postnatal follow-up or pathological examination after termination. Ten fetuses underwent three-dimensional ultrasound, which provided additional diagnostic details. Eight fetuses presented with other systemic deformities: three had facial deformities such as micrognathia, nasal bone absence, and facial cleft, while five had additional structure anomalies including diaphragmatic hernia, cardiac anomalies, and polydactyly. Genetic testing was performed in nine cases: one fetus had complete trisomy 18, one had Xp22.31 duplication, and seven had normal results. Six pregnancies were electively terminated, while eight fetuses were carried to term. Among the newborns, four had no significant hearing impairment, four others (three with microtia and one with a question mark ear) had hearing loss and required further reconstructive treatment.ConclusionCongenital auricular deformities exhibit characteristic ultrasound features, and in most cases, prenatal diagnosis and evaluation can be achieved through ultrasound. This provides valuable information to support clinical decision-making and prenatal counseling.

Fetal growth restriction (FGR) is associated with brain structure and functional abnormalities in fetal brain, significantly elevating perinatal morbidity and mortality. This condition is primarily attributed to placental dysfunction, resulting in chronic intrauterine hypoxia. Ultrasonography and magnetic resonance imaging (MRI) are principal imaging techniques employed for prenatal screening during mid-pregnancy. They are vital tools for diagnosing FGR and assessing its fetal brain morphological changes or functional impairments. With advances in medical imaging and the integrated use of these imaging techniques, the accuracy of assessing fetal development and detecting associated brain malformations has been greatly improved, with the potential to further explore the pathophysiologic mechanisms of fetal brain malformations. This review focuses on recent advancements and the clinical relevance of various brain imaging techniques for FGR, aiming to inform clinical diagnosis and 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.

OBJECTIVES:We aimed to investigate the value of deep learning (DL) models based on multimodal ultrasonographic (US) images to quantify RA activity.METHODS:Static greyscale (SGS), dynamic greyscale (DGS), static power Doppler (SPD) and dynamic power Doppler (DPD) US images were collected and evaluated by two expert radiologists according to the EULAR-OMERACT Synovitis Scoring system. Four DL models were developed based on the ResNet-type structure, evaluated on two separate test cohorts, and finally compared with the performance of 12 radiologists with different levels of experience.RESULTS:In total, 1244 images were used for the model training, and 152 and 354 for testing (cohort 1 and 2, respectively). The best-performing models for the scores of 0/1/2/3 were the DPD, SGS, DGS and SPD models, respectively (Area Under the receiver operating characteristic Curve [AUC] = 0.87/0.95/0.74/0.95; no significant differences). All the DL models provided results comparable to the experienced radiologists on a per-image basis (intraclass correlation coefficient: 0.239-0.756, P < 0.05). The SPD model performed better than the SGS one on test cohort 1 (score of 0/2/3: AUC = 0.82/0.67/0.95 vs 0.66/0.66/0.75, respectively) and test cohort 2 (score of 0: AUC = 0.89 vs 0.81). The dynamic DL models performed better than the static ones in most of the scoring processes and were more accurate than the most of senior radiologists, especially the DPD model.CONCLUSION:DL models based on multimodal US images allow a quantitative and objective assessment of RA activity. Dynamic DL models in particular have potential value in assisting radiologists to improve the accuracy of RA US-based grading.

Hydatid disease is a parasitic disease with a high incidence in pastoral areas in Tibet. The heart is an uncommon location of echinococcosis and involvement of the interventricular septum is even rarer. This disease can remain asymptomatic for a long time, but may result in cardiac tamponade and sudden death. We report a 55-year-old woman who was diagnosed with a giant cardiac hydatid cyst involving the interventricular septum associated with complete right bundle branch block. However, owing to insufficient treatment, spontaneous rupture of the cardiac hydatid cyst occurred 6 months after diagnosis, which caused sudden death of the patient.

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.

Objective:To establish the normal range of fetal bowel width during middle and late pregnancy to provide a reference for the diagnosis of abnormal intestinal dilatation and intestinal malformations.Methods:Singleton pregnant women who underwent routine middle and late prenatal ultrasound were selected at Peking Union Medical College Hospital from September 2020 to March 2021. Fetal bowel width was measured, and pregnancy outcome was followed up. Based on gestational age, the percentile curves of fetal bowel width (P3, P5, P10, P25, P50, P75, P90, P95, and P97) were fitted by the LMS statistical method.Results:A total of 224 women with singleton pregnancy were enrolled in this study. The curves of the 95th percentile of the maximum width of the fetal bowel ranged from 8.00 mm to 21.76 mm, and the 97th percentile of the maximum width of the fetal intestine was 8.22 mm to 22.97 mm at 25 to 40 weeks.Conclusion:The reference value and growth curve of normal singleton fetal bowel width during middle and late pregnancy have been obtained. The P95 and P97 values providea a basis for the diagnosis of abnormal intestinal dilatation, which is of great significance for clinical applications.

Objective:To explore the changes of obstetric ultrasound workload during the epidemic period of Corona Virus Disease 2019 (COVID-19).Methods:A retrospective analysis was conducted on the obstetrics ultrasound workload at the Department of Ultrasonography of Peking Union Medical College Hospital from February to May 2020 (the epidemic period), which was compared with that from February to May 2019 (the same period in 2019) and from October 2019 to January 2020 (the pre-epidemic period). Chi-square test was used to compare the proportion of workload between different periods and between different stages of pregnancy.Results:During the epidemic period, the total workload of the ultrasound department decreased by 60.1% and 61.3%, respectively, compared with that in the same period in 2019 and that in the pre-epidemic period. The total number of examinations of obstetric ultrasound was 7684, with a year-on-year decrease of 23.0% and a decrease of 19.2% from the pre-epidemic period. The proportion of obstetric ultrasound workload increased sharply, and was positively correlated with the severity of the epidemic. From February to May 2020, the proportion of obstetric ultrasound workload was 35.8%, 15.3%, 9.8%, and 7.4%, respectively. Among them, the workload proportion in February 2020 increased by 5.0 times year-on-year and 5.3 times than the pre-epidemic proportion. There were significant changes in the proportion of prenatal ultrasound examinations in different stages of pregnancy. The proportion in the first trimester decreased by 6.8% year-on-year, and decreased by 5.8% compared with the pre-epidemic proportion. The proportion in the third trimester increased by 5.2% year-on-year, and increased by 3.1% compared with the pre-epidemic proportion. During the epidemic period, the number of obstetric ultrasound referrals was 301, accounting for 3.9% of the total obstetric ultrasound workload, and there was no significant difference compared with that in the same period in 2019 (4.1%; χ2=0.331, P=0.588) and the pre-epidemic period (3.4%; χ2=2.895, P=0.093).Conclusion:During the epidemic period of COVID-19, the total workload of ultrasound department declines sharply, while the proportion of obstetric ultrasound workload increases significantly.

Objective:To establish an objective image scoring method for abdominal ultrasound based on virtual ultrasound model, and evaluate the intra- and inter-observer consistency.Methods:Image scoring criteria were set up for the six abdominal standard sections with eight distinct scoring elements. After training with virtual ultrasound model, 11 students collected the images, which were then randomly scrambled. Two experts with more than 10 years of clinical experience in ultrasound medicine scored the above images. Each image was evaluated twice, and the intra- and inter-observer consistency were evaluated with Cohen's kappa value.Results:Agreement was considered almost perfect, for the overall kappa value was between 0.854-1.000 and 0.801-1.000 (P＜0.05). For some of the scoring elements, there was a moderate degree of consistency. The scores of 11 students after virtual ultrasound training were moderate.Conclusion:This new abdominal ultrasound image scoring method is highly reliable in terms of the total score and score of each element, which provides a relevant quality control tool for ultrasound operators.

Objective:To compare the characteristics of uterine artery blood flow spectrum between early pregnant women at different altitudes.Methods:A total of 144 pregnant women at different altitudes who received routine prenatal examination at the People's Hospital of Tibet Autonomous Region and Peking Union Medical College Hospital from June 2019 to January 2020 were prospectively included. Uterine artery Doppler spectrum was measured at 11+0~13+6 weeks of pregnancy. Paired t-test was used to compare the spectrum of bilateral uterine arteries. Independent sample t-test was used to compare the parameters of the uterine artery in pregnant women at difference altitudes, and pregnant women of different ethnic groups in high altitudes.Results:There was no significant difference in Doppler parameters between the left and right uterine arteries in the same pregnant woman (P＞0.05). There was no significant difference in uterine artery pulsatility index (PI) between 43 pregnant women at a high altitude and 101 pregnant women at a low altitude (1.892±0.495 and 1.824±0.404, respectively, P＞0.05). In the high altitude area, the uterine artery PI of 28 Tibetan pregnant women (2.016±0.521) was higher than that of 15 Han pregnant women (1.661±0.351), the difference was statistically significant (t=-2.366, P=0.023).Conclusion:There is no significant difference in the spectral characteristics of uterine artery blood flow in pregnant women at different altitudes, but the average PI of bilateral uterine arteries in Tibetan pregnant women at a high altitude is higher. The influencing factors of uterine artery blood flow spectrum characteristics need to be further studied.

Objective:To assess the value of an ultrasound simulator in evaluating the effect of ultrasonic residents training.Methods:Eleven residents who underwent standardized resident training at Department of Ultrasound of Peking Union Medical College Hospital were selected. Seven normal ultrasound sections and three cases of abdominal organs were displayed by residents using an ultrasound simulator, and six parameters such as the long diameter and short diameter of the largest section of the lesion were completed, which were compared with the measurements of senior doctors. After two months of outpatient practice, the virtual ultrasound model was used again for resident evaluation, which was recorded as G0M and G2M (G, group; M, month) before and after the exercise. Mann-Whitney U test was used to compare the examination time between the two groups, and independent sample t-test was used to compare the measurements between residents and senior doctors. Chi-square test (Fisher exact probability test) was used to compare the completion rate and the qualified rate between the two groups.Results:The average qualified rate of seven normal sections in G0M was 59.46% (44/74), and the average examination time was (8.18±2.96) min. In G2M, the qualified rate was 71.43%, the average qualified rate was increased to 88.31%, and the average time was reduced to (5.45±1.57) min, which were significantly different from those in G0M (χ2=44.101, P＜0.001; t=-2.698, P=0.014). The completion rate for the three cases in G2M was higher than that in G0M, but there was no significant difference between the two groups (P＞0.05). The examination time for case 1 and case 2 in G2M was less than that in G0M [1.00 (2.00, 1.00) min vs 3.00 (4.00, 2.00) min; 2.00 (2.00, 1.00) min vs 2.50 (3.00, 2.00) min], and the difference between the two groups was statistically significant (Z=-3.089 and -2.061, P=0.002 and 0.039, respectively). The long diameter measurement accuracy for case 3 in the G2M group was lower than that of the G0M group, and there was a significant difference between G2M and senior doctors [(8.42±0.88) cm vs 9.45 cm; t=-3.097, P=0.021].Conclusion:The ultrasound simulator can be used to evaluate the effects of skill training of ultrasound residents during the initial and practice stage.