病例1患者,女性,29岁,孕1产0,孕17+5周,产检未闻及胎心.超声检查发现胎儿臀位,胎盘位于子宫后壁;未见胎心胎动;胎儿皮下水肿,其中颈部厚约4.6mm.胎儿腹腔水平可见一不均质回声团,范围约31mmX22mm,内未见血流信号(图1a).遂行引产,引产所见:孕妇自娩两死胎,其一性别男,外观未见明显异常;另一性别不明,身长100 mm,体重20 g,其一侧下肢完整,双上肢及另一侧下肢仅有残端,肩部以上缺如(图1b).

规范化妇科超声检查对于妇科超声实践工作具有十分重要的意义.本文依据国际子宫内膜肿瘤专家组(International Endometrial Tumor Analysis, IETA)[1]、超声评估子宫形态专家组(Morphological Uterus Sonographic Assessment,MUSA)[2]、国际卵巢肿瘤分析专家组(International Ovarian Tumor Analysis,IOTA)颁布的共识[3],以及美国放射学会卵巢及附件超声报告词典白皮书[4]等相关文献,汇总正常子宫和卵巢、子宫及附件区常见疾病的基本术语、定义、测量方法及病变彩色多普勒血流的评估方法;结合本课题组的工作经验,提供部分术语的声像图表现.建议用规范化术语描述正常子宫及卵巢的声像图表现;用规范化术语描述子宫、卵巢及附件区病变的声像图表现及彩色多普勒血流评分;用规范化的方法测量正常子宫、卵巢、子宫病变及附件区病变的范围.

Background and Introduction: Collateral circulation is very crucial for the prognosis of stroke patients. Transcranial color-coded duplexsonography (TCCD) is used widely to evaluate the intracranial arterial blood flow. However, approximately 20% - 30% of the patients with cerebral infarction cannot be detected via TCCD due to the interruption of thickened temporal bones. We assessed the diagnostic efficacy of contrast-enhanced transcranial color-coded duplexsonography (CE-TCCD) in stroke patients with limited bone windows. METHODS CE-TCCD was applied to 70 patients (51 males and 19 females) who presented with ischemic symptoms, to detect the openness of the anterior communicating artery (ACoA) and posterior communicating artery (PCoA) of the Willis ring before Computed Tomography angiography (CTA) or Magnetic Resonance Angiography (MRA) examination. The results from CETCCD is used to compare with CTA/MRA result to verify the diagnostic efficacy. RESULTS Forty-one communicating artery openings were detected by CE-TCCD, among which 37 were PCoA and 4 were ACoA. Among the 70 patients, 23 of 70 patients indicated severe stenosis within intracranial and/or extracranial arteries. Eighteen out of the 23 patients showed collateral circulation, accounting for 78.3% (18/23). Moderate stenosis were 23 cases in total, in which 7 cases showed collateral circulation, accounting for 30.4% (7/23). Slight stenosis were 24 cases in total, none of which showed collateral circulation. CONCLUSION In the stroke patients with limited bone windows, CE-TCCD can evaluate intracranial collateral circulation.

患者女,70岁.主因“左腰痛伴恶心呕吐4d”入院.患者于入院4d前无明显诱因出现左侧腰痛,疼痛较为剧烈,伴恶心、呕吐,无血尿、脓尿,入院3 d前出现发热,体温最高达39℃,自行服用退热药物后体温下降,但腰痛未缓解,并向全腹部放射,恶心、呕吐加重,不能进食;就诊于当地医院行腹部CT检查,提示左肾盂肾炎、肾窝积气、不全梗阻表现;给予抗炎、补液、留置导尿管等治疗,病情略好转,为进一步治疗来我院就诊.患者既往有糖尿病及高血压10余年,口服及皮下注射降糖药、口服降压药控制血糖及血压尚可.

The present study assessed changes in carotid plaque neovascularization following long-term atorvastatin therapy (20 mg/day) using contrast-enhanced ultrasonography (CEUS). In this prospective case series, seven males (mean age, 68±9 years) and three females (mean age, 67±10 years) with a total of 13 carotid plaques underwent standard ultrasonography and CEUS at baseline, as well as after 1 and 2 years of atorvastatin treatment. The same plaques were then examined using real-time CEUS. The results of the enhanced intensity of plaque neovascularization at baseline were compared with results obtained during follow-up to examine the effects of long-term atorvastatin therapy. Standard ultrasonography revealed that 7 of the 13 carotid plaques were uniformly echolucent, whereas 6 carotid plaques were predominantly echolucent. CEUS revealed an enhanced intensity of 10.5±2.1 decibels (dB) prior to treatment, which decreased significantly to 7.3±2.6 dB following 2 years atorvastatin therapy (P<0.001). The ratio of enhanced intensity in the carotid artery lumen to that in the plaque was 3.10±1.10 at baseline and this value significantly increased to 4.96±2.98 following treatment for 2 years (P<0.001). The current pilot study therefore indicates that two-year atorvastatin therapy (20 mg/day) may reduce plaque neovascularization in the Chinese population.

Purpose: The aim of this study was to investigate the changes of CD3 and CD20 in the microenvironment of rabbit peripheral lung cancer before and after microwave ablation (MA). Methods: Twenty-four rabbits with lung VX2 tumor were randomly divided into four groups (n = 6 in each group). Ultrasound-guided MA was gone using 40 W powers as the treatment mode for about 60s. The animals were sacrificed by injecting anesthetic into the ear vein before and after MA. The thoracic ribs were cut off and the lung lobes were removed completely with tumor and then washed with saline. Part of the organization placed into 4% formaldehyde for pathological examination; part placed into 2.5% glutaraldehyde for the electron microscopy. Result: The histological features of ablation lesions showed as morphological abnormalities of tumor cells, cell and nuclear elongated by heat; the cells of alveolar wall degeneration and necrosis. The alveolar wall ruptured and alveolar structure disappeared. Blood cells and inflammatory cells appeared in the alveolar interstitial and a large number of serous exudated. The positive cell numbers of CD3 and CD20 cells at 2 weeks after MA were significantly different from those before MA and at 3 days and 1 week after MA (P< 0.01). There was no significant difference in the positive cells of CD3 and CD20 before and 3 days and 1 week after MA. Conclusion: The number of immune cells in tumor adjacent tissue increased significantly after MA and the level of local anti-tumor immune cells was also increased.

Aim: To evaluate the tumor angiogenesis in lung peripheral VX2 tumor model by contrast-enhanced ultrasound (CEUS) and to determine the correlation between CEUS parameters and microvessel density (MVD) calculated via CD31 and CD34 expression.Material and methods: VX2 pulmonary tumors were created in eight Japanese white rabbits by implanting a VX2 sarcoma into the lower portion of the right lung through ultrasound guidance. Tumors were allowed to grow for 14-21 days to achieve a diameter of 7-15 mm, and were examined by CEUS using a SonoVue contrast agent. The results were recorded as digital video images, and the time-intensity curves and hemodynamic parameters were analyzed. Pathological tumor specimens were immediately obtained after the ultrasound examinations. Tumor specimens were stained with hematoxylin and eosin (H&E) and expressed as CD31 and CD34. The different endothelial cell markers were determined by immunohistochemical staining. MVD was calculated via CD 31 and CD34, and the relationship between CEUS parameters and MVD was analyzed.Results: Two distinct types of microvessels were identified in lung peripheral VX2 tumors: differentiated (CD34+) and undifferentiated (CD31+) vessels. A significant correlation was found between CEUS parameters and undifferentiated MVD (CD31+ vessels) in lung peripheral VX2 tumors (p<0.05). A reverse correlation was observed between different MVDs.Conclusions: Two different degrees of differentiation of vascular endothelial cells (CD31 and CD34) exist in the rabbit lung peripheral VX2 tumor model. CD31 MVD can more effectively evaluate tumor angiogenesis compared with CD34 MVD. CEUS, as a non-invasive imaging method, can effectively evaluate tumor angiogenesis in rabbit peripheral lung cancer.

Objective To investigate the value of abnormal fetal cardiac axis in diagnosis of cardiac structural abnormalities.Methods Two hundred and thirty-one cases with normal fetal heart(normal group) and 36 cases with fetal cardiac structural abnormalities(abnormal group) were randomly selected.Fetal cardiac axis was measured on the four-chamber view of the heart.The fetal cardiac axis ＜20.0° and ＞62.0° were regarded as abnormal.Results The normal group had a mean cardiac axis of (37.9±7.6)°,compared with the abnormal group(52.6±19.8)°.The difference was statistically significant between the two groups (P＜0.01).There was no small or large cardiac axis in normal group,while 16 cases(44.4％) with large cardiac axis and 2 cases (5.6％) with small cardiac axis in the abnormal group.The incidence rate of abnormal cardiac axis in normal group was less than that of the abnormal group(P＜0.01).Conclusion The finding of an abnormal axis should prompt further evaluation of the fetal heart and a detailed anatomical examination.

Background: Fetal echocardiography is an important method in prenatal diagnosis of Congenital Heart Disease (CHD). Fetal cardiac axis can be used as a reliable parameter in the diagnosis of CHD. The objective of this study was to discuss the abnormal fetal cardiac axis in the diagnostic value of fetal congenital heart disease. Methods: In a 3-year period, 296 women with 20 and 40 weeks' singleton gestations referred for perinatal ultrasound consultation underwent evaluation of the fetal cardiac axis. For measurement of fetal cardiac axis, the chest axial image was obtained at the level of the four-chamber view. Of the 296 pregnancies, 260 healthy pregnancies were categorized as Group A while 36 pregnancies with severe heart disease were Group B. Cardiac anomaly was confirmed either by neonatal echocardiography or autopsy. Results: Cardiac anomaly has been found in 36 women, 24 had abnormal axis (three with axis smaller than normal; 21 with axis larger than normal). The mean of cardiac axis for Group A (38.1 +/- 7.6 degrees) was significantly smaller than that of Group B (52.6 +/- 19.8 degrees) (P<0.001). The cardiac axis was independent from gestational age. With two standard deviations above and below the mean of Group A as normal cardiac axis (22.9 degrees-53.5 degrees), abnormal fetuses were defined as having axis < 23 degrees or > 54 degrees. There were 6 cases (2.3%) of cardiac axis larger than normal and no case (0%) smaller in group A, and 21 cases (58.3%) larger and 3 cases (8.3%) smaller in group B. The difference in two groups of patients with abnormal cardiac axis was statistically significant (P<0.01). The incidence of abnormal cardiac axis of group A was less than group B. Conclusions: The measurement of fetal cardiac axis is simple and effective. Any larger or smaller fetal cardiac axis than normal is suggestive of a cardiac anomaly and requires further investigation. Four-chamber view is an important plane of fetal echocardiography.

Objective:To evaluate the relationship between serum total testosterone ( TT) , free androgen index ( FAI) with polycystic ovary syndrome ( PCOS) . Methods:The levels of TT and FAI of 45 patients with polycystic ovary syndrome and 42 healthy controls were detected by chemiluminescence apparatus. The hirsut-ism, severity of acne and androgenic alopecia were assessed by Ferriman-Gallwey ( M-FG) score, Global Acne Grading System ( GAGS) and Ludwig classication method respectively. Results:The sensitivity and spe-cificity of FAI for hirsutism, acne and androgenic alopecia were 80. 2%, 68. 9% and 60. 3%, and 41. 5%, 49.2% and 36.8%, respectively. The sensitivity and specificity of TT were 20.6%, 21.4% and 29.8%, and 46.5%, 44.8% and 58.3% respectively. Conclusion:The hirsutism, severity of acne and androgenic alopecia were closely related with FAI, but the correlation with TT was low. So FAI can be used as a screening bio-chemical markerin the diagnosis of PCOS.

Objective The reasons of the missed diagnosis in congenital heart defect (CHD) were analyzed by reviewing the cases of CHD which were diagnosed prenatal and after birth during the last 8 years. Methods The pregnant cases which were examined and delivered in our hospital were reviewed. We observed the ultrasonic images and analyzed the reasons of missed diganosis in those CHD which diganozed after 24 weeks' gestation or after birth. Results 83 cases were diagnosed CHD, 73 cases had been detected before birth. The Ventricular Septal Defect (VSD) was the only anomaly of the prenatal missed diagnosis. 2 cases were diagnosed before 15 weeks' gestation. 66 cases had the general ultrasound screening, 42 were diagnosed and missed 24. They were 10 cases of VSD, 2 cases of persistent truncus arteriosus, 1 case of atrio-ventricular canal defect, 2 cases of right position of aortic arch, 2 cases of coarctation of the aorta, 1 case of Ebstein anomaly, 1 case of ventricular septal defect with right position of aortic arch, 2 cases of persistent left precava, 1 case of tetralogy of Fallot, 1 case of dextroverted heart and 1 case of pulmonary valve stenosis. Conclusion The single VSD is the most missed diagnosis in prenatal and general ultrasound screening, and the missed abnormalities during the general ultrasound screening are various. The reasons of the missed diagnosis are according to the fetuses, pregnant women, the serious degree of the heart defects and so on. Because of the variety of the CHD and the localization of ultrasonic exam, the prenatal screening and diagnosis of CHD are more difficulties.

Background: The prognostic value of extravascular lung water indices (EVLWI) has been widely investigated, which is determined by lung ultrasound B-lines. However, the clinical value of lung ultrasound B-lines for determining prognosis/intensive care unit (ICU) outcomes in patients with acute respiratory distress syndrome (ARDS) has been rarely reported.Methods: Twenty-one ARDS patients admitted to the ICU of Fu Xing Hospital underwent both lung ultrasonography and pulse index continuous cardiac output (PiCCO) monitoring on the first, second, and third days after diagnosis. The correlation between lung ultrasound score (LUS) and EVLWI measured by the PiCCO system was investigated. The prognostic clinical value of lung ultrasonography in ARDS patients was explored. Chest ultrasound was performed using the 12 regions method. The comprehensive score of lung ultrasound was determined according to the level of lung aeration.Results: With ICU mortality as the end point, 21 patients were divided into a survivor group (8 patients, 39.1 %) and a non-survivor group (13 patients, 61.9 %). Significant positive linear correlations were found between LUS and EVLWI, including predicted body weight (r(2) = 0.906), sequential organ failure assessment score (r(2) = 0.815), lung injury score (r(2) = 0.361), and PaO2/FiO(2) (r(2) = 0.472). Significantly different LUSs were found between the non-survivor and survivor groups (F = 77.64, P < 0.01) by repeated-measures analysis of variance. There were no significant differences between the two groups on different days. The areas under the receiver operating characteristic curves of LUS and EVLW measured by PiCCO were 0.846 (P < 0.01) and 0.918 (P < 0.01), respectively. The cut-off of LUS for prognosis prediction was 16.5.Conclusions: Lung ultrasonography is a non-invasive, economic, simple, user-friendly, and radiation-free bedside method for predicting the prognosis of ARDS patients. Early measurement of LUS is a better prognostic indicator in patients with ARDS.

Objective To observe the intracranial collateral circulation in patients with cerebral infarction and transient ischemic attack with limited bone windows by using of contrast-enhanced transcranial color-coded Doppler (CE-TCCD). Methods Seventy patients with ischemic stroke, and transient ischemic attack of whom transcranial color-coded Doppler could not detect the intracranial blood lfow because of limited bone windows, were detected the intracranial blood flow and the anterior and posterior communicating arteries of Willis ring before magnetic resonance angiography(MRA) examination. And compared the diagnosis of both. Results Seventy patients consists of 51 males and 19 females, mean age was 66.4±11.9 years old. CE-TCCD were detected in 41 communicating arteries, 38 of which were consistent with the MRA diagnosis. Diagnostic consistency between the two was good (Kappa value 0.696,P<0.001). The sensitivity of CE-TCCD was 79.2% and the speciifcity of it was 91.9%. Conclusion Contrast-enhanced transcranial color-coded Doppler can be used to detect intracranial collateral circulation in patients with cerebral infarction and transient ischemic attack with limited bone windows.

PurposeAcute lung injury/acute respiratory distress syndrome is a common severe disease, this paper aims to explore the pathological basis of diffuse comet-tail artifacts in rabbits with acute lung injury and evaluate the imaging value on pathological changes.Materials and Methods The bilateral anterior chest walls of the rabbits were divided into four zones, namely, left upper zone, right upper zone, left lower zone and right lower zone. The normal chest ultrasound images of the 6 rabbits were obtained. After oleic acid (0.1 ml/kg) was injected, the images of comet-tail artifact in the four lung zones were dynamically observed and stored for 1 hour. The chest ultrasound images were evaluated according to the ultrasound scores. The degree of pathological damage in each lung zone was assessed and analyzed in terms of the correlation with the ultrasound results.Results The animal model of acute lung injury with diffuse comet-tail artifacts was successfully made in all of the 6 rabbits. The main pathological changes of the animal model of oleic acid were diffuse pulmonary edema, congestion and congestive hemorrhage; necrosis was found in 4 rabbits. The area of pulmonary edema, congestion, and congestive hemorrhage increased gradually from top to bottom, and double diaphragm leaves were typical. A significant correlation was found between the ultrasound scores of comet-tail artifacts and the degrees of pathological damage (r=0.819,P<0.05).Conclusion The histological changes of chest diffuse comet-tail artifacts due to acute lung injury are pulmonary edema, congestion and congestive hemorrhage. The scope and density of diffuse comet-tail artifacts may indicate the degree of pulmonary parenchyma injury, which is important as reference to guide the treatment and prognosis.

目的 观察颈动脉硬化斑块在药物治疗前后的超声造影表现,指导临床用药.方法 对18例颈动脉硬化斑块患者行颈动脉超声造影检查,经过服用他汀类降脂药物治疗半年后再次行超声造影检查,观察颈动脉硬化斑块药物治疗前后的超声造影表现,观察斑块是否有新生血管形成,如有新生血管形成记录峰值强度(PI值).方法 18例患者行超声造影检查,观察斑块18个,1例患者用药前后斑块内均无造影剂增强,1例患者用药前斑块内无增强,用药后复查斑块出现造影剂增强,14例患者用药后PI差值高于用药前,2例患者用药后PI差值低于用药前.结论 颈动脉超声造影检查可以对应用血管生成抑制剂的患者进行服药前后的对比观察,评价药物疗效并为临床的用药提供依据.

Objective To establish oleic acid acute lung injury animal model and investigate clinical value of chest diffuse comet-tail sign. Methods Nineteen adult female Japanese big ear rabbits were anesthetized via ear marginal vein (1 ml/kg 3%sodium pentobarbital) and fixed on the rabbit platform in supine position, then the chest skin preparation was operated. The bilateral anterior chest wall were divided into upper and lower lung zone, a total of four regions. Transthoracic ultrasound taked normal chest ultrasonography of the four regions. 0.1 ml/kg oleic acid were injected disposable via ear marginal vein, the observer started timing, observed dynamic time and quantity about comet-tail sign of the four lung regions and stored images until 1 hour. Results 18 rabbits occurred chest diffuse comet-tail sign, the success rate of model making was 94.7%. After the injection of oleic acid, chest ultrasonography:short comet-tail sign, isolated comet-tail sign, mild diffuse comet-tail sign, moderate diffuse comet-tail sign and severe diffuse comet-tail sign (falls sign), the time they appear: (5.36±2.16)min, (7.11±2.67)min, (10.94±5.94)min, (28.64±12.04)min, (46.40±5.59)min. Short comet-tail sign is the most early sonographic manifestation of acute lung injury. Until the end of 1 hour, upper lung region was characterized by mild diffuse comet-tail sign, lower lung region was characterized by moderate diffuse-comet tail sign. Conclusions The injection of 0.1ml/kg oleic acid via ear marginal vein can rapidly replicate chest diffuse comet-tail sign model in rabbits, appearance of diffuse comet-tail sign in an hour after injection of oleic acid mean model’s success. Short comet-tail sign is the most early sonographic manifestation of acute lung injury, can be used as the early sonographic signs prompting acute lung injury, and provide important reference value for the clinical prevention of acute lung injury.

目的 探讨家兔VX2肿瘤子宫病灶的超声造影表现.方法 44只成年雌性日本大耳家兔随机分为实验组20只及对照组24只.实验组采用子宫腔及腹腔内瘤块种植法复制家兔VX2肿瘤动物模型,对可疑肿瘤组织进行超声造影增强检查及病理检查,镜下观察确诊是否为肿瘤生长的肿块,对确诊的肿瘤灶分析其超声造影时间-强度曲线;对照组对正常子宫肌层及内膜行超声造影增强检查及病理检查,镜下观察子宫肌层及内膜结构正常者对其超声造影时间-强度曲线进行分析;将实验组与对照组超声造影时间-强度曲线内增强时间、增强强度、增强斜率及消退斜率等参数进行对比分析.结果 实验组成功复制家兔子宫及腹腔肿瘤模型16例,肿瘤组织生长时间13～35 d,其中肿瘤坏死较严重者2例,未纳入结果统计;另有麻醉意外死亡者2例,未见肿瘤生长者2例.14例动物模型中获得34个肿瘤灶的超声造影检查及病理检查结果,肿瘤病灶最大径为4～30 mm;肿瘤组织超声造影增强时间、增强强度、增强斜率及消退斜率分别为(3.91±1.59)s、(12.93±2.98) dB、(3.72±1.41) dB/s及(0.20±0.08) dB/s.对照组24只家兔中的44侧子宫超声造影增强检查及病理检查,超声造影增强时间、增强强度、增强斜率及消退斜率分别为(5.64±2.58)s、(12.33±4.66) dB、(2.79±1.71) dB/s及(0.19±0.07) dB/s.实验组超声造影肿瘤组织增强模式与正常子宫差异有统计学意义,增强时间短于正常子宫(t=3.613,P＜ 0.05),增强斜率大于正常子宫(t=2.611,P＜0.05),呈现快速增强模式,而消退斜率与正常子宫比较差异无统计学意义(t=-0.686,P=0.495).结论 超声造影增强检查可发现实验动物腹腔内小至最长径为4 mm的肿瘤病灶,对早期发现子宫内膜癌腹盆腔淋巴结转移病灶及腹盆腔侵犯肿瘤病灶有指导意义.

目的 总结桥本甲状腺炎(HT)合并甲状腺结节样病变超声与病理学特征.方法 对89例超声显示HT合并甲状腺结节样病变患者的超声声像图表现与病理特征进行总结分析.结果 89例HT合并甲状腺结节术前超声诊断良性结节78例(87.6％,78/89),恶性结节11例(12.4％,11/89).其中78例良性结节最大径6.4 cm×4.6 cm,最小径0.4 cm×0.3 cm,超声表现:(1)甲状腺对称性弥漫性肿大,峡部肿大明显,腺体回声减低,可见细线状强回声交织呈网格状. (2) HT合并甲状腺结节形态多较规则(71.8％,56/78),边界清晰(73.1％,57/78),部分呈高回声(21.8％,17/78),多数结节(74.4％,58/78)内未见钙化,结节周围腺体分布不均匀(75.6％,59/78);少数结节(19.2％,15/78)内见环状或团状粗大钙化灶,结节周围腺体分布均匀(24.4％,19/78).(3)彩色多普勒血流成像示结节内血流信号较丰富(30.8％,24/78),部分结节(25.6％,20/78)边缘血流绕行.11例恶性结节最大径3.8 cm×2.6 cm,最小径0.5 cm×0.4 cm,超声表现:(1)甲状腺回声增粗不均或无明显改变.(2)恶性结节多呈不规则形(54.5％,6/11),边界不清(81.8％,9/11),低回声为主(90.9％,10/11),内部见粗大钙化(36.4％,4/11)或微小钙化(45.5％,5/11);多数结节(72.7％,8/11)周围腺体分布不均匀,少数结节(27.3％,3/11)周围腺体分布均匀.(3)彩色多普勒血流成像示结节边缘血流信号不丰富(9.1％,1/11),4例(36.4％,4/11)见粗大穿支血流信号.89例HT合并甲状腺结节术前超声与病理相关特征:(1)局灶性HT无合并结节22例,病理镜下示甲状腺内局灶性淋巴细胞浸润无明显纤维间隔形成;(2)HT合并结节性甲状腺肿49例,合并甲状腺腺瘤7例,合并甲状腺癌11例,病理镜下示结节周围淋巴细胞浸润,甲状腺滤泡重度萎缩,周边见粗大纤维间隔,与不均匀或网格样结构的声像图表现相吻合;病理镜下显示甲状腺滤泡轻度萎缩,结节周围未见粗大纤维分隔,与声像图表现的腺体回声均匀的图像表现相吻合.与手术病理诊断对照显示:术前超声诊断甲状腺良性结节及恶性结节与病理诊断符合率分别为91.0％ (71/78)及54.5％ (6/11).结论 HT合并甲状腺结节样病变因病理表现不同超声表现各异.腺体萎缩退化伴低回声结节内微小钙化或粗大钙化可能为HT合并甲状腺癌的特征性声像表现;腺体回声不均或出现网格状结构提示HT腺体严重萎缩,可能为HT合并甲状腺良性病变的特征性声像表现.

30岁初产妇，唐氏筛查正常，未做胎儿染色体核型检查，妊娠早期血HCG水平在正常范围内。妊娠22周产前超声检查发现胎盘局部回声减低，内略呈网格样改变，范围69 mm ×60 mm ×33 mm，与正常胎盘间分界较清晰，CDFI该区域内未见明显血流分布（图1）；妊娠中晚期超声复查，胎盘异常回声区仍可见，边界欠清晰。妊娠32周超声显示脐带胎盘附着处局部脐静脉明显扩张，走行迂曲，随孕周增加进一步增宽，至妊娠39周最宽处内径约27 mm，可在部分管腔内观察到中高回声结构（图2）。该孕妇于妊娠40周娩出一活女婴，其出生体重、外观、一般状况及内脏结构未见明显异常。胎盘病理检查：胎盘增大，脐带偏心附着，根部及部分绒毛膜血管迂曲扩张（图3），管腔内见灰白色物质及凝血，母面局部见范围约120 mm ×50 mm ×23 mm灰白色区域；镜检：脐根部扩张血管内见血栓形成，胎盘局部灰白色区域为无绒毛血管区，部分干绒毛扩大并含疏松结缔组织和池样结构，未见滋养细胞增生（图4，5）。病理诊断：胎盘间叶发育不良（ placental mesenchymal dysplasia ，PMD）伴血栓形成。

Objective To observe the early morphological changes of carotid artery thrombus in rabbits by ultrasound.Methods Carotid artery thrombus models were established by stimulated with 3 Volt galvanic current on the carotid wall in 7 Japanese white rabbits to induce the injury of blood vessel. The conventional ultrasound and contrast-enhanced ultrasound (CEUS) were performed immediately,3 d and 1 week after the establishment of carotid artery thrombus models. One week later, the carotid artery thrombus models were dissected to make pathological sections, the pathological results were compared with those of conventional ultrasound and CEUS. Results There was low level echo filled in the carotid artery immediately after operation, no blood flow signal was found, and no contrast media perfusion was found in thrombus. Three days later, thrombus showed low level echo and there was narrow strip blood flow at the edge of thrombus, CEUS showed there was contrast agent at the edge of thrombus. And 1 week later, the internal diameter at the place of thrombus was widen and the echo of the thrombus was higher than before, blood flow was also seen at the edge of thrombus, CEUS showed there was contrast agent at the edge of thrombus. The pathology results showed: thrombus was generated in the carotid artery with part of thrombus organization. Conclusion The morphology of carotid artery thrombus can change in the short time period(1 week) through the observation of conventional ultrasound, CEUS and pathology.