Objective To summarize prenatal two-dimensional ultrasound examination results of different types of fetal limb deformity,and emphasise on some rare deformity disease such as phocomelia and sirenomelia.To investigate the value of systematic continuous sequence approach in the examination of fetal limb during pregnancy periods.Methods Eighteen thousand seven hundred and eight cases of fetus were selected from September 2014 to August 2016 in the 105th Hospital of Chinese People's Liberation Army,which were screened by routine and systematic ultrasonography.The systematic continuous sequence approach was used to focus on examination of the fetal limb.All fetuses with abnormal limbs were followed up.The ultrasonographic images were compared with the results of pathological examination and X-ray examination to summarize the ultrasonographic features of fetal limb deformities.Results Seventy-six cases of fetal limb deformity were detected by prenatal ultrasotmd system in 18 708 cases.Three cases were detected at 11-13 + 6 weeks of gestation,18 at 14-19 + 6 weeks,38 at 20-27 + 6 weeks,17 at 28-35 + 6 weeks.Types of limb deformities are as fllowing,11 cases of abnormal number of fingers (adactylism,polydactyly,syndactyly),2 cases of cleft hand deformity,45 cases of foot varus,1 case of sirenomelia and 4 cases of short limbs.Thirty-seven cases of fetal limb deformity combined with other system malformations and 12 cases were with multiple system malformations.Karyotypes were abnormal in 11 cases,including 3 cases of trisomy 21,6 cases of trisomy 18 and 3 cases of trisomy 13.One case of prenatal ultrasound diagnosis of twins with sirenomelia.An autopsy of twin fetus indicated that there were epactal toes at the left foot.Prenatal ultrasonography.Conclusions The systematic continuous sequence approach in early and middle pregnancy play the advantages of each pregnancy examination.The fetal limb deformity can be detected early by combining application of systematic continuous sequence approach.

Objective Uterine intravenous leiomyomatosiswas a rare type of uterus tumors.Because of the lack of knowledge about the ultrasonic patterns of this kind of disease,misdiagnosis frequently happens.Reviewing the cases and relevant researcheswas helpful to understand the disease and figure it out inultrasonic images.Methods Six cases of patients with uterine intravenous leiomyomatosis were reviewed which werehospitalized in Beijing Obstetrics and Gynecology Hospital during 2014 to 2016.All of the patients underwentultrasound examinations before surgery.The ultrasound findings,clinical presentations and pathological features of the 6 patients were evaluated.Results In 6 patients with uterine intravenous leiomyomatosis,3 cases were solid tumors,located in the cervix region and para uterine region,withirregular veinvascular inside;3 cases performance as multiple tumorlocated in dilated uterine vein,active tumor embolus were found in inferior vena cavain one of the 3 cases.Conclusions Uterine intravenous leiomyomatosisis found to be a solid mass located in the cervix region and para uterine region.The internal fissure of solid tumor is an important feature.Tumor extending to the iliac vein and inferior vena cava in some cases.Thusit is hard to be diagnosed before surgery by ultrasonography.Moreover,transvaginal ultrasound combined with inferior vena cava ultrasonography and echocardiography has a more obvious advantage in the diagnosis of the uterine intravenous leiomyomatosis.

Objective To determine the imaging features and clinical value of first-trimester ultrasonographic screening of fetal megacystis in multifetal pregnancy.Methods Retrospective analysis was undertaken in 2159 cases of multifetal pregnancy screened in our hospital at gestational age from 11th to 13 + 6th weeks by color Doppler ultrasound between Jan 2011 and April 2016.Fetal bladder was defined by showing two umbilical arteries and the longitudinal length of the bladder was measured in mid-sagittalplane.Clinical progression of fetal megacystis diagnosed in first-trimester were followed and the outcomes were recorded.Results Totally six cases of fetal megacystis in multifetal pregnancy were detected,in which five cases were detected in one fetus of twin pregnancy and the other case was detected in one fetus of triplet pregnancy.In all cases of fetal megacystis,longitudinal length of the fetal bladder was more than 7 mm and double umbilical arteries were detected.In two cases of naturally-occurring twin pregnancy,abortion was performed and postnatal autopsy revealed prune belly syndrome.In the rest four cases of multifetal pregnancy through in vitro fertilization-embryo transfer (IVF-ET),two cases of twin pregnancies underwent selective feticide.The other two cases of twin and triplet pregnancies refused intervention,among which still birth happened in the megacystis fetus and spontaneous fetal death at gestational age of 13 + 2 weeks happened in the monochorionic monoamniotic twins of the triplet pregnancy.Totally,four live babies were born,among which three were healthy.The other baby was found to have 1.5 Mb deletion in chromosome 17q12 by microarray at gestational age of 32 weeks due to increased renal echogenicity.Conclusions First-trimester ultrasonography can effectively detect and diagnose megacystis in multifetal pregnancy.Early diagnosis and timely intervention are helpful for improving the outcome of fetal megacystis in multifetal pregnancy.

Objective To discuss the prenatal ultrasound manifestations of intrauterine intussusception.Methods An analysis of prenatal ultrasound findings and postnatal features was performed on five cases of fetuses with intrauterine intussusception that were identified by ultrasonography at Beijing Obstetrics and Gynecology Hospital,in the period of January 2014 to December 2016.Results The 5 fetuses with intrauterine intussusception were diagnosed based on the typical "target sign","telescope sign","doughnut sign" and "crescent-in-doughnut sign "in ultrasonography.Indirect and non-specificultrasonographic signs included dilatation of intestine and ascites.Three cases of emergency caesarian section were performed,and infants underwent surgeries.The intraoperative findings confirmed the prenatal diagnosis,and postoperativelythe infantsrecovered uneventfully.In another 2 cases,whichwere suspected the presence of meconium peritonitis,fetus prematurely bomvia a spontaneous vaginal delivery,and the intraoperative findings confirmed the prenatal diagnosis.However,intestinal atresia occurred,and the neonates died postoperatively.Conclusions Fetuses with intrauterine intussusceptionshad characteristic "target sign","telescope sign","doughnut sign" and "crescent-in-doughnut sign" in ultrasonography.Ultrasonography may be used as the first choice for prenatal diagnosis of this disease.Prenatal diagnosis of intrauterine intussusception can provide guidance for clinical obstetrical management and postnatal treatment.

Objective To determine the image feature and clinical value of first-trimester ultrasonographic diagnosis of fetal holoprosencephaly.Methods A total 35 580 fetuses at gestational age between 11 + 6 and 13 + 6 weeks were scanned in our hospital by color Doppler ultrasound according to the prenatal ultrasound from Jan 2009 to Jan 2017.Fetal craniocerebral and faceprestige were checked carefully.Cases of fetal holoprosencephaly diagnosed in first-trimester were followed sonographically,and the clinical outcomes were recorded.Results Totally five cases of fetal holoprosencephaly were detected.Four fetuses with other associated malformations were detected by first trimester ultrasound,including one case with beak nosetril,eyes too close,one case with beak nosetril,fetal cleft lip and palate,fetal hydrops,congenital heart disease and mid gut herniation,one case with thickened nucha.One translucency (NT),one case with mandibular micrognathia,one case with trisomy 13 syndrome,the other four cases were not checked.Terminal of pregnancy was performed in four cases during early pregnancy,one case was loss to follow-up.Autopsy was refused in these cases.Fetal appearance revealed one case of cleft lip,single nostril,mandibular micrognathia,one case of hydrops,polyphalangia,microtia,one case of beak nosetril,fetal cleft lip and palate,mid gut herniation,hydrops,one case of beak nosetril,eyes too close.Conclusion Fetal holoprosencephaly can be effectively detected and diagnosed during early pregnancy with standardized prenatal ultrasound.

Objective To investigate the value of prenatal ultrasound in diagnosis of fetal posterior urethral valve (PUV) and the differential diagnosis of related diseases.Methods The antenatal ultrasonographic manifestations and the outcomes of 14 cases with congenital lower urinary tract obstruction (LUTO) in Shengjing Hospital of China Medical University from December 2014 to December 2016 were analyzed.The ultrasound features and differential diagnosis of fetal posterior urethral valve were summarized and analyzed.Results Fourteen male fetuses with LUTO were prenatally diagnosed.Eleven fetuses were diagnosed as PUV,I as urethral atresia,2 as megacystis and LUTO.Among the fourteen fetuses,11 were confirmed as PUV after delivery,1 as urethral atresia,2 as vesicoureteral reflux (VUR).One case among them was diagnosed as PUV,and latter proved to be VUR.In 2 cases among them,prenatal ultrasound indicated megacystis,but 1 case was proved to be PUV,and 1 case was VUR.The prenatal ultrasound of the PUV fetuses showed enlarged bladder and thickened bladder wall.Most of them were accompanied by the keyhole sign.Conclusion Prenatal ultrasound can assist in the diagnosis of PUV by analyzing the anatomy of the bladder and accompanying malformations,which provides valuable diagnostic information for the clinical practice.

Objective To investigate the diagnostic value of the acoustic radiation force impulse (ARFI) imaging technology and AST/PLT ratio index (APRI) for the assessment of the liver fibrosis in non-alcoholic fatty liver disease (NAFLD) patients.Method One hundred and thirty-six patients with NAFLD were included from May 2012 to May 2015 in the Third People's Hospital of Shenzhen.The subjects underwent liver biopsy,liver function and blood count test,as well as real-time ultrasonic elastography examination.The measurements of real-time ultrasonic elastography by ARFI technology used an ultrasonic instrument ACUSON S2000.The APRI was calculated according to the following formula,APRI=AST/PLT.ARFI and APRI were compared by correlation with liver fibrosis stage in NAFLD.Referring to the histologic fibrosis stage on liver biopsy,all the ARFI and the APRI value were assessed by using receiver operating characteristic (ROC) curve analysis.The corresponding cut-off values,sensitivity and specificity were also calculated and compared.One hundred and thirty-six patients with non alcoholic fatty liver disease were included in this study.Both of ARFI and APRI index were measured and calculated,and the results were compared with the pathological examination as gold standard.Results All patients underwent ARFI test.Compared with the patients with S0 and S 1,the ARFI of S4 were decreased significantly and the difference was statistically significant (both P ＜ 0.05).There was no significant difference in APRI index (P ＞ 0.05) among different stages of fibrosis.ROC curve of different diagnosis methods were drawn..The area under the ROC curve of diagnosing S2,S3 and S4 or higher stages nonalcoholic fatty liver disease by ARFI were 0.714,0.765,0.853,and corresponding value of APRI were 0.653,0.577 and 0.611.Compared with the APRI index,the area under the ROC curve of the ARFI technique in evaluating the degree of liver fibrosis in non alcoholic fatty liver disease was increased significantly,and the area under the curve of S4 was the highest.The cut-offARFI index of diagnosing severe hepatic fibrosis was 1.362 m/s.Conclusions As a non-invasive technology,ARFI is more accurate in evaluating liver fibrosis in patients with NAFLD than APRI.ARFI technology has potential value for quantitative evaluation of the liver fibrosis for NAFLD.

Objective To evaluate the correlation between enhancement vascular mode and gallbladder polyp nature and size with contrast-enhance ultrasound (CEUS).Methods From December 2014 to May 2016,patients with gallbladder polyp lesions (GPL) larger than 1.0 cm were enrolled in this study.Before cholecystectomy,every patient underwent ultrasound (US) and CEUS examination.All features of US and CEUS were analyzed by two doctors who were blind to the patient clinical data.According to the pathological findings,GPL were divided into cholesterol polyp group and gallbladder adenoma group.The US features and enhancement vascular mode were analyzed statistically by t test and x2 test.The independent risk factors were analyzed by Logistic regression.The relationship between enhancement vascular mod and size of GPL were determined by bivariate correlation analysis.Results There were 103 patients with GPL larger than 1.0 cm.Eighty-two cases were cholesterol polyp and 21 cases were gallbladder adenoma.There were differences in size and color Doppler blood flow between two groups (t=-5.97 and 7.94,P ＜ 0.05).Dotted,branched vascular mod and irregular vascular mode were statistical different between two groups (x2=10.09 and 8.43,P ＜ 0.05).Regression analysis data proved that the size and branch vascular mod were the independent risk factors related with adenoma (P ＜ 0.05).In both cholesterol polyp group and adenoma group,there were weak positive correlation between enhancement vascular mode and size of GPL (r=0.188,0.397,P ＜ 0.05).Conclusions Branch vascular mod and size of GPL were help to distinguish gallbladder adenoma from cholesterol polyp.Comprehensive analysis of GPL's size and vascular mode could offer important guidance for differentiation diagnosis.

Objective To explore the value ofspatio-temporal image correlation (STIC) technique in diagnosis of fetal ductus arteriosus aneurysm (DAA).Methods A total of 67 pregnant women,diagnosed with fetal ductus arteriosus aneurysm,were selected from the Fourth Affiliated Hospital of Harbin Medical University,between September 2014 and September 2016.2DE and STIC techniques were used to observe the form of fetal ductus arteriosus aneurysm.STIC technique was used to measure the maximum diameter,minimum diameter,systolic peak velocity,and diastolic velocity of ductus arteriosus aneurysm in 40 cases caused by ductus arteriosus stenosis.Pearson linear correlation analysis was applied to analyze the correlation between the maximum diameter and the minimum diameter,systolic peak velocity and diastolic velocity.The maximum diameters of 67 ductus arteriosus aneurysm were measured by 2DE and STIC techniques,and the above measurements were repeated one week later.ICC was used to analyze the consistency between 2DE and STIC technique,and internal consistency of 2DE and STIC technique,respectively.Results Pearson linear correlation analysis showed that the maximum diameter of the DAA was negatively correlated with the minimum diameter (r=-0.755,P ＜ 0.001) significantly,and positively correlated with the systolic peak velocity (r=0.779,P ＜ 0.001) significantly.The internal consistency of STIC technique was the best of the three,followed by the consistency between 2DE and STIC techniques,with the 2DE,illustrating the lowest consistency.Conclusions STIC technique provides with more comprehensive and accurate volume data than 2DE in the diagnosis of fetal ductus arteriosus aneurysm.Thus,this technique is conducive to the early detection of ductus arterious stenosis,observation of hemodynamic changes,closely monitoring of relevant indicators to guide clinical timely intervention,and to improve the quality of life of children.

Objective To investigate the value of quantitative analysis of the left ventricular longitudinal strain in patients with hypertrophic cardiomyopathy (HCM) and with normal left ventricular ejection fraction (LVEF) by using two-dimensional speckle tracking imaging.Methods Twenty-eight HCM patients with normal LVEF (all of the cases were non obstructive HCM),who were diagnosed by clinical and ultrasound echocardiography between January 1,2015 and January 1,2016 in the First Affiliated Hospital of Dalian Medical University,served as the experimental group.And twenty healthy volunteers served as the healthy control group.The peak longitudinal strain (LPS) of the left ventricle and the systolic peak of the left ventricle were calculated by the STE technique.The indexes such as the transmural gradient (△ LS=LPSEndo-LPSEpi)and the transmural gradient percentage (△ LS％=△ LS/LPSEndo) were calculated.The Peak systolic longitudinal strain of endocardium (LPSEndo),the peak systolic longitudinal strain of mid-cardium (LPSMid),the peak systolic longitudinal strain of epicardium (LPSEpi),the peak systolic longitudinal strain of basal segment (LPSb),the peak systolic longitudinal strain of middle segment (LPSm),the peak systolic longitudinal strain of apical segment (LPSa),the global peak systolic longitudinal strain (GLPS) and other left ventricular myocardial strain,such as △ LS,△ LS％,in both the HCM group and the healthy control group,were analyzed by using independent samples t test comparison.For each layer of the left ventricle and the overall myocardial longitudinal strain,two independent sample t test was used for comparison between groups,and LSD-t test was used for intra-group comparison.Results (1) There was a gradient of LPS among the three layers and the three segments in both of the two groups:LPSEndo and LPSMid [(18.36±4.97)％ vs (13.80±4.23)％,(26.41±2.93)％ vs (22.19±2.49)％],the difference was statistically significant (t=5.550,8.529,P ＜ 0.05);LPSEndo and LPSEpi [(18.36±4.97) ％ vs (11.91 ±3.63)％,(26.41±2.93)％ vs (19.43±2.20)％],the difference was statistically significant (t=5.550,8.529,P ＜ 0.05);There was significant difference between LPSMid and LPSEpi in the healthy control group [(22.19 ± 2.49)％ vs (19.43 ± 2.20)％,t=3.709,P ＜ 0.05)],that was,LPSEndo ＞ LPSMid ＞ LPSEpi.LPSa and LPSm,the difference was statistically significant (t=4.029,6.839,P ＜ 0.05);LPSa and LPSb,the difference was statistically significant (t=5.304,9.887,P ＜ 0.05);There was significant difference between LPSm and LPSb in the healthy control group (t=4.170,P ＜ 0.05);that was,LPSa ＞ LPSm ＞ LPSb.In the HCM group,LPS in the 3 layers,3 segments,and the whole left ventricular wall were lower than that of the the healthy control group,the differences were statistically significant [GLPS:(14.63± 3.75)％ vs (22.68±2.51)％,t=-8.347;LPSEndo to LPSEpi:t=-6.477,-7.909,-8.242;LPSa to LPSb:t=-6.647,-8.790,-7.267;all P ＜ 0.05).(2) Compared with the healthy control group,both the segmental gradient and global transmural gradient in the HCM group were found reduced,but the difference had no statistical significance (all P ＞ 0.05).(3) The transmural gradient percentage both in the healthy control group and the HCM group were reduced from the apical segment to the basal segment,the difference were statistically significant (HCM group:t=9.985,5.969;healthy control group:t=17.513,7.043;all P ＜ 0.05).Compared with the healthy control group,the △ LS％a and the △ LS％m of HCM group were significantly higher [(58.86± 11.32)％ vs (43.70±4.73)％,(28.43± 11.48)％ vs (20.30± 3.66)％],and the difference was statistically significant (t=5.634,3.049,all P ＜ 0.05).Conclusions (1) Using 2D-STI could accurately determine the regional or the global left ventricular systolic function in patients with HCM.(2) The transmural gradient percentage can be more sensitive to reflect the change of the transmural gradient,and more research needed to explore its value for clinical application.