Placenta，fetal heart and brain affect each other in the process of fetal growth. They are influenced by genetic，environmental，epigenetic and hemodynamic factors，and share several key developmental pathways. Fetal heart defect in ongenital heart disease（CHD）is associated with abnormal development of placenta and brain. One-stop-shop ‘heart-brain-placenta’ imaging is of great value in prenatal diagnosis of CHD fetuses. This review discusses the current research on the one-stop-shop ‘heart-brain-placenta’ imaging of CHD fetuses.

Objective:To investigate the value of carotid，radial and podalic artery intima thickness（CIT，RIT，PIT）combined with monocyte to high-density lipoprotein ratio（MHR）in predicting the severity of coronary artery stenosis in patients with premature coronary artery disease（PCAD）.Methods:A total of 80 patients with PCAD who received treatment in Henan Provincial People's Hospital from October 2023 to May 2024 were prospectively recruited，and they were divided into high group（≥41 score，40 cases）and low group（＜41 score，40 cases）according to the median dichotomy of Gensini score. Thirty-four gender，age and body mass index（BMI）-matched healthy volunteers were selected as the control group. The CIT，RIT，PIT，media and intima media thickness of carotid，radial artery and podalic artery（CMT，RMT，PMT，CIMT，RIMT，PIMT）were measured using 24 MHz ultra-high frequency ultrasound probe，and the ratio of intima to media thickness（CIT/CMT，RIT/RMT，PIT/PMT）was calculated. The differences of general clinical data，laboratory indexes and ultrasonic parameters among the three groups were compared. Risk factors affecting the severity of coronary stenosis in PCAD patients were explored by binary logistic regression. Subject working characteristic curves were plotted，area under the curve（AUC）was calculated，and the values of each ultrasound parameter and MHR in the independent and combined diagnosis of the severity of coronary artery stenosis in PCAD patients were evaluated.Results:①There were no statistically significant differences in age，gender，BMI，total cholesterol，CMT，RMT and PMT among the three groups（all P＞0.05）. There were no statistically significant differences in the comparison of smoking，hypertension，diabetes mellitus，systolic blood pressure，diastolic blood pressure，low-density lipoprotein cholesterol，total cholesterol，and triglycerides between the two subgroups of the PCAD（all P>0.05）. ②CIT，CIMT，CIT/CMT，RIT，RIMT，RIT/RMT，PIT，PIMT，PIT/PMT were thickened in the high group compared with the low group，and MHR was higher than in the low group（all P<0.05），the differences in the above parameters remained statistically significant when comparing the PCAD group with the control group（all P<0.05）. ③The AUC values for MHR，CIT，RIT and PIT alone to predict the severity of coronary stenosis in patients with PCAD were 0.781，0.767，0.780 and 0.722，respectively. The combined diagnostic efficiency of the four parameters was better than the independent diagnostic efficiency（AUC = 0.885）. Conclusions:CIT，RIT and PIT are thicker in PCAD patients with high Gensini score and the combination of artery intima thickness and MHR has good efficacy in predicting the severity of coronary artery stenosis in PCAD patients.

Objective:To evaluate the structural and functional changes of the left atrium in amateur ultra-marathon runners using ultrasound three-dimensional speckle tracking imaging technology.Methods:From June 2023 to June 2024，90 amateur marathon athletes were retrospectively recruited，including 44 amateur ultra-marathon（running distance ≥50 km）athletes（Ultra-marathon，UM group）and 46 amateur classic marathon（running distance<50 km）athletes（Marathon，M group）. Another 39 healthy volunteers who underwent physical examinations in Hangzhou Normal University Affiliated Hospital at the same time were selected as the control group. The distance，running age of amateur marathon runners were recorded. All subjects which underwent conventional echocardiography combined with three-dimensional speckle tracking echocardiography（3D-STE）obtained left atrial volume and functional parameters，including two-dimensional ultrasound indicators such as left atrial anterior posterior diameter（LAd），left ventricular end-diastolic diameter（LVEDd），left ventricular ejection fraction（LVEF），early diastolic peak velocity at the mitral valve orifice（E），and early diastolic peak velocity at the lateral mitral annulus（e'），E/e'，left atrial minimum，maximum，presystolic volumes（LAVmin，LAVmax，LAVpreA），left atrial maximum volume index（LAVImax），left atrial emptying volume（LAEV），overall left atrial ejection fraction，active and passive ejection fraction（LAEF，LAaEF，LApEF），left atrial expansion index（LAEI），left atrial reservoir period，conduit period，systolic long axis and circumferential strain（LASr，LAScd，LASct，LASr-c，LAScd-c，LASct-c）. The differences in left atrial parameters among three groups were compared and the relevant factors affecting LAEF were analyzed.Results:There were statistically significant differences in LAd，LVEDd，LAVmin，LAVmax，LAVpreA，LAVImax，and LAEV among the three groups（all P<0.05），and there were statistically significant differences in pairwise comparisons between the groups（all P<0.05）. Compared with the control group，LAEF，LApEF，LASr，LAScd，LASct，LASr-c，LAScd-c and LASct-c were significantly reduced in the M and UM groups（all P<0.05），while there were no statistically significant differences in these parameters between the UM and M groups（all P>0.05）；There were no statistically significant differences in IVSd，LVEF，E/e'，LAEI，and LAaEF among the 3 groups（all P>0.05）.There were no statistically significant differences in IVSd，LVEF，E/e'，LAaEF and LAEI among the 3 groups（all P>0.05）. Multiple linear regression analysis showed that only weekly running volume was an independent predictor of decreased LAEF in amateur marathon runners. The repeatability test indicated good consistency within and between observers. Conclusions:Amateur marathon runners have varying degrees of damage to their left atrial reservoir function，conduit function，and contraction function，with amateur ultra-marathon runners showing more significant damages，3D-STE technology can evaluate the structural and functional changes in the left atrium in amateur ultra-marathon athletes，and assist clinical understanding of atrial adaptation in amateur ultra- marathon athletes.

Objective:To evaluate left ventricular function and myocardial ischemia in patients with different degrees of left anterior descending（LAD）coronary artery stenosis by using post-stress regional myocardial work（MW）and coronary flow reserve（CFR），and to analyze the diagnostic efficacy of each parameter for different degrees of stenosis in the LAD.Methods:A retrospective analysis was conducted on 76 patients with suspected coronary artery disease who underwent coronary angiography and attended the Fourth Affliiated Hospital of Harbin Medical University from January 2023 to June 2024. According to the degree of LAD stenosis，30 cases were categorized into the mild stenosis group（stenosis < 50%），25 cases in the moderate stenosis group（50%≤stenosis < 70%），and 21 cases in the severe stenosis group（70% ≤ stenosis ≤ 90%）. Transthoracic Doppler echocardiography was applied to obtain CFR LAD. Longitudinal strain in the left anterior descending region（LS LAD），peak strain dispersion（PSD），left anterior descending region work index（WI LAD）and left anterior descending region work efficiency（WE LAD）were obtained at rest and under stress，respectively. The LAD regional MW indexes were compared between the groups in two pairs. The correlation between CFR LAD and the degree of LAD stenosis was analyzed. ROC curves were plotted to compare the diagnostic efficacy of LAD regional MW parameters and CFR LAD for moderate and severe LAD stenosis. Results:①At rest：compared with the mild stenosis group，the absolute value of LS LAD，WI LAD，and WE LAD were reduced in the severe stenosis group，and the differences were statistically significant（all P < 0.05）. Compared with the moderate stenosis group，WE LAD was reduced in the severe stenosis group，and the difference was statistically significant（ P < 0.05）. Differences in two-by-two comparisons between groups in the resting state for the remaining parameters were not statistically significant（all P > 0.05）. Under stress：compared with the mild stenosis group，the absolute values of LS LAD，WI LAD，and WE LAD were reduced in the moderate and severe stenosis groups，and the PSD was increased in the severe stenosis group，and the differences were statistically significant（all P < 0.05）. Compared with the moderate stenosis group，the absolute values of LS LAD，WI LAD，and WE LAD were reduced in the severe stenosis group，and the differences were statistically significant（all P < 0.05）. Differences between two-by-two comparisons between groups in the remaining parameters at loading state were not statistically significant（all P > 0.05）. ②CFR LAD was negatively correlated with the degree of LAD stenosis（ r = -0.809， P < 0.05）. ③The ROC curves showed that the peak WE LAD of the regional MW parameters predicated the largest area under the ROC curve（AUC）for moderate and severe stenosis in LAD，0.803 and 0.897，respectively，with cutoff values of 92.5% and 91.5%. The cutoffs of CFR LAD ≤ 2.5 and CFR LAD ≤ 2.0 predicted the greatest AUC for moderate and severe stenosis in LAD at 0.743 and 0.901，respectively. Peak WE LAD combined with CFR LAD predicted the greatest AUC for moderate and severe stenosis in LAD at 0.826 and 0.967，respectively. Conclusions:Regional MW parameters and CFR LAD can sensitively detect left ventricular hypo-function in patients with different degrees of stenosis in LAD. Peak WE LAD and CFR LAD are reliable predictors of moderate and severe stenosis in LAD. A combination of the two techniques can significantly improve diagnostic efficacy.

Objective:To analyze the differences in heart size，shape and function between fetuses with tetralogy of Fallot（TOF）and fetuses with malalignment ventricular septal defect（VSD）and pulmonary stenosis（PS）（named as，mild TOF）by fetal heart quantification（fetal HQ）and multi-parameter fetal echocardiography.Methods:From June 2021 to June 2023，50 fetuses with TOF（TOF group）diagnosed by fetal echocardiography at the Department of Diagnostic Ultrasound & Echocardiography Sir Run Run Shaw Hospital，Zhejiang University College of Medicine and 34 fetuses with VSD and PS matched to gestational age（mild TOF group）were retrospectively selected. Cardiovascular parameters were measured by 2D echocardiography，M-mode echocardiography and fetal HQ，including aortic dimension（AO）and its Z-score（AO Z-score），pulmonary artery diameter（PA）and its Z-score（PA Z-score），PA/AO ratio，main pulmonary artery diameter（MPA）and its Z-score（MPA Z-score），left pulmonary artery diameter（LPA）and its Z-score（LPA Z-score），right pulmonary artery diameter（RPA）and its Z-score（RPA Z-score），McGoon index（MGI），tricuspid annular diameter（TV）and its Z-score（TV Z-score），mitral annular diameter（MV）and its Z-score（MV Z-score），and MV/TV ratio. Measurements of global ventricular morphologic parameters included cardiac axis，left and right ventricular transverse diameters（LVW，RVW）and their ratio（LVW/RVW），left and right ventricular long diameters（LVL，RVL）and LVL/RVL ratio，left and right ventricular areas（LVA，RVA）and LVA/RVA ratio，global spherical index（GSI）and its Z-score，four chamber view transverse diameter（4CV-Width-ED），four chamber view end-diastolic longitudinal diameter（4CV-Length-ED），four chamber view end-diastolic area（4CV-Area-ED）. Measurements of left and right global ventricular functional parameters included fractional left ventricular and right ventricular area changes（LVFAC，RVFAC），left ventricular ejection fraction（LVEF），left ventricular and right ventricular global longitudinal strains（LVGLS，RVGLS）；end diastolic width diameter（Width-ED），SI and fractional shortening rate（FS）of 24 segments of left and right ventricles. The differences of the above parameters between the two groups were analyzed and compared，and the relationships between absolute values of GLS in left and right ventricles of TOF fetus and PA Z-score，MPA Z-score and PA/AO were analyzed. Binary Logistic regression model was used to select the best variables，and ROC curve was adopted to analyze the predictive values of ultrasonic parameter variables on TOF.Results:There were statistically significant differences in MV，TV，RVW，RVL，LVL，LVA，RVA，4CV-Length-ED，LVGLS，RVGLS，RVFAC，PA/AO，MPA，RPA，LPA，MGI，PA and PA Z-score between TOF group and mild TOF group（all P<0.05）. The Width-ED values of all segments of left ventricle were statistically different between TOF group and mild TOF group（all P<0.05）. There were statistical differences in SI between LV segments 4~6 and 8~24，and RV segments 1~21（all P<0.05）. The FS values between the 8th and 10th to 18th segments of RV revealed statistical differences（all P<0.05）. There were no statistical differences in the other parameters（all P>0.05）. The absolute value of LVGLS in TOF fetuses was positively correlated with PA Z-score，MPA Z-score and PA/AO（ r = 0.313，0.344，0.304，all P<0.05），and the absolute value of RVGLS was positively correlated with PA Z-score，MPA Z-score，and PA/AO（ r = 0.323，0.334，0.357，all P<0.05）. Binary Logistic regression model analysis confirmed that LVGLS，RVFAC and PA/AO were predictive variables. ROC curve analysis showed that the areas under the curves of LVGLS，RVFAC and PA/AO for predicting TOF were 0.746，0.693 and 0.849 respectively. The combined prediction efficiency was higher，and the area under the curve was 0.906. Conclusions:Fetal HQ combined with multiple fetal echocardiographic quantification indices can evaluate the differences in fetal heart size，shape and function between TOF and mild TOF. It is expected to provide important reference information in prenatal diagnosis and consultation for fetuses with TOF and mild TOF.

Objective:To evaluate the elastic characteristics of the pulmonary trunk and its distal branches in fetuses with tetralogy of Fallot（TOF）by Doppler echocardiography.Methods:A total of 42 fetuses with TOF（TOF group）and 84 gestational age-matched normal fetuses（control group）were prospectively collected from the Second Xiangya Hospital of Central South University from August 2022 to January 2023. The severity of TOF was classified into mild TOF（Z-score≥-2），moderate TOF（-40.05）. Conclusions:Fetuses with TOF present with increased MPA-PAS and decreased stiffness in the distal PA. Histological abnormalities of the pulmonary artery wall in fetuses with TOF have been observed during pregnancy.

Objective:To explore the value of prenatal three-dimensional ultrasonography（3DUS）in displaying auricular morphotyping and dimensions for predicting congenital aural atresia（CAA）.Methods:A retrospective collection of 227 fetuses who underwent ultrasound scans and retained auricular 3DUS volumes from January 2018 to December 2023 at the First Affiliated Hospital of Sun Yat-sen University was conducted. Fetuses were divided into two groups：a CAA group（52 fetuses，62 auricles）and a non-CAA group（175 fetuses，202 auricles），based on the presence or absence of external auditory canal identified through postnatal examination. According to 3DUS auricular contour and presence or absence of the concha，the auricles were divided into 4 types：type Ⅰ，C-shaped auricle with a concha；type Ⅱ，Irregular auricle with a concha；type Ⅲ，C-shaped auricle without a concha；type Ⅳ，Irregular auricle without a concha. And auricular length（AL）and width（AW）were measured to calculate the product of the auricular length and width（ALW）. Normal reference ranges for ALW from the non-CAA group were developed. Differences of the auricular morphotyping and Z-score of ALW（ALWZ）were compared between the two groups. Receiver operating characteristic（ROC）curves were used to evaluate the diagnostic efficiency of auricular morphotyping，ALWZ and the regression model. A Logistic regression model for CAA based on auricular morphotyping and ALWZ were established.Results:The auricular morphotyping and ALWZ between the two groups were different statistically（both P<0.05）. The AUC of the auricular morphotyping and ALWZ predicting CAA were 0.960（95% CI = 0.923 - 0.997）and 0.975（95% CI = 0.959 - 0.991）individually. Formula for CAA prediction model combining the two indicators（5.379 × morphotyping - 2.386 × ALWZ - Conclusions:The auricular morphotyping and dimensions can effectively predict CAA.

Objective:To investigate the diagnostic value of contrast-enhanced ultrasound（CEUS）in solid pseudopapillary tumor of pancreas（SPTP），summarize the CEUS characteristics of SPTP，and to compare its CEUS enhancement with contrast-enhanced computed tomography（CECT）.Methods:In this retrospective study，baseline characteristics，basic ultrasound and CEUS images，CECT images of 70 patients diagnosed as SPTP from January 2009 to August 2023 were collected. Images were analyzed for extraction of key features and diagnostic accuracies of both CEUS and CECT were calculated. The relationships between ultrasound features and lesion size of SPTP were analyzed by Point-Biserial correlation analysis and Student t test. The diagnostic accuracy was compared by Mann-Whitney U test. Results:Iso-enhancement（55.7%，39/70）was commonly appeared in the early phase of CEUS for SPTP，while hypo-enhancement（74.3%，52/70）was the most common in the late phase. And the most common enhancement pattern was iso-hypo enhancement（41.4%，29/70）. Lesion membrane enhancement（47.1%，33/70），intralesional compartmentalization（28.6%，20/70），and intralesional vessels（25.7%，18/70）were the 3 typical signs found in CEUS for SPTP，which were correlated with lesion size（ P＜0.001）. Differences were found between the enhancement pattern of SPTP in CEUS and CECT，in which the most common enhancement patterns were hypo-hypo enhancement（41.4%，24/58）and iso-iso enhancement（29.3%，17/58）along with progressive enhancement. The diagnostic accuracies of CEUS and CECT were 71.4% and 74.1% respectively without statistically significant difference（ P=0.733）. Conclusions:CEUS shows high application value in the diagnosis of SPTP，and the accuracy of CEUS is comparable to that of CECT.

Objective:To evaluate the consistency between architectural distortion（AD）observed on coronal images in three-dimensional ultrasonography（3D-US）and full-field digital mammography（FFDM），and to analyze the influencing factors of the presence of AD on 3D-US coronal images.Methods:A retrospective study was conducted on 96 female patients（97 lesions）with AD identified via FFDM that examined at Affiliated Hangzhou First People's Hospital，School of Medicine，Westlake University from January 2019 to December 2021，all of which with corresponding 3D-US results. Kappa analysis was used to assess the consistency between AD on 3D-US and FFDM.The differences of the lesion characteristics on FFDM（glandular density，presence of calcifications，and degree of distortion），3D-US features（number of lesions，presence of mass or non-mass lesions，and skipping sign in coronal images），clinical pathological characteristics（age，location，and pathology）between groups with AD and without AD in 3D-US were compared. Multivariate Logistic regression was used to identify the influencing factors.Results:Among the FFDM-identified AD lesions，62（63.92%，62/97）lesions showed AD on 3D-US coronal images，including 30 malignant lesions（48.39%，30/62）；35（36.08%，35/97）lesions without AD on 3D-US，in which 4（11.43%，4/35）were malignant. The consistency of distortion degree between FFDM and 3D-US was moderate（Kappa=0.455， P<0.001），with no statistically significant difference（ χ2=2.882， P=0.143）. The probability of malignancy was higher in typical AD compared to atypical AD. The comparisons of age，location，number of lesions，presence of skipping sign in 3D-US，breast density，and presence of calcification in the lesion showed no statistically significant differences between the groups with and without AD（all P >0.05）.The pathological results of malignancy，presence of lesions in 3D-US（mass and non-mass lesions），and the degree of distortion in FFDM showed statistically significant differences（all P < 0.05）. The multivariate Logistic regression analysis indicated that there were no independent risk factors for the appearance of AD in 3D-US（all P > 0.05）. Conclusions:In breast FFDM AD lesions，the incidence of 3D-US coronal plane AD was 63.92%，and the consistency between the degree of distortion in FFDM and 3D-US was moderate. The probability of malignancy is higher with typical AD. Pathological malignancy，presence of lesions in 3D-US（both mass and non-mass lesions），and typical AD in FFDM are more likely to correspond with AD in the coronal.

Objective:To explore the value of ultrasound features modified version 2022 of the Ovarian-Adnexal Imaging Reporting and Data System（O-RADS）Category 4 in the differential diagnosis of benign and malignant ovarian-adnexal tumors.Methods:Retrospective analysis was conducted in 501 cases with ovarian masses classified into 4 categories according to the 2022 version of O-RADS who were collected from 4 clinical centers［the Second Afliated Hospital of Harbin Medical University（188 cases），Zhejiang Provincial People's Hospital（146 cases），Sichuan Provincial Maternity and Child Health Care Hospital（90 cases），and Fuling Hospital of Chongqing University（77 cases）］from January 2018 to July 2024 with concomitant surgical resection.The 424 cases from 3 of the clinical centers（the Second Hospital of Harbin Medical University，Zhejiang Provincial People's Hospital，and Sichuan Maternal and Child Health Hospital）were randomly divided into a training group（339 cases）and an internal validation group（85 cases）according to an 8∶2 randomization，while the cases from the other clinical center（Fuling Hospital of Chongqing University）were selected as the external validation group（77 cases），and the pathological diagnosis was used as the “gold standard”.Univariate and multifactorial logistic regression analyses were performed on the ultrasound characteristics of the training group to screen the independent predictors associated with ovarian carcinogenesis，and to formulate the stratification rules for the 4 types of masses in O-RADS. The ROC curve of this stratification method was plotted and the area under the curve（AUC）was calculated，and it was validated in the internal validation group and the external validation group；and the diagnostic accuracy was compared with that of the 2022 version of O-RADS.Results:Univariate logistic analysis showed that cysts with solid components，≥ 4 papillary projections，smooth inner wall of the cyst，color flow score ≥ 3 points，and acoustic shadowing were independent predictors of ovarian cancer（all P < 0.05）；while multifactorial logistic analysis showed that cysts with a solid component and a color flow score ≥3 points were independent risk factors of ovarian cancer（all P < 0.05），and smooth cyst walls and acoustic shadows were independent protective factors（all P < 0.05）.The diagnostic accuracies of the modified training group，internal validation group，and external validation group were 73.7%，68.2%，70.1%，respectively，which were significantly higher than the diagnostic accuracies of the 2022 version of the O-RADS（38.9%，37.6%，33.8%）（all P < 0.05）.The diagnostic sensitivity，specificity and AUC of the training group were 0.871，0.652，0.762，respectively，while the internal validation group were 0.844，0.585，0.714，and 0.846，0.627，0.737 in the external validation group. Conclusions:Improvement of the 2022 version of O-RADS category 4 using ultrasound features may improve the identification of benign and malignant ovarian-adnexal tumors.