Цель исследования. В рамках задания «Разработать и внедрить метод диагностики врожденных аномалий развития пищеварительной системы плода» научно-исследовательской работы ОНТП «Здоровье матери и ребенка – богатство общества» определить новые диагностические признаки наличия и проходимости желчевыводящих путей у плода с целью повышения эффективности диагностики атрезии желчных протоков в случаях невозможности получения изображения желчного пузыря плода.Материалы и методы. У 80 плодов, составивших основную группу изучения, были проведены ультразвуковые исследования и магнитно-резонансная томография печени, желчного пузыря с желчными протоками, тонкого и толстого кишечника с последующим анализом визуализационных характеристик данных структур в норме и в случаях невозможности визуализации желчного пузыря.Результаты. Определены современные критерии атрезии желчных протоков, выявляемые визуализирующими методами диагностики, использование которых позволяет более эффективно выявлять данную врожденную аномалию у плода. Обоснована целесообразность использования магнитно-резонансной томографии брюшной полости плода в качестве дополнительного метода оценки развития желчевыделительной системы, как позволяющего минимизировать число ложноположительных диагнозов атрезии желчных протоков.Заключение. С целью повышения эффективности дифференциальной диагностики врожденных аномалий развития структур желчевыделительной системы в случаях невозможности получения изображения желчного пузыря плода предложен оригинальный метод дородовой диагностики атрезии желчных протоков с использованием магнитно-резонансной томографии кишечника плода.Диагностическим признаком нормального формирования желчевыводящих путей у плода определен гиперинтенсивный уровень сигнала от кишечника плода в Т1-режиме. В случаях, когда в плодном периоде на Т1-взвешенном изображении сигнал от кишечника характеризовался как гипоинтенсивный, у этих новорожденных был установлен окончательный диагноз атрезии желчных протоков.Разработанный метод дородовой диагностики атрезии желчных протоков отличается новизной подхода к решению задачи повышения чувствительности и специфичности, а также своевременностью диагностики врожденного порока развития желчевыводящих путей у плода.С целью повышения качества анализа проведенных ультразвуковых диагностических исследований у плода целесообразно проводить цифровую архивацию этапов данного исследования и сохранять такой архив в течение минимум 2 лет от момента проведения ультразвукового исследования плода. In the framework of the task "To develop and implement a method for the diagnosis of congenital malformations of the fetal digestive system" of the research work "Maternal and child health – wealth of society" to identify new diagnostic signs of the presence and patency of the biliary tract in the fetus in order to improve the diagnosis of atresia of the bile ducts cases of impossibility of obtaining an image of the gallbladder of the fetus. Ultrasound examinations and magnetic resonance imaging of the liver, gall bladder with bile ducts, and small and large intestines were performed in 80 fetuses that made up the main study group, followed by analysis of the visualization characteristics of these structures in normal conditions and in cases of impossibility of visualizing the gall bladder. The modern criteria for gallbladder agenesis and atresia of the bile ducts are identified, identified by visualizing diagnostic methods, the use of which allows more effective detection of these congenital malformations in the fetus. The possibility of using magnetic resonance imaging of the abdominal cavity of the fetus as the primary method for assessing the development of the biliary system, which minimizes the number of false-positive diagnoses of biliary atresia, is substantiated.Conclusion. In order to increase the efficiency of differential diagnosis of congenital malformations of the structures of the biliary system in cases of impossibility to obtain an image of the fetal gallbladder, an original method of antenatal diagnosis of atresia of the bile ducts using magnetic resonance imaging of the intestine of the fetus is proposed. A diagnostic sign of the normal formation of bile ducts in the fetus is the hyperintensive signal level from the intestines of the fetus in the T1 mode. In cases when the signal from the intestine was characterized as hypo-intense in the fetal period on a T1-weighted image, subsequently, a final diagnosis of atresia of the bile ducts was established in these newborns. The developed method of prenatal diagnosis of atresia of the bile ducts is notable for the novelty of the approach to solving the problem of increasing sensitivity and specificity, as well as the timeliness of diagnosis of congenital malformation of the biliary tract in the fetus. In order to improve the quality of analysis of the performed ultrasound diagnostic tests in the fetus, it is advisable to digitally archive the stages of this study and save such an archive for a period of at least 2 years from the date of the ultrasound of the fetus.
Точная дифференциальная диагностика образований малого таза плода критична для определения прогноза и тактики ведения, а также пренатального консультирования.Цель исследования. Проанализировать ультразвуковые и МРТ-характеристики пренатально диагностированных крестцово-копчиковых тератом (ККТ) III–IV типов и кист яичников и выделить наиболее значимые дифференциально-диагностические признаки тератом с внутритазовым компонентом.Материалы и методы. Анализ эхографических и МРТ-характеристик, осложнений беременности и исходов при 8 пренатально диагностированных ККТ III–IV типов и 49 образованиях брюшной полости/малого таза плода (кистах яичников).Результаты. Лишь 37,5% ККТ III–IV типов были диагностированы до 22 недель беременности, средний срок их выявления был 29,6 (25–36) недели, осложнения беременности отмечались в 5 (83,3%) случаях; средний срок диагностики кист яичников составил 34,1 (29,3–37,4) недели, осложнений беременности в связи с наличием кист яичников не отмечалось. Относительный риск (ОР) того, что образование малого таза плода будет крестцово-копчиковой тератомой, повышается при толщине капсулы ≥2 мм (ОР=39,2 (95% ДИ 5,4–286,4)), визуализации гиперэхогенных включений в структуре образования (ОР=32,0 (95% ДИ 4,2–241,3)), наличии солидного компонента (ОР=25,5 (95% ДИ 6,6–99,2)), обнаружении интенсивного кровотока (ОР=17,3 (95% ДИ 5,8–52,0)).Заключение. Наиболее значимыми дифференциально-диагностическими признаками ККТ с внутритазовым компонентом являются: наличие толстой капсулы, гиперэхогенных включений и солидного компонента, интенсивная васкуляризация наряду с визуализацией взвеси, неоднородностью структуры образования; а также развитие гидронефроза, асцит и смещение мочевого пузыря кпереди. Precise differential diagnosis of fetal pelvic lesions is crucial for determining prognosis and management, as well as for prenatal counselling.Purpose. To analyze ultrasound and MRI-features of prenatally diagnosed sacrococcygeal teratomas (SCT) (types III–IV) and ovarian cysts and to define the most significant differential sings of teratomas with intrapelvic component.Materials and methods. Analysis of ultrasound and MRI-features, complications of pregnancy and outcomes in 8 cases of prenatally diagnosed sacrococcygeal teratomas (types III–IV) and 49 cases of abdominal/pelvic lesions (ovarian cysts).Results. Only 37.5% of SCT of types III–IV have been diagnosed before 22 weeks of gestation, mean gestational age at the diagnosis was 29.6 (25–36) weeks, pregnancies have been complicated in 5 (83.3%) cases; mean gestational age at diagnosis of ovarian cysts was 34.1 (29.3–37.4) weeks, there were not complications of pregnancy because of cysts. Relative risk (RR) of being SCT is being increased when the lesion has thick wall ≥2 mm (RR=39.2 (95% CI 5.4–286.4)), hyperechoic inner components (RR=32.0 (95% CI 4.2–241.3)), solid component (RR=25.5 (95% CI 6.6–99.2)), highvascularity (RR=17.3 (95% CI 5.8–52.0)).Conclusions. The most relevant differential features of teratomas with intrapelvic component are thick wall, hyperechoic inner components, solid component, high vascularization along with visualization of suspension inside the lesion and its heterogenicity and development of hydronephrosis, ascites and anterior displacement of the bladder.
Literature review on ultrasound prenatal diagnosis of sacrococcygeal teratomas, including complications, prognosis, management and time and mode of delivery is presented. Ultrasound images of different types of sacrococcygeal teratomas are demonstrated.
Objective: determine the optimal checklist of diagnostic procedures, whose application will make it possible to effectively identify and differentiate malformations of the biliary system of the fetus accompanied by the absence of ultrasound imaging of the gallbladder. Material . The fetuses in single-fetal pregnancy in the period of gestation of 16-37 weeks were examined. Results. The study has determined the optimal checklist of the diagnostic procedures, including dynamic sonography, biochemical amniotic fluid test, magnetic resonance imaging, which should be carried out in the absence of ultrasound imaging of the gallbladder during the screening ultrasound examination of pregnant women aimed at the identification of the congenital malformations of the fetus. The cases and conditions of the biochemical amniotic fluid testing have been identified. The standards of the percentile values of the total alkaline phosphatase and gamma-glutamyl transpeptidase concentrations in amniotic fluid have been developed. Conclusion. If the gall bladder of the fetus cannot be visualized by ultrasound, isolated agenesis of the gall bladder, atresia of the biliary tract, cystic fibrosis, aneuploidy, multiple congenital malformations should be suspected. In view of the extremely unfavorable prognosis in case of biliary atresia, the verification ultrasound examination should be repeated dynamically several times over the next week, and if the gallbladder is not detected, then for the differential diagnosis it is necessary to use additional methods such as MRI and biochemical amniotic fluid test in order to determine changes in their concentration of digestive enzymes in comparison with the normative values determined by the authors.
Objective: to determine the list of ultrasound criteria for normal development of the fetal lung, the use of which will make it possible to identify lung malformations in the fetus effectively, as well as to predict the development of lung hypoplasia in the newborn. Material of the research. The fetuses of singleton pregnancy in 1570 female patients of Minsk during the gestation period of 20-37 weeks. Results. The minimum list of the ultrasound criteria for the features of the lung development, which should be used for screening ultrasound examinations of pregnant women aimed at the detection of congenital lung malformations of the fetus, has been determined. The work indicates cases which require additional measurement of the lung volume of the fetus, the most optimal method for which is to use the VOCAL software package during three-dimensional sonography or direct measurement by MRI. The measurement data for the percentile values of the fetal lung volume taking into account the regional biometric features, as well as the percentile measurement data for the quantity of amniotic fluid have been determined. Conclusion. The minimum list of the ultrasound criteria for adequate lung development, the use of which during the screening ultrasound examinations of pregnant women will make it possible to detect congenital lung malformations of the fetus with high sensitivity, includes such characteristics as parenchyma homogeneity, diaphragm position, fluid in the pleural cavity, and the presence of fluid movement through the airways. The prenatal prediction of the development of respiratory distress syndrome in newborns requires direct measurement of the lung volume by means of the volumetric calculation program of three-dimensional sonography or MRI, followed by the assessment of the results using the tables of the regional percentile values, developed by the authors. Also, in cases of oligohydramnios, to make such a prediction, it is necessary to assess the quantity of amniotic fluid using the tables of the regional percentile values, developed by the authors.
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