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To evaluate the efficacy of the first‐trimester ultrasound scan in the detection of fetal structural anomalies in twin pregnancies. To examine the association between increased nuchal translucency (NT) thickness, crown–rump length (CRL) or NT discordance, and detection of structural anomalies in a large twin series in China. We performed retrospective analysis of twin pregnancies who underwent 11–13+6‐week and second‐trimester anomaly scan and booked at Beijing Obstetrics and Gynecology Hospital between January 2012 and December 2016. Measurement of fetal CRL/NT and assessment of fetal anatomic structures were based on standard (not detailed) protocols. Conjoined twins and twin‐reversed arterial perfusion sequence (TRAPS) were excluded from structural anomalies. The diagnostic performance of first‐trimester ultrasound in detection of fetal structural anomalies in twins was determined and compared with that of second trimester. The accuracy of independent variates associated with structural anomaly detection was calculated. A total of 1442 women with twin pregnancies were included. In 40 women and 45 fetuses, structural anomalies were found. Fetal structural anomalies verified at delivery were detected in 42.5% (17/40) of affected pregnancies in the first trimester and 92.5% (37/40) of affected pregnancies when added second trimester (P= .13). The survival rate of pregnancies detected in second trimester was higher than that of pregnancies detected in first trimester (11.8% vs 65.2%). The mean value of intertwin CRL/NT discordance in cases with fetal structural anomalies was larger in monochorionic twins than dichorionic twins, but monochorionicity was not associated with structural anomalies. CRL discordance ≥10% (OR 3.1, 95%CI 1.5–6.3) and NT ≥95th centile (OR 20.0, 95%CI 9.0–44.2) were associated with fetal structural anomalies. In both dichorionic (DC) and monochorionic (MC) twins, the percentages of CRL discordance ≥10% was larger in twins with structural anomalies than those without structural anomalies (37.5% vs 13.4% in DC twins and 50.0% vs 12.5% in MC twins), and this was also true for NT ≥95th centile (31.3% vs 1.7% in DC twins and 37.5% vs 2.2% in MC twins). In the setting of CRL discordance ≥10%, 40.0% (16/40) of twins with structural anomalies were found, in which the predominant fetal structural anomalies were cardiovascular defects, abdominal wall defects, and central nervous system defects. The AUC for detecting structural anomalies by CRL discordance ≥10% was 0.63. In the setting of NT ≥95th centile, 32.5% (13/40) of twins with structural anomalies were found, in which the predominant fetal structural anomalies were cardiovascular defects, cystic hygroma, and abdominal wall defects. The AUC for detecting structural anomalies by NT ≥95th centile was 0.65. The detection rate of twins with fetal structural anomalies was 42.5% per pregnancy in the first trimester. CRL discordance ≥10% and NT ≥95th centile may indicate higher risk of fetal structural anomalies in twins, but their efficacy was limited. Access the CME test hereand search by article title.

The anatomic integrity of the female mid urethra is an important factor for urinary continence. However, the associations between the urethral volume and potential affecting factors still remain uncertain. The aim of this study was to investigate the impact of potential factors, including age, height, weight, body mass index (BMI), parity number, delivery mode, and menopause, on the midurethral volume to assist in more‐accurate evaluations of urethral anatomy and urinary continence mechanisms in clinical practice. A total of 244 women were included in this study. All patients had no incontinence symptoms and underwent transvaginal ultrasound examinations. Detailed histories and demographic data were collected. Urethral volumes were acquired, and volume parameters were measured offline, including the urethral sphincter volume (USV), midurethral complex volume (CV), and inner core volume (ICV). Correlations were analyzed by the Spearman test. For categorical variables, an analysis of variance, Mann‐Whitney tests, or Kruskal‐Wallis tests were used to estimate associations of potential affecting factors and volumes. The mean age, height, weight, and BMI ± SD of the patients were 35.42 ± 9.88 years, 161.50 ± 4.96 cm, 60.72 ± 11.42 kg, and 23.29 ± 4.20 kg/m2, respectively. Among potential affecting factors, age had a weak correlation with the USV, CV, and ICV (P= .031, .003, and .004; r= 0.140, 0.193, and 0.187), whereas parity numbers significantly affected the USV, CV, and ICV (P= .014, .021, and .026). The urethral volume became larger with increasing parity. Height (P= .391, .637, and .647), weight (P= .077, .130, and .245), BMI (P= .583, .592, and .643), delivery mode (P= .483, .171, and .104), and menopausal status (P= .611, .717, and .830) had no significant impact on the midurethral volume data (USV, CV, and ICV). The midurethral volume tended to increase with age and parity in continent women.

ObjectiveTo describe spinal epidural lipomatosis (SEL) of the lumbar region and evaluate the relative versus absolute values of epidural fat (EF) to determine which is more appropriate when using magnetic resonance imaging (MRI).DesignComparative study.SettingHospital.ParticipantsEight SEL patients and 40 healthy adults.InterventionsMRI measurement of EF.Outcome MeasuresThe MRI-based EF thickness, cutoff value, and coefficient of variation (CV) were calculated. Frequency distribution maps for the absolute EF value and the relative EF/DuS value were created.ResultsSEL involved L3 − L4 in all cases. The mean EF thickness was 12.11 ± 2.28 mm (range: 9.91 − 16.86 mm), and the average diameter of the dural sac (DuS) was 20.02 ± 2.64 mm; the EF/DuS ratio was 0.61 ± 0.03. In controls, the average EF thickness was 7.35 ± 1.68 mm (range: 4.81 − 10.92 mm), and the average DuS was 20.86 ± 2.11 mm; the EF/DuS ratio was 0.35 ± 0.08. The relative and absolute values were significantly higher in the SEL group than in the normal group. A cutoff value of 9.8 mm could distinguish SEL patients from normal individuals. For the SEL group, the CV of the relative values (4.9%) was lower than that of the absolute values (18.8%). The frequency distribution map showed that the distribution of relative values was more concentrated than that of the absolute values for both groups.ConclusionBased on the frequency distribution and CVs, the relative value of EF/DuS maybe a better measure for diagnosing SEL than the absolute EF value.

Imaging assessment of the female urethra is critical for diagnosis and treatment of urinary incontinence. High‐frequency 3‐dimensional (3D) transvaginal ultrasonography (TVUS) is a novel technique for evaluating the female urethra. The aim of this study was to test the repeatability of 3D TVUS between examiners without prior experience with TVUS. Fifty women underwent 3D TVUS. Two examiners without prior experience analyzed the urethral volumes and measured the urethral parameters. Two‐dimensional (2D) parameters included urethral sphincter length and urethral sphincter thickness; 3D parameters included urethral sphincter volume, midurethral complex volume, and inner core volume. One of the examiners repeated the evaluations 1 month later. Subsequently, the measurements were compared. The mean age of the patients ± SD was 34.1 ± 8.1 (range, 23–55) years; the mean height, weight, and body mass index were 160.44 ± 5.12 (range, 150–173) cm, 61.80 ± 13.64 (range, 45–110) kg, and 23.98 ± 4.91 (range, 17.53–39.92) kg/m2, respectively. The results of our study showed excellent to good intraobserver repeatability (intraclass correlation coefficient [ICC], 0.75–0.87) for the evaluations of all parameters but urethral sphincter length (moderate ICC, 0.53), whereas they showed good to moderate interobserver repeatability (ICC, 0.44–0.77) for all parameters. The repeatability of 3D volumes (ICC, 0.59–0.87) tended to be better than that of 2D parameters (ICC, 0.44–0.76). The intraobserver and interobserver repeatability of high‐frequency 3D TVUS measurements of the female urethra was excellent to moderate between examiners without previous experience. The repeatability of 3D measurements tended to be better than that of 2D parameters.

Stroke is a serious medical condition that requires emergency care. In the case of ischemic stroke, ischemia may lead to damage to the blood–brain barrier (BBB); the damage in turn may exacerbate the condition. Therefore, noninvasive detection of BBB damage represents a challenge for experimental and clinical researchers. In this study, we assessed the onset of BBB disruption by means of T1-weighted images with administration of the contrast enhancement agent gadolinium-diethylenetriamine pentaacetic acid (Gd-DTPA) and related BBB breakdown to brain metabolite changes in proton magnetic resonance spectrum (1H-MRS) in the infarcted site following middle cerebral artery occlusion (MCAO) in rats. It was shown that MCAO for 30 min and 1.5 h caused no Gd-DTPA signal change in the T1-weighted images, whereas MCAO for 1 h significantly altered some of 1H-MRS brain metabolites, suggesting that brain metabolite changes occurred earlier than BBB damage after ischemic stroke. MCAO for 2 h caused BBB breakdown, which was related to changes in the levels of some brain metabolites detected by 1H-MRS. Between the second and the third hour after MCAO, brain metabolite changes continued as the result of BBB breakdown and the concurrent overperfusion to the infarcted site, which may ameliorate the metabolite changes, thus compensating for the functional failures of the brain after stroke.