产前超声诊断胎儿透明隔腔缺失及伴发脑中线结构发育异常的临床价值
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摘要
目的探讨产前超声诊断胎儿透明隔腔(CSP)缺失及伴发脑中线结构发育异常的临床价值。方法选取2014年12月至2017年12月间在神木市医院功能科经产前超声诊断为CSP缺失胎儿100胎,依据孕妇不同检测方法分成两组,其中56胎(8胎双胎,48胎单胎)行超声结合MRI检测,纳入观察组,44胎单胎行超声检测,纳入对照组。以随访结果或者引产影像学或者病理学检测作为金标准,比较两组孕妇的检测准确率。结果观察组经过随访结果或者引产后影像学、病理学检测验证,8胎CSP正常或者偏窄,34胎伴随胼胝体发育不良,2胎伴随慢性脑实质出血,2胎孤立性CSP缺失,10胎伴随前脑无裂畸形。产前超声诊断符合率显示孤立性CSP缺失为100%(2/2),CSP缺失伴随前脑无裂畸形为40.00%(4/10),CSP缺失伴随胼胝体发育不良为70.59%(24/34);对照组经随访结果或者产后影像学、病理学验证,4胎为孤立性CSP缺失,诊断率为100%(4/4);16胎为CSP缺失伴随胼胝体发育不良,准确率为50.00%(8/16);24胎为CSP缺失伴随前脑无裂畸形,准确率为100%(24/24);观察组超声总体诊断准确率为53.57%(30/56),MRI修正并明确了26胎儿的诊断结果,MRI诊断准确率为100%(56/56);对照组产前超声检测的总准确率为81.82%(36/44),低于观察组MRI修正后的诊断准确率,差异有统计学意义(P<0.05);观察组总体诊断准确率为100%,高于对照组的81.82%,差异有统计学意义(P<0.05)。结论胎儿颅内结构异常主要线索为CSP缺失,产前超声检测CSP缺失时需联合其孕周持续观察,同时注重对其他中枢神经结构检测。MRI检测可为超声诊断提供修正与补充,对胎儿CSP缺失评估有利。
Objective To analyze the clinical value of prenatal ultrasound in the diagnosis of absence of cavum septum pellucidum(CSP) and associated brain midline dysplasia. Methods From December 2014 to December 2017,100 fetuses in absence of CSP diagnosed by prenatal ultrasound in the Department of Functional Medicine, Shenmu Hospital were selected, which were divided into two groups according to different detection methods: the observation group(56 fetuses, including 8 twins and 48 singletons, examined by ultrasound combined with MRI) and the control group(44 singletons, detected by ultrasound). Taking follow-up results or imaging or pathological examination of induced labor as a gold standard, the accuracy of the two groups were compared. Results After verification by the follow-up results or imaging and pathology tests of induced labor, in the observation group, there were 8 fetuses of normal or narrow CSP, 34 fetuses with corpus callosum dysplasia, 2 fetuses with chronic cerebral parenchymal hemorrhage, 2 fetuses with isolated CSP deficiency, and 10 fetuses with forebrain fissure-free malformation. The coincidence rate of prenatal ultrasound diagnosis was 100%(2/2) for isolated CSP deficiency, 40.00%(4/10) for CSP deficiency associated with forebrain fissure-free malformation, and 70.59%(24/34) for CSP deficiency associated with corpus callosum dysplasia. In the control group, there were 4 fetuses of isolated CSP deficiency, and the diagnostic rate was 100%(4/4); there were 16 fetuses of CSP deficiency with corpus callosum dysplasia, and the accuracy rate was 50.00%(8/16); 24 fetuses had CSP deficiency with forebrain fissure-free malformation, and the accuracy rate was 100%(24/24). The overall diagnostic accuracy of prenatal ultrasound in the observation group was 53.57%(30/56), the diagnostic results were corrected and identified by MRI in 26 fetuses; the diagnostic accuracy of MRI was 100%(56/56). The total accuracy of prenatal ultrasound in the control group was 81.82%(36/44), which was lower than that in the observation group after the correction of MRI(P<0.05). The overall diagnostic accuracy in the observation group was 100%, which was significantly higher than 81.82%in the control group(P<0.05). Conclusion The main clue of fetal intracranial structural abnormalities is the absence of CSP. Prenatal ultrasound should be combined with continuous perinatal observation when detecting CSP deficiency,while paying attention to the detection of other central nervous system structures. MRI examination can provide correction and supplement for ultrasound diagnosis and is beneficial to the evaluation of fetal CSP deficiency.
Objective To analyze the clinical value of prenatal ultrasound in the diagnosis of absence of cavum septum pellucidum(CSP) and associated brain midline dysplasia. Methods From December 2014 to December 2017,100 fetuses in absence of CSP diagnosed by prenatal ultrasound in the Department of Functional Medicine, Shenmu Hospital were selected, which were divided into two groups according to different detection methods: the observation group(56 fetuses, including 8 twins and 48 singletons, examined by ultrasound combined with MRI) and the control group(44 singletons, detected by ultrasound). Taking follow-up results or imaging or pathological examination of induced labor as a gold standard, the accuracy of the two groups were compared. Results After verification by the follow-up results or imaging and pathology tests of induced labor, in the observation group, there were 8 fetuses of normal or narrow CSP, 34 fetuses with corpus callosum dysplasia, 2 fetuses with chronic cerebral parenchymal hemorrhage, 2 fetuses with isolated CSP deficiency, and 10 fetuses with forebrain fissure-free malformation. The coincidence rate of prenatal ultrasound diagnosis was 100%(2/2) for isolated CSP deficiency, 40.00%(4/10) for CSP deficiency associated with forebrain fissure-free malformation, and 70.59%(24/34) for CSP deficiency associated with corpus callosum dysplasia. In the control group, there were 4 fetuses of isolated CSP deficiency, and the diagnostic rate was 100%(4/4); there were 16 fetuses of CSP deficiency with corpus callosum dysplasia, and the accuracy rate was 50.00%(8/16); 24 fetuses had CSP deficiency with forebrain fissure-free malformation, and the accuracy rate was 100%(24/24). The overall diagnostic accuracy of prenatal ultrasound in the observation group was 53.57%(30/56), the diagnostic results were corrected and identified by MRI in 26 fetuses; the diagnostic accuracy of MRI was 100%(56/56). The total accuracy of prenatal ultrasound in the control group was 81.82%(36/44), which was lower than that in the observation group after the correction of MRI(P<0.05). The overall diagnostic accuracy in the observation group was 100%, which was significantly higher than 81.82%in the control group(P<0.05). Conclusion The main clue of fetal intracranial structural abnormalities is the absence of CSP. Prenatal ultrasound should be combined with continuous perinatal observation when detecting CSP deficiency,while paying attention to the detection of other central nervous system structures. MRI examination can provide correction and supplement for ultrasound diagnosis and is beneficial to the evaluation of fetal CSP deficiency.
引文
[1]张亚林,罗伟,廖荣信,等. MRI联合超声对胎儿脑室扩张病因的诊断价值[J].中国医学影像学杂志, 2016, 24(7):486-489.
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[3]JARVIS D, MOONEY C, COHEN J, et al. A systematic review and meta-analysis to determine the contribution of mr imaging to the diagnosis of foetal brain abnormalitiesIn Utero[J]. European Radiology, 2017, 27(6):2367-2380.
[4]李胜利.胎儿畸形产前超声诊断学[M].北京:人民军医出版社,2004:12.
[5]陈薇,张少丹.系统超声对胎儿透明隔腔消失的诊断价值[J].陕西医学杂志, 2016, 45(12):1691.
[6]张旭辉,陈晓荣,张珊珊,等.超声与MRI对胎儿神经系统发育异常的诊断分析[J].磁共振成像, 2016, 7(7):487-490.
[7]TONNI G, PATTACINI P, BONASONI MP, et al. Prenatal diagnosis of lissencephaly type 2 using three-dimensional ultrasound and fetal MRI:case report and review of the literature[J]. Rev Bras Ginecol Obstet, 2016, 38(4):201-206.
[8]GRIFFITHS PD, BRADBURN M, CAMPBELL MJ, et al. Use of MRI in the diagnosis of fetal brain abnormalities in utero(MERIDIAN):a multicentre, prospective cohort study[J]. Lancet, 2017, 72(68):538-546.
[9]GHOSH N, KRUSE D, SUBEH M, et al. Comparing point-of-care-ultrasound(POCUS)to MRI for the diagnosis of medial compartment knee injuries[J]. Journal of Medical Ultrasound, 2017, 25(3):167-172.
[10]李艳彬,孟雷,赵雅萍,等.胎儿透明隔腔缺如产前超声检查及其高危因素分析[J].中国计划生育学杂志, 2016, 24(12):845-847.
[11]LIAO CC, CHEN YF, XIAO F. Brain midline shift measurement and its automation:a review of techniques and algorithms[J]. International Journal of Biomedical Imaging, 2018, 2(7):1-4.
[12]万玉婷,蒋励帅,穆仲平.超声检查在诊断胎儿脑裂畸形中的应用价值[J].安徽医学, 2017, 38(10):1314-1316.
[13]DAVIS J, NOVOTNY N, MACKNIS J, et al. Diagnosis of neonatal neuroblastoma with postmortem magnetic resonance imaging[J]. Radiology Case Reports, 2017, 12(1):191-195.
[14]吕永燕,陈永超,连娟,等.中枢神经系统畸形胎儿产前超声诊断的脑室异常改变[J].东南国防医药, 2016, 18(4):370-373.
[15]罗晓婷.产前超声检查应用于92例胎儿透明隔腔诊断的临床价值分析[J].中国优生与遗传杂志, 2016, 7(12):124-125.
[16]万玉婷.超声在诊断胎儿脑裂畸形中的应用价值[J].安徽医学,2016, 8(10):92-94.
[2]尤淑艳,荆春丽,张鹏.胎儿透明隔腔异常的产前超声诊断及其临床意义分析[J].临床超声医学杂志, 2017,11(7):487-490.
[3]JARVIS D, MOONEY C, COHEN J, et al. A systematic review and meta-analysis to determine the contribution of mr imaging to the diagnosis of foetal brain abnormalitiesIn Utero[J]. European Radiology, 2017, 27(6):2367-2380.
[4]李胜利.胎儿畸形产前超声诊断学[M].北京:人民军医出版社,2004:12.
[5]陈薇,张少丹.系统超声对胎儿透明隔腔消失的诊断价值[J].陕西医学杂志, 2016, 45(12):1691.
[6]张旭辉,陈晓荣,张珊珊,等.超声与MRI对胎儿神经系统发育异常的诊断分析[J].磁共振成像, 2016, 7(7):487-490.
[7]TONNI G, PATTACINI P, BONASONI MP, et al. Prenatal diagnosis of lissencephaly type 2 using three-dimensional ultrasound and fetal MRI:case report and review of the literature[J]. Rev Bras Ginecol Obstet, 2016, 38(4):201-206.
[8]GRIFFITHS PD, BRADBURN M, CAMPBELL MJ, et al. Use of MRI in the diagnosis of fetal brain abnormalities in utero(MERIDIAN):a multicentre, prospective cohort study[J]. Lancet, 2017, 72(68):538-546.
[9]GHOSH N, KRUSE D, SUBEH M, et al. Comparing point-of-care-ultrasound(POCUS)to MRI for the diagnosis of medial compartment knee injuries[J]. Journal of Medical Ultrasound, 2017, 25(3):167-172.
[10]李艳彬,孟雷,赵雅萍,等.胎儿透明隔腔缺如产前超声检查及其高危因素分析[J].中国计划生育学杂志, 2016, 24(12):845-847.
[11]LIAO CC, CHEN YF, XIAO F. Brain midline shift measurement and its automation:a review of techniques and algorithms[J]. International Journal of Biomedical Imaging, 2018, 2(7):1-4.
[12]万玉婷,蒋励帅,穆仲平.超声检查在诊断胎儿脑裂畸形中的应用价值[J].安徽医学, 2017, 38(10):1314-1316.
[13]DAVIS J, NOVOTNY N, MACKNIS J, et al. Diagnosis of neonatal neuroblastoma with postmortem magnetic resonance imaging[J]. Radiology Case Reports, 2017, 12(1):191-195.
[14]吕永燕,陈永超,连娟,等.中枢神经系统畸形胎儿产前超声诊断的脑室异常改变[J].东南国防医药, 2016, 18(4):370-373.
[15]罗晓婷.产前超声检查应用于92例胎儿透明隔腔诊断的临床价值分析[J].中国优生与遗传杂志, 2016, 7(12):124-125.
[16]万玉婷.超声在诊断胎儿脑裂畸形中的应用价值[J].安徽医学,2016, 8(10):92-94.