彩色多普勒超声在胎儿胸腔占位性病变鉴别诊断中的应用
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摘要
目的探讨彩色多普勒超声在胎儿胸腔占位性病变中的鉴别诊断价值。方法回顾性分析54例胎儿胸腔占位性病变的产前超声资料,总结其声像图特征和鉴别诊断技巧。结果经产前超声发现的胸腔占位性病变54例,其中先天性膈疝(CDH)8例,先天性肺囊腺瘤畸形(CCAM)28例,隔离肺(PS)18例。灰阶声像图表现为胸腔内异常回声、心脏移位等。彩色多普勒血流显像(CDFI)探及滋养肿块的肠系膜血管、肺动脉分支、降主动脉分支分别提示CDH、CCAM、PS,尤其是探及翻转入胸腔的肠系膜血管对于胃泡位于膈下的左侧不典型膈疝提供了较为直观及准确的诊断方法。结论灰阶超声发现胎儿胸腔占位性病变后,通过CDFI追踪病灶的滋养血管有利于鉴别诊断。
Objective To explore the differential diagnostic value of color Doppler sonography diagnosis for fetal common thoracic malformation.Methods Sonographic imaging of 54 cases with common thoracic malformation diagnosed by prenatal ultrasonography were retrospectively analyzed,the characteristics of sonographic imaging were summarized,the differential diagnostic skills was concluded.Results Of the 54 cases,8 cases were congenial diaphragmatic hernia(CDH),28 cases were congenital cystic adenomatoid malformation(CCAM),18 cases were pulmonary sequestration(PS).The common grey-scale images of thoracic malformation were abnormal echo in thoracic cavity,displacement of heart,etc.Color doppler flow imaging(CDFI)can validate the nourishing vessels of masses in thoracic cavity,the mesenteric vessels,the pulmonary artery branches and the descending aorta branches in masses indicated CDH,CCAM,PS,respectively.In particular,the upturned mesenteric vessels provided a more intuitive and accurate method for the diagnosis of left CDH with gastric vesicles located under the diaphragm.Conclusions After detecting thoracic malformation of fetus based on grey-scale images,identifying the nourishing vessels of masses in thoracic cavity by Color doppler flow imaging is of great value for differential diagnosing fetal thoracic malformation.
Objective To explore the differential diagnostic value of color Doppler sonography diagnosis for fetal common thoracic malformation.Methods Sonographic imaging of 54 cases with common thoracic malformation diagnosed by prenatal ultrasonography were retrospectively analyzed,the characteristics of sonographic imaging were summarized,the differential diagnostic skills was concluded.Results Of the 54 cases,8 cases were congenial diaphragmatic hernia(CDH),28 cases were congenital cystic adenomatoid malformation(CCAM),18 cases were pulmonary sequestration(PS).The common grey-scale images of thoracic malformation were abnormal echo in thoracic cavity,displacement of heart,etc.Color doppler flow imaging(CDFI)can validate the nourishing vessels of masses in thoracic cavity,the mesenteric vessels,the pulmonary artery branches and the descending aorta branches in masses indicated CDH,CCAM,PS,respectively.In particular,the upturned mesenteric vessels provided a more intuitive and accurate method for the diagnosis of left CDH with gastric vesicles located under the diaphragm.Conclusions After detecting thoracic malformation of fetus based on grey-scale images,identifying the nourishing vessels of masses in thoracic cavity by Color doppler flow imaging is of great value for differential diagnosing fetal thoracic malformation.
引文
[1]中国医师协会超声医师分会.产前超声检查指南(2012)[J/OL].中华医学超声杂志:电子版,2012,09(7):1-3.
[2]DEPREST J,BRADY P,NICOLAIDES K,et al.Prenatal management of the fetus with isolated congenital diaphragmatic hernia in the era of the TOTAL trial[J].Seminars in Fetal&Neonatal Medicine,2014,19(6):338-348.
[3]SISTA A K,FILLY R A.Paradoxical Movements of Abdominal Contents Indicating a Congenital Diaphragmatic Hernia[J].Journal of Ultrasound in Medicine Official Journal of the American Institute of Ultrasound in Medicine,2008,27(3):497.
[4]MORGAN T A,BASTA A,FILLY R A.Fetal stomach and gallbladder in contact with the bladder wall is a common ultrasound sign of stomach-down left congenital diaphragmatic hernia[J].Journal of Clinical Ultrasound Jcu,2016,45(1):8.
[5]LAKSHMY R S,AGNEES J,ROSE N.The Upturned Superior Mesenteric Artery Sign for First‐Trimester Detection of Congenital Diaphragmatic Hernia and Omphalocele[J].Journal of Ultrasound in Medicine Official Journal of the American Institute of Ultrasound in Medicine,2017,36(3):583-592.
[6]BOTASH R J,SPIRT B A.Color Doppler imaging aids in the prenatal diagnosis of congenital diaphragmatic hernia[J].Journal of Ultrasound in Medicine Official Journal of the American Institute of Ultrasound in Medicine,1993,12(6):359.
[7]DETTI L,MARI G,FERGUSON J E.Color Doppler ultrasonography of the superior mesenteric artery for prenatal ultrasonographic diagnosis of a left-sided congenital diaphragmatic hernia[J].Journal of Ultrasound in Medicine Official Journal of the American Institute of Ultrasound in Medicine,2001,20(6):689-692.
[8]SANDERS R C.Prenatal ultrasonic detection of anomalies with a lethal or disastrous outcome[J].Radiol Clin North Am,1990,28(1):163-177.
[9]MACARDLE C A,KUNISAKI S M.Management of perinatal lung malformations[J].Minerva Ginecologica,2014,67(1):81.
[2]DEPREST J,BRADY P,NICOLAIDES K,et al.Prenatal management of the fetus with isolated congenital diaphragmatic hernia in the era of the TOTAL trial[J].Seminars in Fetal&Neonatal Medicine,2014,19(6):338-348.
[3]SISTA A K,FILLY R A.Paradoxical Movements of Abdominal Contents Indicating a Congenital Diaphragmatic Hernia[J].Journal of Ultrasound in Medicine Official Journal of the American Institute of Ultrasound in Medicine,2008,27(3):497.
[4]MORGAN T A,BASTA A,FILLY R A.Fetal stomach and gallbladder in contact with the bladder wall is a common ultrasound sign of stomach-down left congenital diaphragmatic hernia[J].Journal of Clinical Ultrasound Jcu,2016,45(1):8.
[5]LAKSHMY R S,AGNEES J,ROSE N.The Upturned Superior Mesenteric Artery Sign for First‐Trimester Detection of Congenital Diaphragmatic Hernia and Omphalocele[J].Journal of Ultrasound in Medicine Official Journal of the American Institute of Ultrasound in Medicine,2017,36(3):583-592.
[6]BOTASH R J,SPIRT B A.Color Doppler imaging aids in the prenatal diagnosis of congenital diaphragmatic hernia[J].Journal of Ultrasound in Medicine Official Journal of the American Institute of Ultrasound in Medicine,1993,12(6):359.
[7]DETTI L,MARI G,FERGUSON J E.Color Doppler ultrasonography of the superior mesenteric artery for prenatal ultrasonographic diagnosis of a left-sided congenital diaphragmatic hernia[J].Journal of Ultrasound in Medicine Official Journal of the American Institute of Ultrasound in Medicine,2001,20(6):689-692.
[8]SANDERS R C.Prenatal ultrasonic detection of anomalies with a lethal or disastrous outcome[J].Radiol Clin North Am,1990,28(1):163-177.
[9]MACARDLE C A,KUNISAKI S M.Management of perinatal lung malformations[J].Minerva Ginecologica,2014,67(1):81.