超声影像标准断面检查对早孕期筛查胎儿CNS异常可行性临床分析
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摘要
目的分析超声影像标准断面检查对早孕期筛查胎儿中枢神经系统(CNS)异常的可行性。方法回顾性分析2014年9月-2016年9月在该院进行超声影像检测的早孕期(11～13~(+6)周)孕妇1 356例,其中双胎21例,单胎1 335例,胎儿共1 377例,依据孕妇孕周将其分成3组:11～11~(+6)周组(103例)、12～12~(+6)周组(771例)、13～13~(+6)周组(482例);对孕妇进行常规和CNS检测,察看胎儿CNS异常情况。结果不同孕周胎儿后颅窝池和小脑横切面、脊柱的长轴断面、侧脑室的水平横断面及头胸部位的正中矢状断面显示率对比,差异均无统计学意义(均P>0. 05);胎儿CNS畸形前期诊断特异度为100%,敏感度为85. 8%,阴性预测值为99. 8%,阳性预测值为100%;孕妇孕周和胎儿NT数值为正相关关系(r=0. 161,P<0. 05),胎儿NT数值伴随孕周增大而增加。结论超声影像标准断面检测能有效诊断早孕期胎儿CNS异常,胎儿CNS结构显示率比较高。
Objective To analyze the feasibility of ultrasound image standard section examination for screening fetal central nervous system( CNS) abnormalities in early pregnancy. Methods A total of 1 356 early pregnant women( 11-13~(+6) weeks) undergoing ultrasonic image detection in Lishui Municipal Maternal and Child Health Care Hospital from September 2014 to September 2016 were analyzed retrospectively,1 377 fetuses were born,including 21 cases of twins and 1 335 cases of singleton fetus. According to gestational week,the pregnant women were divided into 11-11~(+6) week group( 103 cases),12-12~(+6) week group( 771 cases),and 13-13~(+6) week group( 482 cases). Routine examination and CNS detection were performed,the abnormalities of CNS were observed. Results There was no statistically significant difference in the detection rates of posterior cranial fossa and epencephalon cross section,spine long axis cross section,paracele horizontal cross section,and head-chest median sagittal plane among different groups( P> 0. 05). The specificity,sensitivity,negative predictive value,and positive predictive value of early diagnosis of fetal CNS abnormalities were 100%,85. 8%,99. 8%,and 100%,respectively. Gestational week was positively correlated with fetal NT( r = 0. 161,P< 0. 05). Fetal NT increased with gestational week. Conclusion Ultrasound image standard section examination can effectively diagnose fetal CNS abnormalities in early pregnancy,and the detection rate of fetal CNS structure is relatively high.
Objective To analyze the feasibility of ultrasound image standard section examination for screening fetal central nervous system( CNS) abnormalities in early pregnancy. Methods A total of 1 356 early pregnant women( 11-13~(+6) weeks) undergoing ultrasonic image detection in Lishui Municipal Maternal and Child Health Care Hospital from September 2014 to September 2016 were analyzed retrospectively,1 377 fetuses were born,including 21 cases of twins and 1 335 cases of singleton fetus. According to gestational week,the pregnant women were divided into 11-11~(+6) week group( 103 cases),12-12~(+6) week group( 771 cases),and 13-13~(+6) week group( 482 cases). Routine examination and CNS detection were performed,the abnormalities of CNS were observed. Results There was no statistically significant difference in the detection rates of posterior cranial fossa and epencephalon cross section,spine long axis cross section,paracele horizontal cross section,and head-chest median sagittal plane among different groups( P> 0. 05). The specificity,sensitivity,negative predictive value,and positive predictive value of early diagnosis of fetal CNS abnormalities were 100%,85. 8%,99. 8%,and 100%,respectively. Gestational week was positively correlated with fetal NT( r = 0. 161,P< 0. 05). Fetal NT increased with gestational week. Conclusion Ultrasound image standard section examination can effectively diagnose fetal CNS abnormalities in early pregnancy,and the detection rate of fetal CNS structure is relatively high.
引文
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[8]杨烨,马毅敏,李娟,等.广州地区早孕期超声测量胎儿颈项透明层图像质量分析[J].临床误诊误治,2015,8(4):100-103.
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[10]张玉娟,张辉,李剑,等.11~14孕周胎儿中枢神经系统畸形的早期超声诊断[J].中国超声医学杂志,2014,30(7):667-669.
[11]朱大林,吴菊,冯帆,等.核磁共振联合超声在胎儿中枢神经系统畸形中的诊断价值[J].中国优生与遗传杂志,2015,22(6):82-83.
[12]杨午博,张军.胎儿侧脑室扩张的产前影像学诊断及预后[J].中国临床医学影像杂志,2017,28(5):368-371.
[13]Malinger G,Lerman-Sagie T.Re:additional value of fetal magnetic resonance imaging in the prenatal diagnosis of central nervous system anomalies:a systematic review of the literature[J].Ultrasound Obstet Gynecol,2015,45(2):236-237.
[14]胡剑,王相玉,何媛,等.超声及MRI诊断胎儿中枢神经系统畸形灵敏度、特异度比较[J].现代仪器与医疗,2016,22(4):4-5.
[15]白彦,李春晖,贺立新.超声筛查孕11~13+6周胎儿颅脑畸形的现状及意义[J].中国医学影像技术,2016,3(2):310-313.
[16]李春晖,白彦,王丽岩,等.产前诊断胎儿中枢神经系统异常的研究进展[J].中国医学影像技术,2015,31(4):634-637.
[17]杨建军,姜红芳,耿书军.三维彩超对胎儿中枢神经系统畸形的诊断应用价值[J].医学影像学杂志,2016,5(1):18-21.
[2]徐燕,茹彤,顾燕,等.妊娠11~13+6周超声结构筛查在胎儿中枢神经系统畸形诊断中的应用[J].现代妇产科进展,2015,13(8):569-572.
[3]曾秀梅,王坤,梁元豪,等.早孕期胎儿颈项透明层厚度与结构异常相关性研究[J].医学影像学杂志,2015,25(12):2209-2212.
[4]Sefidbakht S,Dehqhani S,Safari M,et al.Fetal central nervous system anomalies detected by magnetic resonance imaging:a two-year experience[J].Iran J Pediatr,2016,26(4):161-164.
[5]陶斯翠,李建蓉,梁辉,等.超声与MRI在疑似高危胎儿中枢神经系统异常筛查中应用研究[J].中国CT和MRI杂志,2017,15(4):14-16.
[6]焦阳,范海波,甘晗靖,等.早孕期颅脑超声诊断胎儿颅内畸形[J].中国介入影像与治疗学,2014,11(6):361-364.
[7]霍晓恺,刘泰石,解耀锃.早孕期超声筛查在胎儿结构畸形诊断中的应用[J].中国妇幼健康研究,2016,27(9):1071-1073.
[8]杨烨,马毅敏,李娟,等.广州地区早孕期超声测量胎儿颈项透明层图像质量分析[J].临床误诊误治,2015,8(4):100-103.
[9]Shin JE,Shin JC,Kim SJ,et al.Contribution of magnetic resonance imaging to ultrasound for the evaluation of fetal central nervous system anomalies[J].J Reprod Med,2017,62(5-6):295-299.
[10]张玉娟,张辉,李剑,等.11~14孕周胎儿中枢神经系统畸形的早期超声诊断[J].中国超声医学杂志,2014,30(7):667-669.
[11]朱大林,吴菊,冯帆,等.核磁共振联合超声在胎儿中枢神经系统畸形中的诊断价值[J].中国优生与遗传杂志,2015,22(6):82-83.
[12]杨午博,张军.胎儿侧脑室扩张的产前影像学诊断及预后[J].中国临床医学影像杂志,2017,28(5):368-371.
[13]Malinger G,Lerman-Sagie T.Re:additional value of fetal magnetic resonance imaging in the prenatal diagnosis of central nervous system anomalies:a systematic review of the literature[J].Ultrasound Obstet Gynecol,2015,45(2):236-237.
[14]胡剑,王相玉,何媛,等.超声及MRI诊断胎儿中枢神经系统畸形灵敏度、特异度比较[J].现代仪器与医疗,2016,22(4):4-5.
[15]白彦,李春晖,贺立新.超声筛查孕11~13+6周胎儿颅脑畸形的现状及意义[J].中国医学影像技术,2016,3(2):310-313.
[16]李春晖,白彦,王丽岩,等.产前诊断胎儿中枢神经系统异常的研究进展[J].中国医学影像技术,2015,31(4):634-637.
[17]杨建军,姜红芳,耿书军.三维彩超对胎儿中枢神经系统畸形的诊断应用价值[J].医学影像学杂志,2016,5(1):18-21.