摘要
目的探讨胎儿颅脑正中矢状切面超声检查在诊断复杂颅脑畸形中的应用价值，提高颅脑畸形产前超声诊断的准确率。方法：选取2010年1月-2013年6月在该院产检的12 850例孕妇，进行20—32孕周超声检查。常规测量胎儿双顶径、头围、观测颅内结构，发现颅脑异常时联合应用经腹及经阴道二维、三维超声检查，分析超声声像表现，侧重观测正中矢状切面特征。对复杂颅脑畸形病例进行随访，追踪宫内MRI检查结果、引产后病理检查、出生后超声或MRI检查的结果，与该院首次产前超声诊断结果进行对比分析。结果：检出颅脑异常378例，发生率2．94％；复杂颅脑畸形36例，发生率0．28％；33例与追踪随访结局一致，诊断准确率91．67％。通过正中矢状面重点观测，分别诊断后颅窝蛛网膜囊肿6例、Dandy—Walker畸形8例、小脑下蚓部发育不良9例、前脑无裂畸形7例、胼胝体发育不良6例。误诊3例，1例产后正常胎儿产前误诊为胼胝体部分发育不良，1例单纯颅后窝池增宽误诊为小脑下蚓部发育不良，1例叶状全前脑误诊为胼胝体发育不良。结论：经腹经阴道二维、三维超声联合检查，有效提高中、晚孕胎儿颅脑畸形的检出率。规范扫查手法、标准扫查切面、颅脑畸形声像图特征的正确认识能有效避免漏诊、误诊，通过正中矢状切面观察胎儿大脑中线部位结构，在畸形性质和位置判断分析上起重要作用，是诊断复杂颅脑畸形中的关键。
Objective To explore the application value of fetal brain median sagittal section in ultrasonic diagnosis of complex cranial malformations, and improve the accurate rate of prenatal ultrasonic diagnosis for complex cranial malformations. Methods ： A total of 12850 pregnant women receiving prenatal examination in the hospital from January 2010 to June 2013 were selected, then ultrasonography wasconducted during 20 - 32 gestational weeks ; biparietal diameter and head circumference of fetuses were measured conventionally, intracranialstructure was observed and detected, transabdominal and transvaginal two - dimensional and three - dimensional ultrasonography were performed among the fetuses with abnormal brain manifestations; ultrasonic imaging manifestations were analyzed; the characteristics of fetalbrain median sagittal section were observed specifically; the cases with complex cranial malformations were followed up; intrauterine MRI examination results, pathological examination results after labor induction, ultrasonic and MRI examination results after birth were followed up,then the results were compared with the prenatal ultrasonic results for the first time in the hospital. Results： A total of 378 cases were foundwith cranial malformations, the incidence rate was 2. 94% ; 36 cases were found with complex cranial malformations, the incidence rate was0. 28% ; the diagnostic accurate rate was 91.67% （33 cases） ; brain median sagittal section was observed; 6 cases were diagnosed as arachnoid cyst of posterior cranial fossa, 8 cases were diagnosed as Dandy - Walker malformation, 9 cases were diagnosed as maldevelopmem ofcerebellar inferior vermis, 7 cases were diagnosed as holoprosencephaly, and 6 cases were diagnosed as agenesis of corpus callosum; 3 caseswere misdiagnosed, including one case （ normal fetus） misdiagnosed as partial agenesis of corpus callosum, one case （ simple broadening ofposterior cranial fossa） misdiagnosed as maldevelopment of cerebellar inferior vermis and one case （lobar holoprosencephaly） misdiagnosedas agenesis of corpus callosum. Conclusion： Transabdominal and transvaginal two - dimensional and three - dimensional ultrasonographycan effectively improve the detection rate of fetal cranial malformations during the second and the third trimesters of pregnancy; standardscanning method and sections and correct understanding of imaging characteristics of cranial malformations can effectively avoid missed diagnosis and misdiagnosis; observing fetal brain midline structures on median sagittal section plays an important role in analyzing cranial malformation characteristics and positions, which is the key point in diagnosing complex cranial malformations.
出处
《中国妇幼保健》
CAS
北大核心
2014年第18期3016-3018,共3页
Maternal and Child Health Care of China
基金
深圳市科技计划项目基金资助〔20110308〕
关键词
正中矢状切面
三维超声
颅脑畸形
产前超声检查
Median sagittal section
Three -dimensional uhrasonography
Brain malformation
Prenatal ultrasonic examination
