产前三维超声诊断胎儿椎体形成障碍  

Antenatal 3D Sonography Diagnosis of Fetal Failure of Vertebral Formation

作　　者：魏秋菊[1] 蔡爱露[1] 王晓光[1] 解丽梅[1] 王冰[1] 王心田[2] 

机构地区：[1]中国医科大学附属盛京医院超声科,沈阳市110004 [2]中国医科大学附属盛京医院抚顺医院

出　　处：《中国超声医学杂志》2014年第6期548-554,共7页Chinese Journal of Ultrasound in Medicine

基　　金：国家科技支撑计划(No.2006BA105A04)

摘　　要：目的探索三维超声诊断胎儿椎体形成障碍的价值,并通过发育异常的与发育正常的椎体超声图像及其他影像资料比较,为产前可疑的椎体形成障碍建立诊断标准。方法选择30例正常胎儿和13例可疑椎体形成障碍的胎儿,正常胎儿选择生理弯曲角度大的颈胸段和腰骶段脊柱矢状切面进行三维重建,在二维超声怀疑椎体畸形时,选择感兴趣区进行重建,储存数据,与胎儿磁共振(MRI)、新生儿或引产后X光、计算机断层扫描(CT)结果对比分析。结果在30例正常胎儿中,三维超声更适于进行胎儿脊柱的检查,特别是对脊柱生理弯曲明显的位置检查更有优势;13例怀疑椎体形成障碍的胎儿中,证实7例为半椎体,2例为蝴蝶椎,2例为蝴蝶椎、半椎体混合畸形,1例为冠状椎体裂和矢状椎体裂,1例失访。其超声图像特征明确,明显区别于脊柱裂。结论三维超声有助于椎体形成障碍的检出,可能为出生后改善由椎体形成障碍引起的脊柱畸形的预后提供信息。Objective To explore the value of 3D sonography for diagnosis of vertebral formation failure in the developing fetus and to formulate antenatal sonographic diagnostic criteria for suspected vertebral formation failure based on a comparison of sonographic characteristics of the disorder with normal sonographic findings and other imaging data.Methods This study included sonographic data from 30 healthy fetuses and 13 fetuses suspected to have vertebral formation failure.3D reconstruction of sagittal sections of the physiologic curves of the cervicothoracic and lumbosacral regions of the healthy fetuses was performed,and reconstruction was also performed on selected areas of interest when vertebral malformation was suspected.Stored data were analyzed,and a comparison with fetal magnetic resonance imaging （MRI）,neonatal or post-abortion X-ray and computed tomographic （CT） results was performed.Results 3D reconstruction was more suitable for fetal spinal sonography among the 30 healthy fetuses,and it was particularly superior in detecting the positions of spines with evident physiologic curvature.The images revealed suspected vertebral formation failure in 13 cases,and the confirmed findings included 7 cases of hemivertebrae,2 cases of butterfly vertebra,2 cases of mixed malformations （butterfly vertebra and hemivertebra）,and 1 case of a coronal cleft vertebra.One case was lost to follow-up.The sonographic characteristics were definite,and there were evident differences from the sonograms of spina bifida.Conclusions 3D sonography is helpful for detection of vertebral formation failure in the developing fetus and might provide prognostic information with the potential to ameliorate the progressive spinal deformities that can result from embryonic vertebral formation failure.

关 键 词：产前超声 蝴蝶椎 冠状椎体裂 半椎体 三维超声 椎体形成障碍 

分 类 号：R714.5[医药卫生—妇产科学] R445.1[医药卫生—临床医学]