11～13^(+6)周胎儿颅后窝结构的产前超声检测  

Ultrasound measurement of fetal posterior fossa at 11 to 13^(+6) gestational weeks for screening open spina bifida

作　　者：秦凤真 李胜利[1] 文华轩[1] 欧阳玉容 郑琼[1] 毕静茹[1] 

机构地区：[1]南方医科大学附属深圳市妇幼保健院超声科,广东深圳518028

出　　处：《南方医科大学学报》2014年第7期950-955,共6页Journal of Southern Medical University

基　　金：国家自然科学基金(81270707);国家自然科学基金青年基金(60671043);2011年深圳市科技计划项目(201101013)~~

摘　　要：目的建立经腹部超声测量11~13+6周胎儿颅后窝结构的正常参考值范围,探讨其对开放性脊柱裂(OSB)筛查的临床价值。方法随机选取我院2013年1月~9月期间在孕11~13+6周时接受颈项透明层检查的正常组胎儿541例和OSB组胎儿3例,采用经腹超声从正中矢状切面和经前囟小脑横切面对胎儿的颅后窝结构进行观察及测量,建立11~13+6周胎儿颅后窝结构的正常参考值范围,比较两切面的测量差异并比较正常组与OSB组胎儿各参数的差异。结果两切面各测量参数值的差异无统计学意义(P>0.05)。正常组胎儿颅后窝可见两条强回声线,OSB组胎儿的颅后窝仅能看到一条明显的强回声线即脑干后缘与第四脑室顶部,第四脑室与小脑延髓池分界显示不清。正常组胎儿脑干前后径、第四脑室前后径、小脑延髓池前后径均随头臀长的增加呈线性增加。OSB组胎儿的脑干前后径均大于正常值的第95百分位数,第四脑室-小脑延髓池前后径均小于正常值的第5百分位数。OSB组脑干前后径与第四脑室-小脑延髓池前后径的比值明显大于正常组,且大于1。结论建立了11~13+6周胎儿颅后窝结构正常值范围,可能有助于对早孕期OSB的筛查。正中矢状切面或经前囟小脑横切面超声发现胎儿颅后窝第四脑室与小脑延髓池分界不清,且脑干前后径与第四脑室-小脑延髓池前后径的比值大于1,可能成为11~13+6周OSB的筛查指标。Objective To establish the normal reference ranges of transabdominal ultrasound measurements of the posterior fossa structure in fetuses at 11 to 13^＋6 gestational weeks and explore their clinical value in screening open spina bifida （OSB）. Methods Between January, 2013 and September, 541 randomly selected normal fetuses underwent nuchal translucency at the gestational age 11 to 13^＋6 weeks. The parameters of the posterior fossa were measured in mid-sagittal view of the fetal face and the axial view of the transverse cerebellum insonated through the anterior fontanel by transabdominal ultrasound to establish the normal reference ranges. The measurements were obtained from 3 fetuses with OSB for comparison with the reference ranges. Results In normal fetuses, the parameters of the posterior fossa measured in the two views showed no significant differences （P〉0.05）. Two high echogenic lines were observed in normal fetuses, as compared with one in fetuses with OSB representing the posterior border of the brain stem and the anterior border of the fourth ventricle. The line between the posterior border of the fourth ventricle and the anterior border of the cisterna magna was not displayed in fetuses with OSB. The anteroposterior diameters of the brain stem, the fourth ventricle, and cisterna magna all increased in positive correlation with the crown-lump length in normal fetuses. In the 3 OSB fetuses, the anteroposterior diameter of the brain stem exceeded the 95th percentile and the anteroposterior diameter of fourth ventrical-cisterner magena was below the 5th percentile of the reference range for CRL;the brain stem to fourth ventrical-cisterner magena anteroposterior diameter ratio was increased to above 1. Conclusion The established normal reference ranges of the parameters of fetal posterior fossa may provide assistance in early OSB detection. The absence of the posterior border of the fourth ventricle and the anterior border of the cisterna magna and a brainstem to fourth ventrical-cisterner magena

关 键 词：胎儿 早孕期 11~13^+6周 颅后窝 开放性脊柱裂 

分 类 号：R445.1[医药卫生—影像医学与核医学] R714.5[医药卫生—诊断学]