孕11-13^(+6)周胎儿颅内结构超声特征在诊断开放性脊柱裂中的应用  

Diagnostic application of intracranial ultrasound features of fetal 11～13^(+6) weeks in open spina bifida

作　　者：朴雪梅[1] 梁峰[1] 屈晓燕 贾志红[1] PIAO Xuemei;LIANG Feng;QU Xiaoyan;JIA Zhihong(Department of Ultrasound,Beijing Pinggu hospital,Beijing 101200,China)

机构地区：[1]北京市平谷区医院超声科,北京101200

出　　处：《实用医学杂志》2019年第6期989-992,共4页The Journal of Practical Medicine

摘　　要：目的探讨孕11-13^(+6)周胎儿颅内结构的超声特征在诊断开放性脊柱裂(OSB)中的应用价值。方法回顾性选取2011年7月至2018年5月在北京市平谷区医院产前超声检查诊断的132例胎儿超声图像,52例OSB的胎儿作为OSB组,同期随机选取80例健康胎儿作为对照组。所有胎儿均在11-13^(+6)周给予超声检查颅内结构,并测量颅内透明层厚度(ITT)、脑干直径(BS)、脑干-枕骨间距离(BSOB)及计算BS/BSOB比值。结果对照组胎儿间脑及中脑形态"8"字形态及颅内透明层(IT)可清晰显示。OSB组间脑及中脑形态扭曲变形、颅后窝颅内结构移位、IT显示部分受碍且有不同程度的减小或消失。OSB组ITT和BSOB水平明显低于对照组,BS、BS/BSOB明显高于对照组,差异有统计学意义(P <0.01)。ROC曲线结果显示,在鉴别OSB敏感度、特异度、准确度方面,ITT以<1.0 mm为临界值时,分别为90.38%、86.54%、88.46%,BS/BSOB以> 1.0为临界值时,分别为88.50%、84.62%、86.54%,采用C-统计将二者联合时分别为98.08%、98.08%、98.08%,二者联合后发现对OSB的预测价值更佳,曲线下面积为0.803,差异有统计学意义(P <0.01)。结论间脑和中脑形态扭曲变形、ITT减少或消失、BSOB减少、BS和BS/BSOB增大是OSB发生的重要颅内结构超声特征,超声观测间脑和中脑形态特征,测得ITT、BS/BSOB可帮助诊断OSB,且二者联合时具有更佳的鉴别效能。Objective To explore the diagnostic value of fetal intracranial ultrasound features in the treat ment of open spina bifida in 11 ~ 13^+6 weeks of pregnancy. Methods 80 healthy fetuses and 52 fetuses with OSB at 11 ~ 13^+6 weeks of gestation were retrospective selected from July 2010 to July 2017 at Peking Pingu Hospital to compare the morphology of intracranial,the intracranial transparency thickness(ITT), brain stem diameter (BS), brain stem occipital distance( BSOB) were measured and the BS/BSOB level were calculated. Results Diencephalon and mesencephalon showing number“ 8”shape and the IT can clear display in health group. In OSB group,expected“8”shape of diencephalon and midbrain was distorted,posterior fossa intracranial structural shift,IT decrease or disappear. The ITT,BSOB levels were significantly lower than those of health group,the BS, BS/BSOB level of OSB group was significantly higher than that of healthy group,the difference was statistically sig nificant(P < 0.01). The ROC curve results showed that in the identification of OSB sensitivity,accuracy,specific degree,ITT for < 1.0 mm as critical value,they were 90.38%,86.54%,88.46%,BS/BSOB for > 1.0 as critical value,they were 88.50%,84.62%,86.54%,the two joint were 98.08%,98.08%,98.08%. The two joint were significantly higher than those of the two separate,and the difference was statistically significant(P < 0.01). Conclusions IT reduce or disappear and BSOB reduce,BS and BS/BSOB increase at 11 ~ 13^+6 weeks of gestation are the important ultrasonographic features of the transparency and posterior brain structure for the OSB referenc. The detection of ITT,BS/BSOB may can be used as the important identification indexes of OSB ,and the two joint has the better identification efficiency.

关 键 词：胎儿 颅内透明层 后脑结构 超声特征 开放性脊柱裂 

分 类 号：R445.1[医药卫生—影像医学与核医学]