超声小脑前后径与小脑横径比值诊断小脑发育不良的价值  

Diagnostic value of APCD/TCD ratio for cerebellar dysplasia

作　　者：毛晓玲 费晓璐 刘薇[3] 孙潇君 刘榕娟 MAO Xiao-ling;FEI Xiao-lu;LIU Wei;SUN Xiao-jun;LIU Rong-juan(Department of Obstetrics,Qingdao Central Hospital,Qingdao,Shandong 266042,China)

机构地区：[1]青岛市中心医院产科,山东青岛266042 [2]青岛市中心医院妇科,山东青岛266042 [3]青岛大学附属医院妇产科,山东青岛266000 [4]青岛市海慈医疗集团小儿一科,山东青岛266032

出　　处：《中国临床研究》2019年第9期1171-1174,共4页Chinese Journal of Clinical Research

摘　　要：目的确定正常胎儿小脑半球超声测量的参考范围,包括小脑横径(TCD)、小脑前后径(APCD)和APCD/TCD比值,并分析各参数对小脑发育不良的诊断价值。方法选择2009年4月到2018年1月分娩的340例单胎妊娠和52例18-三体征胎儿的临床影像学资料进行回顾性分析。在胎龄14至40周之间时对所有胎儿进行小脑超声测定,测定指标包括TCD、APCD和APCD/TCD比值。结果 Spearman相关性分析结果显示,TCD与孕龄之间具有较强的相关性(r=0.771,P<0.01),其次为APCD(r=0.624,P<0.01),而APCD/TCD比值与孕龄之间无显著相关性(r=0.068,P=0.249)。在52例18-三体胎儿中,APCD的中位值为11.8 mm(范围:5.2~17.7 mm),APCD/TCD的中位比值为0.39(范围:0.29~0.54),而TCD的中位值为30.2 mm(范围:13.3~43.4 mm)。其中,有40例的APCD和48例的APCD/TCD比值低于正常胎儿参考范围。当将APCD/TCD比值的阈值设定为0.43时,其诊断18-三体征的灵敏度为92.6%,特异性为72.4%,AUC为0.78。结论 18-三体征胎儿的APCD/TCD比值比正常胎儿低。识别低APCD/TCD比值较单独评估TCD和APCD对18-三体征的诊断更为方便和有效,其在整个妊娠期有一个相对固定的阈值(低于0.43)。Objective To determine the reference range of ultrasound measurement for normal fetal cerebellar hemisphere,including transverse cerebellar diameter(TCD),anteroposterior cerebellar diameter(APCD) and APCD/TCD ratio to analyze the diagnostic value of each parameter for cerebellar dysplasia.Method A total of 340 singleton pregnancies and 52 fetuses with trisomy 18 from April 2009 to January 2018 were retrospectively analyzed.Cerebellar measurements with ultrasonography were performed in all fetuses between 14 and 40 weeks of gestational age.The determined parameters included TCD,APCD and APCD/TCD ratio.Results Spearman correlation analysis showed that there was a strong correlation between TCD and gestational age(r=0.771,P<0.01),followed by APCD and gestational age(r=0.624,P<0.01),while there was no significant correlation between APCD/TCD ratio and gestational age(r=0.068,P=0.249).In 52 fetuses with trisomy 18,the median values of APCD,APCD/TCD ratio and TCD were 11.8 mm( 5.2-17.7 mm),0.39( 0.29-0.54),and 30.2 mm( 13.3-43.4 mm),respectively.APCD in 40 cases and APCD/TCD ratio in 48 cases were lower than those the reference range of normal fetuses.When the threshold of APCD/TCD ratio was set to 0.43,the sensitivity,specificity and area under the curve(AUC) for the diagnosis of trisomy 18 were 92.6%,72.4% and 0.78,respectively.Conclusion APCD/TCD ratio of trisomy 18 fetus is lower than that of normal fetus.It is more convenient and effective to identify the low APCD/TCD ratio than to evaluate TCD and APCD alone in the diagnosis of trisomy 18,and APCD/TCD ratio has a relatively fixed threshold throughout pregnancy(less than 0.43).

关 键 词：小脑横径 小脑前后径 小脑发育不良 产前诊断 18-三体综合征 超声检查 

分 类 号：R445[医药卫生—影像医学与核医学] R742.82[医药卫生—诊断学]