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  

Clinical value of ultrasonic features of intracranial structures in the diagnosis of open spina bifida in fetus with 11 to 13+6 weeks of gestation

作　　者：吴泽珊 陈雪玲 王霞妹 WU Ze-shan;CHEN Xue-ling;WANG Xia-mei(Department of Ultrasound,Maternal and Child Health Planning Service Center of Huizhou,Huizhou Guangdong 516001,China)

机构地区：[1]广东省惠州市妇幼保健计划服务中心超声科

出　　处：《蚌埠医学院学报》2019年第11期1526-1529,共4页Journal of Bengbu Medical College

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。方法:选取OSB胎儿80例作为OSB组,同期选取80名健康胎儿作为健康组,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),计算BS/BSOB比值。结果:健康组胎儿间脑及中脑形态"8"字形态及颅内透明层可清晰显示;OSB组间脑及中脑形态扭曲变形、颅后窝颅内结构移位、颅内透明层显示部分受碍且有不同程度的减小或消失。OSB组ITT、BS、BSOB均明显低于健康组,BS/BSOB明显高于健康组(P<0.01)。ROC分析显示,在鉴别OSB方面,ITT以<1.0 mm为临界值时,敏感度、特异度分别为90.00%、87.50%;BS/BSOB以>1.0为临界值时,敏感度、特异度分别为87.50%、85.00%;二者联合时分别为97.50%、97.50%。结论:间脑和中脑形态扭曲变形、ITT减少或消失和BS、BSOB减少及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,测量ITT、BS/BSOB可帮助诊断OSB,且二者联合时具有更佳的鉴别效能,值得临床作进一步推广。Objective:To explore the clinical value of ultrasonic features of intracranial structures in the diagnosis of open spina bifida(OSB) in fetus with 11 to 13+6 weeks of gestation.Methods:Eighty healthy fetuses and 80 fetuses with OSB at 11 to 13+6 weeks of gestation were divided into the health group and OSB group,respectively.The intracranial structures in two groups were detected using ultrasound.The intracranial transparency thickness(ITT),brain stem diameter(BS),brain stem-occipital distance(BSOB) were measured,and the ratio of BS/BSOB was calculated.Results:The "8" shape of diencephalon to mesencephalon and ntracranial hyaline layer could be clearly displayed in health group.In OSB group,the diencephalon and mesencephalon distorted,the intracranial structures in the posterior fossa shifted,and the intracranial transparent layer partly blocked.The levels of ITT,BS and BSOB in OSB group were significantly lower than those in health group,and the BS/BSOB level in OSB group was significantly higher than that in health group(P<0.01).In the term of OSB identification,the ITT less than 1.0 mm was set as the critical value,the results of ROC analysis showed that the sensitivity and specificity were 90.00% and 87.50%,respectively.The BS/BSOB more than 1.0 mm was set as the critical value,the sensitivity and specificity were 87.50% and 85.00%,respectively.When two indictors were considered together,the sensitivity and specificity were 97.5% and 97.5%,respectively.Conclusions:The morphological distortion of diencephalon and mesencephalon,reduction or disappearance of ITT,reduction of BS,BSOB and BS/BSOB increasing are the important ultrasonic features of intracranial structures of OSB.Observing the orphological characteristics of diencephalon and mesencephalon,and analyzing the ITT and BS/BSOB can help diagnose OSB,and the diagnosis effect is better under combining two aspects.It is worthy of further clinical promotion.

关 键 词：开放性脊柱裂 胎儿 超声 颅内透明层 后脑结构 

分 类 号：R682.13[医药卫生—骨科学]