超声、磁共振成像及染色体检查在胸腹部异常胎儿筛查中的应用价值  

Application of ultrasound,magnetic resonance imaging and chromosome examination in the screening of fetus with chest and abdomen abnormalities

作　　者：周成礼[1] 刘阳 段桂开[3] 房袁媛 易艳 朱进 Zhou Chengli;Liu Yang;Duan Guikai;Fang Yuanyuan;Yi Yan;Zhu Jin(Department of Ultrasound,Shenzhen Maternal and,Child Health Hospital;Department of Radiology,Shenzhen Maternal and,Child Health Hospital;Department of Clinical Laboratory,Shenzhen Maternal and,Child Health Hospital;Department of Obstetrics and Gynecology,Shekou People's Hospital,Nanshan District of Shenzhen,Sheruhen Peopled Hospital;Department of Ultrasound,Sheruhen Peopled Hospital;Department of Radiology,Sheruhen Peopled Hospital)

机构地区：[1]深圳市妇幼保健院超声科,深圳518028 [2]深圳市妇幼保健院放射科,深圳518028 [3]深圳市妇幼保健院检验科,深圳518028 [4]深圳市南山区蛇口人民医院妇产科,深圳518020 [5]深圳市人民医院超声科,深圳518020 [6]深圳市人民医院放射科,深圳518020

出　　处：《重庆医科大学学报》2021年第8期977-982,共6页Journal of Chongqing Medical University

摘　　要：目的:评价超声(ultrasound,US)联合磁共振成像(magnetic resonance imaging,MRI)诊断胎儿胸腹部异常的价值。提出并探讨以染色体检查结果为基础的结构畸形评分(structural malformation score,SMS)的临床意义。方法:通过对2016年3月至2019年9月经US和MRI检查且符合纳入标准的77例胎儿进行回顾性研究,探讨US和MRI联合应用指征,计算US、MRI及US联合MRI检查的敏感性、特异性、阳性预测值、阴性预测值。采用受试者操作特征(receiver operating characteristics,ROC)曲线分析US、MRI联合诊断胎儿胸腹部异常的价值。通过计算染色体阳性病例百分率对胎儿胸腹部结构畸形进行风险等级评估。结果:(1)鉴别诊断和US应用的局限性是增加MRI联合检查的主要原因。(2)77例受检孕妇经随访证实正常胎儿(阴性)27例(35.1%)、异常胎儿(阳性)50例(64.9%)。US检出阴性25例(32.5%)、阳性52例(67.5%);MRI检出阴性28例(36.4%)、阳性49例(63.6%)。US联合MRI诊断的敏感性、特异性、阳性预测值、阴性预测分别为96.0%、92.6%、96.0%、92.6%,明显高于单一US或单一MRI检查。US诊断的ROC曲线下面积(area under the ROC curve,AUC)为0.792,MRI诊断的AUC为0.819,US联合MRI诊断的AUC为0.943。联合方案与单一US和单一MRI两两比较,差异有统计学意义(Z=2.23,P=0.026;Z=1.97,P=0.049)。(3)根据染色体阳性病例百分率将SMS分为5个评分等级,即0≤1分﹤25%,25%≤2分﹤50%,50%≤3分﹤75%,75%≤4分﹤100%,100%评为5分。当4分≤SMS﹤10分时,建议临床进行染色体或基因检测,当SMS≥10分时,建议临床必要时终止妊娠。结论:US、MRI联合诊断胎儿胸腹部异常的效能最优。准确的诊断和精确的评分对临床决策具有重要指导作用。Objective:To evaluate the value of ultrasound(US)combined with magnetic resonance imaging(MRI)in diagnosing fetal chest and abdomen abnormalities. To propose and discuss the clinical significance of structural malformation score(SMS)based on chromosome examination results. Methods:A retrospective study was conducted on 77 fetuses who were examined by US and MRI from March 2016 to September 2019 and met the inclusion criteria. The indications of US combined with MRI were discussed,and the sensitivity,specificity,positive predictive value and negative predictive value of ultrasound,MRI and ultrasound combined with MRI were calculated. The receiver operating characteristics(ROC)curve was used to analyze the value of ultrasound and MRI physicians in the diagnosis of fetal chest and abdomen abnormalities. According to the chromosome results,the SMS for the chest and abdomen of the fetus was determined by the percentage of chromosomal positive cases. Results:(1)The limitation of ultrasound application was the main reason for increasing MRI examination.(2)Follow-up of 77 pregnant women showed normal(negative)fetuses in 27 cases(35.1%)and abnormal(positive) fetuses in 50 cases(64.9%),25 cases(32.5%)were negative and 52 cases(67.5%)were positive for US,and 28 cases(36.4%)were negative and 49 cases(63.6%)were positive for MRI. The sensitivity,specificity,positive predictive value,and negative predictive value of US combined with MRI were 96.0%,92.6%,96.0% and 92.6%,respectively,which were significantly higher than those of US alone and MRI alone.The area under the ROC curve(AUC)for US diagnosis was 0.792,the AUC for MRI diagnosis was 0.819,and AUC for US combined MRI diagnosis was 0.943. Compared with single US and single MRI,the difference was statistically significant(Z=2.23,P=0.026;Z=1.97,P=0.049).(3)According to the calculation of the positive percentage of chromosome,SMS was divided into 5 grades,namely 0≤1 score<25%,25%≤2 scores<50%,50%≤3 scores<75%,75%≤4 scores<100%,and 100%=5 scores. When 4 scores≤SMS<10

关 键 词：超声 磁共振成像 胎儿 胸腹部异常 染色体检查 

分 类 号：R445.1[医药卫生—影像医学与核医学] R445.2[医药卫生—诊断学]