磁共振联合三维超声筛查胎儿颅脑畸形的价值  

The Value of Magnetic Resonance Combined with 3D Ultrasound in Screening for Fetal Cranio-Cerebral Anomalies

作　　者：白琎 Bai Jin(Department of Radiology,Liuzhou Maternal and Child Health Hospital,Liuzhou 545001,The Guangxi Zhuang Autonomous Region,China)

机构地区：[1]柳州市妇幼保健院放射科,广西柳州545001

出　　处：《中国CT和MRI杂志》2023年第12期10-13,共4页Chinese Journal of CT and MRI

基　　金：广西壮族自治区卫生和计划生育委员会自筹经费科研课题(Z20200149)。

摘　　要：目的本研究通过1.5T磁共振成像(MRI)联合三维超声筛查胎儿颅脑畸形,并分析其临床价值和成本效益。方法选取2020年11月~2022年11月我院150例可疑胎儿颅脑畸形,均行产前三维超声、MRI检查。分析颅脑畸形胎儿产前三维超声、MRI特征,比较颅脑畸形胎儿与无颅脑畸形胎儿孕期超声颈部透明层厚度(NT)值、母体血清甲胎蛋白(AFP)、游离雌三醇(μE3)、游离β-人绒毛膜促性腺激素(Free-β-hCG)水平,分析颅脑畸形胎儿超声NT值与血清AFP、μE3、Free-β-hCG水平相关性,以产后复查胎儿MRI或尸检结果为“金标准”,比较产前三维超声、MRI单独及联合诊断胎儿颅脑畸形的诊断效能、与“金标准”结果的一致性,并通过决策树模型进行成本效益分析。结果颅脑畸形胎儿超声NT值、母体血清AFP、Free-β-hCG水平高于无颅脑畸形胎儿,μE3水平低于无颅脑畸形胎儿(P<0.05);颅脑畸形胎儿超声NT值与母体血清AFP、Free-β-hCG水平呈正相关,与母体血清μE3水平呈负相关(P<0.05);产前三维超声联合MRI诊断胎儿颅脑畸形的一致性Kappa值、敏感度高于二者单独诊断,诊断准确度高于产前三维超声单独诊断(P<0.05);产前三维超声联合MRI诊断胎儿颅脑畸形的效益/成本最大,为3.48。结论MRI联合三维超声筛查胎儿颅脑畸形准确度、敏感度较高,结合相关母体血清指标检查,有助于提高胎儿颅脑畸形检出率,但二者联合成本效益较高。Objective In this study,1.5-t magnetic resonance imaging(MRI)combined with three-dimensional ultrasound was used to screen fetal Craniosynostosis and analyze its clinical value and costeffectiveness.Methods 150 cases of suspected fetal Craniosynostosis in our hospital from November 2020 to November 2022 were selected,all of which underwent prenatal three-dimensional ultrasound and MRI examination.The prenatal three-dimensional ultrasound and MRI characteristics of fetuses with Craniosynostosis were analyzed,and the ultrasound thickness of cervical hyaline layer(NT),maternal serum alpha-fetoprotein(AFP),Free estradiol(μE3)and free human chorionic gonadotropin(Free beta-hCG)levels were compared between fetuses with Craniosynostosis and fetuses without Craniosynostosis.The correlation between fetal ultrasound NT value and serum AFP,μE3 and Free-β-hCG levels with Craniosynostosis was analyzed.The results of fetal MRI or autopsy during postpartum review were used as the"gold standard"to compare the diagnostic efficacy of prenatal threedimensional ultrasound and MRI alone and in combination with the"gold standard"in diagnosing fetal Craniosynostosis.The cost-benefit analysis is carried out by decision tree model.Results The ultrasonic NT value,serum AFP and Free beta-HCG levels of fetuses with Craniosynostosis were higher than those of fetuses without Craniosynostosis,andμE3 levels were lower than those of fetuses without Craniosynostosis(P<0.05).The ultrasound NT value of the fetus with Craniosynostosis was positively correlated with the serum levels of AFP and Free-β-hCG,and negatively correlated with the serum levels ofμE3(P<0.05).The consistency and sensitivity of prenatal three-dimensional ultrasound combined with MRI in the diagnosis of fetal Craniosynostosis were higher than those of prenatal threedimensional ultrasound combined with MRI alone,and the diagnostic accuracy was higher than that of prenatal three-dimensional ultrasound alone(P<0.05).The benefit/cost of prenatal three-dimensional ultrasound com

关 键 词：1.5T磁共振 三维超声 胎儿 颅脑畸形 临床价值 成本效益 

分 类 号：R445.2[医药卫生—影像医学与核医学]