彩色多普勒超声与四维超声对胎儿肢体畸形的诊断及漏诊分析  

Analysis on the diagnosis and missed diagnosis of color Doppler ultrasound and four-dimensional ultrasound on fetal limb deformity

作　　者：赵岩[1] 周伟娜[1] 顾晔 孔亚荣 刘益宁 周慧 Zhao Yan;Zhou Weina;Gu Ye;Kong Yarong;Liu Yining;Zhou Hui(Department of Ultrasound,Baoding No.1 Central Hospital,Baoding 071000,China)

机构地区：[1]保定市第一中心医院超声科,保定071000

出　　处：《中国医学装备》2024年第4期90-93,共4页China Medical Equipment

基　　金：河北省保定市科技计划项目(2241ZF040,18ZF210)。

摘　　要：目的:探讨彩色多普勒超声(CDUS)与四维超声(4D-US)对胎儿肢体畸形的诊断及漏诊情况。方法:选取2021年1月至2022年12月在保定市第一中心医院产检的201例孕妇,以引产后病理结果或出生结果为“金标准”,其中确诊为胎儿肢体畸形52例,并在产前均予以CDUS和4D-US检查,采用四格表法计算阳性、阴性预测值,采用受试者工作特征(ROC)曲线模型分析CDUS、4D-US诊断胎儿肢体畸形的ROC曲线下面积(AUC)值、灵敏度及特异度。结果:201例行胎儿肢体畸形筛查的孕妇经CDUS检查后,阳性预测值为64.15%,阴性预测值为85.53%,与“金标准”相比一致性一般(Kappa=0.532,P<0.001)。经4D-US扫描后,阳性预测值为84.31%,阴性预测值为94.00%,与“金标准”相比一致性较好(Kappa=0.778,P<0.001)。CDUS与4D-US的准确率相比,差异具有统计学意义(x^(2)=8.557,P<0.05)。201例行胎儿肢体畸形筛查的孕妇经4D-US诊断检出的人鱼序列综合征、裂手畸形、多指畸形、桡骨缺失并伴有或不伴有钩状手、长骨短小、足内翻、手掌缺如、胎儿股骨短小、并指畸形以及缺指畸形的总检出率(82.69%)高于CDUS的总检出率(65.38%),差异具有统计学意义(x^(2)=4.514,P<0.05)。ROC曲线分析显示,CDUS、4D-US诊断胎儿肢体畸形的AUC值分别为0.767和0.892;灵敏度分别为66.70%和84.30%;特异度分别为86.70%和94.00%;CDUS与4D-US的AUC比较,差异有统计学意义(Z=2.367,P<0.016)。结论:CDUS与4D-US在胎儿肢体畸形筛查中具有一定价值,其中以4D-US诊断效能更高。Objective:To investigate the diagnosis and missed diagnosis of color Doppler ultrasound(CDUS)and four-dimensional ultrasound(4D-US)on fetal limb deformity.Methods:A total of 201 pregnant women who admitted to Baoding No.1 Central Hospital for antenatal examination from January 2021 to December 2022 were selected as the research objects.The pathological results after induced abortion or birth results were used as the gold standard.In them,a total of 52 cases were confirmed as fetal limb deformity by the gold standard,and all of them underwent CDUS and 4D-US examinations before delivery.The positive and negative predictive values were calculated by using the fourcell table method.The receiver operating characteristics(ROC)curve model was adopted to analyze the area under curve(AUC)values,sensitivities and specificities of CDUS and 4D-US in diagnosing fetal limb deformity.Results:After 201 pregnant women who underwent screening for fetal limb deformity received CDUS examination,the positive predictive value was 64.15%and the negative predictive value was 85.53%,which showed general consistency with the gold standard(Kappa=0.532,P<0.001).After 4D-US scanning,the positive predictive value was 84.31%and the negative predictive value was 94.00%,which had favorable consistency with the gold standard(Kappa=0.778,P<0.001).The accuracy of CDUS was significantly different from that of 4D-US(x^(2)=8.557,P<0.05).In 201 pregnant women who underwent screening for fetal limb deformity,the total diagnostic agreement rate(82.69%)of 4D-US was significantly higher than that(65.38%)of CDUS for mermaid sequence syndrome,split hand deformity,polydactyly deformity,missing radius with or without hook-like hand,shortly long bone,foot varus,missing palm,fetal femoral shortening,syndactyly deformity and missing finger deformity(x^(2)=4.514,P<0.05).ROC curve analysis showed that the AUC values of CDUS and 4D-US were respectively 0.767 and 0.892 in diagnosing fetal limb deformity,and the sensitivities of them were respectively 66.70%and 84.30%

关 键 词：彩色多普勒超声(CDUS) 四维超声(4D-US) 胎儿肢体畸形 漏诊 

分 类 号：R445.1[医药卫生—影像医学与核医学]