产前超声经颅顶部横切面简化分级方法评估正常胎儿外表面脑沟的横断面研究  

A cross-sectional study of simplified grade of the transcalvarial axial plane in evaluating the convexity sulci of normal fetuses

作　　者：秦越 文华轩[1] 罗丹丹 曾晴 郑美玉[1] 梁美玲 廖伊梅 温昕 梁博诚 袁鹰[1] 李胜利[1] Qin Yue;Wen Huaxuan;Luo Dandan;Zeng Qing;Zheng Meiyu;Liang Meiling;Liao Yimei;Wen Xin;Liang Bocheng;Yuan Ying;Li Shengli(Department of Ultrasound,Shenzhen Maternity and Child Healthcare Hospital,Shenzhen 518028,China)

机构地区：[1]深圳市妇幼保健院超声科,深圳518028

出　　处：《中华超声影像学杂志》2024年第10期884-890,共7页Chinese Journal of Ultrasonography

基　　金：国家重点研发计划(2022YFF0606301);国家自然科学基金(62227808);深圳市科技计划项目(JCYJ20230807120304009,JCYJ20210324130812035);深圳市妇幼保健院院内科研基金项目(FYB2022001)。

摘　　要：目的研究20~32周正常胎儿外表面脑沟在经颅顶部横切面上显示的稳定性和形态学变化,探索一种外表面脑沟形态发育简化评估分级方法,分析其临床意义。方法本研究为横断面研究,回顾性收集2019年9月至2022年6月在深圳市妇幼保健院超声科进行常规超声检查的551例孕20~32周正常单胎。评估经颅顶部横切面上远场外表面脑沟的显示情况:0为不显示,1为显示。并进一步根据外表面脑沟的发育形态和出现数目,将其分为5级:外表面脑沟未显示(0级),1条外表面脑沟(1级),2条外表面脑沟(2级),3条外表面脑沟(3级),4条及以上外表面脑沟(4级)。记录检查孕周、妊娠结局。分析外表面脑沟各分级的孕周分布特征,比较左右侧外表面脑沟的孕周分布并分析双侧对称性,采用Weighted Kappa系数分析观察者间和观察者内的一致性,采用曲线回归分析建立孕周预测分级模型。结果孕25周前胎儿颅顶部外表面完全光滑,中央沟于孕26周后恒定显示,额上沟、顶内沟、中央后沟、中央前沟于孕28~31周恒定显示。其中额上沟于孕29周前的显示率较低。孕32周颅顶部外表面脑沟均应显示。311例胎儿获得左侧外表面脑沟分级,240例胎儿获得右侧外表面脑沟分级。随妊娠进展从低向高发展。0级出现在孕20~26周,1级孕25~28周,2级孕26~28周,3级孕27~30周,4级孕27~32周。双侧外表面脑沟相比,0级、1级、3级和4级出现孕周分布情况差异无统计学意义(均P>0.05),而2级中双侧孕周分布差异有统计学意义(P<0.05)。观察者内和观察者间Weighted Kappa系数分别为0.94和0.86,均具有较强的一致性。结论产前超声经颅顶部横切面上的简化正常胎儿外表面脑沟发育评估分级方法可实现孕20~32周胎儿外表面脑沟发育成熟度的初步评价。Objective To study the stability and morphological changes of the convexity sulci in normal fetuses between 20 and 32 weeks,and to explore the simplified grade for evaluating the convexity sulci development and analyzing its clinical significance.MethodsThis study was a cross-sectional analysis.A total of 551 cases of normal singleton pregnancies between 20 and 32 weeks of gestation were retrospectively collected,who underwent routine ultrasound examinations at Shenzhen Maternity and Child Healthcare Hospital from September 2019 to June 2022.The display of the far-field convexity sulci on the transcalvarial axial plane was observed as 0 for not displayed and 1 for displayed.Further,based on the morphology and number of convexity sulci,they were classified into five grades:no sulcus displayed(grade 0),one sulcus(grade 1),two sulci(grade 2),three sulci(grade 3),and four or more sulci(grade 4).The gestational age at examination and pregnancy outcomes were recorded.The distribution characteristics of gestational weeks for each grade of the convexity sulci were analyzed,and the gestational week distribution of the left and right convexity sulci was compared to analyze bilateral symmetry.The Weighted Kappa coefficient was used to analyze inter-observer and intra-observer consistency,and curve regression analysis was employed to establish a model for predicting grade based on gestational weeks.ResultsBefore 25 weeks of gestation,the convexity of the fetal cranial vertex was completely smooth.The central sulcus consistently appeared after 26 weeks,while the superior frontal sulcus,intraparietal sulcus,postcentral sulcus,and precentral sulcus consistently appeared between 28 and 31 weeks.Among these,the superior frontal sulcus had a lower display rate before 29 weeks.By 32 weeks,all convexity sulci of the cranial vertex should be visible.Three hundred and eleven fetuses were graded for the left,and 240 fetuses were graded for the right.The developmental grade of the convexity sulci increased from Grade 0 to Grade 4 as the

关 键 词：超声检查 胎儿 外表面脑沟 脑皮质 分级 

分 类 号：R445.1[医药卫生—影像医学与核医学] R714.5[医药卫生—诊断学]