苏州地区正常早孕期胎儿中枢神经系统相关颅内指标正常值的超声研究  

Ultrasonographic measurements of intracranial markers related to central nervous system of normal fetuses in early pregnancy in Suzhou

作　　者：孙玲玲[1] 曹皎皎 张俊[1] 季春亚 潘琦[1] 杨忠[1] 凌晨[1] 邓学东[1] 殷林亮 Sun Lingling;Cao Jiaojiao;Zhang Jun;Ji Chunya;Pan Qi;Yang Zhong;Ling Chen;Deng Xuedong;Yin Linliang(Center for Medical Ultrasound,the Affiliated Suzhou Hospital of Nanjing Medical University,Suzhou Municipal Hospital,Suzhou 215002,China;Center for Medical Ultrasound,Gusu School,Nanjing Medical University,Suzhou 215002,China)

机构地区：[1]南京医科大学附属苏州医院苏州市立医院超声中心,苏州215002 [2]南京医科大学姑苏学院超声中心,苏州215002

出　　处：《中华超声影像学杂志》2024年第11期975-982,共8页Chinese Journal of Ultrasonography

摘　　要：目的构建苏州本地人群早孕期胎儿中枢神经系统相关颅内指标的正常参考值范围。方法回顾性选取2021年1月至2022年7月在南京医科大学附属苏州医院进行早孕期(11~13+6周)颈项透明层(NT)筛查,且出生结局正常的单胎妊娠胎儿早孕期超声图像。图像包含3个平面:胎头正中矢状切面(即NT测量平面),胎头侧脑室横断面以及胎头后颅窝水平轴平面。于胎头正中矢状面测量脑干厚度(BS)、脑干至枕骨间距(BSOB)、BS与BSOB比值(BS/BSOB)、颅内透明层(IT)厚度、小脑延髓池(CM)宽度、中脑径(MB)与大脑镰径(F)比值MB/F;于胎头侧脑室横断面测量平均脉络丛长度(CPL)与枕额径(OFD)比值CPL/OFD、双侧脉络丛面积和(CPA)与胎头面积(HA)比值CPA/HA;于胎头后颅窝水平轴平面测量第四脑室(4V)及CM前后径。对上述颅内指标测值行统计学分析,获得相应正常值范围。采用组内相关系数(ICC)分析观察者内和观察者间的一致性。采用Pearson相关分析和线性相关分析研究胎儿各颅内指标与头臀长(CRL)的相关性,并推导回归方程。结果共纳入2331例胎儿,由于每例胎儿可提供多切面图像,最终获得胎头正中矢状面图像1023张,胎头侧脑室平面图像817张以及胎头后颅窝水平轴平面图像567张。胎头正中矢状面颅内指标BS、BSOB、BS/BSOB、IT厚度、CM宽度、MB/F,胎头侧脑室横断面颅内指标CPL/OFD,CPA/HA及胎头后颅窝水平轴平面颅内指标4V和CM宽度的观察者内与观察者间ICC均>0.75。胎儿颅内各指标均与CRL呈线性相关。胎头正中矢状面:BS、BSOB、BS/BSOB、IT厚度、CM宽度、MB/F与CRL呈线性相关(r=0.508、0.626、-0.234、0.105、0.508、-0.493,均P<0.05)。侧脑室横断面:CPL/OFD、CPA/HA与CRL呈线性相关(r=-0.324、-0.268,均P<0.001)。后颅窝水平轴平面:4V、CM宽度与CRL呈线性相关(r=0.246、0.467,均P<0.001)。结论在妊娠早期对胎儿颅内各指标的定量分析是可行的。本Objective To establish reference ranges of central nervous system-related fetal intracranial markers during the first trimester in a local population of Suzhou.Methods Ultrasound images of fetuses with normal birth outcomes in singleton pregnancies who underwent nuchal translucency(NT)screening during the first trimester(11-13+6 gestational weeks)from January 2021 to July 2022 at the Affiliated Suzhou Hospital of Nanjing Medical University were retrospectively selected.The images including 3 planes:the midsagittal plane of the fetal head,also known as the plane for NT measurement,the trans-ventricular plane of the fetal head,and the axial plane of the fetal head at the posterior fossa level.The brainstem(BS)thickness,brainstem to occipital bone distance(BSOB),the ratio of BS to BSOB(BS/BSOB),intracranial translucency(IT)thickness,cisterna magna(CM)width,and the midbrain(MB)to falx(F)ratio MB/F were measured in the mid-sagittal plane of the fetal head.Choroid plexus length(CPL)to occipital frontal diameter(OFD)ratio CPL/OFD,and choroid plexus area(CPA)to head area(HA)ratio CPA/HA were measured in the trans-ventricular plane of the fetal head.Anteroposterior diameter of the fourth ventricle(4V)and CM were measured in the axial plane of the fetal head at the posterior fossa level.Statistical analysis was performed to obtain the corresponding normal reference range.Intra-class correlation coefficient(ICC)was used to analyze intra-observer and inter-observer consistency.Pearson correlation analysis and linear correlation analysis were used to study the correlations between crown-lump length(CRL)and intracranial markers,and the regression equation was derived.Results A total of 2331 fetuses were enrolled,providing 1023 images of the midsagittal plane,817 images of the trans-ventricular plane,and 567 images of the axial plane of the fetal head at the posterior fossa level.The intra-observer and inter-observer ICCs of intracranial markers BS,BSOB,BS/BSOB,IT thickness,CM width,MB/F in the mid-sagittal plane,the intracrani

关 键 词：超声检查 早孕期 中枢神经系统 胎儿 颅脑 指标 正常值 

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]