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目的:探讨胎儿颅脑正中矢状切面超声检查在诊断复杂颅脑畸形中的应用价值,提高颅脑畸形产前超声诊断的准确率。方法:选取2010年1月~2013年6月在该院产检的12 850例孕妇,进行20~32孕周超声检查。常规测量胎儿双顶径、头围、观测颅内结构,发现颅脑异常时联合应用经腹及经阴道二维、三维超声检查,分析超声声像表现,侧重观测正中矢状切面特征。对复杂颅脑畸形病例进行随访,追踪宫内MRI检查结果、引产后病理检查、出生后超声或MRI检查的结果,与该院首次产前超声诊断结果进行对比分析。结果:检出颅脑异常378例,发生率2.94%;复杂颅脑畸形36例,发生率0.28%;33例与追踪随访结局一致,诊断准确率91.67%。通过正中矢状面重点观测,分别诊断后颅窝蛛网膜囊肿6例、Dandy-Walker畸形8例、小脑下蚓部发育不良9例、前脑无裂畸形7例、胼胝体发育不良6例。误诊3例,1例产后正常胎儿产前误诊为胼胝体部分发育不良,1例单纯颅后窝池增宽误诊为小脑下蚓部发育不良,1例叶状全前脑误诊为胼胝体发育不良。结论:经腹经阴道二维、三维超声联合检查,有效提高中、晚孕胎儿颅脑畸形的检出率。规范扫查手法、标准扫查切面、颅脑畸形声像图特征的正确认识能有效避免漏诊、误诊,通过正中矢状切面观察胎儿大脑中线部位结构,在畸形性质和位置判断分析上起重要作用,是诊断复杂颅脑畸形中的关键。
Objective: To investigate the value of fetal brain midsagittal plane sagittal sonography in the diagnosis of complex craniocerebral deformity and to improve the accuracy of prenatal ultrasound in the diagnosis of craniocerebral malformation. Methods: A total of 12 850 pregnant women who were inspected in our hospital from January 2010 to June 2013 were enrolled in this study. Ultrasonography was performed for 20 to 32 gestational weeks. Conventional measurement of fetal biparietal diameter, head circumference, observation of intracranial structures, found abnormal brain combined with transabdominal and transvaginal two-dimensional, three-dimensional ultrasound examination, analysis of ultrasound imaging, focusing on the observation of the median sagittal section features. The patients with complicated craniocerebral malformations were followed up, the results of intrauterine MRI examination, pathological examination after induction of labor, postnatal ultrasound or MRI examination were compared with those of the first prenatal ultrasound diagnosis in this hospital. Results: Among 378 cases, the incidence of craniocerebral abnormalities was detected, the incidence rate was 2.94%. Complicated craniocerebral malformations were 36 cases, the incidence rate was 0.28%. The 33 cases were consistent with the follow-up results. The diagnostic accuracy was 91.67%. Through the mid-sagittal focus observation, 6 cases of posterior fossa arachnoid cyst, 8 cases of Dandy-Walker malformation, 9 cases of inferior cerebellar vermis dysplasia, 7 cases of anterior cerebral fissure deformity and 6 cases of corpus callosum were diagnosed respectively. Misdiagnosis in 3 cases, 1 case of postpartum normal fetus prenatal misdiagnosed as corpus callosum partial dysplasia, a case of simple posterior fossa pool widened misdiagnosed as cerebellar vermis dysplasia, 1 case of leafy anterior cerebral was misdiagnosed as corpus callosum dysplasia. Conclusion: Transabdominal transvaginal two-dimensional, three-dimensional ultrasound combined examination, effectively improve the fetus in middle and late pregnancy detection rate of brain deformity. Correct scanning techniques, standard scan section, craniocerebral malformations of the correct understanding of the characteristics of sonography can effectively avoid missed diagnosis, misdiagnosis, through the mid-sagittal section to observe the fetal brain midline structure, in the nature of malformations and position to determine the role of analysis and play an important role , Is the diagnosis of complex cranial deformity in the key.