胎儿孤立性小脑出血的产前超声诊断

Prenatal ultrasound diagnosis of fetal solitary cerebellar hemorrhage

目的探讨胎儿孤立性小脑出血的产前超声声像图特征及临床预后。方法总结2012年1月到2021年8月在南方医科大学附属深圳妇幼保健院胎儿系统超声检查中诊断为小脑出血的7例胎儿的产前超声声像图表现,与MRI图像特征进行对比,并结合相关文献对小脑出血的产前诊断特征及临床预后进行分析。结果7例胎儿产前超声显示小脑内异常回声,5例(71.4%)为高回声,2例(28.6%)为不均匀的低-无混合回声,7例(100%)均伴有双侧小脑半球不对称,彩色多普勒显示:异常回声内均未见血流信号。2例产前MRI均提示为右侧小脑半球出血并右侧小脑发育不全。胎儿小脑出血产前超声早期表现为小脑内高回声,后方无声影;1~2周后,血肿逐渐吸收部分液化,高回声缩小,内可见囊性无回声,或表现为不均匀的低-无混合回声;1个月后血肿吸收,高回声或混合回声消失,双侧小脑半球不对称,小脑半球发育不全。妊娠结局及随访:3例(42.9%)引产,2例(28.6%)胎死宫内,2例(28.6%)产后随访神经发育正常。结论超声联合MRI能够提高产前小脑出血的诊断符合率。产前诊断小脑出血患儿长期神经随访结果,可以为产前小脑出血胎儿的产前咨询提供数据支持,改善其妊娠结局。

ObjectiveTo explore the prenatal ultrasound imaging features and clinical prognosis of fetal solitary cerebellar hemorrhage(CBH).MethodsThe prenatal ultrasonographic manifestations of seven fetuses diagnosed with CHB detected by ultrasonography at Shenzhen Maternity and Child Healthcare Hospital Affiliated to Southern Medical University from January 2012 to August 2021 were reviewed and compared with the MRI image features.The prenatal diagnosis and clinical prognosis of CHB were then analyzed based on the relevant literature.ResultsAbnormal echoes were found in the cerebellum of seven fetuses by prenatal ultrasound,of which five(71.4%)showed hyperecho in the cerebellum,two(28.6%)showed uneven mixed hypoecho and anecho,and all had bilateral cerebellar hemisphere asymmetry.Color Doppler showed no signal of blood flow in tissues with abnormal echo.Antenatal MRI examination of two cases showed right CHB and right cerebellar hypoplasia.The early ultrasonic manifestations of fetal CHB were hyperecho in the cerebellum and silent shadow behind.After 1-2 weeks,the hematoma was gradually absorbed and partially liquefied,and hyperecho was reduced to cystic anecho or uneven hypoecho and anecho.After 1 month,the hematoma was absorbed and the hyperecho or mixed echo disappeared,with asymmetrical bilateral cerebellar hemispheres and hypoplastic cerebellar hemispheres.In terms of pregnancy outcome and follow-up,there were three(42.9%)cases of induced labor,two cases of fetal death(28.6%)in utero,and two cases of normal neurodevelopment in seven months of follow-up postpartum.ConclusionUltrasound combined with MRI can improve the prenatal diagnostic accuracy for CHB.The long-term neurological follow-up results of children with a prenatal diagnosis of CBH can provide data support in parental counseling and improve the pregnancy outcome of fetuses with prenatal CHB.