三维超声在产前诊断胎儿Dandy-Walker综合征各亚型中的应用

The application of three-dimensional ultrasound in subtypes of Dandy-Walker complex

目的探讨三维超声产前诊断胎儿Dandy-Walker综合征各亚型的应用价值。方法应用腹部二维超声检查初步诊断为Dandy-Walker综合征(DWC)的11例胎儿,进一步用腹部三维超声任意平面成像功能,得到小脑正中矢状切面后,分析Dandy-Walker综合征3个亚型(Dandy-Walker畸形;Dandy-Walker变异;单纯后颅窝池增宽)的后颅窝各解剖结构,包括小脑蚓部的形态,位置及头尾径的测量,第四脑室形态,小脑幕附着点。结果三维超声诊断Dandy-Walker畸形2例,Dandy-Walker变异4例,单纯后颅窝池扩张5例,均经引产后尸检及产前、产后MRI证实产前超声诊断正确。结论二维超声小脑横切面检查疑为Dandy-Walker综合征时,应进一步应用三维超声进行细致的扫查,在重建的胎儿头部正中矢状切面重新加以评估胎儿后颅窝的各解剖结构,注意观察小脑蚓部发育不全及上旋、第四脑室的扩大与后颅窝的相通、小脑幕上抬。

Objective To evaluate the value of three-dimensional ultrasound in subtypes of Dandy-Walker complex.Methods Eleven fetuses with suspicious of Dandy-Walker complex in 2D,underwent further scan of the multi slice view of 3D to received standard image of the axis sagittal plane of the cerebella.In this plane,the anatomy of the posterior fossa in various subtypes of Dandy-Walker complex was analysed,including the relationship among the shape and position of the vermis,the shape of the fourth ventricle and tentorial attachment.Results Two cases were diagnosed as Dandy-Walker malformation,four cases as Dandy-Walker variant and five cases as megacisterna magna.which were confirmed by autopsy or prenatal and postnatal MRI.Conclusions Once Dandy-Walker complex is suspected in standard axial plane with 2D,further evaluation for the posterior fossa should be conducted by 3D,i.e in the reconstructed sagittal plane to identify the relationship of the cyst with the fourth ventricle,subarachnoid spaces,the morphology,position and biometry of the vermis and the tentorial attachment.