三维彩超诊断胎儿小下颌畸形

Diagnosis of Fetal Micrognathia by Three-Dimensional Color Doppler Ultrasound

目的:运用二维彩色多普勒及实时三维成像探讨胎儿小下颌畸形的超声表现及各指标综合诊断方法,提高其超声诊断准确率,总结其临床应用价值。方法:应用二维彩色多普勒超声测量6 300例孕周为18-32周的胎儿下颌骨纵径(FML),左右径,下颌骨纵径与双顶径的比值即下颌指数(JI),胎儿下颌面部角度(IFA)。观察胎儿正中矢状面下颌曲线及冠状面下颌显像,并应用实时三维表面成像技术进一步显示胎儿下颌结构。结果:正常胎儿下颌骨左右径及纵径FML与其孕周正相关(R分别为0.952,0.954,P均<0.01);小下颌组胎儿JI、IFA较正常对照组胎儿显著减小,差异有统计学意义(P<0.05),FML明显小于正常同孕周胎儿。结论:胎儿FML明显小于同孕周正常值,JI<31%,IFA<45%为产前诊断小下颌畸形的超声综合数据指标,二维及实时三维彩超联合应用诊断胎儿小下颌畸形明显优于传统诊断方法,具有其他影像学检查不可取代的临床应用价值。

Objective： To investigate the value of prenatal ultrasonography in the diagnosis of fetal mi- crognathia. Methods： A total of 6 300 cases of 18-32 week fetus were screened. The indices of mandible longitudinal diameter （FML）, transverse diameter, mandibular longitudinal diameter, biparietal diameter ratio （mandibular index, JI）, and fetal mandibular facial angle （IFA） were measured by using two-dimensional color Doppler ultrasound. Then the mandibular curve of fetal median sagittal plane and the mandible image of coronal plane were obtained by visual observa- tion. Real-time three dimensional surface imaging was adopted to directly observe the fetal man- dibular structure. Results： FML, JI, and mandibular plane angle （IFA） was highly correlated with mandibular micrognathia （R--0. 931, 0. 941, and 0. 937, respectively, P〈0.01 for all）. A- mong 300 cases, which were highly suspected as micrognathia, 21 cases were confirmed after in- duction of labor. Conclusion： Two-dimensional and real-time three-dimensional ultrasound in the diagnosis of fetal micrognathia is obviously superior to the traditional diagnostic methods.