超声和MRI对胎儿唇腭裂的诊断价值

Significance of ultrasonography and MRI in the prenatal diagnosis of cleft lip and palate

目的比较超声(US)和磁共振成像(MRI)在诊断胎儿唇腭裂中的价值与意义。方法采用前瞻性双盲对照的方法,征集US怀疑胎儿颌面部畸形或US无法清晰显示正常颌面部结构的孕妇。超声和磁共振医师在互不了解孕妇所有资料的前提下分别对US声像图及MRI图像进行独立诊断,将产前US及MRI诊断与产后随访结果进行对照。应用SPSS 20.0软件对数据进行ROC曲线分析,比较二者的诊断效能,并把诊断信心分为4个等级。结果唇腭裂畸形共47例,单纯唇裂23例,单侧唇裂并牙槽突裂1例,唇腭裂19例,单纯腭裂4例。(1)对于唇裂的诊断US和MRI的诊断效能一致,诊断正确率、敏感性、特异性均为100%。(2)对于腭裂的诊断,MRI诊断的正确率明显高于US,分别为93.6%、48.9%。(3)对于唇腭裂的诊断,MRI的诊断效能明显高于US,MRI和US的ROC曲线下面积(AUC)分别为0.954、0.704,两者比较差异有统计学意义(P<0.05)。(4)在确诊或排除腭裂方面M RI的诊断信心高于US,M RI的确定性诊断占91.5%,US的确定性诊断占44.7%。结论 M RI较US诊断胎儿唇腭裂具有明显优势,可以作为US的有效补充,尤其是当US对是否合并腭裂存疑时有必要行MRI检查。

Objective To evaluate the accuracy of ultrasound (US)and magnetic resonance imaging (MRI)in the diagnosis of fetal cleft lip and palate.Methods Pregnant women suspected of fetal facial malformations or unable to clearly display normal maxillofacial anatomy were enrolled in the prospective blinded case-control study.The US and MRI images were reviewed in a blinded fashion by experienced radiologists without knowledge of indications or prior imaging findings.The prenatal US and MRI diagnosis were compared with the postnatal results.Receiver operating characteristic curve (ROC)analysis of data by SPSS 20.0 software was conducted to compare the diagnostic efficiency of US and MRI.Diagnostic confidence was divided into four levels.Results All of the 47 fetuses had craniofacial anomaly,including isolated cleft lip in 23 cases,unilateral cleft lip and alveolus in 1 case,cleft lip and palate in 19 cases,and isolated cleft palate in 4 cases.The accuracy,sensitivity and specificity of both US and MRI in the diagnosis of cleft lip were 100%.The accuracy of US and MRI in the detection of cleft palate was 93.6% vs 48.9%.The AUC of US and MRI was 0.954 vs 0.704 for the detection of cleft lip and palate (P<0.05).The diagnostic confidence of MRI in the diagnosis or exclusion of cleft lip and palate was higher than that of US (91.5% vs 44.7%).Conclusion MRI is superior to US in the diagnosis of cleft lip and palate,which can serve as an auxiliary diagnostic method,especially when US is unable to confirm the presence of complicated cleft palate.