胎儿半椎体畸形产前超声图像分析

The ultrasound imageing analysis of fetal hemivertebrae

目的总结分析半椎体畸形胎儿产前及产后超声图像特征。方法对2012年1月至2013年5月在广东省妇幼保健院产前超声诊断并经磁共振成像(产前2例,产后4例)或引产胎儿X线检查(3例)证实为半椎体畸形的12例胎儿超声图像进行总结分析。结果 12例半椎体畸形胎儿产前超声显示单发椎体畸形5例,多发椎体畸形7例;其中发生在脊柱胸段6例,腰段3例,骶尾段1例,1例脊柱颈段及胸段同时发生,1例脊柱胸段及腰段同时发生。超声异常表现:(1)椎体异常形态:小于正常椎体的不规则形骨性强回声呈楔形嵌入正常椎体间、脊柱侧弯或成角畸形。(2)合并其他畸形:12例半椎体畸形胎儿中4例未合并其他畸形,胎儿足月分娩后MRI检查均诊断为半椎体畸形(2例产前MRI及产后3日内X线检查均显示为半椎体畸形);8例合并心脏等其他系统畸形,其中3例引产胎儿标本X线检查诊断为半椎体畸形;5例孕妇在当地医院引产,电话随访获知引产胎儿X线检查显示为半椎体畸形,其中1例胎儿胸段半椎体合并肋骨缺失,证实产前超声漏诊肋骨缺失。结论三维超声能清晰显示脊柱侧弯程度、准确定位病变椎体,可为胎儿生后治疗提供重要的影像学诊断依据。

Objective To summarize the characteristics of prenatal and postnatal ultrasonic image in hemivertebra fetal malformation. Methods The present study enrolled 12 ultrasound diagnosed hemivertebra fetal malformation and confirmed by either magnetic resonance imaging （MRI） or X-ray in Guangdong Provincial Maternal and Children＇s Hospital from January 2012 to May 2013. All the ultrasonic image were collected to summarize their characteristics. Results In the twelve cases of prenatal ultrasonic image of hemivertebrae： （1） Vertebral anomaly patterns： the irregular-shape of bones are smaller than normal vertebral bony hyperechoic which inserted into the normal intervertebral in wedge-shape, scoliosis or angular deformity. （2） Diseased parts： in the 12 fetuses, 5 had single vertebral deformity while the other 7 had multiple vertebral deformities. For the location of the lesion, there were 6 dysmorphia appeared in thoracic, 3 appearedin lumbar, 1 appeared in sacrococcygeal, 1 appeared in both cervical and thoracic, and 1 appeared in both thoracic and lumbar. （3） Associated with other malformations： 4 term delivery fetuses confirmed diagnosis of hemivertebra malformation by MRi （the diagnosis of hemivertebra was confirmed by both the fetal MRI and postnatal X-ray in 2 of them within 3 days）; 8 fetuses had additional anomalies, including heart malformations. Three of them were induced abortion, the X-ray images of the fetal sample showed hemivertebradysmorphia. Five women chosed induced laborin local hospital, and the X-ray images of the fetal were diagnosed as hemivertebradysmorphia. One of them with rib deletion in thoracic was missed diagnosed. Conclusions Three-dimensional ultrasonicimages can clearly show the degree of scoliosis, locate vertebra. It provides important imaging evidence for the treatment of fetal dysmorphiaafter labor.