三维彩超对胎儿中枢神经系统畸形的诊断应用价值

The applying values of three-dimensional ultrasound for diagnosis of fetal malformations of the central nervous system

目的探讨三维彩超对胎儿中枢神经系统畸形的诊断运用价值。方法2011年8月-2015年1月选择在我院行产前超声检查的高危妊娠妇女共320例,都进行二维彩超与三维多切面彩超检查。结果二维彩超检查出胎儿中枢神经系统畸形28例,检出率为8.75%;主要影像学特征表现为小脑延髓池增宽、灰质异位或侧脑室室管膜下灰质信号,胼胝体发育不良。三维彩超中检查出胎儿中枢神经系统畸形30例,检出率为9.38%,其中比二维超声多检出1例脑积水与1例脉络膜囊肿,使用的三维切面为侧脑室切面。经过正常分娩或引产尸检后证实,三维彩超无漏诊情况,诊断准确率为100.0%;二维彩超漏诊2例,诊断准确率为93.3%,三维彩超的诊断准确率高于二维彩超,但是对比差异无统计学意义（P〉0.05）。结论超声检查对胎儿中枢神经系统的畸形检出率较高,三维彩超以多切面成像功能弥补二维彩超的漏诊情况,可明显提高产前诊断正确率。

Objective To investigate the applying value of three-dimensional ultrasound for diagnosis of fetal malformations of the central nervous system. Methods From August 2011 to January 2015, 320 women, who were suffered from high-risk pregnancy as confirmed by prenatal ultrasound in our hospital, were selected in this work, and then, all were subjected to the two-dimensional color Doppler ultrasound examination and three-dimensional ultrasound surface analysis. Results Via the two-dimensional ultrasound examination, the abnormalities of the fetal central nervous system were found in 28 patients, the detection rate was 8.75% ; the main imaging characteristics exhibited that cerebellar cistern were widened, gray matter was heterotopie or gray matter signal appeared under the ependymal, and the development of corpus callosum was. By the the three - dimensional ultra-sound, the abnormalities of fetal central nervous system were checked out in 30 patients, the detection rate was 9.38%, in which two-dimensional ultrasound detected more than one patient with of hydrocephalus and one patient with choroid cysts by using the three-dimensional aspect with the lateral ventricles section. The satiation of misdiagnosis by the three-dimensional color Doppler was not seen as confirmed by the normal delivery or abortion autopsy, and the diagnostic accuracy was 100.0% ; as for the situa- tion by the two-dimensional ultrasound, two patients were misdiaguosed, the diagnostic accuracy was 93.3 %. Thus, the diagnos- tic accuracy by three-dimensional ultrasound was higher than that by the two-dimensional ultrasound. However, the difference by both methods was not statistically significant （ P 〉 0.05 ）. Conclusion Ultrasonography has higher detection rate for the abnormalities of fetal central nervous system. Three-dimensional multi-slice imaging ultrasound can make up the misdiaguosis by dimensional color Doppler ultrasound, which significantly improves prenatal diagnostic accuracy.