胎儿颅脑超声筛查与中枢神经超声学检查同MRI的一致性

Consistency of fetal brain ultrasound screening and neurosonogram with MRI

目的研究胎儿颅脑超声筛查与中枢神经超声学（neurosonogram，NSG）检查同MRI的一致性，探讨2种超声检查方法在胎儿神经系统发育异常诊断中的临床价值及NSG检查在胎儿颅脑畸形诊断中的应用价值。方法回顾性分析2012年1月至2015年7月问在北京大学第一医院进行颅脑超声筛查与NSG检查提示胎儿颅脑发育异常，并于1周内行胎儿头颅MRI检查的221例病例。根据留存的图像确定胎儿神经系统检查的方法，将只有3个基本横切面者分为筛查组（111例），将有10个平面者分为NSG组（110例）。根据超声及MRI诊断结果，可分为以下4种情况：超声和MRI均提示一种疾病（A）；MRI部分诊断结果与超声一致，但MRI补充了重要的诊断信息（B）；超声和MRI分别提示不同的疾病（C）；超声异常，但MRI正常（D）。将2组超声与MRI诊断结果进行分析。采用t检验和z。检验进行统计学分析。结果NSG组和筛查组中属于A的比例分别为70．9％（78／110）与44．1％（49／111），B为7．3％（8／110）与8．1％（9／111），C为3．6％（4／110）与21．6％（24／111），D为18．2％（20／110）与26．1％（29／111）。而NSG组的超声诊断与MRI诊断的一致性高于筛查组（χ^2=18．985，P〈0．001）。结论与胎儿颅脑超声筛查的诊断相比，NSG与MRI有更好的一致性，提示NSG检查对于胎儿神经系统畸形的诊断具有重要的价值。

Objective To evaluate the consistency of fetal brain ultrasound screening and neurosonogram （NSG） with magnetic resonance imaging （MRI）, and the clinical values of ultrasound and NSG in the diagnosis of fetal nervous system abnormalities, and the values of NSG in the diagnosis of fetal brain malformations. Methods A retrospective study was conducted on 221 gravidas who were diagnosed with fetal brain development abnormality by ultrasound screening or NSG in Peking University First Hospital between January 2012 and July 2015 and received fetal brain MRI within one week after ultrasound examination. According to the saved images, the 221 cases were divided into two groups： fetal brain ultrasound basic screening group （111 cases） which had three basic transverse planes and NSG group （110 cases） which had ten basic transverse planes. There were four conditions according to the diagnostic results of ultrasonography and MRI： ultrasonography and MRI suggesting the same diseases （A）; ultrasonography and MRI suggesting the same diseases, but MRI providing more information for diagnosis （B）; ultrasonography and MRI suggesting different diseases （C）; ultrasonography suggesting abnormal, but MRI suggesting normal （D）. Diagnostic results of ultrasonography and MRI were respectively comparatively analyzed in the two groups. T-test and Chi-test were used for statistical analysis. Results The diagnostic results for NSG group and fetal brain ultrasound basic screening group were listed as follows： A： 70.9%（78/110） and 44.1%（49/111）; B： 7.3% （8/110） and 8.1% （9/111）; C： 3.6% （4/110） and 21.6% （24/111）; D： 18.2% （20/110） and 26.1% （29/111）. The consistency with MRI results was higher in NSG group than that of fetal brain ultrasound basic screening group （X^2=18.985, P〈0.001）. Conclusions Compared with fetal brain ultrasound basic screening, NSG provides more consistent results with MRI, suggesting its great clinical value in the diagnosis of fetal nervous system malformations.