胎儿隐性脊柱裂并脊髓拴系的产前超声诊断

Prenatal ultrasound diagnosis of fetal cryptorachischisis complicated with tethered cord syndrome

目的探讨胎儿隐性脊柱裂并脊髓拴系的产前超声声像图特征。方法回顾性分析在厦门市妇幼保健院超声医学科产前超声诊断为隐性脊柱裂并脊髓拴系的18例胎儿的声像图特征及尸体解剖结果,将胎儿声像图特征与病理解剖结果进行比对,总结隐性脊柱裂并脊髓拴系产前超声声像图特点。结果产前超声诊断18例病例中,其中11例合并其他结构畸形,7例单纯性隐性脊柱裂并脊髓拴系,13例引产后经病理解剖均证实产前超声诊断,3例单纯病变者产后复查超声及MR检查证实,其余2例失访。18例胎儿产前超声均表现脊髓圆锥位置明显低于L3水平,失去正常的"鼠尾征",大部分位于L4-S2水平。结论隐性脊柱裂并脊髓拴系有典型声像图表现,胎儿脊髓圆锥位置及其形态产前超声能够准确清晰显示,超声成像技术能够无创准确评价脊髓栓系的病变类型及程度,有利于产前正确咨询及临床处理决策。

Objective To explore the characteristics of prenatal ultrasound of fetal cryptorachischisis complicated with tethered cord syndrome. Methods Ultrasonographic features and autopsy results of 18 fetuses with cryptorachischisis and tethered cord syndrome were analyzed retrospectively; the characteristics of prenatal ultrasound and the results of pathological anatomy were compared,prenatal ultrasonographic characteristics of fetal cryptorachischisis complicated with tethered cord syndrome were summarized. Results Among 18 fetuses with cryptorachischisis complicated with tethered cord syndrome,11 fetuses complicated with other structural abnormalities and 7 fetuses with simple cryptorachischisis complicatedwith tethered cord syndrome were included,13 cases were confirmed by prenatal ultrasound diagnosis and pathological anatomy after induced labor,3 simple cases were confirmed by repeated ultrasonography and MR examination after delivery,2cases were lost to follow-up. Fetal prenatal ultrasound of 18 cases showed that conus medullaris position were significantly lower than L3 level,which lost the normal ＂ rat tail＂ feature,the most located in L4-S2 level. Conclusion Fetal cryptorachischisis complicated with tethered cord syndrome has typical ultrasonographic features,the position and form of conus medullaris can be displayed clearly by ultrasonography during prenatal period,the type and extent of tethered cord syndrome can be evaluated exactly and noninvasively by ultrasonic imaging technologies,which has significant value in prenatal counseling and clinical treatment decisions.