经颅超声诊断新生儿胼胝体发育不全的临床价值

Clinical value of transcranial ultrasound in diagnosis of neonatal agenesis of the corpus callosum

目的探讨经颅超声检查在新生儿胼胝体发育不全(ACC)诊断中的应用价值。方法对47例ACC患儿分别行经颅超声和MRI检查,以MRI检查结果为金标准,比较超声和MRI对ACC的诊断准确率和一致性。结果 47例ACC患儿中超声诊断ACC 45例,包括胼胝体完全缺如11例,部分缺如24例,局部薄弱者10例。MRI诊断胼胝体完全缺如9例,部分缺如25例,局部薄弱者13例。超声诊断ACC完全缺如的敏感性、特异性、阳性预测值、阴性预测值及准确率分别为100%、94.7%、81.8%、100%及95.7%。超声诊断ACC部分缺如的敏感性、特异性、阳性预测值、阴性预测值及准确率分别为80.0%、86.4%、86.9%、79.2%及82.9%。超声诊断ACC局部薄弱的敏感性、特异性、阳性预测值、阴性预测值及准确率分别为61.5%、97.1%、88.9%、86.8%及87.2%。两种检查方法的诊断具有较高的一致性(Kappa=0.687,P=0.023)。其中4例超声检查为阴性者,MRI提示2例为局部缺损,2例为局部薄弱。结论经颅超声检查与MRI对ACC有较好的诊断一致性,具有一定的临床应用价值。

Objective To explore the application value of transcranial ultrasound in diagnosis of neonatal agenesis of the corpus callosum（ACC）.Methods Forty-seven neonates with ACC were enrolled,and all cases were examined by ultrasound and MRI.Taken MRI examination results as golden standard,the diagnostic accuracy and consistence of ultrasound and MRI were compared.Results A total of 45 cases of ACC neonates were diagnosed by ultrasonography,including 11 cases with complete absence,24 cases with incomplete absence and 10 cases with local weakness.While MRI examined 9 cases with complete absence,25 cases with incomplete absence and 13 cases with local weakness.The sensitivity,specificity,positive predictive value,negative predictive value and accuracy of the ultrasonic diagnosis of complete absence of ACC were 100%,94.7%,81.8%,100% and95.7%,respectively.The sensitivity,specificity,positive predictive value,negative predictive value and accuracy of ultrasonic diagnosis of ACC were 80.0%,86.4%,86.9%,79.2% and 82.9%,respectively.The sensitivity,specificity,positive predictive value,negative predictive value and accuracy of ultrasonic diagnosis of ACC were 61.5%,97.1%,88.9%,86.8% and 87.2%,respectively.Ultrasound and MRI showed a high consistency（Kappa=0.687,P=0.023）.Additionally,4 patients were negative in ultrasonography,but 2 case were proved with local defect and 2 cases with local weakness by MRI.Conclusion Transcranial ultrasound and MRI showed a high consistency in the diagnosis of neonatal ACC,and has certain clinical value.