系列颌部轴切面在胎儿上腭超声检查中的应用

Application of series of axial views of the jaw in prenatal ultrasound examination of fetal palate

目的研究不同医师应用系列颌部轴切面观察胎儿上腭是否存在差异,评估产前应用该方法检查胎儿上腭的可行性。方法随机选取3名不同年资超声医师2018年5月至9月在武汉大学人民医院行中孕产前超声筛查并随访正常的孕妇共120例(除外多胎),每人各40例,回顾留存的颌部系列轴切面图像,包括:上牙槽横向轴(UA)切面、下牙槽横向轴(IA)切面、软腭水平轴(SP)切面、腭骨水平板水平轴(HP)切面、上颌骨腭突水平轴(MPP)切面,并对留存的HP切面进行评分。采用χ2检验比较不同医师间各切面的获得率和HP切面合格率的差异。结果所有病例均获得UA和IA切面。86.7%(104/120)获得SP切面,A、B、C医师获得率分别为87.5%(35/40)、85.0%(34/40)和87.5%(35/40)。92.5%(111/120)获得HP切面,A、B、C医师获得率分别为97.5%(39/40)、87.5%(35/40)和92.5%(37/40)。91.7%(110/120)获得MPP切面,A、B、C医师获得率分别为92.5%(37/40)、95.0%(38/40)和87.5%(35/40)。不同医师间各切面获得率比较,差异均无统计学意义(P> 0.05)。94.6%(105/111)HP切面评分合格,A、B、C医师合格率分别为97.4%(38/39)、91.4%(32/35)和94.6%(35/37),不同医师间合格率比较,差异无统计学意义(P> 0.05)。HP切面合格病例中,88.6%(93/105)水平夹角<30°,6例不合格病例水平夹角均> 30°。无法获取HP切面病例中,77.8%(7/9)入射角度> 30°。结论产前超声筛查时可采用连续扫查获取系列颌部轴切面观察上腭,且不同年资医师间切面获得率和HP切面合格率无显著差异。

Objective To study whether there are significant differences in observing fetal palate by using series of axial views of the jaw among different sonographers,and to evaluate the feasibility of prenatal ultrasonography of the palate with the series of views.Methods From May to September 2018,120 pregnant women(excluding multiple births)at Renmin Hospital of Wuhan University were randomly selected by three sonographers of different seniority,with 40 cases assigned to each sonographer.The pregnant women had been examined by mid-trimester ultrasonography,and the pregnancy outcomes by follow-up were normal.A series of axial views of the jaw were reviewed,including axial view of the upper alveolar(UA),axial view of the inferior alveolar(IA),axial view of the soft palate(SP),axial view of the horizontal plate(HP),and axial view of the maxilla palatine process(MPP).The HP was graded.Theχ2 test was used to compare the obtained rate of each section and the qualified rate of HP section between different sonographers.Results UA and IA views were obtained in all cases.SP view was obtained in 86.7%(104/120)of cases,and sonographers A,B,and C obtained 87.5%(35/40),85.0%(34/40),and 87.5%(35/40),respectively.HP view was obtained in 92.5%(111/120)of cases,and sonographers A,B,and C obtained 97.5%(39/40),87.5%(35/40),and 92.5%(37/40),respectively.MPP view was obtained in 91.7%(110/120)of cases,and sonographers A,B,and C obtained 92.5%(37/40),95.0%(38/40),and 87.5%(35/40),respectively.The obtaining rates of all these views had no significant difference among different sonographers(P>0.05).The qualification rate of HP was 94.6%(105/111).The qualification rates of the three sonographers were 97.4%(38/39),91.4%(32/35),and 94.6%(35/37),respectively.The rates had no significant difference among different sonographers(P>0.05).In the eligible HP view,the horizontal angle of 88.6%(93/105)cases was less than 30°,and the horizontal angle of 6 unqualified cases was more than 30°.The incidence angle of insonation was more than 30°in 77.8%(7/9)of the patients in whom HP view could not be obtained.Conclusion Series of axial views of the jaw could be used to observe the palate during prenatal ultrasound screening.There is no significant difference between different sonographers in the acquisition and quality of HP view.