对比增强超声在妊娠糖尿病患者胎儿Dandy-walker畸形诊断中的作用

Role of contrast-enhanced ultrasound in diagnosis of fetal Dandy-walker malformation in patients with gestational diabetes mellitus

目的探讨对比增强超声(CEUS)在妊娠糖尿病(GDM)患者胎儿Dandy-walker综合征(DWS)诊断中的作用。方法收集该院GDM患者103例,其中胎儿DWS患者8例(DWS组),非DWS患者95例(非DWS组);另选同孕期正常孕妇95例作为对照组。于产后6个月进行超声、CEUS和磁共振成像检查诊断DWS。采用Sonoliver定量软件进行定量分析。结果与对照组比较,非DWS组、DWS组GDM患者分娩时产妇体重、空腹血糖、餐后2 h血糖、胰岛素抵抗指数(HOMA-IR)和定量胰岛素敏感指数(QUICKI)明显增加,且胎盘重量明显减少(P<0.05);与非DWS组比较,DWS组GDM患者胎盘重量明显减少(P<0.05)。DWS组比非DWS组新生儿头部直径明显减小(P<0.05)。CEUS比超声检测GDM患者DWS诊断图像信号明显增强。DWS组的GDM患者参考区最大强度(IMAX-R)、参考区上升时间(RT-R)、参考区达到峰值时间(TTP-R)、参考区平均通过时间(mTT-R)和参考区对数压缩信号与推注灌注模型之间的拟合质量(QOF-R)无明显变化(P>0.05)。DWS组目标脑区的IMAX-D、RT-D、TTP-D、mTT-D和QOF-D明显减小(P<0.05)。结论CEUS定量参数可明确显示GDM患者胎儿DWS和DWS患儿诊断,具有产前和产后诊断和筛查价值。

Objective To investigate the role of contrast-enhanced ultrasonography(CEUS)in the diagnosis of fetal Dandy-walker Syndrome(DWS)in the patients with gestational diabetes mellitus(GDM).Methods A total of 103 patients with GDM in this hospital were collected,including 8 cases of fetal DWS(DWS group)and 95 cases of non-DWS(non-DWS group);other 95 normal pregnant women with the same gestation period were selected as the control group.DWS was diagnosed at postpartum 6 months by ultrasound(US),CEUS and MRI.The Sonoliver quantitative software was used for conducting the quantitative analysis.Results Compared with the control group,the body weight,fasting blood glucose,postprandial 2h blood glucose,Homeostatic Model Assessment of Insulin Resistance(HOMA-IR)and Quantitative Insulin Sensitivity Check Index(QUICKI)at delivery in the GDM patients of the non-DWS group and DWS group were increased significantly,moreover the placenta weight was decreased significantly(P<0.05).Compared with the non-DWS group,the placenta weight in the GDM patients of the DWS group was significantly reduced(P<0.05).The head diameter of the DWS group was significantly reduced compared with the non-DWS(P<0.05).CEUS had significantly enhanced DWS diagnostic image signal compared with ultrasound detection of the GDM patients.The fitting quality(QOF-R)between the maximum intensity of the reference zone(IMAX-R),rise time of the reference zone(RT-R),time to reach the peak of the reference zone(TTP-R),average transit time of the reference zone(mTT-R)and logarithmic compression signal of reference zone in the GDM patients of the DWS group with the injection perfusion model had no significant change(P>0.05).IMAX-D,RT-D,TTP-D,mTT-D and QOF-D in the target brain area of the DWS group were significantly reduced(P<0.05).Conclusion The quantitative parameters of CEUS can clearly indicate the diagnosis of fetal DWS and infantile DWS in the GDM patients,and have the value of prenatal and postnatal diagnosis and screening.