三维超声检查与MRI对胎儿中枢神经系统发育异常的诊断价值对比

Comparison of three dimensional ultrasonography and MRI in the diagnosis of fetal central nervous system abnormalities

目的探讨三维超声检查与磁共振成像(MRI)诊断胎儿中枢神经系统发育异常(CNS)的临床价值。方法选取50例产前检查提示胎儿神经系统可疑异常的孕妇,孕妇均行三维超声检查、MRI检查,并以终止妊娠后或分娩后诊断结果为金标准,比较检查方法检出情况、诊断价值及对比两种方法图像质量评分。结果50例可疑孕妇最终检出46例CNS发育异常;三维超声检出40例CNS发育异常,MRI检出45例CNS发育异常;两组阳性检出率相比,差异无统计学意义(P>0.05);MRI图像质量评分高于三维超声,差异有统计学意义(P<0.05);以临床最终诊断结果为金标准,MRI诊断敏感度、特异度、准确率高于三维超声检查,差异有统计学意义(P<0.05)。Kappa检验显示,三维超声与临床最终诊断结果一致性差(Kappa值=0.032,P=0.794);MRI与临床最终诊断结果一致性尚可(Kappa值=0.634,P=0.000)。结论MRI诊断胎儿CNS发育异常效果确切,图像质量高,能提高诊断敏感度、准确率,减少漏诊、误诊发生,以便于临床早期干预。

Objective To investigate the clinical value of three-dimensional ultrasonography and magnetic resonance imaging(MRI) in the diagnosis of fetal central nervous system abnormalities(CNS). Methods Fifty pregnant women with suspected abnormal fetal nervous system were selected as the research object during prenatal examination in our hospital. All pregnant women underwent three-dimensional ultrasonography and MRI, and the diagnosis results after termination of pregnancy or after delivery were used as the gold standard to compare the detection conditions, diagnostic value and image quality scores of the two methods. Results Among 50 suspected pregnant women, 46 cases of CNS dysplasia were finally detected. Forty cases of CNS dysplasia were detected by three-dimensional ultrasound and 45 cases were detected by MRI. There was no significant difference in the positive detection rate between the two groups(P>0.05). The image quality score of MRI was higher than that of 3D ultrasound, and the difference was statistically significant(P<0.05). Taking the final clinical diagnosis as the gold standard, the sensitivity, specificity and accuracy of MRI diagnosis were higher than those of three-dimensional ultrasound, and the differences were statistically significant(P<0.05). Kappa test showed that the consistency between three-dimensional ultrasound and clinical final diagnosis was poor(Kappa value =0.032, P=0.794). The consistency between MRI and clinical final diagnosis was good(Kappa value =0.634, P=0.000). Conclusion MRI is effective in diagnosing fetal CNS dysplasia with high image quality, which can improve the diagnostic sensitivity and accuracy, reduce the occurrence of missed diagnosis and misdiagnosis, and facilitate early clinical intervention.