产前超声及MRI在胎儿闭合性脊柱裂诊断中的应用价值

Application value of prenatal ultrasound and MRI in the diagnosis of fetal closed spinal dysraphism

目的探讨产前超声及MRI在胎儿闭合性脊柱裂诊断中的应用价值。方法选取我院经产后临床确诊的闭合性脊柱裂胎儿26例和未合并神经系统畸形的胎儿38例,比较产前超声、MRI单独及联合应用对胎儿闭合性脊柱裂的诊断结果。绘制受试者工作特征(ROC)曲线分析产前超声、MRI单独及联合应用对胎儿闭合性脊柱裂的诊断效能。结果26例闭合性脊柱裂胎儿中,产前超声检出20例,漏诊6例;产前MRI检出17例,漏诊9例;联合应用检出24例,漏诊2例。产前超声联合MRI与产后临床诊断相符者24例,其中7例为MRI漏诊经超声补充诊断,4例为超声漏诊经MRI补充诊断。ROC曲线分析显示,产前超声联合MRI诊断胎儿闭合性脊柱裂的曲线下面积为0.9120,高于其单独应用(0.8964、0.8757),差异均有统计学意义(P=0.023、0.014)。结论产前超声可作为诊断胎儿闭合性脊柱裂的首选检查方式,MRI可作为补充检查方式,二者联合应用可提高对胎儿闭合性脊柱裂的诊断效能。

Objective To investigate the application value of prenatal ultrasound and MRI in the diagnosis of fetal closed spinal dysraphism.Methods A total of 26 fetuses with clinically confirmed closed spinal dysraphism and 38 cases of fetuses without nervous system abnormalities in our hospital were selected.Prenatal ultrasound,MRI and their combination were performed in both groups,and the diagnostic results were compared.Receiver operating characteristic(ROC)curve analysis was drawn to evaluate the diagnostic performance of different examination method for fetal closed spinal dysraphism.Results Among the 26 cases of closed spinal dysraphism fetuses,prenatal ultrasound detected 20 cases with 6 missed diagnoses,prenatal MRI detected 17 cases with 9 missed diagnoses,and the combination of both methods detected 24 cases with 2 missed diagnoses.Prenatal ultrasound combined with MRI showed agreement with postnatal clinical diagnosis in 24 cases,including 7 cases diagnosed by ultrasound supplementation after MRI missed diagnosis,and 4 cases diagnosed by MRI supplementation after ultrasound missed diagnosis.ROC curve analysis showed that the area under the curve(AUC)of prenatal ultrasound combined with MRI in diagnosing fetal closed spinal dysraphism was 0.9120,which was higher than that of prenatal ultrasound or MRI alone(0.8964 and 0.8757),with statistically significant differences(P=0.023,0.014).Conclusion Prenatal ultrasound can be used as the preferred examination method for diagnosing fetal closed spinal dysraphism,and MRI can be used as a supplementary examination method,the two methods combined application can improve the diagnostic performance of fetal closed spinal dysraphism.