产前多模式超声对胎儿脊柱裂的诊断价值

Diagnostic value of prenatal multimodal ultrasound for fetal spina bifida

目的探究产前多模式超声诊断胎儿脊柱裂的价值。方法选取2017年1月至2022年1月于保定市第一中心医院产前超声检查疑似胎儿脊柱裂孕妇186例,均行多模式超声检查,结合妊娠结束后随访结果,统计分析产前多模式超声诊断胎儿脊柱裂的价值,并比较胎儿开放性与闭合性脊柱裂超声特征、多模式超声颅脑指标,分析多模式超声鉴别诊断胎儿开放性与闭合性脊柱裂的价值,并分析其诊断结果与病理结果的一致性,评价超声颅脑指标鉴别诊断胎儿开放性与闭合性脊柱裂的价值。结果本研究186例疑似胎儿脊柱裂孕妇妊娠结束后的随访结果显示:74例为胎儿脊柱裂,产前多模式超声诊断胎儿脊柱裂的检出率为98.65%,漏诊率为1.35%。开放性脊柱裂胎儿脑干(brain stem,BS)厚度、颈项透明层(nuchal translucency,NT)厚度均大于闭合性脊柱裂胎儿,头臂长(crown-rump length,CRL)、脑干至枕骨距离(brain stem to occipital bone,BSOB)、颅内透明层(intracranial translucency,IT)厚度均小于闭合性脊柱裂胎儿(P<0.05)。多模式超声鉴别诊断胎儿开放性与闭合性脊柱裂与病理结果的一致性Kappa值为1.000(95%CI:0.771-1.229),准确度为100.00%(P<0.05);CRL、BSOB、BS厚度、IT厚度、NT厚度鉴别诊断胎儿开放性与闭合性脊柱裂的曲线下面积(area under the curve,AUC)均>0.7,联合鉴别诊断的AUC最大,为0.923。结论产前多模式超声在胎儿开放性与闭合性脊柱裂的鉴别诊断方面具有较高价值,与病理结果的一致性较高。

Objective To investigate the value of prenatal multimodal ultrasound in the diagnosis of fetal spina bifida.Methods From January 2017 to January 2022,186 pregnant women with suspected fetal spina bifida on prenatal ultrasound in the Baoding No.1 Central Hospital were selected,all of whom underwent multimodal ultrasound examinations.Combined with the results of follow-up at the end of pregnancy,the value of prenatal multimodal ultrasound in diagnosing fetal spina bifida was statistically analyzed,and the ultrasound characteristics of fetal open and closed spina bifida and multimodal ultrasound cranial indices were compared,and the value of multimodal ultrasound in differentially diagnosing fetal open and closed spina bifida was analyzed,and the consistency of their diagnostic results with pathological findings was analyzed,and the value of ultrasound cranial indices in differentially diagnosing fetal open and closed spina bifida was evaluated.Results The follow-up results of 186 pregnant women suspected of fetal spina bifida after the end of pregnancy in this study showed that 74 cases were diagnosed as fetal spina bifida.The detection rate of prenatal multimodal ultrasound diagnosis of fetal spina bifida was 98.65%,and the missed diagnosis rate was 1.35%.The thickness of the brain stem(BS)and the nuchal translucency(NT)in the fetus with open spina bifida were greater than those in the fetus with closed spina bifida,while the thickness of the crown-rump length(CRL),brain stem to occipital bone(BSOB),and intracranial translucency(IT)in the fetus with open spina bifida were smaller than those in the fetus with closed spina bifida(P<0.05).The consistency Kappa value between the pathological results and the differential diagnosis of fetal open and closed spina bifida by multimodal ultrasound was 1.000(95%CI:0.771-1.229),with an accuracy of 100.00%(P<0.05).The area under the curve(AUC)of CRL,BSOB,BS thickness,IT thickness,and NT thickness in the differential diagnosis of fetal open and closed spina bifida were all greater than 0.7,and the combined differential diagnosis had the largest AUC,which was 0.923.Conclusion Multimodal prenatal ultrasonography is of high value in the differential diagnosis of open and closed spina bifida in fetus,and has high consistency with pathological results.