胎儿鼻后三角在妊娠早期颜面部筛查中的应用

The application value of retronasal triangle in ultrasound screening of fetal facial anomalies in first trimester

目的探讨鼻后三角切面在妊娠早期筛查颜面部异常中的诊断价值。方法选择2015年9月至2016年12月在浙江省金华市人民医院超声科行产前超声检查的孕11~13+6周孕妇3 000例,常规留取胎儿鼻后三角区的正中矢状切面、冠状切面和横切面的二维超声图像及三维超声断层超声显像(TUI)技术重建的各切面断层图像,比较鼻后三角区二维、三维重建图像的超声特征、合格显示率及图像质量评分。结果孕妇年龄18~41岁,平均(27.5±6.1)岁,胎儿头臀径(CRL)44~85mm,颈项透明层(NT)测量值0.71~5.83mm。三维重建的鼻后三角横切面合格率(97.30%vs.95.33%)和图像质量[(2.56±0.61)分vs.(2.48±0.78)分]均明显高于二维超声(χ2=16.353,t=-4.425,均P<0.001),而正中矢状切面和冠状切面的图像合格率及图像质量与二维超声比较无明显差异(均P>0.05)。孕13~13+6周胎儿三维重建的鼻后三角切面合格率和图像质量均明显高于二维超声(χ2=14.223,t=-5.592,均P<0.001),而孕11~11+6周和孕12~12+6周胎儿鼻后三角图像合格率及图像质量与二维超声比较无明显差异(均P>0.05)。结论鼻后三角是妊娠早期筛查胎儿颜面部异常的可靠、易获取的声像学指标,对于胎儿颜面部畸形的早期筛查具有重要意义。

Objective To evaluate the value of the retronasal triangle section in ultrasound screening of fetal facial anomalies in the first trimester.Methods 3,000 pregnant women received ultrasonic examination at 11~13+6 weeks in Jinhua People’s Hospital from September 2015 to December 2016.The mid-sagittal,coronal,and transverse views of section of the posterior nasal triangle were evaluated and the tomographic image of each slice reconstructed by tomographic ultrasound imaging.The ultrasonic features and qualified display rate of the posterior triangle in each group were compared,and the retronasal triangle abnormal cases were analyzed.Results The age of the pregnant women was 18~41 years old,averaged(27.5±6.1)years old,with fetal CRL being 44~85 mm,and NT value being 0.71~5.83 mm.Each section of the three-dimensional reconstruction image and two-dimensional ultrasound triangle directly obtained nose after the qualified rate and the image score comparison,three-dimensional reconstruction of the nose after the triangular cross section passing rate(97.3%vs.95.3%;χ2=16.353,P<0.001)and image quality[(2.94 0.60)vs.(2.82 0.48);t=-4.425,P<0.001]were significantly higher than that of two-dimensional ultrasound(P<0.001),and the median sagittal and coronal images of the qualified rate and the quality of the image and two-dimensional ultrasound showed no significant difference(P>0.05).At 13~13+6 weeks of gestation,fetal postnasal triangle section of three-dimensional reconstruction of the qualified rate and image quality were significantly higher than that of two-dimensional ultrasound(P<0.001),and at 11~11+6 weeks and 12~12+6 weeks of gestation fetal postnasal triangle image pass rate and image quality with two-dimensional ultrasound showed no obvious difference(P>0.05).Conclusion The posterior triangle is a reliable and easy to obtain image index for early screening of fetal facial abnormalities.It is of great significance for the early screening of fetal facial deformity.