产前二维超声与四维超声对胎儿隐性脊柱裂的诊断价值

Diagnostic values of prenatal two-dimensional ultrasound and four-dimensional ultrasound for fetal spina bifida occulta

目的探讨二维超声与四维超声对胎儿隐性脊柱裂的诊断价值。方法选择2012年6月至2018年6月在浙江萧山医院进行产前检查疑似胎儿隐性脊柱裂孕妇90例,根据分娩新生儿随访结果分为胎儿隐性脊柱裂组75例,非胎儿隐性脊柱裂组15例。回顾性分析2组二维超声和四维超声产前检查结果。结果隐性脊柱裂组75例,单独二维超声诊断阳性45例,而四维超声诊断阳性69例;非隐性脊柱裂组15例,单独二维超声诊断阴性11例,四维超声诊断阴性13例。二维超声诊断一致性较差(Kappa=0. 378),四维超声诊断一致性较好(Kappa=0. 912)。四维超声诊断胎儿隐性脊柱裂的敏感度为92. 0%(69/75)、特异度为86. 7%(13/15)、假阳性率为13. 3%(2/15)、假阴性率为8. 0%(6/75),准确率为91. 1%(82/90);二维超声诊断胎儿隐性脊柱裂的敏感度为60. 0%(45/75)、特异度为73. 3%(11/15)、假阳性率为26. 7%(4/15)、假阴性率为40. 0%(30/75),准确率为62. 2%(56/90)。四维超声诊断胎儿隐性脊柱裂各项指标均优于二维超声。结论四维超声对产前胎儿隐性脊柱裂有着较高的诊断准确率,四维超声动态检查可提供清晰、直观、连续的动态声像图,弥补二维超声检查的不足而提高诊断的准确性。

Objective To investigate the diagnostic values of prenatal two-dimensional ultrasound and four-dimensional ultrasound for fetal spina bifida occulta. Methods Ninety pregnant woman with suspected diagnosis of fetal spina bifida occulta in Zhejiang Xiaoshan Hospital from June 2012 to June 2018 were included,75 of them were confirmed as spina bifida according to neonatal outcomes and 15 cases were healthy babies. Prenatal records of two-and four-dimensional ultrasound were retrospectively analyzed. Results Among 75 cases of fetal spina bifida occulta,45 fetuses were diagnosed by two-dimensional ultrasound and 69 fetuses were diagnosed by four-dimensional ultrasound. Among the 15 misdiagnosed cases,two-dimensional ultrasound suggested negative results in 11 fetuses and four-dimensional ultrasound indicated 13 ones. Two-dimensional ultrasound showed poor diagnostic consistency( Kappa = 0. 378) and four-dimensional ultrasound showed good diagnostic consistency( Kappa =0. 912). Sensitivity of four-dimensional ultrasound was 92. 0%( 69/75),specificity was 86. 7%( 13/15),false positive rate was 13. 3%( 2/15),false negative rate was 8. 0%( 6/75),accuracy was 91. 1%( 82/90).Sensitivity of two-dimensional ultrasound was 60. 0%( 45/75),specificity was 73. 3%( 11/15),false positive rate was 26. 7%( 4/15),false negative rate was 40. 0%( 30/75),accuracy was 62. 2%( 56/90). Four-dimensional ultrasound showed a better diagnostic value than two-dimensional ultrasound. Conclusion Four-dimensional ultrasound provides clear,audio-visual,continuous and dynamic images and has higher diagnostic accuracy than two-dimensional ultrasonogram for fetal spina bifida occulta.