胎儿脑沟回生长发育规律的影像学研究

发布时间：2018-06-05 08:49

本文选题：胎儿 + 脑沟　；参考：《南方医科大学》2014年硕士论文

【摘要】：胎儿大脑发育过程较为复杂,胎儿脑沟回是其表面明显的结构；而长期以来缺乏胎儿脑沟回发育系统完整的影像学资料。现阶段关于胎儿脑沟回发育的影像学资料主要来源于产前超声检查、产后超声检查、宫内MRI检查及产后MRI检查。产前超声检查是目前评价胎儿发育的首选影像学方法,其优点包括安全、经济、方便、可实时成像等。但对于胎儿颅脑的扫查,超声有其局限性,如空间分辨率、组织分辨率相对较低,对孕妇体型肥胖、羊水过少、成像区气体较多的情况显像效果较差等。妊娠晚期胎儿颅骨及母体骨盆骨骼容易影响声波的穿透性。随着MRI技术的发展,特别是快速成像序列的采用,增加了宫内胎儿成像的清晰度,使其成为继超声之后的最佳辅助诊断方法。但是,应用于宫内胎儿采集场强一般为1.5T,且受到采集序列、采集时间、层厚及层间距的制约,同时还受到胎动、母体结构、母体动脉搏动等因素的影响,使中孕期胎儿扫描难度较大。胎儿大脑沟回发育过程中,其外部形态大小与内部细胞结构都会发生复杂变化。超声检查胎儿大脑沟回的深度、宽度、角度及覆盖率等都可作为胎儿脑成熟的标志,对评价胎儿脑健康状况有重要意义。因此,大样本、大孕龄跨度的影像学检查显示人类胚胎大脑沟回的发育变化,所得其表面脑沟的发育规律及脑沟回的深度、宽度、角度及覆盖率的准确测量值将是胎儿脑研究的突破点。本研究旨在丰富与完善人类脑发育的胚胎学与影像学知识,为临床宫内胎儿脑发育状况诊断与评估提供指导,以提高产前诊断胎儿中枢神经系统异常的水平,提高人口出生质量,优生优育,同时提高早产儿存活率。本研究分为四个部分： (1)胎儿脑沟回超声观测切面的确定； (2)胎儿脑沟回生长发育规律的超声研究； (3)胎儿脑沟回生长发育规律的核磁共振研究； (4)胎儿脑沟回发育异常的影像学研究。第一部分：胎儿脑沟回超声观测切面的确定目的：根据胎儿产前超声检查及产后标本超声检查,对胎儿脑沟回观测切面进行定位。材料与方法：研究对象为2013年3月至2013年4月在南方医科大学附属深圳妇幼保健院因“计划外生育”的胎儿。行产前超声检查诊断或染色体检查无异常且在该院引产,其父母同意尸体解剖的30例引产胎儿。主要仪器使用Acuson Sequoia512型彩色多普勒血流显像仪,超声检查探头频率为4.0-6.0MHz。产前对这30例胎儿进行特定切面外侧裂宽度、顶枕沟深度、距状沟深度测量,对引产胎儿进行特定切面脑沟回测量。对同一切面产前、产后所得数据进行配对比较。结果：产前超声在规定的外侧裂切面、顶枕沟切面、距状沟切面测量胎儿脑沟回结果与产后超声检查胎儿脑沟回观测数据对比。差异无统计学意义。结论：本研究所选择的切面相对固定,所测数据稳定性较好,可作为产前超声观测胎儿脑沟回的切面。第二部分：胎儿脑沟回生长发育规律的超声研究目的：应用产前超声检查定量分析胎儿大脑沟回的发育过程。材料与方法：2012年4月至2014年1月在南方医科大学附属深圳妇幼保健院超声科进行常规超声检查的674例单胎妊娠孕妇。使用仪器：使用Acuson Sequoia512、西门子S2000型彩色多普勒超声仪,探头频率为4.0-6.0MHz。观测切面：外侧裂切面、顶枕沟切面及距状沟切面。测量内容：顶枕沟深度及角度、距状沟深度、外侧裂宽度及深度、脑岛未覆盖宽度。计算内容：取脑岛未覆盖宽度与外侧裂宽度之间比为脑岛未覆盖率。记录内容：孕妇年龄、身高、体重、胎儿性别、检查时间、检查者在检查完毕后对所测数据及评估内容进行详细填表。统计方法：采用SPSS13.0统计软件,计量资料以均数±标准差表示,计数资料以率表示,P0.05表示差异有统计学意义。取所测得数据与孕周绘制散点图,采用Pearson相关性分析。对数据满足正态分布者进行一元线性回归分析。对男、女胎儿大脑沟回数据采用两独立样本t检验分析。结果：胎儿各大脑沟深度随孕周增加而增加,具有显著正相关(P0.05)；脑岛未覆盖率随孕周增加而减小,具有显著负相关(P0.05)。孕32周以后97.32%(218/224)胎儿脑岛未覆盖率为0,即孕32周后97.32%胎儿脑岛被完全覆盖；顶枕沟角随孕周增加而减小,具有显著负相关(P0.05),孕31周以后97.31%(253/260)胎儿顶枕沟角度为0°。经回归分析拟合得出最适合回归曲线,为线性回归曲线模型。男、女胎儿大脑沟回发育无显著差异(P0.05)。结论：因切面原因,之前部分研究得出的胎儿脑沟回测值时刻表需重新定义。本研究结果可作为胎儿脑沟发育正常与否的参考。第三部分：胎儿脑沟回生长发育规律的核磁共振研究目的：应用产前核磁共振检查定量观测胎儿大脑沟回发育过程。材料与方法：2009年4月至2013年12月在南方医科大学附属深圳妇幼保健院对337例胎龄为19～40周无中枢神经系统发育异常的单活胎孕妇。使用仪器：Philips1.5T Nova Dual磁共振仪,6通道相控阵表面线圈。对每个入组胎儿的横断面、冠状面及矢状面分别行Balance-FFE及T2WI序列扫描。观测切面：半卵圆中心横断面、上丘和后联合横断面、经乳头体冠状断面。测量内容：顶枕沟深度及角度、扣带沟深度、外侧裂宽度及深度、脑岛未覆盖宽度。计算内容：取脑岛未覆盖宽度除以外侧裂宽度之商未脑岛未覆盖率。记录内容：胎儿性别、左右大脑半球、孕妇年龄、检查时间。采用SPSS13.0统计软件,计量资料以均数±标准差表示,计数资料以率表示,P0.05表示差异有统计学意义。取所测数据与孕周绘制散点图,采用Pearson相关性分析。对数据满足正态分布者进行一元线性回归分析。对胎儿左、右大脑半球脑沟回数据采用两独立样本t检验分析。结果：胎儿各大脑沟深度与孕周呈显著正相关(P0.05)；脑岛未覆盖率随孕周增加而减小,具有显著负相关(P0.05),孕32周以后97.81%(134/137)胎儿脑岛未覆盖率为0。顶枕沟角随孕周增加而减小,具有显著负相关(P0.05),31周以后100%(137/137)胎儿顶枕沟角度为0°。经回归分析拟合得出最适合回归曲线,为线性回归曲线模型。男女胎儿大脑沟回发育速度差异没有统计学意义。胎儿左右大脑半球发育无显著性差异(P0.05)。结论：本研究首次提出核磁共振检查多观察面测量胎儿大脑沟回的方法。核磁共振研究结果与第二部分超声研究结果趋势基本相同。样本量更大,孕周范围更广的研究可进一步证实本研究结论。第四部分胎儿脑沟回发育异常的超声检查研究目的：探讨本研究所得结果对于胎儿脑沟回发育异常诊断的意义。材料与方法：回顾性分析来自于南方医科大学附属深圳妇幼保健院超声科资料库里2001年1月至2014年1月脑沟回发育异常的30例单胎胎儿。其中包括小头畸形(9例),脑沟回发育迟缓(4例),半侧巨脑畸形(2例)。回顾性分析病例图像在外侧裂切面测量几组异常病例胎儿的外侧裂宽度、外侧裂深度、脑岛未覆盖宽度,计算脑岛未覆盖率。结合第二部分研究结果绘制复合箱丝图及复合散点图。结果：经图像筛选将15例胎儿纳入本研究,产前诊断小头畸形及胎儿脑沟回发育迟缓可根据其外侧裂宽度测值位于同孕周正常值的第5百分位数线下,小头畸形外侧裂深度亦位于同孕周正常值第5百分位数线下。半侧巨脑畸形,较窄侧大脑外侧裂深度低于同孕周正常胎儿第5百分位数线。半侧巨脑畸形两侧大脑半球外侧裂未覆盖率分别位于第95百分位数线上及第5百分位数线下结论：第二部分研究得出的超声检查结果对筛查胎儿大脑沟回发育异常有临床意义。可作为临床上筛查小头畸形、脑沟回发育迟缓、半侧巨脑畸形等疾病的客观依据。样本量更大,孕周范围更广的研究可进一步证实本研究所得结论。
[Abstract]:The fetal brain development is more complicated, and the fetal cerebral trench gyrus is an obvious surface structure; and the complete imaging data of the fetal cerebral sulcus development system have been lacking for a long time. The current imaging data on fetal cerebral sulcus development are mainly derived from prenatal ultrasound examination, postpartum ultrasonography, intrauterine MRI examination and postpartum MRI examination. Anterior ultrasound is the first choice imaging method to evaluate fetal development. Its advantages include safety, economy, convenience and real-time imaging. But for the scanning of fetal brain, ultrasound has its limitations, such as spatial resolution, relatively low resolution of tissue, obesity in pregnant women, too little amniotic fluid, and more imaging area gas imaging results. In the late pregnancy, the fetal skull and the mother pelvis are easy to affect the penetration of sound waves. With the development of MRI technology, especially the use of rapid imaging sequence, the definition of intrauterine fetal imaging is increased, which makes it the best assistant diagnosis method after ultrasound. However, it is generally used in the intrauterine fetal collection field to be 1.5T, It is also restricted by the collection sequence, the time of collection, the thickness of the layer and the interval between the layers. It is also influenced by the factors such as the fetal movement, the structure of the mother body and the pulsation of the mother artery, which makes the fetal scanning in the middle pregnancy more difficult.
In the process of fetal cerebral trench gyrus, the external morphologic size and internal cell structure of the fetal brain are complicated. The depth, width, angle and coverage of the fetal cerebral gyrus can be used as a sign of fetal brain maturation. It is of great significance for the evaluation of fetal brain health.
Therefore, the imaging examination of large sample and large gestational age shows that the development of the cerebral sulcus of human embryo, the development of the surface of the brain and the depth, width, angle and coverage of the cerebral sulcus will be a breakthrough point in the research of fetal brain. This study aims to enrich and improve the embryology and image of human brain development. To provide guidance for the diagnosis and evaluation of fetal brain development in clinical uteri, to improve the level of prenatal diagnosis of fetal central nervous system abnormalities, improve the quality of birth, eugenics, and increase the survival rate of preterm infants.
This study is divided into four parts:
(1) the determination of the tangent surface of the fetal cerebral sulcus.
(2) ultrasonographic study of fetal brain sulcus gyrus growth and development;
(3) NMR study of fetal brain sulcus gyrus growth and development;
(4) imaging study of fetal cerebral gyrus dysplasia.
Part one: Determination of the section of fetal brain sulcus.
Objective: according to prenatal ultrasound examination and postnatal specimen ultrasound examination, fetal cerebral groove observation section was located.
Materials and methods: the study was conducted from March 2013 to April 2013 at the Shenzhen maternity and child health care hospital, affiliated to the Shenzhen maternity and child health care hospital, which was born in the maternal and child health care hospital of Southern Medical University. The prenatal ultrasound examination and chromosome examination were not abnormal and induced labor in the hospital. The parents agreed to the autopsy 30 fetuses. The main instrument used the Acuson Sequoia512 type. Color Doppler flow imaging instrument, the frequency of ultrasonography was 4.0-6.0MHz. prenatal, the width of the specific lateral fissure, the depth of the occipital sulcus, the depth of the trench, and the measurement of the specific facial trench gyrus of the induced fetus. The data were compared with all the antenatal and postpartum data.
Results: prenatal ultrasound showed no significant difference between the prescribed lateral fissure surface, the top occipital groove surface, and the distance between the fetal cerebral trench gyrus and the postpartum ultrasound examination of fetal brain trench gyrus.
Conclusion: the selected sections of this study are relatively fixed, and the stability of the measured data is good. It can be used as a section for prenatal ultrasound examination of fetal cerebral sulcus.
The second part: ultrasound study on the growth and development of fetal brain sulcus gyrus.
Objective: to quantitatively analyze the development of fetal sulcus gyrus by prenatal ultrasound.
Materials and methods: from April 2012 to January 2014, 674 pregnant women with single pregnancy were used in the ultrasound department of the Shenzhen maternal and child health care hospital, Southern Medical University. The use of instruments: Acuson Sequoia512, SIEMENS S2000 color Doppler sonography and the probe frequency of 4.0-6.0MHz., the lateral fissure cut surface, the top occipital groove Content: the depth and angle of the occipital groove, the depth of the trench, the width and depth of the lateral fissure, and the uncovered width of the insula. The contents were calculated: the ratio of the uncovered width of the insula to the lateral fissure width was not covered by the insula. The contents of the contents: the age, height, weight, sex of the fetus, the sex of the fetus, the examination time, and the examination of the examiners After the examination, the data and the content of the evaluation were filled in detail. Statistical method: the SPSS13.0 statistical software was used. The measurement data were expressed with the average number of standard deviation, the count data were expressed, and the P0.05 indicated that the difference was statistically significant. The measured data and the gestational weeks were drawn and the Pearson correlation analysis was used. The data met the normal score. A regression analysis was performed on a single linear regression analysis. The data of cerebral gyrus of male and female fetuses were analyzed by two independent sample t test.
Results: the depth of the cerebral sulcus of the fetus increased with the increase of gestational age, with significant positive correlation (P0.05). The uncovered rate of the insula decreased with the increase of gestational age, and had a significant negative correlation (P0.05). After 32 weeks of pregnancy, the uncovered rate of the fetal insula was 0, that is, 97.32% fetal insula was completely covered after 32 weeks of pregnancy, and the occipital sulcus angle increased with the gestational age. There was a significant negative correlation (P0.05), and the angle of the top occipital sulcus of 97.31% (253/260) fetus was 0 degrees after 31 weeks of pregnancy. The regression curve was fitted by regression analysis to be the linear regression curve model. There was no significant difference between male and female fetal cerebral trench gyrus development (P0.05).
Conclusion: the timetable of fetal brain trench retest should be redefined for the reasons of cutting surface. The results of this study can be used as a reference for the normal development of fetal brain trench.
The third part: NMR study on the growth and development of fetal brain sulcus gyrus.
Objective: to quantitatively observe fetal cerebral sulcus development by prenatal MRI.
Materials and methods: from April 2009 to December 2013, 337 pregnant women with no central nervous system dysplasia were treated at the Shenzhen maternity and child health care hospital, affiliated to Southern Medical University, from April 2009 to December 2013. Instrument: the Philips1.5T Nova Dual magnetic resonance apparatus and the 6 channel phased array surface coil. The cross section, the coronal plane and the sagittal plane of each group of fetus were used. Balance-FFE and T2WI sequence scanning respectively. Observation section: central cross section of semi oval circle, upper colliculus and posterior joint cross section, through coronal section of papillary body. Measurement contents: the depth and angle of the occipital groove, depth of cingulate groove, width and depth of lateral fissure, and uncovered width of insula. The content: fetal sex, left and right hemispheres, pregnant women's age, examination time. Using SPSS13.0 statistical software, the measurement data were expressed in mean number of standard deviation, and the number of data was expressed by P0.05, and the difference was statistically significant. The measured data were drawn with the gestational weeks, and the Pearson correlation analysis was used. Data were analyzed by unitary linear regression. The left and right hemisphere cerebral sulcus data were analyzed by two independent sample t test.
Results: there was a significant positive correlation between the depth of the fetal cerebral trench and the gestational weeks (P0.05). The uncovered rate of the insula decreased with the increase of gestational age, and had a significant negative correlation (P0.05). After 32 weeks of pregnancy, the uncovered rate of the 0. top occipital sulcus angles decreased with the increase of gestational weeks, with a significant negative correlation (P0.05), and 100% (137/137) fetal top after 31 weeks. The angle of the occipital groove was 0 degrees. The regression analysis was used to get the most suitable regression curve, and it was a linear regression curve model. There was no significant difference in the development speed of the cerebral sulcus in the fetus and the fetus. There was no significant difference in the development of the cerebral hemisphere in the fetus (P0.05).
Conclusion: This study first proposed a method for measuring the fetal cerebral trench gyrus by magnetic resonance imaging. The results of NMR study are basically the same as those of the second part of ultrasound. The larger sample size and a wider range of gestational scope can further confirm the conclusion of this study.
The fourth part of the fetal brain sulcus gyrus dysplasia examined by ultrasonography
Objective: To explore the significance of the results of this study in the diagnosis of fetal brain sulcus gyrus dysplasia.
Materials and methods: a retrospective analysis of 30 single fetuses from January 2001 to January 2014 in the ultrasound department of the Shenzhen maternal and child health care institute, Southern Medical University, including 9 cases of small head malformation (9 cases), cerebral sulcus gyrus retardation (4 cases) and hemipsilateral megaberebral malformation (2 cases). Retrospective analysis of case images in lateral fissure The width of the lateral fissure, the depth of the lateral fissure, the uncovered width of the insula, and the uncoverage of the insula were measured in several groups of abnormal cases. Combined with the results of the second parts, the composite box Silk Map and the composite scatter plot were drawn.
Results: 15 cases of fetus were included in this study by image screening. The diagnosis of small head deformity and fetal cerebral sulcus growth retardation could be located under the fifth percentile line of normal value of the same gestational week. The depth of the lateral fissure of the small head is also under the fifth percentile line of the normal value of the same pregnancy. The lateral fissure depth of the brain is lower than the fifth percentile line of the same pregnant Zhou Zhengchang fetus. The lateral fissure of the lateral hemispheres on both sides of the hemical megaberebral malformation is located at the ninety-fifth percentile line and the 500 digit line, respectively.
Conclusion: the results obtained in the second part are of clinical significance for screening fetal cerebral sulcus dysplasia. It can be used as an objective basis for clinical screening of small head deformity, cerebral sulcus growth retardation, and hemi megaberebral malformation. The larger sample size and a wider range of gestational weeks can further confirm the conclusions of this study.
【学位授予单位】：南方医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R714.5;R445.1

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