经腹三维超声容积对比成像联合C平面技术评价胎儿小脑蚓部发育的临床研究
发布时间：2018-09-10 06:44
【摘要】：目的 本研究旨在应用经腹三维超声容积对比成像联合C平面（VCI-C）技术观察胎儿小脑蚓部发育，测量胎儿小脑蚓部各观察指标，评价这些观察指标测量值与孕周的关系，建立本地区正常胎儿小脑蚓部正常参考值范围，并将小脑蚓部发育异常胎儿与正常组作对照观察，探讨经腹部三维超声VCI-C技术对胎儿小脑蚓部发育异常的诊断及鉴别诊断的价值。 方法 选择2013年7月至2014年7月间于苏州市立医院产前超声中心接受系统超声检查的孕18～34周正常胎儿335例，经腹二维超声扫查胎儿，观察胎儿结构，测量生长发育指标，重点观察小脑及其蚓部形态，测量后颅窝池宽度。经腹三维超声扫查胎儿头颅，应用VCI-C技术获得胎儿小脑蚓部正中矢状切面，观察小脑蚓部形态和原裂、次裂、蚓部各叶等细微结构，观察第四脑室形态及蚓部与脑干、小脑幕等相邻组织的关系，测量蚓部观察指标包括上下径、前后径、面积、周长、脑干小脑蚓部（BV）角、脑干小脑幕（BT）角，并分析上述测值与孕周的关系。同期选择二维超声检查拟诊为Dandy-Walker综合征（DWC）的胎儿27例，应用相同方法观察小脑蚓部结构和测量蚓部各观察指标，与正常组蚓部测量值对比观察。27例异常组胎儿均行胎儿磁共振（MRI）检查，15例胎儿引产，2例胎儿引产后接受病理解剖。 结果 1、正常组胎儿的小脑蚓部正中矢状切面超声表现：小脑蚓部形态饱满，走形与脑干几乎平行，第四脑室顶点凹陷成锐角。孕18周后可观察到第四脑室顶部，孕22周后可观察到蚓部的原裂，孕25周后蚓部原裂、次裂可清晰显示，各叶隐约可见；随着孕周的进展，孕29周后蚓部各裂及各叶显示更加清晰。 2、正常组胎儿小脑蚓部上下径、前后径、面积、周长随孕周增加而增大，与孕周有明显相关性，相关系数（r）分别为0.915、0.87、0.932、0.926。 3、正常组胎儿BV角平均值为（3.3±1.7°），与孕周无明显相关性，相关系数（r）为0.1，，P=0.07（P0.05）。BT角平均值为（31.5±6.9°），BT角与孕周相关系数（r）为0.4，相关性小。 4、27例小脑蚓部异常组胎儿，包括4例典型Dandy-Walker畸形（DWM），7例Dandy-Walker变异（DWV），6例Blake’s囊肿（BPC），10例单纯后颅窝池增宽（MCM）。胎儿头颅正中矢状切面上观察，4例DWM表现为：小脑蚓部原裂及次裂显示不清，蚓部面积明显缩小，囊性扩张的第四脑室与增大的后颅窝池相通，BV角明显增大（88.9±18.1°），小脑幕上抬，BT角明显增大（89.0±12.8°）；7例DWV表现为：小脑蚓部形态不饱满，下蚓部变小变尖，小脑蚓部原裂及次裂不能清晰显示，蚓部面积测量值变小，低于5th百分位数，第四脑室顶部变浅变平，第四脑室扩张与后颅窝池相通，小脑蚓部上旋，BV角增大，平均值（23.7±5.2°），BT角稍增大，平均值（54.5±12.0°）；6例BPC表现为小脑蚓部形态饱满，蚓部测量值在正常参考值范围内，第四脑室轻度扩张与后颅窝池相通，小脑蚓部上旋，BV角轻度增大，平均值（16.7±1.8°），BT角稍增大，平均值为（50.3±8.2°）；10例MCM表现为后颅窝池宽度≥10mm，小脑蚓部外形饱满，测量值在正常参考值范围内，第四脑室顶部凹陷呈锐角，BV、BT角均在正常参考值范围内。 结论 1、经腹三维超声VCI-C技术可清晰显示胎儿小脑蚓部形态、细微结构，以及蚓部与周围组织的关系，可以用于评估胎儿小脑蚓部发育情况。 2、在孕18～34周，正常胎儿小脑蚓部上下径、前后径、面积、周长随孕周增加而增大；正常胎儿BV角平均值（3.3±1.7°），BT角平均值为（31.5±6.9°）。 3、在胎儿小脑蚓部正中矢状切面上，仔细观察胎儿小脑蚓部以及其相邻组织的形态，辨认小脑蚓部细微结构，测量小脑蚓部的面积、BV和BT角，有助于胎儿小脑蚓部发育异常疾病的诊断和鉴别诊断。
[Abstract]:objective
The purpose of this study was to observe the development of fetal cerebellar vermis by transabdominal three-dimensional ultrasound volume contrast imaging combined with C-plane (VCI-C) technique, measure the observed indexes of fetal cerebellar vermis, evaluate the relationship between the measured values of these indexes and gestational age, establish the normal reference range of fetal cerebellar vermis in this region, and make the cerebellar vermis develop abnormally. The value of transabdominal three-dimensional ultrasonography (VCI-C) in the diagnosis and differential diagnosis of fetal vermis cerebellum dysplasia was studied.
Method
From July 2013 to July 2014, 335 normal fetuses of 18-34 weeks gestation were examined by prenatal ultrasound in Suzhou State Hospital. The fetal structures were observed by transabdominal two-dimensional ultrasonography. The growth and development indexes were measured. The cerebellum and its vermis were observed with emphasis. The width of posterior fossa cistern was measured by transabdominal three-dimensional ultrasonography. VCI-C technique was used to obtain the median sagittal section of the fetal cerebellar vermis. The morphology of the cerebellar vermis and the fine structures of the protofissure, the secondary fissure and the lobes of the vermis were observed. The morphology of the fourth ventricle and the relationship between the vermis and the adjacent tissues such as brain stem and tentorium cerebellum were observed. 27 fetuses suspected to be Dandy-Walker syndrome (DWC) were examined by two-dimensional ultrasonography at the same time. The structure of cerebellar vermis was observed by the same method and the observed indexes of vermis were measured. The results were compared with those of normal group. Vibration (MRI) was performed in 15 fetuses, and 2 fetuses were pathologically dissected after induction of labor.
Result
1. Ultrasonographic findings of the normal fetus in the middle sagittal section of the cerebellar vermis: the shape of the cerebellar vermis is plump, the shape of the vermis is almost parallel to the brain stem, and the apex of the fourth ventricle is pitted into an acute angle. With the progress of gestational age, the 29 weeks after gestation, the lobes and the lobes of each part of the worm showed more clearly.
2. The upper and lower cerebellar vermis diameter, anterior and posterior cerebellar vermis diameter, area and perimeter of the normal fetus increased with the increase of gestational weeks, and the correlation coefficients (r) were 0.915, 0.87, 0.932, 0.926 respectively.
3. The average value of BV angle in normal group was (3.3
4,27 fetuses with cerebellar vermis abnormalities, including 4 cases of typical Dandy-Walker malformation (DWM), 7 cases of Dandy-Walker variation (DWV), 6 cases of Blake's cyst (BPC) and 10 cases of simple posterior fossa cistern enlargement (MCM). The mid-sagittal section of the fetal skull showed that the primary and secondary fissures of the cerebellar vermis were unclear, the area of the vermis was significantly reduced, cystic dilatation was found in 4 cases of DWM. The fourth ventricle was connected with the enlarged posterior fossa cistern, the BV angle was significantly increased (88.9 65507 The top of the ventricle became shallow and flat, the fourth ventricle was dilated and connected with the posterior fossa cistern, the vermis was rotated upward, the BV angle was increased, the mean value was (23.7 5.2), the BT angle was slightly increased, the mean value was (54.5 65 The BV angle increased slightly in the supination of the cerebellum, and the BT angle increased slightly in average (16.7 65507
conclusion
1. The VCI-C technique of transabdominal three-dimensional ultrasound can clearly display the morphology and fine structure of the fetal cerebellar vermis and the relationship between the vermis and the surrounding tissues. It can be used to evaluate the development of the fetal cerebellar vermis.
2. At 18-34 weeks of gestation, the upper and lower cerebellar vermis diameter, anterior and posterior cerebellar vermis diameter, area and perimeter of normal fetus increased with the increase of gestational age, and the average BV angle and BT angle of normal fetus increased with the increase of gestational age.
3. On the median sagittal section of the fetal cerebellar vermis, the morphology of the fetal cerebellar vermis and its adjacent tissues should be observed carefully, the fine structure of the cerebellar vermis should be identified, the area of the cerebellar vermis should be measured, the angle of BV and BT should be measured, which is helpful for the diagnosis and differential diagnosis of the fetal cerebellar vermis.
【学位授予单位】：苏州大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R445.1;R714.5
本文编号：2233694
[Abstract]:objective
The purpose of this study was to observe the development of fetal cerebellar vermis by transabdominal three-dimensional ultrasound volume contrast imaging combined with C-plane (VCI-C) technique, measure the observed indexes of fetal cerebellar vermis, evaluate the relationship between the measured values of these indexes and gestational age, establish the normal reference range of fetal cerebellar vermis in this region, and make the cerebellar vermis develop abnormally. The value of transabdominal three-dimensional ultrasonography (VCI-C) in the diagnosis and differential diagnosis of fetal vermis cerebellum dysplasia was studied.
Method
From July 2013 to July 2014, 335 normal fetuses of 18-34 weeks gestation were examined by prenatal ultrasound in Suzhou State Hospital. The fetal structures were observed by transabdominal two-dimensional ultrasonography. The growth and development indexes were measured. The cerebellum and its vermis were observed with emphasis. The width of posterior fossa cistern was measured by transabdominal three-dimensional ultrasonography. VCI-C technique was used to obtain the median sagittal section of the fetal cerebellar vermis. The morphology of the cerebellar vermis and the fine structures of the protofissure, the secondary fissure and the lobes of the vermis were observed. The morphology of the fourth ventricle and the relationship between the vermis and the adjacent tissues such as brain stem and tentorium cerebellum were observed. 27 fetuses suspected to be Dandy-Walker syndrome (DWC) were examined by two-dimensional ultrasonography at the same time. The structure of cerebellar vermis was observed by the same method and the observed indexes of vermis were measured. The results were compared with those of normal group. Vibration (MRI) was performed in 15 fetuses, and 2 fetuses were pathologically dissected after induction of labor.
Result
1. Ultrasonographic findings of the normal fetus in the middle sagittal section of the cerebellar vermis: the shape of the cerebellar vermis is plump, the shape of the vermis is almost parallel to the brain stem, and the apex of the fourth ventricle is pitted into an acute angle. With the progress of gestational age, the 29 weeks after gestation, the lobes and the lobes of each part of the worm showed more clearly.
2. The upper and lower cerebellar vermis diameter, anterior and posterior cerebellar vermis diameter, area and perimeter of the normal fetus increased with the increase of gestational weeks, and the correlation coefficients (r) were 0.915, 0.87, 0.932, 0.926 respectively.
3. The average value of BV angle in normal group was (3.3
4,27 fetuses with cerebellar vermis abnormalities, including 4 cases of typical Dandy-Walker malformation (DWM), 7 cases of Dandy-Walker variation (DWV), 6 cases of Blake's cyst (BPC) and 10 cases of simple posterior fossa cistern enlargement (MCM). The mid-sagittal section of the fetal skull showed that the primary and secondary fissures of the cerebellar vermis were unclear, the area of the vermis was significantly reduced, cystic dilatation was found in 4 cases of DWM. The fourth ventricle was connected with the enlarged posterior fossa cistern, the BV angle was significantly increased (88.9 65507 The top of the ventricle became shallow and flat, the fourth ventricle was dilated and connected with the posterior fossa cistern, the vermis was rotated upward, the BV angle was increased, the mean value was (23.7 5.2), the BT angle was slightly increased, the mean value was (54.5 65 The BV angle increased slightly in the supination of the cerebellum, and the BT angle increased slightly in average (16.7 65507
conclusion
1. The VCI-C technique of transabdominal three-dimensional ultrasound can clearly display the morphology and fine structure of the fetal cerebellar vermis and the relationship between the vermis and the surrounding tissues. It can be used to evaluate the development of the fetal cerebellar vermis.
2. At 18-34 weeks of gestation, the upper and lower cerebellar vermis diameter, anterior and posterior cerebellar vermis diameter, area and perimeter of normal fetus increased with the increase of gestational age, and the average BV angle and BT angle of normal fetus increased with the increase of gestational age.
3. On the median sagittal section of the fetal cerebellar vermis, the morphology of the fetal cerebellar vermis and its adjacent tissues should be observed carefully, the fine structure of the cerebellar vermis should be identified, the area of the cerebellar vermis should be measured, the angle of BV and BT should be measured, which is helpful for the diagnosis and differential diagnosis of the fetal cerebellar vermis.
【学位授予单位】：苏州大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R445.1;R714.5
【相似文献】
相关期刊论文 前10条
1 邢东风;鲍庆华;燕勇;;小脑蚓部肿瘤83例诊治体会[J];中国实用神经疾病杂志;2007年05期
2 程靖;儿童小脑蚓部肿瘤误诊1例[J];南京军医学院学报;1998年03期
3 杭春华,孙克华;儿童小脑蚓部肿瘤术后小脑性缄默3例报告[J];中国神经精神疾病杂志;1999年02期
4 闫瑞芳;沈桂权;闫瑞香;王金周;;20例小脑蚓部肿瘤的影像分析[J];贵阳医学院学报;2007年01期
5 胡碧清;阳桂丽;廖芝玲;;小脑蚓部髓上皮瘤1例及文献复习[J];广西医学;2008年10期
6 李国雄;黄文才;;小脑蚓部常见肿瘤的临床病理分析[J];华南国防医学杂志;2008年05期
7 祁衍;张宗逸;;无小脑病征的小脑蚓部出血1例报告[J];哈尔滨医药;1987年02期
8 高乔;张慕骞;滕松如;;小脑蚓部畸胎瘤一例[J];临床放射学杂志;1989年01期
9 何奇元,姜德福;小脑蚓部转移癌一例报告[J];第三军医大学学报;1991年03期
10 王立;张贞浏;;酷似小脑梗塞的老年小脑蚓部出血1例报告[J];实用老年医学;1991年01期
相关会议论文 前6条
1 俞文华;车志豪;许培源;朱强;陆镛民;傅林;张祖勇;陈锋;杜权;江林涌;董晓巧;;原发性中枢神经系统淋巴瘤12例临床分析[A];2006年浙江省神经外科学术会议论文汇编[C];2006年
2 吕国荣;林惠通;刘金蓉;;经腹超声检测胎儿小脑蚓部及其临床意义[A];中国超声医学工程学会第三届全国妇产及计划生育超声医学学术会议论文汇编[C];2010年
3 吕国荣;刘金蓉;苏珊珊;侯敏;赵艳春;凌乐文;;三维超声定量评估胎儿小脑蚓部发育[A];中国超声医学工程学会第十一届全国超声医学学术大会论文汇编[C];2012年
4 高凤玲;王俊芳;徐忠宝;;以动态TCD高颅压为主要表现的小脑蚓部肿瘤1例报告[A];第七届全国颅脑及颈动脉超声学术会议论文汇编[C];2007年
5 张军;;MRI对可疑小脑蚓部发育异常胎儿的评价[A];中华医学会第十三届全国放射学大会论文汇编（上册）[C];2006年
6 解左平;;三维超声立体成像评价胎儿小脑蚓部发育及其临床意义[A];2011年浙江省超声医学学术年会论文汇编[C];2011年
相关重要报纸文章 前1条
1 华迅;海南成功实施小脑蚓部微创手术[N];中国医药报;2004年
相关硕士学位论文 前6条
1 郭翠霞;经腹三维超声检测胎儿小脑蚓部发育的应用[D];中国人民解放军医学院;2014年
2 张丽丽;经腹三维超声容积对比成像联合C平面技术评价胎儿小脑蚓部发育的临床研究[D];苏州大学;2014年
3 刘金蓉;经腹三维超声检测胎儿小脑蚓部结构的方法和应用[D];福建医科大学;2011年
4 沈军;小脑延髓裂入路的显微解剖学及其临床应用研究[D];安徽医科大学;2012年
5 开治国;磁共振对胎儿小脑蚓部发育的研究[D];山东大学;2011年
6 刘炜;三维超声扩展成像检测胎儿小脑蚓部发育的研究[D];中国医科大学;2008年
本文编号：2233694
本文链接：https://www.wllwen.com/yixuelunwen/fangshe/2233694.html
