经腹三维超声检测胎儿小脑蚓部发育的应用

发布时间：2018-11-20 12:00

【摘要】：目的探讨经腹三维超声Ominiview结合VCI模式诊断胎儿小脑发育异常的应用价值，观察并测量小脑延髓池的宽度、小脑蚓部大小、小脑蚓部和小脑幕的位置随孕周的变化。从形态学和生物学测值两个方面探索鉴别诊断小脑发育异常疾病的分类方法。方法 2012年10月-2013年10月在解放军总医院行颅脑3DUS检查的胎儿共130例，同期2DUS检出可疑Dandy-Walker综合征（DWS）13例，小脑延髓池增宽（MCM）36例。在标准横切面上测量小脑延髓池的宽度；在正中矢状切面上观察胎儿小脑蚓部的形态及主要解剖学标志的发育，测量胎儿小脑蚓部的上下径、前后径、周长和面积，，脑干-蚓部夹角（BV角）、脑干-小脑幕夹角（BT角）。从小脑蚓部的形态学和生物学测量两个方面对可疑异常病例进行评估，提出胎儿DWS的定量分类方法。结果（1）正常胎儿小脑延髓池的宽度与孕周相关，随孕周的变化呈先增后减的趋势，32-33周左右达到最大值，回归方程为小脑延髓池宽度（cm）=-1.50×10-5GA3+0.05GA-0.303，R2=0.336；32周左右出现的小脑延髓池一过性增宽者，预后较好。（2）正常胎儿小脑蚓部的上下径、前后径，周长、面积均与孕周相关，回归方程分别为蚓部前后径（cm）=-0.001GA2+0.10GA-0.933，R2=0.907；蚓部上下径（cm）=-0.002GA2+0.191GA-1.928，R2=0.955；蚓部周长（cm）=-0.01GA2+0.836GA-9.169，R2=0.950；蚓部面积（cm2）=㧟0.002GA2+0.313GA-4.748，R2=0.968（GA为孕周），以面积的相关性和重复性最好。（3） BV角、BT角与孕周均不相关，其值分别为8.0°±3.2°、31.4°±7.5°，当BV角大于14.4°可定义为蚓部上旋，当BT角大于46.6°可定义为小脑幕上抬。（4）从胎儿小脑蚓部的形态学和生物学测值两方面进行评估，可疑DWS13例胎儿最终诊断为Dandy-Walker畸形（DWM）2例，Dandy-Walker变异型（DWV）3例，单纯性蚓部上旋4例，小脑延髓池增宽（MCM）4例。DWM胎儿的小脑蚓部失去正常的“心”形，主要的解剖学标志显示不清，各测值均低于正常胎儿的第5个百分位点，小脑延髓池增宽，BV角和BT角均增大；DWV胎儿的小脑蚓部亦失去正常的“心”形，主要的解剖学标志部分未显示，各测值均低于正常胎儿的第5个百分位点，伴或不伴小脑延髓池增宽，BV角增大，BT角在正常范围内；单纯性小脑蚓部上旋和小脑延髓池增宽者，蚓部形态及各测值、BT角均在正常范围内，前者BV角稍增大，后者表现为MCM、伴或不伴BV角稍增大。结论（1）经腹三维超声Ominiview结合VCI技术可准确获取胎儿颅脑的正中矢状切面，在该切面上可观察小脑蚓部的形态结构，测量小脑蚓部的生物学测值，评估其与周围结构之间的位置关系。（2）在经腹三维超声正中矢状切面上，结合小脑蚓部形态学和生物学测值可鉴别诊断DWM、DWV、单纯性蚓部上旋和小脑延髓池增宽。
[Abstract]:Objective to investigate the value of transabdominal three-dimensional ultrasound (Ominiview) combined with VCI in the diagnosis of fetal cerebellar dysplasia, and to observe and measure the width of cerebellar medulla cistern, the size of cerebellar vermis, and the position of cerebellar vermis and tentorium with gestational weeks. The classification method for differential diagnosis of cerebellar dysplasia was explored in terms of morphological and biological values. Methods from October 2012 to October 2013, 130 fetuses underwent craniocerebral 3DUS examination in PLA General Hospital. 13 cases of suspected Dandy-Walker syndrome (DWS) and 36 cases of cerebellar medullary cistern widening (MCM) were detected by 2DUS during the same period. The width of cerebellar medulla oblongata cistern was measured on the standard transverse plane. The shape and the development of the main anatomical markers of the cerebellar vermis were observed on the median sagittal section. The upper and lower diameter, the anteroposterior diameter, the circumference and area of the cerebellar vermis, the angle between the brainstem and the vermis (BV angle) were measured. Brainstem-cerebellar tentorial angle (BT angle). The suspected abnormal cases were evaluated from the morphological and biological measurements of cerebellar vermis, and a quantitative classification method of fetal DWS was proposed. Results (1) the width of medulla oblongata cistern of normal fetus was correlated with gestational weeks, and increased first and then decreased with the change of gestational week, and reached the maximum value about 32-33 weeks. The regression equation was (cm) = -1.50 脳 10-5GA3 0.05GA-0.303N R2N 0.336.The regression equation was: the width of cerebellar medulla cistern (cm) = -1.50 脳 10-5GA3 0.05GA-0.303); The prognosis of patients with temporary enlargement of cerebellar medullary cistern around 32 weeks was better. (2) the inferior and inferior diameter, anteroposterior diameter, circumference and area of normal fetal cerebellar vermis were all correlated with gestational weeks. The regression equation was: (cm) = -0.001GA2 0.10GA-0.933 R2U 0.907; The upper and lower diameter of vermis (cm) =-0.002GA2 0.191GA-1.928 R2N 0.955, the circumference of vermis (cm) = -0.01GA2 0.836GA-9.169R2N 0.950; The area of vermis (cm2) =? 0.002GA2 0.313GA-4.748R2O0.968 (GA is gestational week), the area correlation and reproducibility are the best. (3) BV angle and BT angle were not correlated with gestational age, their values were 8.0 掳卤3.2 掳and 31.4 掳卤7.5 掳, respectively. When the BV angle was greater than 14.4 掳, it could be defined as vermis superrotation, and when BT angle was greater than 46.6 掳, it could be defined as cerebellar tentorial elevation. (4) to evaluate the morphological and biological values of cerebellar vermis, suspected DWS13 cases were diagnosed as Dandy-Walker malformation (2 cases), Dandy-Walker variant (DWV) (3 cases), simple vermis superior rotation (4 cases). The cerebellar vermis of the DWM fetus lost its normal "heart" shape, and the main anatomical markers were unclear. The measured values were lower than the fifth percentile of the normal fetus, and the cerebellar medulla cistern widened. Both BV angle and BT angle increased. The cerebellar vermis of the DWV fetus also lost its normal "heart" shape, and the main anatomical markers were not shown. The measured values were lower than the fifth percentile of the normal fetus, with or without enlargement of the cerebellar medulla oblongata cistern, and the BV angle was increased. The BT angle is in the normal range. In the cases of simple cerebellar vermis supination and cerebellar medullary cistern widening, the morphology of vermis and the measured values and BT angle of the vermis were within normal range. The BV angle of the former increased slightly, while the latter showed MCM, with or without BV angle. Conclusion (1) the median sagittal section of fetal brain can be accurately obtained by transabdominal three-dimensional Ominiview and VCI technique. The morphology and structure of cerebellar vermis can be observed and the biological value of cerebellar vermis can be measured. Evaluate the location relationship with the surrounding structure. (2) on the median sagittal section of transabdominal three dimensional ultrasound, combined with morphological and biological values of cerebellar vermis, the diagnosis of DWM,DWV, simple vermis superior rotation and cerebellar medullary cistern enlargement can be distinguished.
【学位授予单位】：中国人民解放军医学院
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R445.1;R714.5

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