摘要
目的：建立孕早期11~13+6周正常胎儿颅后窝结构的正常参考值范围。方法：选取孕11~13+6周正常胎儿共计238例。分析影响胎儿颅后窝结构显示的母体及胎儿因素；在胎儿正中矢状面上测量颅后窝相关结构参数，将其与头臀长（CRL）进行直线回归分析，计算直线回归方程并绘制散点图；随机抽取30例胎儿，行组内及组间测量一致性检验。结果：238例胎儿中清晰可辨认颈内透明层（IT）者222例（93%）。影响图像质量的主要因素有母体肥胖13例，胎儿俯卧位10例，子宫后位5例，剖宫产瘢痕3例。胎儿脑干（BS）直径、IT、脑干至枕骨（BSOB）直径均随CRL的增加呈线性增加，BS/BSOB随CRL的增加呈线性递减。BS、IT、BSOB测得的组内相关系数（ICCs）分别为0.621 3、0.696 2、0.936 1；组间ICCs分别为0.581 3、0.812 5、0.960 1。结论：早孕期获得清晰胎儿颅后窝结构声像图，不仅需要对超声医师进行规范化培训，而且需要避免母体及胎儿不利因素对图像质量的影响。颅后窝各结构测量具有较好的一致性，为今后早孕期筛查胎儿畸形奠定了基础。
Abstract
Objective: To establish the normal reference ranges of the posterior fossa structure in normal fetuses at the 11~13+6 gestational weeks. Methods: Two hundreds and thirty-eight normal fetuses at the gestational age 11 to 13+6 weeks were selected. Maternal and fetal factors were analyzed which would affect the posterior fossa’s appearance. The parameters of the posterior fossa were measured in mid-sagittal plane. We compared the parameters with the crown-rump length(CRL), used linear regression analysis to get the linear regression equation and drew scatter diagram. Thirty randomly selected cases were reviewed for intraobserver and interobserver reliability. Results: In the 238 normal fetuses, intracranial translucency was seen in 222(93%). The main factors influencing the image quality were obesity(n=13), fetal position(n=10), retroverted uterus(n=5) and cesarean scar(n=3). With increasing CRL, there was a significant increase in brain stem diameter, intracranial translucency diameter and brain stem-occipital bone diameter. The brain stem diameter-to-brain stem-occipital bone diameter ratio decreased with increasing CRL. Intraobserver intraclass correlation coefficients of BS, IT, BSOB were 0.621 3, 0.696 2 and 0.936 1. Intreobserver intraclass correlation coefficients of BS, IT, BSOB were 0.581 3, 0.812 5 and 0.960 1. Conclusions: To obtain clear fetal posterior fossa structures’ sonogram, we not only need to standardize the training of the ultrasound physician, but also need to avoid the influence of maternal and fetal adverse factors on image quality. The measurement of posterior fossa structures is reproducible, and it will be useful for the future of early pregnancy screening for fetal malformation.
关键词
颅窝 /
后 /
胎儿 /
超声检查 /
产前
Key words
Cranial fossa /
posterior /
Fetus /
Ultrasonography /
prenatal
李顺振;胡兴荣;李 强;刘支义;李 扬.
11~13+6周正常胎儿颅后窝结构的超声评价[J]. 中国临床医学影像杂志. 2015, 26(4): 271-274
LI Shun-zhen;HU Xing-rong;LI Qiang;LIU Zhi-yi;LI Yang.
Evaluation of posterior fossa in normal fetuses at the 11~13+6 gestational weeks[J]. Journal of China Clinic Medical Imaging. 2015, 26(4): 271-274
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