本文選題：胎兒 + 腦溝��； 參考：《南方醫(yī)科大學(xué)》2014年碩士論文

【摘要】：胎兒大腦發(fā)育過程較為復(fù)雜,胎兒腦溝回是其表面明顯的結(jié)構(gòu)；而長期以來缺乏胎兒腦溝回發(fā)育系統(tǒng)完整的影像學(xué)資料�，F(xiàn)階段關(guān)于胎兒腦溝回發(fā)育的影像學(xué)資料主要來源于產(chǎn)前超聲檢查、產(chǎn)后超聲檢查、宮內(nèi)MRI檢查及產(chǎn)后MRI檢查。產(chǎn)前超聲檢查是目前評價(jià)胎兒發(fā)育的首選影像學(xué)方法,其優(yōu)點(diǎn)包括安全、經(jīng)濟(jì)、方便、可實(shí)時(shí)成像等。但對于胎兒顱腦的掃查,超聲有其局限性,如空間分辨率、組織分辨率相對較低,對孕婦體型肥胖、羊水過少、成像區(qū)氣體較多的情況顯像效果較差等。妊娠晚期胎兒顱骨及母體骨盆骨骼容易影響聲波的穿透性。隨著MRI技術(shù)的發(fā)展,特別是快速成像序列的采用,增加了宮內(nèi)胎兒成像的清晰度,使其成為繼超聲之后的最佳輔助診斷方法。但是,應(yīng)用于宮內(nèi)胎兒采集場強(qiáng)一般為1.5T,且受到采集序列、采集時(shí)間、層厚及層間距的制約,同時(shí)還受到胎動(dòng)、母體結(jié)構(gòu)、母體動(dòng)脈搏動(dòng)等因素的影響,使中孕期胎兒掃描難度較大。 胎兒大腦溝回發(fā)育過程中,其外部形態(tài)大小與內(nèi)部細(xì)胞結(jié)構(gòu)都會發(fā)生復(fù)雜變化。超聲檢查胎兒大腦溝回的深度、寬度、角度及覆蓋率等都可作為胎兒腦成熟的標(biāo)志,對評價(jià)胎兒腦健康狀況有重要意義。 因此,大樣本、大孕齡跨度的影像學(xué)檢查顯示人類胚胎大腦溝回的發(fā)育變化,所得其表面腦溝的發(fā)育規(guī)律及腦溝回的深度、寬度、角度及覆蓋率的準(zhǔn)確測量值將是胎兒腦研究的突破點(diǎn)。本研究旨在豐富與完善人類腦發(fā)育的胚胎學(xué)與影像學(xué)知識,為臨床宮內(nèi)胎兒腦發(fā)育狀況診斷與評估提供指導(dǎo),以提高產(chǎn)前診斷胎兒中樞神經(jīng)系統(tǒng)異常的水平,提高人口出生質(zhì)量,優(yōu)生優(yōu)育,同時(shí)提高早產(chǎn)兒存活率。 本研究分為四個(gè)部分： (1)胎兒腦溝回超聲觀測切面的確定； (2)胎兒腦溝回生長發(fā)育規(guī)律的超聲研究； (3)胎兒腦溝回生長發(fā)育規(guī)律的核磁共振研究； (4)胎兒腦溝回發(fā)育異常的影像學(xué)研究。 第一部分：胎兒腦溝回超聲觀測切面的確定 目的：根據(jù)胎兒產(chǎn)前超聲檢查及產(chǎn)后標(biāo)本超聲檢查,對胎兒腦溝回觀測切面進(jìn)行定位。 材料與方法：研究對象為2013年3月至2013年4月在南方醫(yī)科大學(xué)附屬深圳婦幼保健院因“計(jì)劃外生育”的胎兒。行產(chǎn)前超聲檢查診斷或染色體檢查無異常且在該院引產(chǎn),其父母同意尸體解剖的30例引產(chǎn)胎兒。主要儀器使用Acuson Sequoia512型彩色多普勒血流顯像儀,超聲檢查探頭頻率為4.0-6.0MHz。產(chǎn)前對這30例胎兒進(jìn)行特定切面外側(cè)裂寬度、頂枕溝深度、距狀溝深度測量,對引產(chǎn)胎兒進(jìn)行特定切面腦溝回測量。對同一切面產(chǎn)前、產(chǎn)后所得數(shù)據(jù)進(jìn)行配對比較。 結(jié)果：產(chǎn)前超聲在規(guī)定的外側(cè)裂切面、頂枕溝切面、距狀溝切面測量胎兒腦溝回結(jié)果與產(chǎn)后超聲檢查胎兒腦溝回觀測數(shù)據(jù)對比。差異無統(tǒng)計(jì)學(xué)意義。 結(jié)論：本研究所選擇的切面相對固定,所測數(shù)據(jù)穩(wěn)定性較好,可作為產(chǎn)前超聲觀測胎兒腦溝回的切面。 第二部分：胎兒腦溝回生長發(fā)育規(guī)律的超聲研究 目的：應(yīng)用產(chǎn)前超聲檢查定量分析胎兒大腦溝回的發(fā)育過程。 材料與方法：2012年4月至2014年1月在南方醫(yī)科大學(xué)附屬深圳婦幼保健院超聲科進(jìn)行常規(guī)超聲檢查的674例單胎妊娠孕婦。使用儀器：使用Acuson Sequoia512、西門子S2000型彩色多普勒超聲儀,探頭頻率為4.0-6.0MHz。觀測切面：外側(cè)裂切面、頂枕溝切面及距狀溝切面。測量內(nèi)容：頂枕溝深度及角度、距狀溝深度、外側(cè)裂寬度及深度、腦島未覆蓋寬度。計(jì)算內(nèi)容：取腦島未覆蓋寬度與外側(cè)裂寬度之間比為腦島未覆蓋率。記錄內(nèi)容：孕婦年齡、身高、體重、胎兒性別、檢查時(shí)間、檢查者在檢查完畢后對所測數(shù)據(jù)及評估內(nèi)容進(jìn)行詳細(xì)填表。統(tǒng)計(jì)方法：采用SPSS13.0統(tǒng)計(jì)軟件,計(jì)量資料以均數(shù)±標(biāo)準(zhǔn)差表示,計(jì)數(shù)資料以率表示,P0.05表示差異有統(tǒng)計(jì)學(xué)意義。取所測得數(shù)據(jù)與孕周繪制散點(diǎn)圖,采用Pearson相關(guān)性分析。對數(shù)據(jù)滿足正態(tài)分布者進(jìn)行一元線性回歸分析。對男、女胎兒大腦溝回?cái)?shù)據(jù)采用兩獨(dú)立樣本t檢驗(yàn)分析。 結(jié)果：胎兒各大腦溝深度隨孕周增加而增加,具有顯著正相關(guān)(P0.05)；腦島未覆蓋率隨孕周增加而減小,具有顯著負(fù)相關(guān)(P0.05)。孕32周以后97.32%(218/224)胎兒腦島未覆蓋率為0,即孕32周后97.32%胎兒腦島被完全覆蓋；頂枕溝角隨孕周增加而減小,具有顯著負(fù)相關(guān)(P0.05),孕31周以后97.31%(253/260)胎兒頂枕溝角度為0°。經(jīng)回歸分析擬合得出最適合回歸曲線,為線性回歸曲線模型。男、女胎兒大腦溝回發(fā)育無顯著差異(P0.05)。 結(jié)論：因切面原因,之前部分研究得出的胎兒腦溝回測值時(shí)刻表需重新定義。本研究結(jié)果可作為胎兒腦溝發(fā)育正常與否的參考。 第三部分：胎兒腦溝回生長發(fā)育規(guī)律的核磁共振研究 目的：應(yīng)用產(chǎn)前核磁共振檢查定量觀測胎兒大腦溝回發(fā)育過程。 材料與方法：2009年4月至2013年12月在南方醫(yī)科大學(xué)附屬深圳婦幼保健院對337例胎齡為19～40周無中樞神經(jīng)系統(tǒng)發(fā)育異常的單活胎孕婦。使用儀器：Philips1.5T Nova Dual磁共振儀,6通道相控陣表面線圈。對每個(gè)入組胎兒的橫斷面、冠狀面及矢狀面分別行Balance-FFE及T2WI序列掃描。觀測切面：半卵圓中心橫斷面、上丘和后聯(lián)合橫斷面、經(jīng)乳頭體冠狀斷面。測量內(nèi)容：頂枕溝深度及角度、扣帶溝深度、外側(cè)裂寬度及深度、腦島未覆蓋寬度。計(jì)算內(nèi)容：取腦島未覆蓋寬度除以外側(cè)裂寬度之商未腦島未覆蓋率。記錄內(nèi)容：胎兒性別、左右大腦半球、孕婦年齡、檢查時(shí)間。采用SPSS13.0統(tǒng)計(jì)軟件,計(jì)量資料以均數(shù)±標(biāo)準(zhǔn)差表示,計(jì)數(shù)資料以率表示,P0.05表示差異有統(tǒng)計(jì)學(xué)意義。取所測數(shù)據(jù)與孕周繪制散點(diǎn)圖,采用Pearson相關(guān)性分析。對數(shù)據(jù)滿足正態(tài)分布者進(jìn)行一元線性回歸分析。對胎兒左、右大腦半球腦溝回?cái)?shù)據(jù)采用兩獨(dú)立樣本t檢驗(yàn)分析。 結(jié)果：胎兒各大腦溝深度與孕周呈顯著正相關(guān)(P0.05)；腦島未覆蓋率隨孕周增加而減小,具有顯著負(fù)相關(guān)(P0.05),孕32周以后97.81%(134/137)胎兒腦島未覆蓋率為0。頂枕溝角隨孕周增加而減小,具有顯著負(fù)相關(guān)(P0.05),31周以后100%(137/137)胎兒頂枕溝角度為0°。經(jīng)回歸分析擬合得出最適合回歸曲線,為線性回歸曲線模型。男女胎兒大腦溝回發(fā)育速度差異沒有統(tǒng)計(jì)學(xué)意義。胎兒左右大腦半球發(fā)育無顯著性差異(P0.05)。 結(jié)論：本研究首次提出核磁共振檢查多觀察面測量胎兒大腦溝回的方法。核磁共振研究結(jié)果與第二部分超聲研究結(jié)果趨勢基本相同。樣本量更大,孕周范圍更廣的研究可進(jìn)一步證實(shí)本研究結(jié)論。 第四部分胎兒腦溝回發(fā)育異常的超聲檢查研究 目的：探討本研究所得結(jié)果對于胎兒腦溝回發(fā)育異常診斷的意義。 材料與方法：回顧性分析來自于南方醫(yī)科大學(xué)附屬深圳婦幼保健院超聲科資料庫里2001年1月至2014年1月腦溝回發(fā)育異常的30例單胎胎兒。其中包括小頭畸形(9例),腦溝回發(fā)育遲緩(4例),半側(cè)巨腦畸形(2例)�；仡櫺苑治霾±龍D像在外側(cè)裂切面測量幾組異常病例胎兒的外側(cè)裂寬度、外側(cè)裂深度、腦島未覆蓋寬度,計(jì)算腦島未覆蓋率。結(jié)合第二部分研究結(jié)果繪制復(fù)合箱絲圖及復(fù)合散點(diǎn)圖。 結(jié)果：經(jīng)圖像篩選將15例胎兒納入本研究,產(chǎn)前診斷小頭畸形及胎兒腦溝回發(fā)育遲緩可根據(jù)其外側(cè)裂寬度測值位于同孕周正常值的第5百分位數(shù)線下,小頭畸形外側(cè)裂深度亦位于同孕周正常值第5百分位數(shù)線下。半側(cè)巨腦畸形,較窄側(cè)大腦外側(cè)裂深度低于同孕周正常胎兒第5百分位數(shù)線。半側(cè)巨腦畸形兩側(cè)大腦半球外側(cè)裂未覆蓋率分別位于第95百分位數(shù)線上及第5百分位數(shù)線下 結(jié)論：第二部分研究得出的超聲檢查結(jié)果對篩查胎兒大腦溝回發(fā)育異常有臨床意義�？勺鳛榕R床上篩查小頭畸形、腦溝回發(fā)育遲緩、半側(cè)巨腦畸形等疾病的客觀依據(jù)。樣本量更大,孕周范圍更廣的研究可進(jìn)一步證實(shí)本研究所得結(jié)論。
[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.
【學(xué)位授予單位】：南方醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R714.5;R445.1

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