發(fā)布時(shí)間：2018-09-10 06:44

【摘要】：目的 本研究旨在應(yīng)用經(jīng)腹三維超聲容積對(duì)比成像聯(lián)合C平面（VCI-C）技術(shù)觀察胎兒小腦蚓部發(fā)育，測(cè)量胎兒小腦蚓部各觀察指標(biāo)，評(píng)價(jià)這些觀察指標(biāo)測(cè)量值與孕周的關(guān)系，建立本地區(qū)正常胎兒小腦蚓部正常參考值范圍，并將小腦蚓部發(fā)育異常胎兒與正常組作對(duì)照觀察，探討經(jīng)腹部三維超聲VCI-C技術(shù)對(duì)胎兒小腦蚓部發(fā)育異常的診斷及鑒別診斷的價(jià)值。 方法 選擇2013年7月至2014年7月間于蘇州市立醫(yī)院產(chǎn)前超聲中心接受系統(tǒng)超聲檢查的孕18～34周正常胎兒335例，經(jīng)腹二維超聲掃查胎兒，觀察胎兒結(jié)構(gòu)，測(cè)量生長(zhǎng)發(fā)育指標(biāo)，重點(diǎn)觀察小腦及其蚓部形態(tài)，測(cè)量后顱窩池寬度。經(jīng)腹三維超聲掃查胎兒頭顱，應(yīng)用VCI-C技術(shù)獲得胎兒小腦蚓部正中矢狀切面，觀察小腦蚓部形態(tài)和原裂、次裂、蚓部各葉等細(xì)微結(jié)構(gòu)，觀察第四腦室形態(tài)及蚓部與腦干、小腦幕等相鄰組織的關(guān)系，測(cè)量蚓部觀察指標(biāo)包括上下徑、前后徑、面積、周長(zhǎng)、腦干小腦蚓部（BV）角、腦干小腦幕（BT）角，并分析上述測(cè)值與孕周的關(guān)系。同期選擇二維超聲檢查擬診為Dandy-Walker綜合征（DWC）的胎兒27例，應(yīng)用相同方法觀察小腦蚓部結(jié)構(gòu)和測(cè)量蚓部各觀察指標(biāo)，與正常組蚓部測(cè)量值對(duì)比觀察。27例異常組胎兒均行胎兒磁共振（MRI）檢查，15例胎兒引產(chǎn)，2例胎兒引產(chǎn)后接受病理解剖。 結(jié)果 1、正常組胎兒的小腦蚓部正中矢狀切面超聲表現(xiàn)：小腦蚓部形態(tài)飽滿，走形與腦干幾乎平行，第四腦室頂點(diǎn)凹陷成銳角。孕18周后可觀察到第四腦室頂部，孕22周后可觀察到蚓部的原裂，孕25周后蚓部原裂、次裂可清晰顯示，各葉隱約可見(jiàn)；隨著孕周的進(jìn)展，孕29周后蚓部各裂及各葉顯示更加清晰。 2、正常組胎兒小腦蚓部上下徑、前后徑、面積、周長(zhǎng)隨孕周增加而增大，與孕周有明顯相關(guān)性，相關(guān)系數(shù)（r）分別為0.915、0.87、0.932、0.926。 3、正常組胎兒BV角平均值為（3.3±1.7°），與孕周無(wú)明顯相關(guān)性，相關(guān)系數(shù)（r）為0.1，，P=0.07（P0.05）。BT角平均值為（31.5±6.9°），BT角與孕周相關(guān)系數(shù)（r）為0.4，相關(guān)性小。 4、27例小腦蚓部異常組胎兒，包括4例典型Dandy-Walker畸形（DWM），7例Dandy-Walker變異（DWV），6例Blake’s囊腫（BPC），10例單純后顱窩池增寬（MCM）。胎兒頭顱正中矢狀切面上觀察，4例DWM表現(xiàn)為：小腦蚓部原裂及次裂顯示不清，蚓部面積明顯縮小，囊性擴(kuò)張的第四腦室與增大的后顱窩池相通，BV角明顯增大（88.9±18.1°），小腦幕上抬，BT角明顯增大（89.0±12.8°）；7例DWV表現(xiàn)為：小腦蚓部形態(tài)不飽滿，下蚓部變小變尖，小腦蚓部原裂及次裂不能清晰顯示，蚓部面積測(cè)量值變小，低于5th百分位數(shù)，第四腦室頂部變淺變平，第四腦室擴(kuò)張與后顱窩池相通，小腦蚓部上旋，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表現(xiàn)為小腦蚓部形態(tài)飽滿，蚓部測(cè)量值在正常參考值范圍內(nèi)，第四腦室輕度擴(kuò)張與后顱窩池相通，小腦蚓部上旋，BV角輕度增大，平均值（16.7±1.8°），BT角稍增大，平均值為（50.3±8.2°）；10例MCM表現(xiàn)為后顱窩池寬度≥10mm，小腦蚓部外形飽滿，測(cè)量值在正常參考值范圍內(nèi)，第四腦室頂部凹陷呈銳角，BV、BT角均在正常參考值范圍內(nèi)。 結(jié)論 1、經(jīng)腹三維超聲VCI-C技術(shù)可清晰顯示胎兒小腦蚓部形態(tài)、細(xì)微結(jié)構(gòu)，以及蚓部與周圍組織的關(guān)系，可以用于評(píng)估胎兒小腦蚓部發(fā)育情況。 2、在孕18～34周，正常胎兒小腦蚓部上下徑、前后徑、面積、周長(zhǎng)隨孕周增加而增大；正常胎兒BV角平均值（3.3±1.7°），BT角平均值為（31.5±6.9°）。 3、在胎兒小腦蚓部正中矢狀切面上，仔細(xì)觀察胎兒小腦蚓部以及其相鄰組織的形態(tài)，辨認(rèn)小腦蚓部細(xì)微結(jié)構(gòu)，測(cè)量小腦蚓部的面積、BV和BT角，有助于胎兒小腦蚓部發(fā)育異常疾病的診斷和鑒別診斷。
[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.
【學(xué)位授予單位】：蘇州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R445.1;R714.5

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