經(jīng)腹三維超聲檢測胎兒小腦蚓部發(fā)育的應(yīng)用
發(fā)布時(shí)間：2018-11-20 12:00
【摘要】：目的 探討經(jīng)腹三維超聲Ominiview結(jié)合VCI模式診斷胎兒小腦發(fā)育異常的應(yīng)用價(jià)值，觀察并測量小腦延髓池的寬度、小腦蚓部大小、小腦蚓部和小腦幕的位置隨孕周的變化。從形態(tài)學(xué)和生物學(xué)測值兩個(gè)方面探索鑒別診斷小腦發(fā)育異常疾病的分類方法。 方法 2012年10月-2013年10月在解放軍總醫(yī)院行顱腦3DUS檢查的胎兒共130例，同期2DUS檢出可疑Dandy-Walker綜合征（DWS）13例，小腦延髓池增寬（MCM）36例。在標(biāo)準(zhǔn)橫切面上測量小腦延髓池的寬度；在正中矢狀切面上觀察胎兒小腦蚓部的形態(tài)及主要解剖學(xué)標(biāo)志的發(fā)育，測量胎兒小腦蚓部的上下徑、前后徑、周長和面積，，腦干-蚓部夾角（BV角）、腦干-小腦幕夾角（BT角）。從小腦蚓部的形態(tài)學(xué)和生物學(xué)測量兩個(gè)方面對可疑異常病例進(jìn)行評估，提出胎兒DWS的定量分類方法。 結(jié)果 （1）正常胎兒小腦延髓池的寬度與孕周相關(guān)，隨孕周的變化呈先增后減的趨勢，32-33周左右達(dá)到最大值，回歸方程為小腦延髓池寬度（cm）=-1.50×10-5GA3+0.05GA-0.303，R2=0.336；32周左右出現(xiàn)的小腦延髓池一過性增寬者，預(yù)后較好。 （2）正常胎兒小腦蚓部的上下徑、前后徑，周長、面積均與孕周相關(guān)，回歸方程分別為蚓部前后徑（cm）=-0.001GA2+0.10GA-0.933，R2=0.907；蚓部上下徑（cm）=-0.002GA2+0.191GA-1.928，R2=0.955；蚓部周長（cm）=-0.01GA2+0.836GA-9.169，R2=0.950；蚓部面積（cm2）=㧟0.002GA2+0.313GA-4.748，R2=0.968（GA為孕周），以面積的相關(guān)性和重復(fù)性最好。 （3） BV角、BT角與孕周均不相關(guān)，其值分別為8.0°±3.2°、31.4°±7.5°，當(dāng)BV角大于14.4°可定義為蚓部上旋，當(dāng)BT角大于46.6°可定義為小腦幕上抬。 （4）從胎兒小腦蚓部的形態(tài)學(xué)和生物學(xué)測值兩方面進(jìn)行評估，可疑DWS13例胎兒最終診斷為Dandy-Walker畸形（DWM）2例，Dandy-Walker變異型（DWV）3例，單純性蚓部上旋4例，小腦延髓池增寬（MCM）4例。DWM胎兒的小腦蚓部失去正常的“心”形，主要的解剖學(xué)標(biāo)志顯示不清，各測值均低于正常胎兒的第5個(gè)百分位點(diǎn)，小腦延髓池增寬，BV角和BT角均增大；DWV胎兒的小腦蚓部亦失去正常的“心”形，主要的解剖學(xué)標(biāo)志部分未顯示，各測值均低于正常胎兒的第5個(gè)百分位點(diǎn)，伴或不伴小腦延髓池增寬，BV角增大，BT角在正常范圍內(nèi)；單純性小腦蚓部上旋和小腦延髓池增寬者，蚓部形態(tài)及各測值、BT角均在正常范圍內(nèi)，前者BV角稍增大，后者表現(xiàn)為MCM、伴或不伴BV角稍增大。 結(jié)論 （1）經(jīng)腹三維超聲Ominiview結(jié)合VCI技術(shù)可準(zhǔn)確獲取胎兒顱腦的正中矢狀切面，在該切面上可觀察小腦蚓部的形態(tài)結(jié)構(gòu)，測量小腦蚓部的生物學(xué)測值，評估其與周圍結(jié)構(gòu)之間的位置關(guān)系。 （2）在經(jīng)腹三維超聲正中矢狀切面上，結(jié)合小腦蚓部形態(tài)學(xué)和生物學(xué)測值可鑒別診斷DWM、DWV、單純性蚓部上旋和小腦延髓池增寬。
[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 擄鹵3.2 擄and 31.4 擄鹵7.5 擄, respectively. When the BV angle was greater than 14.4 擄, it could be defined as vermis superrotation, and when BT angle was greater than 46.6 擄, 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.
【學(xué)位授予單位】：中國人民解放軍醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R445.1;R714.5
本文編號：2344857
[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 擄鹵3.2 擄and 31.4 擄鹵7.5 擄, respectively. When the BV angle was greater than 14.4 擄, it could be defined as vermis superrotation, and when BT angle was greater than 46.6 擄, 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.
【學(xué)位授予單位】：中國人民解放軍醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R445.1;R714.5
【共引文獻(xiàn)】
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