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学科主题: 影像医学与核医学
题名:
胎儿先天性椎体畸形的产前超声分型及其预后评估探讨
作者: 石宇
答辩日期: 2016-11-16
导师: 李建国
专业: 影像医学与核医学
授予单位: 北京大学
授予地点: 北京大学第二临床医学院
学位: 博士
关键词: 产前超声检查 ; 感兴趣区 ; 多模式三维超声 ; 椎体畸形 ; 分型 ; 预后
其他题名: Classification and evaluation of the prognosis of fetal vertebral malformation with prenatal ultrasound
分类号: R828.2
摘要:

摘要

目的:探讨应用二维超声结合感兴趣区多模式三维超声,在胎儿先天性椎体发育异常的分型诊断及在其预后评估中的价值,为产前诊断胎儿椎体发育异常的分型探索及评估预后建立超声诊断系统化途径。1:产前通过多种模式超声在脊柱扫查中的应用,探索多种模式超声诊断胎儿椎体畸形的应用价值。2:通过产前超声检查和与出生后X线、CT、MRI影像资料及引产后病理解剖相对照,研究胎儿椎体畸形的超声影像特征。探讨产前多种模式超声评估椎体发育异常分型的可行性及产前超声分型诊断椎体发育异常的规范化途径,与出生后手术及支具治疗的随访结果进行对比分析,为胎儿脊柱畸形的分型诊断及其预后判断提供可靠依据。方法:产前超声疑似胎儿椎体畸形(均除外染色体异常)的胎儿,采用二维超声及二维超声结合感兴趣区多模式三维超声的扫查方式,分别获得矢状、冠状及脊柱横断面扫查图像。分析总结声图像特征,与经典椎体畸形分型进行对比,与胎儿磁共振(MRI)、新生儿或引产后X线或尸检结果对比分析。统计软件采用SPSS 15.0,定量资料采用t检验,独立样本执行χ2检验。计算显示率上的差异及产前超声对先天性椎体畸形分型与其他影像学诊断方法的关联系数。结果:1:应用二维超声结合感兴趣区多模式三维超声扫查对病变椎体的矢状面、水平横断面及冠状面成像显示率100%(38/38),二维超声及大范围的三维超声扫查74%(28/38)及84%(32/38),两者间差异有统计学意义(P<0.O5)。2:通过二维超声结合感兴趣区三维超声多模式扫查,得出椎体畸形的整体声像图特征:病变椎体骨化中心的强回声形态不规则、排列不整齐。62例超声可疑椎体畸形,其中38例有产后影像学检查(X线、CT、MR)及或引产后病理解剖诊断等随访结果,另外24例失访,38例可疑病例中经临床证实36例。其中⑴椎体形成障碍型,即半椎体,共25例:完全分节型半椎体8例,超声诊断6例;部分分节型半椎体2例,超声诊断1例;未分节型半椎体2例,超声诊断1例;对称的双侧半椎体(蝴蝶椎)4例,超声诊断2例;不对称的同侧两个半椎体2例,超声诊断2例;多发半椎体7例,超声诊断5例。⑵椎体分节不良型,即融合椎8例:四周融合型,即阻滞椎6例,单侧融合型2例,超声诊断6例。⑶混合型3例:单侧部分融合并对侧半椎体3例,单侧部分融合并同侧半椎体,超声诊断1例。应用二维超声结合感兴趣区多模式三维超声的扫查方式,对椎体畸形总体的诊断关联系数0.763,其中椎体形成障碍的诊断关联系数0.842。36例临床证实椎体畸形中,引产8例,分娩28例,最长随访时间3年。小儿伴明显脊柱异常弯曲畸形14例(形成障碍型12例,其中单发或多发完全分节型10例,部分分节型2例,均为1/4半椎体;分节不良型2例,均为单侧融合型),择期手术11例,脊柱弯曲不明显或进展缓慢14例(椎体形成障碍8例,其中完全分节型4例,未分节型4例;椎体分节不良6例,均为四周融合型),6例采用支具替代治疗。结论:二维超声联合感兴趣区多模式三维超声的应用,有助于提高胎儿先天性椎体发育不良的检出率及诊断符合率。椎体发育异常的超声图像具有特征性,产前超声对胎儿先天性椎体发育异常进行分型是可行的,诊断关联系数较高,分型诊断能为胎儿先天性椎体畸形预后评估提供有价值的信息。

英文摘要:

Abstract

Objective:To investigate the the clinical value of multiple mode scanning mode of two-dimensional ultrasound(2-DUS) and three-dimensional ultrasound(3-DUS) in the area of interest in diagnosis of classification and evaluation of fetal vertebral malformation and to established a prenatal ultrasonic diagnostic criteria for fetal vertebral dysplasia。1:To explore the application value of ultrasound in the diagnosis of fetal vertebral deformity through the application of multiple mode ultrasound in the spine scan.2:To study The ultrasound imaging features of fetal vertebral malformation by comparing the prenatal ultrasound examination and X-ray, CT, MRI after birth and the pathological anatomy after the induction of labor.To explore the standardized method of prenatal ultrasound diagnosis of vertebral abnormalities through discussion on the feasibility of ultrasonic classification of abnormal development of vertebral body with various modes of ultrasound to provide a reliable basis for the diagnosis, differential diagnosis and prognosis of fetal vertebral deformity. Methods: Analysis the ultrasonic imaging of fetus diagnosed as fetal vertebral dysplasia (excepting omosomal abnormalities) compared with the classic type of vertebral deformity. Their final diagnosis by ultrasound was contrasted with prenatal MRI, X-ray after birth or abortion and autopsy findings.T test and χ2 test were used to calculate the display rate and correlation coefficient. The statistic program was SPSS15.0. Results: 1:The successful display rate of sagittal, horizontal and coronal inspection through multiple mode scanning of the 2-DUS and focused 3-DUS was 100%(38/38),while 2-DUS was 74%(28/38)and 3-DUS was 84%(32/38).There was statistic significance(P<0.O5) 2:Through multiple mode scanning of the 2-DUS and focused 3-DUS in the area of interest the sonographic acteristics of vertebral deformity are as follows: The strong echo of the ossification center of the diseased vertebral body is not orderly. 62 cases are  suspected as vertebral deformity while 24 cases missed follow up. The following 36 cases in 38 suspected as vertebral deformity by ultrasonography were clinically confirmed. (1) 25 cases were diagnosed as hemivertebrae including 8 cases of fully segmented hemivertebrae,6 cases were diagnosed by ultrasound; 2 cases of part segmented hemivertebrae,1 case was diagnosed by ultrasound; not segmented hemivertebrae 2 cases,1 case was diagnosed by ultrasound; 4 cases of butterfly vertebrae, 2 cases were diagnosed by ultrasound; 2 cases of the same side asymmetry two hemivertebra, which were both diagnosed by ultrasound;7 cases of multiple hemivertebra, 5 cases were diagnosed by ultrasound.(2)8 cases were diagnosed as fusion vertebra including 2 cases block vertebra unilateral fusion and 3 cases of mixed type, 6 cases were diagnosed by ultrasound.(3) mixed type,including 3 cases unilateral fusion with contralateral hemivertebrae and unilateral fusion with homolateral hemivertebrae,1 case was diagnosed by ultrasound. The correlation coefficient of overall vertebral deformity and vertebral hypogenesis was 0.763 and 0.842 through multiple mode scanning mode of the 2-DUS and 3-DUSin the area of interest. Within the 36 cases of clinically confirmed vertebral malformation ,8 cases labor,28 cases delivery,follow up 3 years at the most.14 cases of obvious crooked vertebral column(hemivertebrae 12 cases, including 10 cases of fully or multy-segmented hemivertebra, 2 cases of part segmented 1/4 hemivertebrae; 2 cases of fusion vertebra),11 cases ive operation, 14 cases of unconspicuous crooked vertebral column,(hemivertebrae 8 cases, including 4cases of fully segmented hemivertebra, 4cases of part segmented hemivertebrae; 6 cases of fusion vertebra)6 cases braces support. Conclusion: The application of multiple mode scanning mode of the 2-DUS and 3-DUS in the area of interest can help to improve detection rate and diagnosis consistency rate of fetal congenital vertebral dysplasia. The ultrasound image of vertebral abnormal development is specific and the diagnosis consistency rate is high enough. It is feasible to classify fetal congenital vertebral abnormalities by prenatal ultrasound which can provide valuable information for its outcomes.

语种: 中文
相关网址: 查看原文
内容类型: 学位论文
URI标识: http://ir.bjmu.edu.cn/handle/400002259/124611
Appears in Collections:北京大学第二临床医学院_学位论文

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作者单位: 北京大学第二临床医学院

Recommended Citation:
石宇. 胎儿先天性椎体畸形的产前超声分型及其预后评估探讨[D]. 北京大学第二临床医学院. 北京大学. 2016.
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