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中华医学超声杂志（电子版）

中华医学超声杂志（电子版） ›› 2018, Vol. 15 ›› Issue (08) : 593 -599. doi: 10.3877/cma.j.issn.1672-6448.2018.08.006

所属专题： 妇产科超声影像学； 文献； 妇产科超声；

妇产科超声影像学

50例胎儿颅后窝异常的超声诊断及预后分析
郭翠霞1, 吴青青1,†(), 王莉1, 孙丽娟1, 王新莲2   
  1. 1. 100026　首都医科大学附属北京妇产医院超声科
    2. 100026　首都医科大学附属北京妇产医院放射科
  • 收稿日期:2018-07-02 出版日期:2018-08-01
  • 通信作者: 吴青青
  • 基金资助:
    国家重点研发计划(2016YFC1000104); 北京市医院管理局"登峰"计划专项经费资助(DFL20151302); 首都医科大学附属北京妇产医院中青年学科骨干培养专项(fcyy201516)

Ultrasonic diagnosis and outcome of 50 fetuses with posterior fossa abnormalities

Cuixia Guo1, Qingqing Wu1,†(), Li Wang1, Lijuan Sun1, Xinlian Wang2   

  1. 1. Department of Ultrasound, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing 100026, China
    2. Department of Radiology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing 100026, China
  • Received:2018-07-02 Published:2018-08-01
  • Corresponding author: Qingqing Wu
  • About author:
    Corresponding author: Wu Qingqing, Email:
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郭翠霞, 吴青青, 王莉, 孙丽娟, 王新莲. 50例胎儿颅后窝异常的超声诊断及预后分析[J]. 中华医学超声杂志（电子版）, 2018, 15(08): 593-599.

Cuixia Guo, Qingqing Wu, Li Wang, Lijuan Sun, Xinlian Wang. Ultrasonic diagnosis and outcome of 50 fetuses with posterior fossa abnormalities[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2018, 15(08): 593-599.

目的

分析胎儿颅后窝异常超声诊断准确性及预后表现。

方法

对2015年8月至2018年3月于首都医科大学附属北京妇产医院超声检查提示颅后窝异常50例胎儿的二维和三维超声图像进行分析，总结不同种类颅后窝异常胎儿产前超声声像图特点，与胎儿颅脑磁共振检查、出生后检查及随访结果对照，分析超声诊断胎儿颅后窝异常的准确性。

结果

50例颅后窝异常胎儿经三维超声检查最终提示Dandy-Walker畸形8例，小脑蚓部发育不良8例，Blake′s陷窝囊肿6例，小脑发育不良5例，颅后窝蛛网膜囊肿9例，单纯小脑延髓池增宽13例，小脑蚓部形态异常1例。其中26例胎儿颅脑磁共振检查证实23例与产前三维超声提示诊断相符合，2例与产前三维超声提示诊断不符合，1例胎儿颅脑磁共振检查对超声诊断进行了补充。妊娠结局：50例胎儿经超声及颅脑磁共振检查后，24例孕妇选择终止妊娠（5例失访）；26例孕妇继续妊娠（小脑蚓部发育不良和小脑发育不良各1例，Blake′s陷窝囊肿4例，颅后窝蛛网膜囊肿7例，单纯性小脑延髓池增宽13例）。其中1例小脑蚓部发育不良胎儿出生后诊断为Joubert综合征，余25例胎儿预后良好。诊断准确性：与胎儿颅脑磁共振及出生后检查随访结果相比，产前二维超声诊断准确率为62.2%（28/45），产前三维诊断准确率为88.9%（40/45）。

结论

不同种类颅后窝异常（Dandy-Walker畸形、小脑蚓部发育不良、Blake′s陷窝囊肿）产前二维超声图像上表现相似，产前三维超声对颅后窝异常疾病分类及诊断有重要意义。

关键词: 超声检查，产前, 胎儿, 颅后窝异常, 三维超声
Objective

To analyze the ultrasound diagnostic accuracy and postnatal outcome of fetal posterior fossa abnormalities.

Methods

The ultrasonic image features of 50 fetuses with posterior fossa abnormalities between Aug. 2015 to Mar. 2018 in Beijing Obstetrics and Gynecology Hospital, Capital Medical University were retrospectively summarized and compared with their brain magnetic resonance imaging (MRI) findings and the results of checkups and follow-ups after birth. And the prenatal diagnostic accuracy of two dimensional (2D) and three dimensional (3D) ultrasound was analyzed.

Results

Among 50 cases with posterior fossa abnormalities, prenatal 3D ultrasound diagnosed 8 cases of Dandy-Walker malformation, 8 cases of vermian hypoplasia, 6 cases of Blake's pouch cyst, 5 cases of cerebellar hypoplasia, 9 cases of posterior fossa arachnoid cyst, 13 cases of isolated mega cisterna magna and 1 case of vermian abnormal morphology. Among them, fetal brain MRI were performed in 26 cases, and the results of 23 cases were consistent with the prenatal 3D ultrasound results. In the rest 2 inconsistent cases, the fetal brain MRI added supplementary diagnosis in 1 case. Postnatal outcome: after the performances of ultrasound and fetal MRI, 24/50 patients chose intrauterine termination of pregnancy (5 cases were lost), and 26/50 patients chose to continue with pregnancy (I case of vermian hypoplasia and cerebellar hypoplasia, 4 cases of Blake′s pouch cyst, 7 cases of posterior fossa arachnoid cyst, 13 cases of isolated mega cisteran magna). Among the 26 cases, one fetus was diagnosed as Joubert Syndrome after birth, the other 25 fetuses were of good prognosis. The diagnostic accuracy: compared with fetal brain MRI and the results of checkups and follow-ups after birth, the diagnostic accuracy of 2D and 3D was 62.2% (28/45) and 88.9% (40/45), respectively.

Conclusions

Different posterior fossa abnormalities (eg. Dandy-Walker malformation, vermian hypoplasia and Blake's pouch cyst) have similar prenatal 2D ultrasonic characteristics. Prenatal 3D ultrasound is of great significance in the classification and diagnosis of posterior fossa abnormalities.

Key words: Ultrasonography, prenatal, Fetus, Abnormal posterior fossa, Three-dimensional ultrasound
图1~12 颅后窝异常胎儿小脑横切面及矢状切面超声声像图。图1，2　孕24＋3周胎儿Dandy-Walker畸形，声像图示小脑蚓部缺失，第四脑室与增宽的颅后窝相通（箭头所示）；小脑蚓部小，且上旋，小脑幕上抬；图3，4　孕29＋5周胎儿小脑蚓部发育不良，声像图示小脑蚓部缺失，第四脑室与颅后窝相通（箭头所示）；小脑蚓部小且上旋，小脑幕位置正常；图5，6　孕26周胎儿Blake′s陷窝囊肿，声像图示小脑蚓部"缺失" ，第四脑室与颅后窝相通（箭头所示）；正常大小的小脑蚓部上旋；图7，8　孕26周胎儿小脑发育不良，声像图示胎儿小脑横径小（大小相当于孕22＋4周）；小脑蚓部面积小；图9，10　孕31＋2周胎儿颅后窝蛛网膜囊肿，声像图示小脑后上方囊肿及囊壁（箭头所示），同时小脑幕（T）受压上抬；图11，12　孕28＋5周胎儿小脑蚓部形态异常，声像图示增大且形态异常的小脑蚓部（箭头所示）；小脑蚓部内部结构不清，蚓部面积偏大
表1 50例颅后窝异常胎儿产前二维、三维超声及磁共振检查结果（例数）
检查方法 检查例数 Dandy-Walker畸形（8例） 小脑蚓部发育不良（8例） Blake′s陷窝囊肿（6例） 小脑发育不良（5例） 颅后窝蛛网膜囊肿（9例）
二维超声 50 13a 5b 2b 5 5a
三维超声 50 8 8 6 5 9
磁共振 26 7b 5b 2b 3b 4b
检查方法 检查例数 单纯小脑延髓池增宽（13例） 小脑蚓部形态异常（1例） 诊断不确定（6例） 妊娠结局
存活 引产
二维超声 50 13 1 6 26 24
三维超声 50 13 1 0 26 24
磁共振 26 4b 1 0 8 18
图13~16 孕26＋2周胎儿产前三维超声提示小脑蚓部发育不良，胎儿颅脑磁共振提示为Dandy-Walker畸形，同时合并单侧小脑发育不良。图13小脑横切面声像图示小脑蚓部缺失，第四脑室与颅后窝相通（箭头所示），左侧（L）小脑半球（CB）较右侧（R）小；图14颅脑磁共振轴切面声像图示小脑蚓部缺失，第四脑室与颅后窝相通（箭头所示）；图15三维超声小脑矢状切面声像图。操作者将单箭头所指部分误认为是面积偏小的蚓部。图16颅脑磁共振矢状切面图像示小脑蚓部（V）部分缺失，且明显上抬；与图16对照，图15小脑蚓部无明显上抬，图中单箭头可能为小脑半球，双箭头所示可能为发育不良的小脑蚓部
表2 50例颅后窝异常胎儿产前二维超声、三维超声、磁共振检查结果及符合率（例数）
检查方法 随访例数a 超声提示诊断 与产后诊断符合率（%）
二维超声 45 28bc 56.0
三维超声 45 40 88.9
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