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中华医学超声杂志(电子版) ›› 2019, Vol. 16 ›› Issue (07) : 495 -503. doi: 10.3877/cma.j.issn.1672-6448.2019.07.003

所属专题: 妇产科超声影像学 产前超声 文献 妇产科超声

妇产科超声影像学

中晚孕期胎儿胼胝体观察新方法:二维颅脑横切面法
曾晴1, 文华轩1, 袁鹰1, 丁妍1, 罗丹丹1, 廖伊梅1, 彭桂艳1, 林毅1, 官勇1, 邹于1, 梁美玲1, 秦越1, 李胜利1,()   
  1. 1. 518028 南方医科大学附属深圳妇幼保健院超声科
  • 收稿日期:2019-05-17 出版日期:2019-07-01
  • 通信作者: 李胜利
  • 基金资助:
    国家重点研发计划(2018YFC1002202); 国家自然科学基金(81771598); 深圳市科技计划项目(JCYJ2017030709103214)

Two-dimensional cross-sectional method: a new method for observing fetal corpus callosum in the second and third trimesters

Qing Zeng1, Huaxuan Wen1, Ying Yuan1, Yan Ding1, Dandan Luo1, Yimei Liao1, Guiyan Peng1, Yi Lin1, Yong Guan1, Yu Zou1, Meiling Liang1, Yue Qin1, Shengli Li1,()   

  1. 1. Department of Ultrasound, Shenzhen Maternity and Child Healthcare Hospital Affiliated to Nanfang Medical University, Shenzhen 518028, China
  • Received:2019-05-17 Published:2019-07-01
  • Corresponding author: Shengli Li
  • About author:
    Corresponding author: Li Shengli, Email:
引用本文:

曾晴, 文华轩, 袁鹰, 丁妍, 罗丹丹, 廖伊梅, 彭桂艳, 林毅, 官勇, 邹于, 梁美玲, 秦越, 李胜利. 中晚孕期胎儿胼胝体观察新方法:二维颅脑横切面法[J/OL]. 中华医学超声杂志(电子版), 2019, 16(07): 495-503.

Qing Zeng, Huaxuan Wen, Ying Yuan, Yan Ding, Dandan Luo, Yimei Liao, Guiyan Peng, Yi Lin, Yong Guan, Yu Zou, Meiling Liang, Yue Qin, Shengli Li. Two-dimensional cross-sectional method: a new method for observing fetal corpus callosum in the second and third trimesters[J/OL]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2019, 16(07): 495-503.

目的

确定二维超声颅脑横切面上胼胝体观测切面及建立20周至足月正常胎儿横切面上胼胝体各径线参考值。

方法

选取2018年6月至2018年12月在南方医科大学附属深圳妇幼保健院行产前超声检查诊断无结构异常且因"计划外生育"或者母体宫颈机能不全在我院引产,其父母同意尸体解剖的10例20~30周单胎胎儿作为研究对象。采用三维自由解剖成像法和冰冻标本解剖法获取胼胝体的系列横切面/横断面。观察上述两种方法获取的系列横切/断面,总结各切面及对应断面的特征,得出横切面上胼胝体结构观察的稳定切面。选取同时期在南方医科大学附属深圳妇幼保健院常规产前超声检查无结构异常的670例孕20周至足月的单胎胎儿,在第一部分选定的胼胝体横切面进行胼胝体膝部前角、后角,压部前角、后角,胼胝体最大前后径,膝部左右径、前后径,压部左右径、前后径,体部前后径、左右径的测量。随机抽取40例胎儿行上述参数两测量者间的重复性检验;建立各孕周颅脑横切面上胼胝体各参数的正常参考值范围,绘制所测数据与孕周的散点图并行相关性分析,建立线性回归方程。

结果

三维自由解剖成像法和冰冻标本解剖法所获胼胝体3个横切面恒定显示相同的解剖结构。两观察者之间的重复性检验未见明显差异。各散点图显示正常胎儿胼胝体各参数测值与孕周呈正相关(r=0.232、0.343、0.284、0.182、0.913、0.895、0.748、0.787、0.736、0.684、0.734,P均<0.01)。对各参数与孕周进行回归分析,回归方程分别为:Y=0.514X+52.214,Y=0.785X+42.897,Y=0.600X+47.327,Y=0.436X+53.056,Y=0.117X+0.019,Y=0.070X-0.169,Y=0.013X+0.054,Y=0.065X+0.180,Y=0.014X+0.064,Y=0.047X+0.547,Y=0.027X-0.116。

结论

基于三维自由解剖成像和冰冻标本解剖确定的系列切面相对固定,可作为胼胝体结构评估的切面。不同孕周胎儿胼胝体各径线正常参考值可作为产前评估胼胝体发育异常的参考依据。

Objective

To determine the transverse sections of corpus callosum on two-dimensional ultrasound and to establish the reference ranges for fetal corpus callosum dimensions on the transverse sections of normal foetus from 20 weeks to full term.

Methods

From June 2018 to December 2018, 10 singleton fetuses with no structural abnormalities diagnosed by prenatal ultrasound were selected as study subjects at Shenzhen Maternal and Child Health Hospital, whose parents consented to autopsy at 20-30 weeks of pregnancy due to inevitable abortion for ″cervical incompetence″ or ″unplanned birth″. A series of transverse sections obtained by three-dimensional oblique technique and frozen autopsy specimens were observed, and the characteristics of each section were summarized. The stable sections of corpus callosum on the transverse section were selected. From June 2018 to December 2018, 670 singleton pregnant women underwent routine ultrasound examination at the Ultrasound Department of our hospital. The corpus callosum diameters including the longest diameter of the corpus callosum, left to right genu diameter, anterior to posterior genu diameter, left to right splenium diameter, anterior to posterior splenium diameter, left to right body diameter, and anterior to posterior body diameter, and the angle of genu and splenium were measured at the cross-sectional plane mentioned above. Forty fetuses were randomly sampled and tested for repeatability between the two measurements. The normal reference ranges of the parameters of corpus callosum on the transverse section of the brain of each gestational week were established, and the correlation between the measured data and the scatter plot of gestational week was analyzed in parallel to establish regression equations.

Results

Three cross sections of corpus callosum obtained by the two different methods showed the same anatomical structures. There was no significant difference in the repeatability test between two observers. The scatter plots showed that the parameters of normal fetal corpus callosum were positively correlated with gestational age (r=0.232, 0.343, 0.284, 0.182, 0.913, 0.895, 0.748, 0.787, 0.736, 0.684, and 0.734, respectively, P<0.01). The regression equations were Y=0.514X+ 52.214, Y=0.785X+ 42.897, Y=0.600X+ 47.327, Y=0.436X+ 53.056, Y=0.117X+ 0.019, Y=0.070X-0.169, Y=0.013X+ 0.054, Y=0.065X+ 0.180, Y=0.014X+ 0.064, Y=0.047X+ 0.547, and Y=0.027X-0.116, respectively.

Conclusions

The serial transverse sections based on 3D oblique technique and frozen autopsy specimens are relatively stable and can be used to evaluate the structure of corpus callosum. The reference charts for normal fetal corpus callosum of different gestational ages may be useful for prenatal evaluation of congenital corpus callosum anomalies.

图3 三维自由解剖成像法所得颅脑横切面上胼胝体体部观测切面
图4 冰冻解剖胼胝体大体图像。图a为胼胝体最大前后径横断面;图b为胼胝体膝部和压部观测横断面;图c为胼胝体体部观测横断面
图5 胼胝体最大前后径二维横切面超声图及模式图。图a为胼胝体最大前后径二维横切面超声图;图b为该切面对应模式图
图6 胼胝体膝部和压部二维横切面超声测量图及模式图。图a为胼胝体膝部和压部左右径及前后径切面及测量图;图b为该切面对应模式图;图c为胼胝体膝部和压部前角及后角测量图;图d为该切面对应模式图
图7 胼胝体体部二维横切面超声测量图及模式图。图a为胼胝体体部二维超声测量图;图b为该切面对应模式图
表1 两观察者所测参数正态性检验结果
表2 两观察者各测值间的配对t检验结果
表3 两观察者各测值间的Wilcoxon带符号秩检验
图8 胼胝体各参数与孕周的散点图。图a为膝部前角与孕周分布的散点图;图b为膝部后角与孕周分布的散点图;图c为压部前角与孕周分布的散点图;图d为压部后角与孕周分布的散点图;图e为膝部左右径与孕周分布的散点图;图f为膝部前后径与孕周分布的散点图;图g为压部左右径与孕周分布的散点图;图h为压部前后径与孕周分布的散点图;图i为体部前后径与孕周分布的散点图;图j为体部左右径与孕周分布的散点图;图k为胼胝体最大前后径与孕周分布的散点图
表4 胼胝体各参数的正常参考值范围
孕周(例数) 膝部前角(° 膝部后角(° 压部前角(° 压部后角(° 最大前后径(cm) 膝部左右径(cm)
20(24) 54.7(32.9,77.7) 54.3(39.2,70.0) 50.5(32.4,60.2) 45.4(34.3,57.2) 1.88(1.50,2.12) 1.16(0.94,1.40)
21(29) 62.1(39.2,78.5) 60.3(42.2,71.9) 57.8(36.8,73.5) 57.3(34.1,74.9) 2.21(1.57,2.70) 1.23(0.99,1.56)
22(34) 65.7(49.9,85.7) 58.8(44.5,79.6) 59.7(47.5,79.2) 60.9(46.1,87.5) 2.53(2.31,2.85) 1.34(1.13,1.57)
23(41) 67.2(56.5,84.8) 62.5(51.3,77.7) 63.0(52.9,73.3) 63.8(47.9,81.1) 2.74(2.46,2.97) 1.50(1.29,1.69)
24(57) 68.9(51.6,84.9) 64.6(50.5,78.6) 62.4(47.7,88.8) 65.8(48.5,87.9) 2.83(2.57,3.16) 1.54(1.28,1.69)
25(53) 65.1(51.6,81.6) 62.7(52.3,76.4) 64.1(47.5,78.6) 68.0(47.5,86.2) 3.00(2.62,3.38) 1.57(1.36,1.88)
26(37) 63.6(47.6,79.0) 60.7(47.9,78.9) 62.0(49.5,80.4) 67.0(48.9,87.0) 3.26(2.78,3.62) 1.69(1.45,1.94)
27(30) 69.1(46.8,83.4) 63.9(48.0,79.0) 62.3(51.1,81.7) 67.1(49.0,86.0) 3.35(3.03,3.65) 1.73(1.51,1.97)
28(38) 63.8(52.1,85.5) 63.3(50.5,80.4) 66.2(54.2,76.2) 71.3(54.2,86.6) 3.48(3.16,3.84) 1.82(1.59,2.07)
29(26) 66.4(54.1,89.7) 64.5(52.6,84.8) 66.0(48.7,85.7) 67.5(48.4,88.9) 3.65(3.24,4.16) 1.86(1.61,2.19)
30(81) 64.3(49.3,81.0) 64.7(49.2,78.4) 64.1(46.8,83.7) 65.6(45.9,80.6) 3.71(3.30,4.05) 1.97(1.60,2.32)
31(41) 67.3(50.3,80.5) 68.8(54.4,84.2) 65.3(48.7,80.0) 65.0(42.6,84.7) 3.70(3.35,4.15) 2.01(1.62,2.34)
32(39) 67.0(49.0,89.0) 67.6(49.3,88.1) 72.4(49.5,90.3) 72.2(45.7,89.7) 3.80(3.53,4.20) 2.10(1.71,2.36)
33(24) 70.4(40.2,85.8) 69.3(42.5,88.7) 71.5(47.4,103.8) 72.0(41.4,104.6) 3.80(2.96,4.23) 2.058(1.6,2.39)
34(22) 70.9(47.8,87.5) 69.4(50.0,85.9) 68.3(49.7,86.9) 69.0(50.0,87.4) 3.92(3.60,4.33) 2.25(1.92,2.56)
35(20) 70.48(49.0,84.6) 67.6(47.7,84.3) 60.4(49.8,81.5) 62.2(53.5,78.9) 3.86(3.56,4.27) 2.28(1.86,2.82)
36(34) 75.6(49.3,96.3) 76.5(49.4,98.1) 65.4(53.7,80.8) 63.4(53.4,81.6) 3.97(3.53,4.49) 2.31(1.77,2.80)
≥37(40) 71.3(44.6,91.5) 73.0(47.3,95.3) 65.5(51.5,86.5) 64.1(49.0,83.4) 4.15(3.78,4.63) 2.39(1.71,2.83)
孕周(例数) 膝部前后径(cm) 压部左右(cm) 压部前后径(cm) 体部前后径(cm) 体部左右径(cm)
20(24) 0.28(0.23,0.40) 1.32(1.08,1.68) 0.31(0.27,0.39) 1.24(1.03,1.48) 0.43(0.34,0.54)
21(29) 0.30(0.25,0.40) 1.47(1.13,1.93) 0.34(0.27,0.41) 1.43(1.19,1.68) 0.44(0.30,0.56)
22(34) 0.35(0.26,0.42) 1.59(1.32,1.88) 0.37(0.30,0.43) 1.59(1.23,1.85) 0.48(0.36,0.63)
23(41) 0.36(0.29,0.45) 1.67(1.42,1.93) 0.39(0.31,0.46) 1.60(1.29,1.92) 0.51(0.38,0.75)
24(57) 0.38(0.31,0.50) 1.78(1.44,2.02) 0.39(0.33,0.49) 1.67(1.29,1.97) 0.55(0.41,0.67)
25(53) 0.39(0.30,0.46) 1.79(1.38,2.14) 0.40(0.33,0.51) 1.72(1.38,2.08) 0.52(0.38,0.72)
26(37) 0.41(0.34,0.50) 1.89(1.63,2.28) 0.41(0.36,0.50) 1.88(1.50,2.26) 0.60(0.38,0.73)
27(30) 0.41(0.34,0.52) 1.98(1.74,2.32) 0.42(0.34,0.51) 1.89(1.62,2.39) 0.62(0.40,0.77)
28(38) 0.44(0.35,0.56) 2.17(1.71,2.57) 0.47(0.36,0.59) 1.96(1.59,2.45) 0.64(0.49,0.86)
29(26) 0.46(0.36,0.56) 2.03(1.61,2.73) 0.45(0.32,0.57) 1.91(1.57,2.38) 0.74(0.32,0.93)
30(81) 0.48(0.37,0.63) 2.24(1.83,2.69) 0.52(0.42,0.69) 1.97(1.63,2.60) 0.74(0.52,0.94)
31(41) 0.48(0.39,0.62) 2.18(1.84,2.71) 0.48(0.38,0.65) 1.97(1.68,2.34) 0.68(0.49,1.00)
32(39) 0.48(0.36,0.58) 2.26(1.86,2.89) 0.51(0.37,0.60) 2.03(1.67,2.50) 0.74(0.52,0.97)
33(24) 0.48(0.39,0.59) 2.28(1.84,2.86) 0.50(0.39,0.78) 1.98(1.54,2.55) 0.76(0.50,1.02)
34(22) 0.49(0.35,0.60) 2.47(2.11,2.99) 0.52(0.38,0.68) 2.17(1.91,2.41) 0.73(0.57,0.98)
35(20) 0.50(0.42,0.63) 2.42(2.03,2.81) 0.51(0.45,0.63) 2.12(1.51,2.41) 0.77(0.44,1.03)
36(34) 0.51(0.41,0.71) 2.32(1.89,2.93) 0.55(0.39,0.79) 2.07(1.78,2.56) 0.84(0.60,1.23)
≥37(40) 0.55(0.44,0.71) 2.55(1.99,3.01) 0.56(0.43,0.75) 2.15(1.51,2.89) 0.93(0.57,1.26)
表5 胼胝体各参数与孕周线性回归分析结果
1
Aboitiz F, Montiel J. One hundred million years of interhemispheric communication: the history of the corpus callosum [J]. Braz J Med Biol Res, 2003, 36(4): 409-420.
2
Malinger G, Zakut H. The corpus callosum: normal fetal development as shown by transvaginal sonography [J]. AJR Am J Roentgenol, 1993, 161(5): 1041-1043.
3
Achiron R, Achiron A. Development of the human fetal corpus callosum: a high-resolution, cross-sectional sonographic study [J]. Ultrasound Obstet Gynecol, 2001, 18(4): 343-347.
4
Monteagudo A, Timor-Tritsch IE. Normal sonographic development of the central nervous system from the second trimester onwards using 2D, 3D and transvaginal sonography [J]. Prenat Diagn, 2009, 29(4): 326-339.
5
徐晚虹, 金鹏, 李少辉, 等. 二维超声测量20~40周正常胎儿胼胝体径线[J]. 福建医科大学学报, 2008, 42(3): 280-283.
6
Miguelote RF, Vides B, Santos RF, et al. The role of three-dimensional imaging reconstruction to measure the corpus callosum: comparison with direct mid-sagittal views [J]. Prenat Diagn, 2011, 31(9): 875-880.
7
黎文雅. 中晚孕期胼胝体缺失超声相关间接征象系列研究及早孕期筛查胼胝体缺失高危人群新方法探索[D]. 南方医科大学, 2014, 34: 1092-1097.
8
Malinger G, Lerman-Sagie T, Viñals F. Three-dimensional sagittal reconstruction of the corpus callosum: fact or artifact? [J]. Ultrasound Obstet Gynecol, 2006, 28(5): 742-743.
9
International Society of Ultrasound in Obstetrics & Gynecology Education Committee. Sonographic examination of the fetal central nervous system: guidelines for performing the ′basic examination′ and the ′fetal neurosonogram′ [J]. Ultrasound Obstet Gynecol, 2007, 29(1): 109-116.
10
Winter TC, Kennedy AM, Byrne J, et al. The cavum septi pellucidi: why is it important? [J]. J Ultrasound Med, 2010, 29(3): 427-444.
11
Griffiths PD, Batty R, Reeves MJ, et al. Imaging the corpus callosum, septum pellucidum and fornix in children: normal anatomy and variations of normality [J]. Neuroradiology, 2009, 51(5): 337-345.
12
Barkovich AJ, Lyon G, Evrard P. Formation, maturation, and disorders of white matter [J]. AJNR Am J Neuroradiol, 1992, 13(2): 447-461.
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