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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） ›› 2021, Vol. 18 ›› Issue (12) : 1173 -1179. doi: 10.3877/cma.j.issn.1672-6448.2021.12.009

妇产科超声影像学

产前超声诊断胎儿半椎体的价值
季春亚1, 殷林亮1,†(), 邓学东1, 杨忠1   
  1. 1. 215000　江苏苏州，南京医科大学附属苏州医院超声中心
  • 收稿日期:2020-10-14 出版日期:2021-12-01
  • 通信作者: 殷林亮

Diagnostic value of prenatal ultrasound in fetal hemivertebra

Chunya Ji1, Linliang Yin1,†(), Xuedong Deng1, Zhong Yang1   

  1. 1. Center for Medical Ultrasound, the Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou 215000, China
  • Received:2020-10-14 Published:2021-12-01
  • Corresponding author: Linliang Yin
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季春亚, 殷林亮, 邓学东, 杨忠. 产前超声诊断胎儿半椎体的价值[J]. 中华医学超声杂志（电子版）, 2021, 18(12): 1173-1179.

Chunya Ji, Linliang Yin, Xuedong Deng, Zhong Yang. Diagnostic value of prenatal ultrasound in fetal hemivertebra[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2021, 18(12): 1173-1179.

目的

探讨胎儿半椎体的产前超声声像图特征及产前超声的诊断价值。

方法

回顾性选取2015年1月至2019年12月南京医科大学附属苏州医院进行产前超声结构筛查的胎儿图像，分析超声诊断为半椎体的胎儿产前超声声像图特征、合并畸形情况，胎儿均随访至出生后或引产后。应用四格表评价产前超声诊断胎儿半椎体的诊断价值。

结果

共100 822例胎儿纳入研究。其中产前超声诊断的97例半椎体胎儿中，67例为单发性半椎体，30例为多发性半椎体，合并最多的畸形是血管异常（17例）、中枢神经系统畸形（16例）、心脏异常（16例）及泌尿系统畸形（15例）。经随访，7例失访，90例半椎体中84例通过胎儿磁共振、出生后或引产后X线检查等证实，4例蝴蝶椎误诊为半椎体，2例正常。产前超声未见明显异常的98 562例胎儿经随访，2958例失访，95 595例出生后正常，有9例半椎体胎儿产前超声漏诊，均在出生后证实。产前超声对胎儿半椎体的诊断符合率为93.33%（84/90），敏感度为90.32%（84/93），特异度为99.99%（95 595/95 597），阳性预测值为97.67%（84/86），阴性预测值为99.99%（95 595/95 604）。

结论

半椎体具有典型的超声声像图特征，产前超声是诊断胎儿半椎体畸形的主要手段，敏感度和特异度均较高，有利于明确病变的类型和部位、早期诊断、评估胎儿预后及临床处理。

关键词: 胎儿, 半椎体, 超声检查，产前, 诊断
Objective

To explore the characteristics of prenatal ultrasonography characteristics of fetal hemivertebra to assess the clinical value of prenatal ultrasonography in this congenital spinal abnormality.

Methods

Fetal ultrasound images for fetuses who underwent prenatal ultrasound structural screening at Suzhou Hospital Affiliated to Nanjing Medical University from January 2015 to December 2019 were selected. Ultrasonographic features and associated malformations of fetal hemivertebra were analyzed. All fetuses were followed to birth or induction of labor. The value of prenatal ultrasound in the diagnosis of fetal hemivertebral body was then assessed.

Results

A total of 100 822 fetuses were included in the study. Among them, 97 cases of hemivertebra were diagnosed by prenatal ultrasound, including 67 cases of single hemivertebra and 30 cases of multiple hemivertebra. The most common associated malformations were vascular anomalies (17 cases), central nervous system anomalies (16 cases), urinary anomalies (16 cases), and cardiac anomalies (15 cases). During follow-up, 7 cases were lost. Of the remaining 90 cases of hemivertebra, 84 were confirmed by fetal magnetic resonance imaging (MRI), X-ray examination after birth, or induction of labor, 4 were finally diagnosed as butterfly vertebrae, and 2 were normal. Out of 98 562 fetuses without abnormal ultrasound findings who were followed, 2958 were lost to follow-up, 95 595 were normal after birth, and 9 were misdiagnosed by prenatal ultrasound, which were confirmed after birth. The diagnostic accuracy of prenatal ultrasound for hemivertebra was 93.33% (84/90), and the sensitivity, specificity, positive predictive value, and negative predictive value were 90.32% (84/93), 99.99% (95 595/95 597), 97.67% (84/86), and 99.99% (95 595/95 604), respectively.

Conclusion

Hemivertebra has typical ultrasonographic characteristics. Prenatal ultrasound is the main approach to diagnose fetal hemivertebra, with a high sensitivity and specificity, which is conducive to evaluation of the type and location of lesions, early diagnosis, evaluation of fetal prognosis, and clinical management.

Key words: Fetus, Hemivertebra, Ultrasonography, prenatal, Diagnosis
表1 胎儿半椎体的类型、合并其他系统异常情况及妊娠结局（例）
类型 妊娠结局 未合并其他系统异常 合并其他系统异常
单发半椎体 正常 23 5
终止妊娠 20 19
多发半椎体 正常 1 0
终止妊娠 9 20
表2 胎儿半椎体合并其他系统异常详细情况
系统异常 例数 详细分类
血管异常 17 单脐动脉15例；门体静脉分流2例
中枢神经系统畸形 16 小脑发育不良5例；脑积水3例；脑膨出2例；颅缝早闭2例；Blake's囊肿2例；胼胝体缺失1例；前脑无裂畸形1例
泌尿系统畸形 15 肾缺如（单侧或双侧）7例；肾积水3例；多囊性肾发育不良2例；梗阻性肾发育不良1例；盆腔肾1例；马蹄肾1例；巨膀胱1例
心脏异常 16 右心室双出口5例；左心室发育不良3例；单心房、单心室1例；完全性房室间隔缺损1例；心包积液1例；心脏增大、心肌肥厚1例
颜面部异常 10 唇腭裂5例；小下颌3例；小眼畸形1例；眼球缺如1例
肢体畸形 8 足内翻6例；并腿畸形、桡骨缺失1例；手足姿势异常1例
消化道畸形 4 消化道闭锁3例；肠重复畸形1例
异常积液 4 全身水肿2例；淋巴水囊瘤2例；腹腔积液1例
图1 胎儿产前二维超声脊柱旁矢状切面示第10胸椎椎体偏小、排列紊乱
图2 胎儿产前二维超声脊柱冠状切面示第2腰椎椎体偏于一侧，椎体强回声不在同一条直线上
图3 胎儿产前二维超声脊柱横切面示椎体变小、边缘模糊、偏于一边，正常“品”字形结构消失
图4 胎儿三维超声成像示脊柱侧弯、半椎体偏于一侧
图5 胎儿三维超声成像示病变椎体缩小，呈楔形，边缘较模糊
表3 产前超声诊断及出生后胎儿半椎体的情况
产前超声诊断 出生后 合计
半椎体 正常
半椎体 84 2 86
正常 9 95 595 95 604
合计 93 95 597
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