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中华医学超声杂志(电子版) ›› 2022, Vol. 19 ›› Issue (07) : 667 -674. doi: 10.3877/cma.j.issn.1672-6448.2022.07.013

所属专题: 妇产科超声影像学

妇产科超声影像学

胎儿大脑皮层观察的新方法:三维颅脑表面反转成像法
温昕1, 钟晓红1, 文华轩1, 彭桂艳1, 廖伊梅1, 罗丹丹1, 杨霞1, 谭莹1, 丁妍1, 李胜利1,()   
  1. 1. 518028 南方医科大学第一临床医学院,深圳市妇幼保健院超声科
  • 收稿日期:2021-03-18 出版日期:2022-07-01
  • 通信作者: 李胜利
  • 基金资助:
    国家自然科学基金(81771598)

A new method for observation of the fetal cerebral cortex: three-dimensional brain surface inversion imaging

Xin Wen1, Xiaohong Zhong1, Huaxuan Wen1, Guiyan Peng1, Yimei Liao1, Dandan Luo1, Xia Yang1, Yin Tan1, Yan Ding1, Shengli Li1,()   

  1. 1. Department of Ultrasound, Shenzhen Maternity and Child Healthcare Hospital the First School of Clinical Medicine, Southern Medical University, Shenzhen 518028, China
  • Received:2021-03-18 Published:2022-07-01
  • Corresponding author: Shengli Li
引用本文:

温昕, 钟晓红, 文华轩, 彭桂艳, 廖伊梅, 罗丹丹, 杨霞, 谭莹, 丁妍, 李胜利. 胎儿大脑皮层观察的新方法:三维颅脑表面反转成像法[J/OL]. 中华医学超声杂志(电子版), 2022, 19(07): 667-674.

Xin Wen, Xiaohong Zhong, Huaxuan Wen, Guiyan Peng, Yimei Liao, Dandan Luo, Xia Yang, Yin Tan, Yan Ding, Shengli Li. A new method for observation of the fetal cerebral cortex: three-dimensional brain surface inversion imaging[J/OL]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2022, 19(07): 667-674.

目的

研究三维颅脑表面反转成像法在产前评价正常胎儿颅脑沟回的临床应用价值。

方法

选取2019年6月至2020年7月在深圳市妇幼保健院行产前超声检查诊断无结构异常的133例19~36周正常单胎胎儿作为研究对象。观察不同孕周外侧裂、顶枕沟、距状沟在超声二维、三维表面成像中的显示、变化情况。检查结果按胎龄分为6组,按缺失或存在进行统计,形态变化汇总成图片。采用Pearson χ2检验比较二维超声和三维新方法对外侧裂、顶枕沟、距状沟显示率的差异。随机抽取30例胎儿进行研究者内和研究者间的重复性检验。

结果

随着妊娠周数的增加,胎儿颅脑外侧裂、顶枕沟、距状沟的二维和三维超声检查的显示率都越来越高。二维、三维超声对22周外侧裂,23周、24~36周外侧裂、顶枕沟和距状沟显示率均达100%。二维观察与三维反转成像法的超声显示率差异无统计学意义(P均>0.05)。三维反转成像显示沟回变化比二维超声更直观,更加接近实际解剖形态的变化。研究者内和研究间重复性检验显示一致性均可接受(Kappa系数均>0.7)。

结论

三维反转成像法可以直观形象地观察顶枕沟、距状沟、外侧裂的形态及空间变化情况,对于产前评估大脑皮层发育是一种补充手段,为未来大脑皮层发育的教学与研究提供了一种新的思路。

Objective

To evaluate the clinical value of prenatal three-dimensional (3D) inversion imaging of the sylvian fissure, parietal occipital sulcus, and calcarine sulcus.

Methods

The sylvian fissure, parietal occipital sulcus, and calcarine sulcus were assessed prospectively by 3D ultrasound (3D-US) inversion imaging and two-dimensional ultrasound (2D-US) in 133 fetuses with no structural abnormalities between 19 and 36+6 weeks of gestation at Shenzhen Maternity and Child Healthcare Hospital from June 2019 to July 2020. The examinations were divided into six groups according to gestational age. For each group, these sulci were assessed as absent or present. The changes of these 3D sulci imaging were observed in different groups. Thirty fetuses were randomly selected for intra- and inter-observer reproducibility testing by pearson chi-square test.

Results

Along with the increase of the gestation age in different groups, the rates of 2D and 3D examinations to display the structures both became higher and higher. 2D-US and 3D-US showed 100% of sylvian fissure, parietal occipital sulcus, and calcarine sulcus at 22, 23, and 24~36 weeks, respectively. The display rate had no statistical difference between 2D-US and 3D inverted ultrasound in the six groups (P>0.05). However, 3D inversion ultrasound was more vivid and intuitive than 2D-US. No significant intra- and inter-observer variability was found.

Conclusion

3D inversion imaging can be used to better observe the morphological and spatial changes of the sylvian fissure, parietal occipital sulcus, and calcarine sulcus during middle and late pregnancy, which is an intuitive supplementary means for prenatal evaluation of cerebral cortex development and provides a new idea for future teaching and research of cerebral cortex development.

图1 胎儿产前、产后外侧裂切面及三维容积成像示意图。图a为32周胎儿切面标本示意图;图b为胎儿外侧裂三维容积表面成像图;图c为32周胎儿丘脑横切面外侧裂产前图;图d为模式图。图中白色箭头标注的是外侧裂 注:LVAH为侧脑室前角,CSP为透明隔腔、T为丘脑、TV为第三脑室、AC为环池、GCC为胼胝体膝部,SF为外侧裂
图2 胎儿颅脑超声三维观察切面调节示意图。图a为三维容积界面对外侧裂进行成像示意图,感兴趣区域线通过外侧裂及颅脑表面:图b为外侧裂(黑色箭头)及颅脑表面成像放大图示;图c三维容积界面对顶枕沟距状沟进行成像示意图,感兴趣区域线通过顶枕沟和距状沟结构;图d为顶枕沟(黑色箭头)距状沟(白色箭头)表面成像放大图示
图3 胎儿产前、产后顶枕沟距状沟切面及三维容积成像示意图。图a 28周标本可同时显示顶枕沟距状沟正中矢状切面示意图:图b为28周胎儿顶枕沟距状沟三维容积表面成像图;图c为产前胎儿距状沟切面示意图;图d为模式图。图a~c中黑色箭头为顶枕沟,白色箭头为距状沟 注:POF为顶枕沟、CaS为距状沟,CC为胼胝体、CSP为透明隔腔、CV为小脑蚓
表1 不同孕周组二维、三维超声观察胎儿外侧裂、顶枕沟、距状沟显示率比较[人(%)]
图4 外侧裂平面在不同孕周的三维新方法图示。图a~f分别为22周、24周、26周、28周、30周、32周的三维表面成像图示。外侧裂(黑色箭头围住的三角形结构)图示中均可显示,图中颞上沟(黄色箭头)走行逐渐加深,还可见额下沟(红色箭头)和中央沟(白色箭头)图5 顶枕沟距状沟平面在不同孕周的三维新方法图示。图a~f分别为22周、24周、26周、28周、30周、32周的三维成像图示。20周顶枕沟、距状沟显示欠清,可见透明隔腔及部分胼胝体;22周顶枕沟(黑色箭头)显示清晰,该图距状沟为一个小切迹(白色箭头);24周时顶枕沟和距状沟已经逐步形成“Y”字结构,随孕周增长,26周后顶枕沟距状沟图示中均清晰可见,随孕周增长逐渐加深,走行逐渐迂曲
图6 22周外侧裂异常胎儿与正常胎儿颅脑图示。图a为颅脑异常胎儿切迹样二维超声外侧裂图像;图b为22周正常胎儿平台状外侧裂图像;图c三维新方法示异常外侧裂为细线状,未见明显脑岛结W构,脑表面光滑未见明显沟回;图d显示正常胎儿孕22周外侧裂呈三角形,深面可见在发育中的脑岛
表2 两观察者间、观察者内的重复性检验[Kappa值(95%CI)]
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