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中华医学超声杂志(电子版) ›› 2022, Vol. 19 ›› Issue (09) : 888 -893. doi: 10.3877/cma.j.issn.1672-6448.2022.09.004

所属专题: 经典病例

妇产科超声影像学

妊娠11~13+6周胎儿侧脑室脉络丛参数初步研究及异常病例分析
张书杰1, 姜凡1,(), 罗平1, 顾莉莉1, 高玉伟1, 周楠1   
  1. 1. 230601 合肥,安徽医科大学第二附属医院超声诊断科
  • 收稿日期:2022-04-12 出版日期:2022-09-01
  • 通信作者: 姜凡

Preliminary study on parameters of the choroid plexus of fetal lateral ventricle during 11 to 13+6 weeks of gestation and analysis of abnormal cases

Shujie Zhang1, Fan Jiang1,(), Ping Luo1, Lili Gu1, Yuwei Gao1, Nan. Zhou1   

  1. 1. Department of Ultrasonography, the Second Affiliated Hospital of Anhui Medical University, Hefei 230601, China
  • Received:2022-04-12 Published:2022-09-01
  • Corresponding author: Fan Jiang
引用本文:

张书杰, 姜凡, 罗平, 顾莉莉, 高玉伟, 周楠. 妊娠11~13+6周胎儿侧脑室脉络丛参数初步研究及异常病例分析[J/OL]. 中华医学超声杂志(电子版), 2022, 19(09): 888-893.

Shujie Zhang, Fan Jiang, Ping Luo, Lili Gu, Yuwei Gao, Nan. Zhou. Preliminary study on parameters of the choroid plexus of fetal lateral ventricle during 11 to 13+6 weeks of gestation and analysis of abnormal cases[J/OL]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2022, 19(09): 888-893.

目的

分析正常妊娠11~13+6周胎儿侧脑室脉络丛相关参数及其价值。

方法

选取2017年1月至2021年1月在安徽医科大学第二附属医院超声诊断科行早孕期胎儿结构筛查的正常胎儿277例(妊娠11~13+6周),测量胎儿双侧侧脑室脉络丛长径、面积及大脑镰长度(CF-L),侧脑室脉络丛长径、面积,采用配对t检验分析左、右侧有无差异;侧脑室脉络丛平均长径(CP-L)、侧脑室脉络丛总面积(CP-A)、CP-L/CF-L与头臀长(CRL)的相关性采用Pearson相关性分析;以CRL作为自变量,CP-L、CP-A、CP-L/CF-L作为因变量,应用简单线性回归模型探索分析变量之间的关系,并建立CRL与相关参数测量值的线性回归方程;同时分析2017年1月至2022年3月在安徽医科大学第二附属医院超声诊断科行早孕期胎儿结构筛查发现的侧脑室脉络丛异常的11例胎儿(妊娠11~13+6周)的侧脑室脉络丛参数。

结果

正常妊娠11~13+6周胎儿左侧与右侧侧脑室脉络丛长径、面积差异均无统计学意义(P均>0.05)。CP-L与CRL呈线性正相关(r=0.681,P<0.001),线性回归方程为:CP-L=0.134×CRL+0.577;CP-A与CRL呈线性正相关(r=0.736,P<0.001),线性回归方程为:CP-A=0.251×CRL-0.267;CP-L/CF-L与CRL呈线性负相关(r=-0.514,P<0.001),线性回归方程为:CP-L/CF-L=-0.047×CRL+1.011。早孕期侧脑室脉络丛异常者共11例,其中3例为双侧侧脑室脉络丛融合,1例为无侧脑室脉络丛,1例为侧脑室脉络丛不对称,另6例为侧脑室脉络丛小。

结论

妊娠11~13+6周时,CP-L、CP-A、CP-L/CF-L与CRL呈线性相关,为侧脑室脉络丛检查提供一个可参考范围,具有一定的临床意义。

Objective

To study the parameters of the choroid plexus of the lateral ventricle in normal fetuses during 11 to 13+6 weeks of gestation and to analyze their clinical value.

Methods

From January 2017 to January 2021, 277 normal fetuses (during 11 to 13+6 weeks of gestation) who underwent fetal structure screening at the Second Affiliated Hospital of Anhui Medical University were selected to measure the length and area of bilateral ventricular choroid plexus and the length of the cerebral falx (CF-L). The length and area of the choroid plexus of bilateral ventricles were analyzed by paired t test. Pearson correlation analysis was performed to determine the correlation between the mean length of the choroid plexus of lateral ventricle (CP-L), the total area of the choroid plexus of lateral ventricle (CP-A), CP-L/CF-L ratio, and crown-rump length (CRL). Using CRL as the independent variable and CP-L, CP-A, and CP-L/CF-L ratio as dependent variables, a simple linear regression model was used to explore the relationship between the variables, and linear regression equations between CRL and the values of related parameters were established. Meanwhile, the parameters of 11 fetuses with abnormal choroid plexus of the lateral ventricle were analyzed, who underwent fetal structure screening at the Second Affiliated Hospital of Anhui Medical University during 11 to 13+6 weeks of gestation from January 2017 to March 2022.

Results

There were no statistically significant differences in the length and area of the choroid plexus between the left and right lateral ventricles in normal fetuses during 11 to 13+6 weeks of gestation (P>0.05). The linear regression equation of CP-L and CRL was: CP-L=0.134×CRL+0.577 (r=0.681, P<0.001), showing a positive linear correlation. The linear regression equation of CP-A and CRL was: CP-A=0.251×CRL-0.267 (r=0.736, P<0.001), showing a positive linear correlation. The linear regression equation of CP-L/CF-L ratio and CRL was: CP-L/CF-L ratio=-0.047×CRL+1.011 (r=-0.514, P<0.001), showing a linear negative correlation. There were 11 cases of abnormal lateral ventricular choroid plexus in early pregnancy, including 3 cases of bilateral choroid plexus fusion, 1 case of absence of lateral ventricular choroid plexus, 1 case of asymmetric lateral ventricular choroid plexus, and 6 cases of small lateral ventricular choroid plexus.

Conclusion

CP-L, CP-A, and CP-L/ CF-L are linearly correlated with CRL during 11 to 13+6 weeks of gestation, which provides a reference range for the examination of the choroid plexus of the lateral ventricle and has appreciated clinical significance.

图1 侧脑室脉络丛长径及面积测量方法。图a中蓝色线段为大脑镰长度,沿着侧脑室脉络丛前缘和后缘作垂直于大脑镰的垂线(红色线段),绿色线段为双侧侧脑室脉络丛长径;图b为侧脑室脉络丛面积测量
表1 妊娠11~13+6周胎儿侧脑室脉络丛相关参数测量值范围(
xˉ
±s
图2 侧脑室脉络丛平均长径(CP-L)与胎儿头臀长(CRL)相关性散点图(黑点为正常组,红点为异常组)
图3 侧脑室脉络丛总面积(CP-A)与胎儿头臀长(CRL)相关性散点图(黑点为正常组,红点为异常组)
图4 侧脑室脉络丛平均长径(CP-L)/大脑镰长度(CF-L)与胎儿头臀长(CRL)相关性散点图(黑点为正常组,红点为异常组)
表2 早孕期11例侧脑室脉络丛异常病例情况
病例 孕周(周) 侧脑室脉络丛异常表现 合并畸形 染色体检查结果 中孕超声检查结果 妊娠结局
1 13+5 侧脑室脉络丛融合 无叶全前脑并全前脑面部畸形 16p11.2p11.2区域约1.78 Mb缺失 终止妊娠
2 13+4 侧脑室脉络丛融合 无叶全前脑并全前脑面部畸形 终止妊娠
3 13+5 侧脑室脉络丛融合 无叶全前脑并全前脑面部畸形 终止妊娠
4 13+1 双侧侧脑室脉络丛不显示 静脉导管a波反向,单脐动脉 5 d后复查超声,胎死宫内 终止妊娠
5 12+4 双侧侧脑室脉络丛不对称(右侧较左侧偏短) 双耳不对称(左侧偏小) 低深度全基因组测序(CNV-seq)未见致病异常 左侧小耳畸形,余未见明显异常 终止妊娠
6 11+6 双侧侧脑室脉络丛偏小、不对称右侧侧脑室脉络丛呈“悬挂征” 大脑镰前半部分向左侧偏移 CNV-seq未见致病异常 右侧脑室增宽伴脑中线左移,局部脑中线不连续 终止妊娠
7 13+6 侧脑室脉络丛体积偏小,左右不对称 颜面部异常、右上肢一侧长骨缺失,右腕关节侧翻,脊柱侧弯 终止妊娠
8 11+6 侧脑室脉络丛体积偏小,左右不对称 胎儿水肿、颈部水囊瘤、后脑发育异常、小眼小耳小下颌 终止妊娠
9 13+0 侧脑室脉络丛小 丘脑部分融合,腭裂,室间隔缺损 半叶全前脑、唇腭裂、室间隔缺损 终止妊娠
10 12+1 侧脑室脉络丛小 丘脑前方局部脑中线中断 半叶全前脑 终止妊娠
11 12+4 侧脑室脉络丛小 双侧脑室、第三脑室扩张 脑积水 终止妊娠
图5 妊娠11~13+6周异常侧脑室脉络丛声像图。图a全前脑,融合的丘脑前方可见单一侧脑室,脉络丛融合,“蝴蝶征”消失;图b侧脑室脉络丛不显示,但大脑镰存在;图c左侧及右侧侧脑室脉络丛长径及面积均在正常范围,但两侧脉络丛不对称;图d双侧侧脑室脉络丛偏小、不对称,大脑镰前半部分向左侧移位;图e双侧侧脑室脉络丛小、不对称,失去“蝴蝶征”形态,分别呈三角形及椭圆形;图f侧脑室脉络丛缩短,集中在颅脑后方,失去“蝴蝶征”形态,呈近似圆形
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