中华医学超声杂志（电子版） ›› 2023, Vol. 20 ›› Issue (01) : 23 -27. doi: 10.3877/cma.j.issn.1672-6448.2023.01.004 × 扫一扫
妇产科超声影像学
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Xiaowei Xue1, Chao Zhang1, Yani Yan1, Zhenjuan Yang1, Yuntao Li1, Xiaohong Zhang1, Qiuyan Pei1,†()
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薛小伟, 张超, 闫亚妮, 杨振娟, 李云桃, 张晓红, 裴秋艳. 连续横向扫查结合连续冠状扫查对胎儿双主动脉弓的诊断价值[J]. 中华医学超声杂志（电子版）, 2023, 20(01): 23-27.
Xiaowei Xue, Chao Zhang, Yani Yan, Zhenjuan Yang, Yuntao Li, Xiaohong Zhang, Qiuyan Pei. Value of continuous transverse scanning combined with continuous coronary scanning in diagnosis of fetal double aortic arch[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(01): 23-27.
探讨连续横向扫查（CTS）结合连续冠状扫查（CCS）方法在胎儿右位主动脉弓合并镜像分支（MB-RAA）与胎儿双主动脉弓（DAA）鉴别诊断中的价值。
采用队列研究方法，对2017年1月至2020年2月北京大学人民医院经产前超声CTS方法诊断的42例MB-RAA及DAA胎儿，利用CTS结合CCS方法复核上述诊断。随访至胎儿引产或出生后。采用McNemar检验比较CTS与CTS结合CCS方法对胎儿DAA的诊断准确率差异。
采用CTS方法诊断MB-RAA胎儿39例（孤立性22例，合并心内畸形者15例，合并心外畸形者6例，其中合并心内、外畸形病例存在重叠），DAA胎儿3例（均未发现心内心外其他结构异常）；采用CTS结合CCS方法复核，最终诊断MB-RAA胎儿32例，DAA胎儿10例（包括7例CTS方法诊断为孤立性MB-RAA者）。引产13例，足月分娩29例（包括10例产前诊断为DAA，17例产前诊断为孤立性MB-RAA，1例MB-RAA合并法洛四联症，1例MB-RAA合并轻度脑室增宽）。随访至胎儿出生后：1例MB-RAA合并法洛四联症胎儿出生后手术治疗，术中证实诊断；1例MB-RAA合并轻度脑室增宽及16例孤立性MB-RAA均无压迫症状；另1例孤立性MB-RAA出生后6个月出现喘鸣，行CT检查诊断为DAA，并行手术治疗；10例产前诊断为DAA的新生儿，2例出生后出现压迫症状行手术治疗，8例复查超声或CT均证实DAA，无压迫症状暂时观察。CTS结合CCS方法产前诊断DAA的诊断准确率高于CTS方法（10/42 vs 3/42），且差异具有统计学意义（P=0.016）。
CTS结合CCS方法能提高产前超声诊断DAA的准确率，有助于DAA与MB-RAA的鉴别诊断。
To assess the value of continuous transverse scanning (CTS) combined with continuous coronary scanning (CCS) in the differential diagnosis between fetal right aortic arch with mirror branch (MB-RAA) and double aortic arch (DAA).
This is a cohort study conducted at our hospital between January 2017 and February 2020. Forty-two cases of MB-RAA and DAA fetuses diagnosed by CTS were included in the study. CTS combined with CCS was used to review the diagnosis. The pregnant women were followed until induced labor or fetus birth. The diagnostic accuracy rate for prenatal DAA by CTS and CTS combined with CCS was compared.
There were 39 cases of MB-RAA, including 22 cases of isolated MB-RAA, 15 cases of MB-RAA with intracardiac malformations, 6 cases of MB-RAA with extracardiac malformations (among them, there were cases with both intracardiac and extracardiac malformations), and 3 cases of DAA who had no other abnormalities. CTS combined with CCS was used to review the diagnosis, and it finally diagnosed 32 cases of MB-RAA and 10 cases of DAA, including 7 cases of isolated MB-RAA diagnosed by CTS alone. Thirteen cases underwent induced labor, and 29 cases had full-term delivery, including 10 cases of DAA, 17 cases of isolated MB-RAA, 1 case of MB-RAA with tetralogy of Fallot, and 1 case of MB-RAA with mild lateral ventriculomegaly. The case of MB-RAA with tetralogy of Fallot underwent a surgery after birth and our diagnosis was confirmed by surgery. The case of MB-RAA with mild lateral ventriculomegaly and 16 cases of isolated MB-RAA had no compression symptoms, and one case of isolated MB-RAA diagnosed by prenatal ultrasound presented wheezing 6 months after birth but CT examination found that it was DAA, which was then treated by surgery. Among ten neonates diagnosed prenatally as having DAA, two had compression symptoms after birth and underwent surgical treatment, and eight having no compression symptoms were confirmed by ultrasound or CT. The accuracy of CTS combined with CCS in the prenatal diagnosis of DAA was significantly higher than that of CTS (10/42 vs 3/42, P=0.016).
CTS combined with CCS can improve the prenatal diagnostic accuracy for DAA and facilitate the differential diagnosis between DAA and MB-RAA.