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中华医学超声杂志(电子版) ›› 2023, Vol. 20 ›› Issue (03) : 343 -355. doi: 10.3877/cma.j.issn.1672-6448.2023.03.015

综述

胎儿眼球及眼附属结构异常的产前超声研究及进展
罗丹丹, 文华轩, 陈曦, 李胜利()   
  1. 518028 深圳,南方医科大学附属深圳妇幼保健院超声科
    610045 成都,四川省妇幼保健院超声科
  • 收稿日期:2021-09-16 出版日期:2023-03-01
  • 通信作者: 李胜利
  • 基金资助:
    国家重点研发计划(2022YFF0606301); 深圳市科技计划项目(JCYJ20210324130812035)

Prenatal ultrasound diagnosis of fetal eyeball and ocular adnexal abnormalities

Dandan Luo, Huaxuan Wen, Xi Chen   

  • Received:2021-09-16 Published:2023-03-01
引用本文:

罗丹丹, 文华轩, 陈曦, 李胜利. 胎儿眼球及眼附属结构异常的产前超声研究及进展[J]. 中华医学超声杂志(电子版), 2023, 20(03): 343-355.

Dandan Luo, Huaxuan Wen, Xi Chen. Prenatal ultrasound diagnosis of fetal eyeball and ocular adnexal abnormalities[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(03): 343-355.

图1 眼的胚胎发育模式图
图2 13周胎儿双眼球斜冠状切面超声图(图a)与模式图(图b) 注:NB为鼻骨;FP为上颌骨额突;CL为晶状体;E为眼球;EAR为耳;HP为上颌骨腭突
图3 23周胎儿双眼球水平横切面超声图(图a)及模式图(图b),可显示鼻骨、上颌骨额突、双侧眼球及晶状体、骨性眼眶和眼球后间隙 注:NB为鼻骨;FP为上颌骨额突;CL为晶状体;E为眼球;MA为上颌骨
图4 32周胎儿局部放大的眼球超声图(图a)和模式图(图b) 注:CO为角膜;AC为前房;CI为睫状体;CL为晶状体:SC为巩膜;VB为玻璃体
图5 胎儿玻璃体动脉超声声像图。声束从胎儿眼球颞侧入射,可以显示胎儿晶状体(长箭头)和玻璃体动脉(短箭头)
图6 胎儿眼距、眼内距和眼外距的测量方法 注:OD为眼距;IOD为眼内距;BOD为眼外距
图7 胎儿面额冠状切面二维超声图
图8 胎儿眼冠状切面超声声像图。图a为颞侧的眼球横切面,彩色线条为b~f切面的对应的切面位置,图b~f分别为眼睑和眼裂切面、瞳孔切面、睫状环切面、晶状体切面和玻璃体及玻璃体动脉切面,箭头所指分别为眼睑和眼裂、瞳孔、睫状环、晶状体和玻璃体动脉
图9 颜面部旁正中矢状切面超声声像图 注:FB为额骨;E为眼;CL为晶状体;MA为上颌骨;N为鼻;UL为上唇;LL为下唇;IM为下颌骨
图10 胎儿视交叉横切面超声声像图(图a)及示意图(图b) 注:ON为视神经;OC为视交叉;OT为视束
图11 无叶全前脑胎儿超声声像图显示眼距过近。图a:双眼横切面示眼距过近,眼内距(0.99 cm)明显小于眼距;图b:丘脑水平横切面仅显示一个原始脑室,大脑镰及透明隔腔消失,丘脑不完全融合
图12 额部脑膜脑膨出胎儿超声声像图显示眼内距及眼外距明显增宽
图13 无叶全前脑合并独眼畸形图像。25周胎儿,产前超声检查双眼冠状切面(图a)仅见单眼眶,眶内可见两个眼球紧贴。产后高频超声检查双眼横切面(图b)证实产前超声检查结果。产后高频超声检查面部正中矢状切面(图c)示鼻呈长条形位于眼眶上方。标本面部正面观(图d)显示独眼、喙鼻畸形,无人中 注:B为大脑;E为眼球;N为鼻
图14 一侧小眼畸形患儿产前超声图像及产后CT图像。双眼横切面(图a)示右侧眼球明显小于左侧,左侧大小为1.5 cm×1.4 cm,右侧大小仅为1.0 cm×0.8 cm,右侧眼球内可见不均质回声。产后CT检查(图b)显示右侧小眼畸形
图15 双侧无眼畸形,双肺缺如,心脏复杂畸形等多发畸形。产前超声检查双眼水平横切面(图a)不能显示双侧眼眶及眼球图像(箭头所示)。双眼水平冠状切面(图b)显示双眼眶部位无眼球结构回声(箭头所示)。产后高频超声检查双眼水平横切面(图c)亦未见双侧眼眶、双侧玻璃体、双侧晶状体图像(箭头所示)。标本正面观(图d)示双侧眼睑粘合,未见眼裂
图16 胎儿正常晶体及先天性白内障3种超声表现模式图。图a:正常胎儿晶状体呈透明无回声;图b:晶状体呈弥漫性强回声;图c:晶状体内表现为环状高回声;图d:晶状体内出现高回声区,呈点状或簇状
图17 孕22+2周胎儿产前超声双眼横切面(图a)及晶状体冠状切面(图b)显示双侧晶状体完全呈高回声(箭头)
图18 永存原始玻璃体增生症胎儿超声声像图。33周胎儿,右眼眼球较左侧小,横切面(图a)和旁矢状切面(图b)玻璃体内见高回声团,连接晶状体与眼球后壁
图19 23周晶状体缺如胎儿超声声像图。胎儿双侧眼球小,多角度观察晶状体未显示
图20 23周胎儿视网膜母细胞瘤超声图。双眼球横切面(图a)及颜面部旁矢状切面(图b)显示右侧眼球内混合强回声,呈分叶状,右侧眼球较左侧眼球稍小
图21 单侧和双侧泪囊膨出胎儿产前超声图像。孕30周胎儿双眼球水平横切面双眼球(图a)及一侧眼球(图b)内侧囊性暗区 注:C为泪囊膨出囊性暗区;E为眼球
图22 鱼鳞病胎儿产前超声图。图a:胎儿颜面部冠状切面,可见双侧眼球前方向前突出的团状软组织低回声,双侧基本对称,并向羊膜腔突出,为眼睑外翻;图b:胎儿唇部冠状切面声像图示嘴唇增大,增厚,呈外翻状,可见舌外露;图c:胎儿背部矢状切面显示皮肤连续性中断
图23 视隔发育不良胎儿产前超声声像图。27周胎儿,侧脑室水平横切面(图a)显示侧脑室增宽约1.16 cm;颅脑冠状切面(图b)显示透明隔腔缺失,侧脑室前角融合;侧脑室内壁(图c)不光滑,可见小点状突起(箭头),提示可能存在灰质异位;双眼球水平横切面(图d)显示右侧眼球较小;视交叉横切面(图e)测量显示视神经及视束直径小于正常。经全基因组 检查提示该胎儿存在SOX2基因缺失,该基因异常相关的综合征为视神经发育不全和中枢神经系统异常,或称为小眼综合征
图24 眼眶成熟畸胎瘤产前超声图像。24周胎儿,左眼球明显小于右眼球(图a),眼球后方的肿物内可见血流信号,高频超声(图b)可显示眼球后方眼眶间隙内的带状高回声,产后病理证实为眼眶畸胎瘤
1
李胜利, 罗国阳. 胎儿畸形产前超声诊断学 [M]. 北京: 科学出版社, 2017: 721-722
2
Dollfus H, Verloes A. Dysmorphology and the orbital region: a practical clinical approach [J]. Surv Ophthalmol, 2004, 49(6): 547-561.
3
Timor-Tritsch IE, Peisner DB, Raju S. Sonoembryology: an organ-oriented approach using a high-frequency vaginal probe [J]. J Clin Ultrasound, 1990, 18(4): 286-298.
4
Souka AP, Pilalis A, Kavalakis Y, et al. Assessment of fetal anatomy at the 11-14-week ultrasound examination [J]. Ultrasound Obstet Gynecol, 2004, 24(7): 730-734.
5
Timor-Tritsch IE, Bashiri A, Monteagudo A, et al. Qualified and trained sonographers in the US can perform early fetal anatomy scans between 11 and 14 weeks [J]. Am J Obstet Gynecol, 2004, 191(4): 1247-1252.
6
李胜利, 文华轩, 罗丹丹. 孕11~13~(+6)周胎儿颅面部扫查新方法:五切面法筛查与诊断研究 [J/CD]. 中华医学超声杂志(电子版), 2017, 14(8): 586-597.
7
Ondeck CL, Pretorius D, Mccaulley J, et al. Ultrasonographic prenatal imaging of fetal ocular and orbital abnormalities [J]. Surv Ophthalmol, 2018, 63(6): 745-753.
8
李胜利, 邓学东. 产前超声检查指南(2012) [J/CD]. 中华医学超声杂志(电子版), 2012, 9(7): 574-580.
9
Jeanty P, Dramaix-Wilmet M, Van Gansbeke D, et al. Fetal ocular biometry by ultrasound [J]. Radiology, 1982, 143(2): 513-516.
10
Goldstein I, Tamir A, Zimmer EZ, et al. Growth of the fetal orbit and lens in normal pregnancies [J]. Ultrasound Obstet Gynecol, 1998, 12(3): 175-179.
11
Achiron R, Kreiser D, Achiron A. Axial growth of the fetal eye and evaluation of the hyaloid artery: in utero ultrasonographic study [J]. Prenat Diagn, 2000, 20(11): 894-899.
12
张葵. 中晚孕期胎儿视交叉结构的产前超声研究 [D]. 广州: 南方医科大学, 2016.
13
De Jong-Pleij EA, Ribbert LS, Tromp E, et al. Three-dimensional multiplanar ultrasound is a valuable tool in the study of the fetal profile in the second trimester of pregnancy [J]. Ultrasound Obstet Gynecol, 2010, 35(2): 195-200.
14
Tutschek B, Blaas HK, Abramowicz J, et al. Three-dimensional ultrasound imaging of the fetal skull and face [J]. Ultrasound Obstet Gynecol, 2017, 50(1): 7-16.
15
Odeh M, Feldman Y, Degani S, et al. Fetal eyeball volume: relationship to gestational age and biparietal diameter [J]. Prenat Diagn, 2009, 29(8): 749-752.
16
Verma AS, Fitzpatrick DR. Anophthalmia and microphthalmia [J]. Orphanet J Rare Dis, 2007, 2: 47.
17
Feldman E, Shalev E, Weiner E, et al. Microphthalmia--prenatal ultrasonic diagnosis: a case report [J]. Prenat Diagn, 1985, 5(3): 205-207.
18
Blazer S, Zimmer EZ, Mezer E, et al. Early and late onset fetal microphthalmia [J]. Am J Obstet Gynecol, 2006, 194(5): 1354-1359.
19
宋宴鹏, 毕华婷, 于海燕, 等. 可疑先天性青光眼胎儿一例 [J]. 中华围产医学杂志, 2020, 23(8): 549-551.
20
Gennette S, Carlan SJ, Busowski J, et al. Congenital glaucoma detected by unilateral megalophthalmos on prenatal sonography [J]. J Clin Ultrasound, 2017, 45(8): 499-501.
21
Tsukitome H, Uji Y, Yagi T, et al. A case of developmental glaucoma suspected from megalophthalmos represented by obstetric ultrasonography [J]. Jpn J Ophthalmol, 2011, 55(6): 686-687.
22
欧良松, 徐海兵. 胎儿先天性青光眼超声表现1例 [J]. 临床超声医学杂志, 2008, 10(9): 624.
23
Leonard A, Bernard P, Hiel AL, et al. Prenatal diagnosis of fetal cataract: case report and review of the literature [J]. Fetal Diagn Ther, 2009, 26(2): 61-67.
24
Monteagudo A, Timor-Tritsch IE, Friedman AH, et al. Autosomal dominant cataracts of the fetus: early detection by transvaginal ultrasound [J]. Ultrasound Obstet Gynecol, 1996, 8(2): 104-108.
25
郭家菊, 秦越, 李胜利. 胎儿先天性白内障产前超声诊断及研究分析 [J]. 中华医学超声杂志(电子版), 2021, 18(3): 285-289.
26
刘家琦, 李凤鸣. 实用眼科学 [M]. 北京: 人民卫生出版社, 2010: 334, 465.
27
Esmer AC, Sivrikoz TS, Gulec EY, et al. Prenatal diagnosis of persistent hyperplastic primary vitreous: report of 2 cases and review of the literature [J]. J Ultrasound Med, 2016, 35(10): 2285-2291.
28
叶艳艳, 刘燕娜, 石璐. 双眼先天性无晶状体超声表现1例 [J]. 中国超声医学杂志, 2018, 34(4): 318-319.
29
Di Meglio F, Vascone C, Di Meglio L, et al. Ultrasound prenatal diagnosis of congenital primary aphakia: case report [J]. J Prenat Med, 2015, 9(1-2): 16-17.
30
Gould DB, Smith RS, John SWM. Anterior segment development relevant to glaucoma [J]. Int J Dev Biol, 2004, 48(8-9): 1015-1029.
31
首都医科大学眼部肿瘤临床诊疗与研究中心, 中华医学会放射学分会头颈学组, 中华医学会放射学分会儿科学组. 视网膜母细胞瘤影像检查与诊断及选择性眼动脉化疗专家共识 [J]. 中华放射学杂志, 2021, 55(5): 470-477.
32
Paquette LB, Miller D, Jackson HA, et al. In utero detection of retinoblastoma with fetal magnetic resonance and ultrasound: initial experience [J]. AJP Rep, 2012, 2(1): 55-62.
33
Manjandavida FP, Xia J, Zhang J, et al. In-utero ultrasonography detection of fetal retinoblastoma and neonatal selective ophthalmic artery chemotherapy [J]. Indian J Ophthalmol, 2019, 67(6): 958-960.
34
Sepulveda W, Wojakowski AB, Elias D, et al. Congenital dacryocystocele: prenatal 2- and 3-dimensional sonographic findings [J]. J Ultrasound Med, 2005, 24(2): 225-230.
35
Li SL, Luo GY, Tian XX, et al. Prenatal diagnosis and perinatal outcome of congenital dacryocystocele: a large case series [J]. Prenat Diagn, 2015, 35(2): 103-107.
36
Tourette C, Tron E, Mallet S, et al. Three-dimensional ultrasound prenatal diagnosis of congenital ichthyosis: contribution of molecular biology [J]. Prenat Diagn, 2012, 32(5): 498-500.
37
Webb EA, Dattani MT. Septo-optic dysplasia [J]. Eur J Hum Genet, 2010, 18(4): 393-397.
38
张葵, 李胜利, 文华轩, 等. 胎儿视交叉的产前超声初步研究 [J]. 中华超声影像学杂志, 2016, 25(3): 232-237.
39
Chen X, Yang J, He G, et al. Orbital teratoma in the foetus: a rare case without proptosis [J]. BMC Ophthalmol, 2020, 20(1): 415.
40
Yen MT, Tse DT. Congenital orbital cyst detected and monitored by prenatal ultrasonography [J]. Ophthalmic Plast Reconstr Surg, 2001, 17(6): 443-446.
41
Hingorani M, Mannor G, Vardy SJ, et al. Prenatal diagnosis of orbital heterotopic brain tissue [J]. J Pediatr Surg, 1997, 32(9): 1348-1350.
42
Ahmed A, Noureldin R, Gendy M, et al. Antenatal sonographic appearance of a large orbital encephalocele: a case report and differential diagnosis of orbital cystic mass [J]. J Clin Ultrasound, 2013, 41(5): 327-331.
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