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中华医学超声杂志(电子版) ›› 2023, Vol. 20 ›› Issue (05) : 498 -505. doi: 10.3877/cma.j.issn.1672-6448.2023.05.006

妇产科超声影像学

Joubert综合征产前超声与MRI对比分析
黄细玲, 卢桂贤(), 尚宁, 韩鹏慧, 刘向娇, 舒爽   
  1. 511400 广州,广东省妇幼保健院超声科
    511400 广州,广东省妇幼保健院体检科
    511400 广州,广东省妇幼保健院放射科
  • 收稿日期:2022-03-29 出版日期:2023-05-01
  • 通信作者: 卢桂贤

Comparative analysis of Joubert syndrome by prenatal ultrasound and magnetic resonance imaging

Xiling Huang, Guixian Lu(), Ning Shang, Penghui Han, Xiangjiao Liu, Shuang Shu   

  1. Department of Ultrasound, Guangdong Women and Children Hospital, Guangzhou 511400, China
    Department of Physical Examination, Guangdong Women and Children Hospital, Guangzhou 511400, China
    Department of Radiology, Guangdong Women and Children Hospital, Guangzhou 511400, China
  • Received:2022-03-29 Published:2023-05-01
  • Corresponding author: Guixian Lu
引用本文:

黄细玲, 卢桂贤, 尚宁, 韩鹏慧, 刘向娇, 舒爽. Joubert综合征产前超声与MRI对比分析[J/OL]. 中华医学超声杂志(电子版), 2023, 20(05): 498-505.

Xiling Huang, Guixian Lu, Ning Shang, Penghui Han, Xiangjiao Liu, Shuang Shu. Comparative analysis of Joubert syndrome by prenatal ultrasound and magnetic resonance imaging[J/OL]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(05): 498-505.

目的

提高对Joubert综合征(JS)的超声及MRI产前影像学特征的认识。

方法

回顾性分析2014年1月至2022年1月于广东省妇幼保健院确诊的14例JS的产前超声及MRI特征。

结果

14例JS胎儿中,行系统性超声检查17次及MRI检查16次。超声与MRI一致诊断为JS共8例(57%,8/14),不一致共6例(43%,6/14);17次超声检查与16次MRI检查中,超声诊断JS 7次(41%,7/17)、可疑JS 4次(23%,4/17),MRI诊断JS 13次(81%,13/16)。超声与MRI的影像特征:一致显示典型磨牙征者共7例(50%,7/14),不一致者共7例(50%,7/14);一致未见或仅见少许小脑蚓部者共10例(71%,10/14),不一致者共4例(29%,4/14);一致显示第四脑室纵横比>1者共12例(86%,12/14),不一致者共2例(14%,2/14);一致显示小脑半球紧密靠拢者8例(57%,8/14)而明显分开者2例(14%,2/14),不一致者4例(29%,4/14);17次超声检查与16次MRI检查显示“中线裂”分别是3次(18%,3/17)、13次(81%,13/16);超声显示小脑半球高回声区者12例(86%,12/14),而高回声区被误诊为小脑蚓部者2例(17%,2/12)。

结论

正确认识JS的产前影像学特征及陷阱,有助于提高JS的产前诊断率。

Objective

To compare the prenatal ultrasound (US) and magnetic resonance imaging (MRI) characteristics of Joubert syndrome (JS) to enrich the knowledge on JS and improve its diagnosis.

Methods

The prenatal US and MRI characteristics of 14 cases of JS at Guangdong Women and Children Hospital from January 2014 to January 2022 were retrospectively analyzed.

Results

Among the 14 cases of JS fetuses, systematic US examination and MRI examination were performed 17 times and 16 times, respectively. A total of 8 cases (57%, 8/14) were diagnosed with JS by both US and MRI, while 6 cases (43%, 6/14) had inconsistent diagnosis results. Among all the 17 ultrasound and 16 MRI examinations, US suggested a diagnosis of JS 7 times (41%, 7/17) and a suspicious diagnosis of JS 4 times (23%, 4/17) while MRI suggested a diagnosis of JS 13 times (81%, 13/16). Regarding the image characteristics of US and MRI, consistent typical molar tooth sign was suggested in 7 cases (50%, 7/14), while inconsistent results were suggested in 7 cases (50%, 7/14); consistent little or no cerebellar vermis was suggested in 10 cases (71%, 10/14), while inconsistent results were suggested in 4 cases (29%, 4/14); consistent aspect ratio of the fourth ventricle >1 was suggested in 12 cases (86%, 12/14), while inconsistent results were suggested in 2 cases (14%, 2/14); consistent closely adjacent cerebellar hemispheres were suggested in 8 cases (57%, 8/14), consistent distinctly separated cerebellar hemispheres were suggested in 2 cases (14%, 2/14), and inconsistent results were suggested in 4 cases (29%, 2/14). Among the 17 ultrasound and 16 MRI examinations, the sign of "midline fissure" was showed 3 times (18%, 3/17) and 13 times (81%, 13/16) by ultrasound and MRI, respectively. Hyperechoic region of the cerebellar hemisphere was shown by US in 12 cases (86%, 12/14), while hyperechoic region was misdiagnosed as vermis in 2 cases (17%, 2/12).

Conclusion

Accurate recognition of the prenatal imaging characteristics and pitfalls of JS is helpful to improve the prenatal detection rate of JS.

图1 胎儿中脑-脑桥轴平面上二维超声图像及示意图。图a示正常第四脑室呈“梯形”。图b示第四脑室呈“三角形”,其顶部呈“狭缝形”(白色箭头)。图c示整个第四脑室呈“狭缝形”。图d示第四脑室呈“长条形”。图e示不典型“磨牙征”:小脑上脚延长但不增粗(红色箭头),小脑半球向中线处紧密靠拢无“中线裂”,小脑半球高回声区(白色箭头)。图f示Joubert综合征胎儿小脑半球及第四脑室示意图,小脑半球高回声区(灰色区域)注:红色圈示第四脑室,AP为第四脑室前后经,T为第四脑室最大横径,B为小脑半球。
表1 9例Joubert综合征胎儿及其父母外显子组测序结果
病例 基因 突变 纯合子/杂合子 ACMG分类 OMIM ID
1 F:未见异常 - - - 300804
M:OFD1 c.2848A>T(p.K950*) 杂合子 LPV
Fe:OFD1 c.2848A>T(p.K950*) 半合子 LPV
2 F:未见异常 - - - 300804
M:OFD1 c.2848A>T(p.K950*) 杂合子 LPV
Fe:OFD1 c.2848A>T(p.K950*) 半合子 LPV
3 F:TMEM 67 c.224G>A(p.Gly75Glu) 杂合子 VUS 610688
M:TMEM 67 c.2345A>G(p.His782Arg) 杂合子 VUS
Fe:TMEM 67 c.224G>A(p.Gly75Glu)和c.2345A>G(p.His782Arg) 杂合子 VUS
5 F:RPGRIP1L c.1641dupA(p.Val548SerfsTer9) 杂合子 VUS 611560
M:RPGRIP1L c.3764T>C(p.Ile1255Thr) 杂合子 VUS
Fe:RPGRIP1L c.1641dupA(p.Val548SerfsTer9)和c.3764T>C(p.Ile1255Thr) 杂合子 VUS
7 F:CC2D2A c.3688C>T(p.R1230*) 杂合子 LPV 216360/612285/612284
M:CC2D2A c.418insGAGGGAGGAGCCAAGA? 杂合子 LPV
Fe:CC2D2A c.3688C>T(p.R1230*)和c.418insGAGGGAGGAGCCAAGA_? 杂合子 LPV
8 F:TCTN3 c.1441dupT(p.C481Lfs*133) 杂合子 LPV 614518
M:TCTN3 c.1441dupT(p.C481Lfs*133) 杂合子 LPV
Fe:TCTN3 c.1441dupT(p.C481Lfs*133) 纯合子 LPV
9 F:CEP290 c.4303-2A>T 杂合子 VUS 610188
M:CEP290 c.2569A>T(K857X) 杂合子 VUS
Fe:CEP290 c.4303-2A>T和c.2569A>T(K857X) 杂合子 VUS
10 F:TMEM 67 c.1175C>G 杂合子 LPV 610688
M:TMEM 67 c.1250A>G 杂合子 LPV
Fe:TMEM 67 c.1175C>G和c.1250A>G 杂合子 LPV
12 F:CC2D2A 20-21号外显子杂合缺失 杂合子 LPV 216360/612285/612284
M:CC2D2A c.2003+2T>C 杂合子 LPV
Fe:CC2D2A 20-21号外显子杂合缺失和c.2003+2T>C 杂合子 LPV
表2 14例Joubert综合征胎儿产前影像诊断及其他表型
病例 超声 MRI 影像其他表型 尸体解剖
诊断孕周(周) 诊断结果 磨牙征 诊断孕周(周) 诊断结果 磨牙征
1 25 JS 典型 26 JS 典型 后颅窝池增宽,侧脑室增宽,双手多指,永存左上腔静脉,皮质发育不良 JS,CV缺如,双手多指,单侧多趾,永存左上腔静脉
2 30 JS 典型 32 JS 典型 后颅窝池增宽,双手多指,单侧多趾,永存左上腔静脉 -
3 17 JS 典型 21 JS 典型 后颅窝池增宽,单侧多趾、双肾实质回声增强 JS,CV大部分缺如,单侧多趾
4 20 JS 典型 21 JS 典型 双肾实质回声增强 -
5 28 可疑JS 不典型 28 CV偏小 典型 - -
6 23 Blake-Pouch囊肿 未见 23 JS 典型 双足多趾及并趾、唇裂、皮质发育不良 JS,CV缺如,双手多指及并指、双足多趾及并趾,唇裂
7 25 JS 典型 25 JS 典型 脑膨出、脑积水、皮质发育不良 -
8 24 JS 典型 24 JS 典型 后颅窝池增宽、皮质发育不良、双侧多指及多趾 -
9 18 JS 典型 18 JS 典型 双侧多囊肾 -
10 20 Dandy-Walker综合征 未见 26 JS 典型 双侧多囊肾、后颅窝池增宽、侧脑室增宽 JS,CV缺如,双侧多囊肾,室间隔缺损
25 Dandy-Walker综合征 典型 - - - 双侧多囊肾、后颅窝池增宽、侧脑室增宽 -
11 27 可疑JS 不典型 27 JS 典型 后颅窝池增宽 JS,CV大部分缺如
12 23 可疑JS 不典型 21 Dandy-Walker综合征 典型 后颅窝池增宽、侧脑室增宽、皮质发育不良、单侧多指 JS,CV缺如,单侧多指,胼胝体发育不良,侧脑室增宽,皮质发育不良
27 JS 典型 后颅窝池增宽、侧脑室增宽、皮质发育不良、单侧多指 -
13 26 小脑蚓部发育不良 不典型 26 Blake-Pouch囊肿 不典型 后颅窝池增宽 JS,胆道闭锁
29 小脑蚓部发育不良 不典型 29 JS 典型 后颅窝池增宽 -
14 32 未见异常 未见 34 JS 典型 - JS,单侧多趾
34 可疑JS 未见
图2 病例8在孕18周时超声及MRI检查均诊断为Joubert综合征:中脑-脑桥轴平面上二维超声(图a)及MRI(图b)显示磨牙征(箭头),第四脑室(红色圈)呈椭圆形改变,前后径>最大横径;二维超声(图c、d)示双肾增大、回声增强呈多囊肾改变(星号)
表3 Joubert综合征胎儿产前超声及MRI检查诊断结果及其影像特征[次(%)]
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