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中华医学超声杂志(电子版) ›› 2024, Vol. 21 ›› Issue (05) : 454 -459. doi: 10.3877/cma.j.issn.1672-6448.2024.05.002

妇产科超声影像学

经腹二维超声评价胎儿大脑外侧裂的新参数——外侧裂平台角度
曾晴1, 文华轩1, 袁鹰,1, 廖伊梅1, 秦越1, 罗丹丹1, 梁美玲1, 李胜利1   
  1. 1. 518028 深圳市妇幼保健院超声科
  • 收稿日期:2023-06-21 出版日期:2024-05-01
  • 通信作者: 袁鹰
  • 基金资助:
    国家重点研发计划(2022YFF0606301); 国家自然科学基金(62227808); 深圳市科技计划项目(JCYJ20220530155208018); 深圳市妇幼保健院院内科研基金项目(FYB2022001)

Sylvian fissure plateau angle: a new parameter to evaluate fetal sylvian fissure by transabdominal two-dimensional ultrasound

Qing Zeng1, Huaxuan Wen1, Ying Yuan,1, Yimei Liao1, Yue Qin1, Dandan Luo1, Meiling Liang1, Shengli Li1   

  1. 1. Department of Ultrasound, Shenzhen Maternity and Child Healthcare Hospital, Shenzhen 518028, China
  • Received:2023-06-21 Published:2024-05-01
  • Corresponding author: Ying Yuan
引用本文:

曾晴, 文华轩, 袁鹰, 廖伊梅, 秦越, 罗丹丹, 梁美玲, 李胜利. 经腹二维超声评价胎儿大脑外侧裂的新参数——外侧裂平台角度[J/OL]. 中华医学超声杂志(电子版), 2024, 21(05): 454-459.

Qing Zeng, Huaxuan Wen, Ying Yuan, Yimei Liao, Yue Qin, Dandan Luo, Meiling Liang, Shengli Li. Sylvian fissure plateau angle: a new parameter to evaluate fetal sylvian fissure by transabdominal two-dimensional ultrasound[J/OL]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2024, 21(05): 454-459.

目的

通过测量胎儿颅脑3个常规筛查横切面上外侧裂平台角度,探讨胎儿大脑皮层发育异常筛查中外侧裂平台角度的截断值。

方法

收集2018年6月至2020年7月到深圳市妇幼保健院进行常规超声检查且孕周范围在23~28+6周的180例正常单胎孕妇(正常组)和3例异常病例(异常组)。所有病例都在3个常规颅脑筛查横切面(丘脑水平横切面、侧脑室水平横切面和小脑水平横切面)上测量外侧裂平台角度。外侧裂平台角度测量为脑中线与外侧裂平台线相交的夹角。采用非参数检验比较3个切面测值是否有差异。采用组内相关系数(ICC)评价重测一致性或观察者一致性。

结果

在3个切面上正常组所有病例的外侧裂平台角度都>0°,而异常组的3个病例外侧裂角度均<0°。丘脑水平横切面和侧脑室水平横切面上外侧裂平台角度比较(8.28°±3.00° vs 7.98°±2.86°),差异无统计学意义(P>0.05);但小脑水平横切面上外侧裂平台角度(10.20°±3.46°)大于丘脑水平横切面和侧脑室水平横切面外侧裂平台角度,差异均具有统计学意义(H=-87.458、-103.208,P均<0.05)。重测一致性和观察者间一致性ICC分别为0.971(95%CI:0.945~0.984)、0.936(95%CI:0.819~0.979)。

结论

3个横切面上正常的外侧裂平台角度在23~28+6周相对稳定,0°可能是评估外侧裂异常的较好截断值,可在丘脑水平横切面测量外侧裂平台角度来评价外侧裂发育情况。

Objective

To evaluate the sylvian fissure plateau by sylvian fissure plateau angle (SFPA) and explore the cut-off value of the SFPA in screening for fetal cortical developmental abnormalities.

Methods

From June 2018 to July 2020, a prospective ultrasound evaluation was conducted on 180 normal and 3 abnormal singleton pregnant women at 23-28 weeks of gestation in Shenzhen Maternity and Child Healthcare Hospital. All cases were assessed in three axial planes of the fetal brain (transthalamic, transventricular, and transcerebellar) using transabdominal two-dimensional images. The SFPA of all cases was measured between the brain midline (BM) and a line drawn along the sylvian fissure plateau. Non-parametric test was used to compare the differences of the measured SFPA values on the three axial planes. Intraclass correlation coefficient (ICC) was used for assessing the intra- and inter-observer repeatability of the SFPA measurements.

Results

The SFPA in normal cases in the transthalamic, transventricular, and transcerebellar planes were all greater than 0°, while in abnormal cases they were smaller than 0°. However, there was no major difference in the angles measured on the transthalamic and transventricular planes (8.28°±3.00° vs 7.98°±2.86°, P>0.05). There was a major difference in the SFPA on the transcerebellar plane (10.20°±3.46°) and transthalamic/transventricular plane (H=-87.458 and -103.208, respectively, P<0.05). The intra- and inter-observer ICC were excellent at 0.971 (95% confidence interval [CI]: 0.945-0.984) and 0.936 (95%CI: 0.819-0.979), respectively.

Conclusion

The SFPA of normal cases in the three axial views are stable at 23-28+6 weeks of gestation and 0° may be a good cut-off value for evaluating abnormal SFPA. We recommend the SFPA on the transthalamic plane to be used to evaluate the sylvian fissure in clinical work.

图1 胎儿外侧裂平台角度测量方法。图a、b、c分别为正常胎儿经丘脑水平横切面、经侧脑室水平横切面、经小脑水平横切面超声图像上外侧裂平台角度的测量及相应的示意图;图d、e、f分别为异常病例经丘脑水平横切面、经侧脑室水平横切面、经小脑水平横切面超声图像上外侧裂平台角度的测量及相应的示意图;外侧裂平台直线和脑中线向胎儿颅脑前方相交成锐角定义角度为正,而两条直线向胎儿颅脑后方相交成锐角定义角度为负,两条直线平行定义角度为0°
图2 正常和异常组外侧裂平台角度随孕周变化的复合散点图。图a~c分别为丘脑水平横切面、侧脑室水平横切面和小脑水平横切面测得的数据
表1 本研究中3例异常病例的产前和产后随访资料
1
Gindes L, Malach S, Weisz B, et al. Measuring the perimeter and area of the Sylvian fissure in fetal brain during normal pregnancies using 3-dimensional ultrasound[J]. Prenatal Diag, 2015, 35(11): 1097-1105.
2
Toi A, Lister WS, Fong KW. How early are fetal cerebral sulci visible at prenatal ultrasound and what is the normal pattern of early fetal sulcal development?[J]. Ultrasound Obstet Gynecol, 2004, 24(7): 706-715.
3
Chen X, Li SL, Luo GY, et al. Ultrasonographic characteristics of cortical sulcus development in the human fetus between 18 and 41 weeks of gestation[J]. Chin Med J, 2017, 130(8): 920-928.
4
陈曦, 李胜利, 袁鹰, 等. 胎儿脑沟回生长发育规律的超声研究[C]. 西安: 中国超声医学工程学会成立30周年暨第十二届全国超声医学学术大会, 2014.
5
Spinelli M, Sica C, Ghezzi F, et al. Nomograms of the fetal sylvian fissure and insular lobe throughout gestation: a multicentric, ultrasonographic cross-sectional study[J]. Fetal Diagn Ther, 2019, 45(5): 325-331.
6
Poon LC, Sahota DS, Chaemsaithong P, et al. Transvaginal three‐dimensional ultrasound assessment of Sylvian fissures at 18–30 weeks' gestation[J]. Ultrasound Obstet Gynecol, 2019, 54(2): 190-198.
7
Quarello E, Stirnemann J, Ville Y, et al. Assessment of fetal Sylvian fissure operculization between 22 and 32 weeks: a subjective approach[J]. Ultrasound Obstet Gynecol, 2008, 32(1): 44-49.
8
廖伊梅, 文华轩, 汪兵, 等. 产前超声简化分级方法评估正常胎儿外侧裂的可行性研究[J]. 中华超声影像学杂志, 2022, 31(1): 30-36.
9
Droullé P, Gaillet J, Schweitzer M. Maturation of the fetal brain. Echoanatomy: normal development, limits and value of pathology[J]. J Gynecol Obstet Biol Reprod (Paris), 1984, 13(3): 228-236.
10
Monteagudo A, Timor-Tritsch IE. Development of the fetal gyri, sulci and fissures: a transvaginal sonographic study[J]. Ultrasound Obstet Gynecol, 1997, 9(4): 222-228.
11
Pistorius LR, Stoutenbeek P, Groenendaal F, et al. Grade and symmetry of normal fetal cortical development a longitudinal two and three dimensional ultrasound study[J]. Ultrasound Obstet Gynecol, 2010, 36(6): 700-708.
12
Alves CMS, Júnior EA, Nardozza LMM, et al. Reference ranges for fetal brain fissure development on 3‐dimensional sonography in the multiplanar mode[J]. J Ultras Med, 2013, 32(2): 269-277.
13
Harvey B, Sarnat LF. Telencephalic flexure and malformations of the lateral cerebral (Sylvian) fissure[J]. Pediatr Neurol, 2016, 63: 23-38.
14
Cohen-Sacher B, Lerman-Sagie T, Lev D, et al. Sonographic developmental milestones of the fetal cerebral cortex a longitudinal study[J]. Ultrasound Obstet Gynecol, 2006, 27(5): 494-502.
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