【摘要】 目的探讨胎儿半椎体的产前超声声像图特征及产前超声的诊断价值。方法回顾性选取2015年1月至2019年12月南京医科大学附属苏州医院进行产前超声结构筛查的胎儿图像,分析超声诊断为半椎体的胎儿产前超声声像图特征、合并畸形情况,胎儿均随访至出生后或引产后。应用四格表评价产前超声诊断胎儿半椎体的诊断价值。结果共100 822例胎儿纳入研究。其中产前超声诊断的97例半椎体胎儿中,67例为单发性半椎体,30例为多发性半椎体,合并最多的畸形是血管异常(17例)、中枢神经系统畸形(16例)、心脏异常(16例)及泌尿系统畸形(15例)。经随访,7例失访,90例半椎体中84例通过胎儿磁共振、出生后或引产后X线检查等证实,4例蝴蝶椎误诊为半椎体,2例正常。产前超声未见明显异常的98 562例胎儿经随访,2958例失访,95 595例出生后正常,有9例半椎体胎儿产前超声漏诊,均在出生后证实。产前超声对胎儿半椎体的诊断符合率为93.33%(84/90),敏感度为90.32%(84/93),特异度为99.99%(95 595/95 597),阳性预测值为97.67%(84/86),阴性预测值为99.99%(95 595/95 604)。结论半椎体具有典型的超声声像图特征,产前超声是诊断胎儿半椎体畸形的主要手段,敏感度和特异度均较高,有利于明确病变的类型和部位、早期诊断、评估胎儿预后及临床处理。更多还原

【Abstract】 Objective To explore the characteristics of prenatal ultrasonography characteristics of fetal hemivertebra to assess the clinical value of prenatal ultrasonography in this congenital spinal abnormality. Methods Fetal ultrasound images for fetuses who underwent prenatal ultrasound structural screening at Suzhou Hospital Affiliated to Nanjing Medical University from January 2015 to December 2019 were selected. Ultrasonographic features and associated malformations of fetal hemivertebra were analyzed. All fetuses were followed to birth or induction of labor. The value of prenatal ultrasound in the diagnosis of fetal hemivertebral body was then assessed. Results A total of 100 822 fetuses were included in the study. Among them, 97 cases of hemivertebra were diagnosed by prenatal ultrasound, including 67 cases of single hemivertebra and 30 cases of multiple hemivertebra. The most common associated malformations were vascular anomalies(17 cases), central nervous system anomalies(16 cases), urinary anomalies(16 cases),and cardiac anomalies(15 cases). During follow-up, 7 cases were lost. Of the remaining 90 cases of hemivertebra, 84 were confirmed by fetal magnetic resonance imaging(MRI), X-ray examination after birth,or induction of labor, 4 were finally diagnosed as butterfly vertebrae, and 2 were normal. Out of 98 562 fetuses without abnormal ultrasound findings who were followed, 2958 were lost to follow-up, 95 595 were normal after birth, and 9 were misdiagnosed by prenatal ultrasound, which were confirmed after birth. The diagnostic accuracy of prenatal ultrasound for hemivertebra was 93.33%(84/90), and the sensitivity, specificity, positive predictive value, and negative predictive value were 90.32%(84/93), 99.99%(95 595/95 597), 97.67%(84/86),and 99.99%(95 595/95 604), respectively. Conclusion Hemivertebra has typical ultrasonographic characteristics. Prenatal ultrasound is the main approach to diagnose fetal hemivertebra, with a high sensitivity and specificity, which is conducive to evaluation of the type and location of lesions, early diagnosis, evaluation of fetal prognosis, and clinical management.更多还原