50例胎儿颅后窝异常的超声诊断及预后分析

目的分析胎儿颅后窝异常超声诊断准确性及预后表现。 方法对2015年8月至2018年3月于首都医科大学附属北京妇产医院超声检查提示颅后窝异常50例胎儿的二维和三维超声图像进行分析,总结不同种类颅后窝异常胎儿产前超声声像图特点,与胎儿颅脑磁共振检查、出生后检查及随访结果对照,分析超声诊断胎儿颅后窝异常的准确性。 结果50例颅后窝异常胎儿经三维超声检查最终提示Dandy-Walker畸形8例,小脑蚓部发育不良8例,Blake′s陷窝囊肿6例,小脑发育不良5例,颅后窝蛛网膜囊肿9例,单纯小脑延髓池增宽13例,小脑蚓部形态异常1例。其中26例胎儿颅脑磁共振检查证实23例与产前三维超声提示诊断相符合,2例与产前三维超声提示诊断不符合,1例胎儿颅脑磁共振检查对超声诊断进行了补充。妊娠结局：50例胎儿经超声及颅脑磁共振检查后,24例孕妇选择终止妊娠（5例失访）;26例孕妇继续妊娠（小脑蚓部发育不良和小脑发育不良各1例,Blake′s陷窝囊肿4例,颅后窝蛛网膜囊肿7例,单纯性小脑延髓池增宽13例）。其中1例小脑蚓部发育不良胎儿出生后诊断为Joubert综合征,余25例胎儿预后良好。诊断准确性：与胎儿颅脑磁共振及出生后检查随访结果相比,产前二维超声诊断准确率为62.2%（28/45）,产前三维诊断准确率为88.9%（40/45）。 结论不同种类颅后窝异常（Dandy-Walker畸形、小脑蚓部发育不良、Blake′s陷窝囊肿）产前二维超声图像上表现相似,产前三维超声对颅后窝异常疾病分类及诊断有重要意义。

Ultrasonic diagnosis and outcome of 50 fetuses with posterior fossa abnormalities

ObjectiveTo analyze the ultrasound diagnostic accuracy and postnatal outcome of fetal posterior fossa abnormalities. MethodsThe ultrasonic image features of 50 fetuses with posterior fossa abnormalities between Aug. 2015 to Mar. 2018 in Beijing Obstetrics and Gynecology Hospital, Capital Medical University were retrospectively summarized and compared with their brain magnetic resonance imaging (MRI) findings and the results of checkups and follow-ups after birth. And the prenatal diagnostic accuracy of two dimensional (2D) and three dimensional (3D) ultrasound was analyzed. ResultsAmong 50 cases with posterior fossa abnormalities, prenatal 3D ultrasound diagnosed 8 cases of Dandy-Walker malformation, 8 cases of vermian hypoplasia, 6 cases of Blake's pouch cyst, 5 cases of cerebellar hypoplasia, 9 cases of posterior fossa arachnoid cyst, 13 cases of isolated mega cisterna magna and 1 case of vermian abnormal morphology. Among them, fetal brain MRI were performed in 26 cases, and the results of 23 cases were consistent with the prenatal 3D ultrasound results. In the rest 2 inconsistent cases, the fetal brain MRI added supplementary diagnosis in 1 case. Postnatal outcome: after the performances of ultrasound and fetal MRI, 24/50 patients chose intrauterine termination of pregnancy (5 cases were lost), and 26/50 patients chose to continue with pregnancy (I case of vermian hypoplasia and cerebellar hypoplasia, 4 cases of Blake′s pouch cyst, 7 cases of posterior fossa arachnoid cyst, 13 cases of isolated mega cisteran magna). Among the 26 cases, one fetus was diagnosed as Joubert Syndrome after birth, the other 25 fetuses were of good prognosis. The diagnostic accuracy: compared with fetal brain MRI and the results of checkups and follow-ups after birth, the diagnostic accuracy of 2D and 3D was 62.2% (28/45) and 88.9% (40/45), respectively. ConclusionsDifferent posterior fossa abnormalities (eg. Dandy-Walker malformation, vermian hypoplasia and Blake's pouch cyst) have similar prenatal 2D ultrasonic characteristics. Prenatal 3D ultrasound is of great significance in the classification and diagnosis of posterior fossa abnormalities.