超声与MRI在疑似高危胎儿中枢神经系统异常筛查中应用研究

目的研究超声与磁共振成像(MRI)在疑似高危胎儿中枢神经系统异常筛查中的应用价值。方法选取我院2012年10月至2014年10月疑似高危胎儿中枢神经系统异常的孕妇87例,对所有孕妇均进行超声和MRI检查,以胎儿出生后结果或胎儿的尸检结果为金标准,比较两种检查方式在中枢神经系统检查中所呈图像质量以及对中枢神经系统主要畸形的检出率,比较超声检查、MRI检查以及两者联合检查的灵敏度、特异度、阳性预测率、阴性预测率以及准确度。结果超声检查在血流显示、脉络丛室管膜显示方面的图像质量评分较MRI检查显著较高(P0.05);MRI检查在视野、分辨率、组织特异性以及脑沟、裂、回显示方面的图像质量评分较超声检查显著较高(P0.05);超声检查Dandy-Walker综合症和脑发育不良的符合率分别为80%、66.67%较MRI检查符合率100%、100%显著较低(P0.05);超声检查小头畸形的符合率为100%较MRI检查符合率0%显著较高(P0.05);MRI检查和MRI联合超声检查准确率分别为78.21%、79.12%较超声58.94%显著较高(P0.05)。结论超声检查在疑似高危胎儿中枢神经系统异常中诊断率较高,MRI可对超声检查的结果进行补充,两者联合可提高诊断准确率。

Application of Ultrasound and MRI in Screening of Suspected High-risk Fetal Central Nervous System Abnormalities

Objective To study the application value of ultrasound and magnetic resonance imaging (MRI) in the screening of suspected high-risk fetal central nervous system abnormalities.Methods Eighty-seven pregnant women with suspected highrisk fetal central nervous system abnormalities who were admitted in our hospital between October 2012 and October 2014 were enrolled in the study.Ultrasound and MRI examination were performed in all pregnant women.With the postnatal results or aucopsy results of fetusesas the golden standard,the image quality and the detection rate ofmain abnormalities of central nervous system were compared between the two kinds of examination methods.The sensitivity,specificity,positive predictive value,negative predictive rate and accuracy were compared between ultrasound,MRI and the combination of the two.Results The image quality scores of ultrasound on blood flow display and choroid plexus ependyma display were significantly higher than those of MRI (P＜0.05).The image quality scores of MRI on field of vision,resolution,tissue specificity,and display of the cerebral sulcus,fissure and gyrus were significantly higher than those of ultrasound (P＜0.05).The coincidence rates of ultrasound in detection of Dandy-Walker syndrome and brain dysplasia (80％,66.67％) were significantly lower than those of MRI(100％,100％) (P＜0.05).The coincidence rates of ultrasound in detection of microcephalus (100％) was significantly higher than that of MRI (0％) (P ＜ 0.05).The accuracy rates of MRI and MRI combined with ultrasound (78.21％,79.12％) were significantly higher than that of ultrasound (58.94％) (P＜0.05).Conclusion The rate of ultrasound in the diagnosis of suspected high-risk fetal central nervous system abnormalities is high.MRI can supplement the results of ultrasound examination.The combined use of the two can improve the diagnostic accuracy rate.