二维超声及三维超声多种成像技术在胎儿唇腭裂畸形诊断中的联合应用

目的研究二维超声及三维超声多种成像技术在胎儿唇腭裂畸形诊断中的图像特征。 方法选取2016年1月至2017年12月在南京医科大学附属苏州医院产科接受中孕期结构畸形筛查发现唇腭部异常的胎儿均行三维超声表面成像、断层成像（TUI）及自由解剖成像（OmniView模式）多种成像技术联合检查，并随访至出生后或引产后。结合产前超声检查图像，研究唇腭裂胎儿颜面部三维超声图像特征。 结果产前超声筛查的19 168例中孕期胎儿中检出唇腭部结构畸形36例（0.19%）。36例唇腭裂胎儿超声征象：单纯唇裂（CL）8例，二维、TUI及OmniView模式均检出胎儿唇裂；三维表面成像漏诊1例唇红裂。二维及三维成像技术均显示胎儿上唇连续性中断，但三维成像显示更直观。唇裂合并上牙槽突裂（CLA）11例，二维超声显示8例，三维表面成像、TUI均诊断9例，漏诊2例，OmniView技术诊断10例，漏诊1例，联合检查诊断10例，漏诊1例。主要超声征像：上唇及上牙槽突连续性中断，二维超声对于牙槽突裂显示较困难，TUI及OmniView可从多角度显示牙槽突裂。唇裂合并腭裂（CLP）17例，二维超声（诊断10例）、三维超声表面成像模式（诊断13例）、TUI（诊断15例）、OmniView模式（诊断16例）均未全部检出；而17例CLP经联合检查全部检出。超声征象为上唇、原发腭及继发腭的连续中断，断层成像及OmniView可从多角度显示原发腭及继发腭，优于二维超声对于原发腭及继发腭的显示。 结论产前二维超声及三维超声能清晰显示胎儿唇裂，但对于腭裂，三维超声多种成像模式图像优于二维超声，产前超声筛查联合三维多成像技术能清晰显示胎儿颜面部异常，减少唇腭裂的漏诊。

Combination of two-dimensional ultrasonography with multiple three-dimensional ultrasonographic technologies in prenatal diagnosis of fetal cleft lip/palate

ObjectiveTo evaluate the value of the combination of two-dimensional ultrasonogrphy (2D) with multiple three-dimensional (3D) ultrasonographic technologies in prenatal diagnosis of fetal cleft lip/palate. MethodsTwo-dimensional ultrasonography and 3D ultrasonography were utilized to evaluate 19168 fetal faces when anomaly scans were performed during the second trimester. Multiple 3D ultrasonographic technologies, including surface imaging, tomography ultrasound imaging (TUI), and OmniView mode, were used. All fetuses were followed to live birth or induced abortion. ResultsThirty-six fetuses were detected with cleft lip/palate by prenatal ultrasonography screening among the 19168 cases, with a detection rate of 0.19%. Of 36 fetuses with cleft lip and palate, eight with cleft lip (CL) were detected by 2D ultrasonography, TUI, and OmniView mode; however, 1 was missed by 3D surface imaging. Both 2D and 3D imaging techniques showed the continuity interruption of the upper lip, but 3D imaging was more intuitive. Among 11 cases with cleft lip and alveolus (CLA), 8 were detected by 2D ultrasonography, 9 each were detected by 3D surface imaging and TUI, and 2 had missed diagnosis; 10 were detected by OmniView technology and 1 was missed; 10 were detected by combined 2D with 3D ultrasonography , and 1 was missed. The main ultrasonographic features of CLA were: continuity of upper lip and alveolar process was interrupted, 2D ultrasound was difficult to display alveolar process cleft, and TUI and OmniView can display alveolar process cleft from multiple angles. Among 17 fetuses with cleft lip and palate (CLP), 10 were detected by 2D ultrasonography, 13 by surface imaging, 15 by TUI, and 16 by OmniView mode. All of the 17 fetuses were detected by combined 2D with 3D ultrasonography. The ultrasonographic signs of CLP were the continuous interruption of the upper lip, primary palate, and secondary palate. TUI and OmniView can display the primary palate and secondary palate from multiple angles, which is better than 2D ultrasound with regard to displaying the primary palate and secondary palate. ConclusionsBoth 2D and 3D ultrasonography have a high detection accuracy for fetal CL. However, 3D ultrasonography is better than 2D ultrasonography for diagnosis of fetal cleft palate. Combination of 2D ultrasonography with 3D can significantly improve the detection rate of cleft lip/palate and avoid missed diagnosis and misdiagnosis.