三维超声自由解剖成像新技术在胎儿腭显示中的应用

目的评价三维超声自由解剖成像新技术（全方位观中任选切面）在胎儿腭部显示中的应用价值。方法应用三维超声自由解剖成像技术对100例正常胎儿经下颌颜面部正中矢状切面的容积数据进行分析,在参考切面（颜面部正中矢状切面）上描画解剖线,获取横切面（经上颌、经口裂）、冠状切面、斜冠状切面（经梨状孔、经口裂、经颏下三角）以及腭的曲面平铺成像。对5例唇腭裂胎儿按照相同技术获取容积数据并进行分析。结果 100例正常胎儿中91例（91.0%,91/100）成功采集到颜面部容积数据,经三维超声自由解剖成像技术对91例容积数据进行分析,不同成像切面上腭部显示结果：（1）经上颌横切面显示胎儿牙槽突弓91例（100%,91/91）,声像图表现为＂C＂形的弓状结构;显示硬腭91例（100%,91/91）,声像图表现为两侧牙槽骨间片状强回声;经口裂横切面显示软腭81例（89.0%,81/91）,声像图表现为条状软组织带。（2）冠状切面显示硬腭91例（100%,91/91）,声像图表现为条状强回声带,分隔口腔和鼻腔。（3）经梨状孔斜冠状切面显示硬腭91例（100%,91/91）,声像图表现为短条状强回声带;经口裂斜冠状切面显示硬腭91例（100%,91/91）;经颏下三角斜冠状切面显示硬腭91例（100%,91/91）,声像图均表现为条状强回声带,其后方为声影,不能显示其上方的鼻腔及鼻中隔。（4）经梨状孔斜冠状切面显示软腭81例（89.0%,81/91）,显示悬雍垂25例（27.5%,25/91）,声像图表现为片状软组织回声,悬雍垂为软腭下缘正中乳头状突起;经口裂斜冠状切面显示软腭81例（89.0%,81/91）;经颏下三角斜冠状切面显示软腭81例（89.0%,81/91）,声像图均表现为条状软组织带,后上方为鼻咽部无回声区。（5）腭的曲面成像显示牙槽突弓91例（100%,91/91）,显示硬腭91例（100%,91/91）,显示软腭81例（89.0%,81/91）,显示悬雍垂25例（27.5%,25/91）,声像图表现为牙槽突弓呈＂C＂形弓状结构,硬腭呈片状骨性强回声,软腭为片状软组织低回声。在15例包含唇腭裂畸形的容积数据中,分析者能全部确认其中的5例畸形病例,并能确认腭裂累及的部位及范围。结论三维超声自由解剖成像技术易于获取二维超声难以显示的胎儿腭部横切面和冠状切面图像,并可获取继发腭的特殊斜冠状切面图像;通过追踪腭的结构画线,可获取腭的曲面平铺成像,形象直观地显示腭部全景图。此方法可简化胎儿腭的超声检测,减少对操作者技术和经验的依赖,能较快评估胎儿原发腭及继发腭的完整性,确认唇裂胎儿有无腭裂,并可明确腭裂累及的部位及范围。

The study of OmniView technology with three-dimensional ultrasound in displaying the fetal palate

Objective To evaluate the application of ＂OmniView＂,a new three-dimensional ultrasound technology,in displaying the fetal palate.Methods The three-dimensional volume data was acquired from 100 normal fetuses,analysed by OmniView technology with the facial midsagittal plane as the starting plane.The imaging of fetal palate was obtained in axial plane（through maxilla,oral cleft）,coronal plane,oblique coronal plane（through piriform aperture,oral cleft,submental triangle）,and the palate′s curved plane tiled imaging by drawing the anatomical lines on referenced sagittal plane（facial midsagittal plane）.The volumes of five fetuses with cleft lip and palate were obtained and analysed by the same technology.Results The volume dataset of 91（91.0%,91/100） normal fetuses were acquired successfully,and analyzed by OmniView technology,the results of 91 normal fetal palate in different plane were：（1） In axial plane through maxilla,the visualization of alveolar process bow was 91（100%,91/91）.It was shown as＂C＂shaped arcuate structure,the anechoic structure of alveolar socket could be seen on the bow,and the first 6 alveolar sockets were displayed clearly.The visualization number of hard palate was 91（100%,91/91）,it was shown as hyperechoic flake between two sides of alveolar bones.In axial plane through oral cleft,the visualization number of soft palate was 81（89.0%,81/91）,it was shown as a strip of soft tissue echo band.（2） In coronal plane,the visualization number of hard palate was 91（100%,91/91）,it was shown as a strip of hyperechoic band and separated the oral and nasal cavity.（3） In oblique coronal plane through piriform aperture,the visualization number of hard palate was 91（100%,91/91）,it was shown as a short strip of hyperechoic band.In oblique coronal plane through oral cleft,the visualization number of hard palate was 91（100%,91/91）.In oblique coronal plane through submental triangle,the visualization number of hard palate was 91（100%,91/91）.In the above two planes,the hard palate was shown as a strip of hyperechoic band,due to acoustic shadow behind the hard palate,the nasal cavity and nasal septum above the hard palate couldn＇t be displayed.（4） In oblique coronal plane through piriform aperture,the visualization number of soft palate was 81（89.0%,81/91）.The visualization number of uvula was 25（27.5%,25/91）.The soft palate was shown as a flake of soft tissue echo behind the hard palate,and the uvula was shown as papillary protrusions on the edge of the soft palate in the midline.In oblique coronal plane through oral cleft,the visualization number of soft palate was 81（89.0%,81/91）.In oblique coronal plane through submental triangle,the visualization number of soft palate was 81（89.0%,81/91）.In the above two planes,the soft palate was shown as a strip of soft tissue echo band,the soft tissue echo of fetal tongue was in the lower front of soft palate,and the anechoic region of nasopharynx was superior behind the soft palate.（5） In the curved plane tiled imaging of palate,the visualization number of alveolar process bow（primary palate） was 91（100%,91/91）.The visualization number of hard palate was 91（100%,91/91）.The visualization number of soft palate was 81（89.0%,81/91）.the visualization number of uvula was 25（27.5%,25/91）,the planar panorama of alveolar process bow,hard palate and soft palate could be visualized intuitively,the alveolar arch and hard palate were shown as bonelike hyperecho,and the soft palate was shown as soft tissue hypoecho.In fifteen cases′ volume involved cleft lip and palate,all five cases of malformations were detected through three-dimensional data analysis,the position and range of the cleft palate could also be confirm.Abnormal fetuses were all verified after induction of labor.Conclusions By three-dimensional ultrasound technology-＂OmniView＂,the axial and coronal plane of fetal palate could be obtained easily which was difficult by two-dimensional ultrasound,and the special oblique coronal plane of secondary palate could be displayed easily.The panorama of the palate could be visualized intuitively though curved plane tiled imaging by drawing a line tracking the structure of the palate.This technology could simplify the ultrasound examination procedure of the fetal palate,reduce the operators′ skill-dependence,and quickly evaluated the integrity of the fetal primary palate and secondary palate.For the cleft lip fetus,this technology can determine whether the cleft palate exist or not,together with their position and range.