南方医科大学学报

南方医科大学学报 ›› 2014, Vol. 34 ›› Issue (07): 950-.

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11~13+6周胎儿颅后窝结构的产前超声检测

秦凤真，李胜利，文华轩，欧阳玉容，郑琼，毕静茹   

  • 出版日期:2014-07-20 发布日期:2014-07-20

Ultrasound measurement of fetal posterior fossa at 11 to 13 + 6 gestational weeks for
screening open spina bifida

  • Online:2014-07-20 Published:2014-07-20

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摘要： 目的建立经腹部超声测量11~13+6周胎儿颅后窝结构的正常参考值范围，探讨其对开放性脊柱裂（OSB）筛查的临床价
值。方法随机选取我院2013年1月~9月期间在孕11~13+6周时接受颈项透明层检查的正常组胎儿541例和OSB组胎儿3例，
采用经腹超声从正中矢状切面和经前囟小脑横切面对胎儿的颅后窝结构进行观察及测量，建立11~13+6周胎儿颅后窝结构的正
常参考值范围，比较两切面的测量差异并比较正常组与OSB组胎儿各参数的差异。结果两切面各测量参数值的差异无统计
学意义（P>0.05）。正常组胎儿颅后窝可见两条强回声线，OSB组胎儿的颅后窝仅能看到一条明显的强回声线即脑干后缘与第
四脑室顶部，第四脑室与小脑延髓池分界显示不清。正常组胎儿脑干前后径、第四脑室前后径、小脑延髓池前后径均随头臀长
的增加呈线性增加。OSB组胎儿的脑干前后径均大于正常值的第95百分位数，第四脑室-小脑延髓池前后径均小于正常值的第
5百分位数。OSB组脑干前后径与第四脑室-小脑延髓池前后径的比值明显大于正常组，且大于1。结论建立了11~13+6周胎儿
颅后窝结构正常值范围，可能有助于对早孕期OSB的筛查。正中矢状切面或经前囟小脑横切面超声发现胎儿颅后窝第四脑室
与小脑延髓池分界不清，且脑干前后径与第四脑室-小脑延髓池前后径的比值大于1，可能成为11~13+6周OSB的筛查指标。

Abstract: Objective To establish the normal reference ranges of transabdominal ultrasound measurements of the posterior
fossa structure in fetuses at 11 to 13+ 6 gestational weeks and explore their clinical value in screening open spina bifida (OSB).
Methods Between January, 2013 and September, 541 randomly selected normal fetuses underwent nuchal translucency at the
gestational age 11 to 13+6 weeks. The parameters of the posterior fossa were measured in mid-sagittal view of the fetal face and
the axial view of the transverse cerebellum insonated through the anterior fontanel by transabdominal ultrasound to establish
the normal reference ranges. The measurements were obtained from 3 fetuses with OSB for comparison with the reference
ranges. Results In normal fetuses, the parameters of the posterior fossa measured in the two views showed no significant
differences (P>0.05). Two high echogenic lines were observed in normal fetuses, as compared with one in fetuses with OSB
representing the posterior border of the brain stem and the anterior border of the fourth ventricle. The line between the
posterior border of the fourth ventricle and the anterior border of the cisterna magna was not displayed in fetuses with OSB.
The anteroposterior diameters of the brain stem, the fourth ventricle, and cisterna magna all increased in positive correlation
with the crown-lump length in normal fetuses. In the 3 OSB fetuses, the anteroposterior diameter of the brain stem exceeded
the 95th percentile and the anteroposterior diameter of fourth ventrical-cisterner magena was below the 5th percentile of the
reference range for CRL; the brain stem to fourth ventrical-cisterner magena anteroposterior diameter ratio was increased to
above 1. Conclusion The established normal reference ranges of the parameters of fetal posterior fossa may provide assistance
in early OSB detection. The absence of the posterior border of the fourth ventricle and the anterior border of the cisterna
magna and a brainstem to fourth ventrical-cisterner magena anteroposterior diameter ratio greater than 1 can be indicative of
OSB at 11 to 13+6 gestational weeks.