正常与隐性脊柱裂胎儿脊髓圆锥位置的三维超声评估

摘要

目的 探讨三维超声定位胎儿脊髓圆锥辅助诊断隐性脊柱裂的价值.方法 三维超声分别检测102例孕中晚期正常胎儿(正常组)及11例隐性脊柱裂胎儿(异常组)脊髓圆锥所对应椎体水平；检验三维超声法定位脊髓圆锥的组间、组内一致性；建立正常组脊髓圆锥位置与孕周的回归模型；比较两组脊髓圆锥位置的差异.结果 三维超声脊髓圆锥定位的操作者一致性检验加权Kappa值分别为1.0和0.788;正常组脊髓圆锥位置均位于L3或L3水平以上；异常组1例脊髓圆锥位置位于L3水平,10例低于L3水平.结论 三维超声可准确标记胎儿脊髓圆锥位置；隐性脊柱裂胎儿脊髓圆锥水平明显低于正常；脊髓圆锥定位是发现和诊断胎儿隐性脊柱裂的重要声像标志.%Objective To investigate the application value of positioning fetal conus medullaris using three dimensional ultrasound in diagnosis of spina bifida occulta.Methods One hundred and two normal fetuses in second and third trimester (normal group) and 11 cases of spina bifida occulta (abnormal group) were included.Intra and interobserver agreement of two different operators for 3D ultrasound were assessed.Linear regression analysis was used to determine the correlation between the gestational weeks and the level of the conus medullaris.The position of conus medullaris in two groups was compared.Results The Weighted Kappa value for intra-and inter observer agreement were 1.0 and 0.788.In normal group,the conus medullaris all positioned at L3 or above L3,whereas in abnormal group the conus medullaris positioned at L3 in one case and below L3 in 10 cases.Conclusions 3D ultrasound may be accurately used to evaluate fetal conus medullaris position; The conus medullaris position of fetuses with spina bifida occulta is lower than that of normal fetus.Position of the conus medullaris is an important imaging marker for detecting and diagnosing fetal spina bifida occulta.