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Abstract：
The aim of this systematic review is to report the normal cortical development of different fetal cerebral fissures on ultrasound, describe associated anomalies in fetuses with cortical malformations, and evaluate the quality of published charts of cortical fissures. The inclusion criteria were studies reporting development, anomalies, and reference charts of fetal cortical structures on ultrasound. The outcomes observed were the timing of the appearance of different cortical fissures according to different gestational age windows, associated central nervous system (CNS) and extra-CNS anomalies detected at ultrasound in fetuses with cortical malformation, and rate of fetuses with isolated anomaly. Furthermore, we performed a critical evaluation of the published reference charts for cortical development on ultrasound. Random-effect meta-analyses of proportions were used to combine the data. Twenty-seven studies (6875 fetuses) were included. Sylvian fissure was visualized on ultrasound in 97.69% (95% CI 92.0-100) of cases at 18-19, 98.17% (95% CI 94.8-99.8) at 20-21, 98.94% (95% CI 97.0-99.9) at 22-23, and in all cases from 24 weeks of gestation. Parieto-occipital fissure was visualized in 81.56% (95% CI 48.4-99.3) of cases at 18-19, 96.59% (95% CI 83.2-99.8) at 20-21, 96.85% (95% CI 88.8-100) at 22-23, and in all cases from 24 weeks of gestation, while the corresponding figures for calcarine fissure were 37.27% (95% CI 0.5-89.6), 80.42% (95% CI 50.2-98.2), 89.18% (95% CI 74.0-98.2), and 96.02% (95% CI 96.9-100). Malformations of cortical development were diagnosed as an isolated finding at ultrasound in 6.21% (95% CI 2.9-10.9) of cases, while they were associated with additional CNS anomalies in 93.79% (95% CI 89.1-97.2) of cases. These findings highlight the need for large studies specifically looking at the timing of the appearance of the different brain sulci. Standardized algorithms for prenatal assessment of fetuses at high risk of malformations of cortical development are also warranted.
摘要：
这项系统评价的目的是报告超声检查不同胎儿脑裂的正常皮质发育，描述胎儿皮质畸形的相关异常，并评估已发布的皮质裂隙图表的质量。纳入标准是报告发展的研究，异常,和超声检查胎儿皮质结构的参考图。观察结果为不同胎龄窗不同皮质裂隙出现的时间,在有皮质畸形的胎儿中，超声检测到相关的中枢神经系统（CNS）和中枢神经系统外异常，和孤立异常胎儿的比率。此外，我们对已发表的超声皮质发育参考图进行了严格评估.使用比例的随机效应荟萃分析来组合数据。包括27项研究（6875例胎儿）。在18-19岁的97.69％（95％CI92.0-100），20-21岁的98.17％（95％CI94.8-99.8），22-23岁的98.94％（95％CI97.0-99.9）以及所有妊娠24周的病例中，超声检查显示了Sylvian裂。18-19岁的病例中有81.56％（95％CI48.4-99.3），20-21岁的病例中有96.59％（95％CI83.2-99.8），22-23岁的病例中有96.85％（95％CI88.8-100），所有病例均为妊娠24周，而钙石裂隙的相应数字为37.27%(95%CI0.5-89.6)，80.42%（95%CI50.2-98.2），89.18%（95%CI74.0-98.2），和96.02%（95%CI96.9-100）。在6.21％（95％CI2.9-10.9）的病例中，皮质发育的畸形被诊断为孤立的超声发现，而在93.79%(95%CI89.1-97.2)的病例中,它们与额外的CNS异常相关.这些发现强调了需要进行大型研究，特别是研究不同脑沟的出现时间。也有必要对处于皮质发育畸形高风险的胎儿进行产前评估的标准化算法。
