背景:据报道,在妊娠18周后,大多数患有开放性脊柱裂的胎儿中,胎儿侧脑室的大小增加。在妊娠早期,脑室肥大的定义是基于脉络丛的大小与心室空间或整个胎儿头部的大小之间的比率。然而,与中期看到的相反,在大多数11-13周有开放性脊柱裂的胎儿中,心室系统中的液体量似乎减少而不是增加。
目的:比较正常胎儿和确诊为开放性脊柱裂的胎儿在11+0-13+6周时侧脑室的生物特征。
方法:回顾性队列研究,包括所有在5年期间妊娠11+0-13+6周检测到的孤立性开放性脊柱裂病例,以及一组结构正常的胎儿在我们中心进行1年的非整倍体筛查作为对照。从档案中提取病例和对照中获得的胎儿大脑的跨心室轴向视图,以进行脑室的事后测量。脉络丛和侧脑室宽度(CPVLr)和面积(CPVAr)之间的比率,计算两组的脉络丛面积总和与胎儿头部面积(CPHAr)之比以及脉络丛长度平均值与枕骨额径(CPHLr)之比.比较两组的测量结果,研究了各参数与开放性脊柱裂的关系。
结果:将10例开放性脊柱裂胎儿与358例对照进行比较,显示脑室测量值明显较小,由较大的CPVAr值表示(0.72vs0.49,p<0.001),CPVLr(0.79对0.70,p<0.001),与对照组相比,CPHAr(0.33vs0.28,p=0.006)和CPHLr(0.60vs0.52,p<0.001)。发现CPVAr是OSB的最准确的预测因子,其曲线下面积为0.88,灵敏度为90%,特异性为82%。
结论:妊娠11+0-13+6周时,开放性脊柱裂与胎儿侧脑室液体量减少有关,正如CPVLr显著增加所见证的那样,CPVAr,CPHAr和CPHLr。
BACKGROUND: Beyond 18 weeks of gestation an increased size of the fetal lateral ventricles is reported in the majority of fetuses with open spina bifida. At 1st trimester, the definition of ventriculomegaly is based on the ratio between the size of the choroid plexus and that of the ventricular space or of the entire fetal head. However, contrary to what is seen from midtrimester, in most fetuses with open spina bifida at 11-13 weeks the amount of fluid in the ventricular system seems to be reduced rather than increased.
OBJECTIVE: To compare the biometry of the lateral ventricles at 11+0-13+6 weeks between normal fetuses and those with a confirmed open spina bifida.
METHODS: Retrospective cohort study including all cases of isolated open spina bifida detected at 11+0-13+6 weeks of gestation over a period of 5 years and a group of structurally normal fetuses attending at our Centre over a period of 1 year for the aneuploidies screening as controls. The transventricular axial views of the fetal brain obtained among cases and controls were extracted from the archive for post-hoc measurement of the cerebral ventricles. The ratios between choroid plexus and lateral ventricle lenghts (CPVLr) and areas (CPVAr), the ratio between the sum of both choroid plexus areas and fetal head area (CPHAr) and the ratio between the mean of choroid plexus lengths and occipito-frontal diameter (CPHLr) were calculated for both groups. Measurements obtained from the two groups were compared, and the association of each parameter with open spina bifida was investigated.
RESULTS: Ten fetuses with open spina bifida were compared with 358 controls, showing significantly smaller size of the cerebral ventricles measurements as expressed by larger values of CPVAr (0.72 vs 0.49, p<0.001), CPVLr (0.79 vs 0.70, p<0.001), CPHAr (0.33 vs 0.28, p=0.006) and CPHLr (0.60 vs 0.52, p<0.001) compared with controls. CPVAr was found to be the most accurate predictor of OSB showing an area under the curve of 0.88 with a sensitivity of 90% and a specificity of 82%.
CONCLUSIONS: At 11+0-13+6 weeks\' gestation open spina bifida is consistently associated with a reduced amount of fluid in the lateral cerebral ventricles of the fetus, as witnessed by significantly increased CPVLr, CPVAr, CPHAr and CPHLr.