孕11至13⁺⁶周时经三维超声评估胎儿鼻骨间距

Assessment of the gap between the fetal nasal bones at 11 to 13 + 6 weeks of gestation by three-dimensional ultrasound.

作者信息

Peralta C F A, Falcon O, Wegrzyn P, Faro C, Nicolaides K H

机构信息

Harris Birthright Research Centre for Fetal Medicine, King's College Hospital Medical School, London, UK.

出版信息

Ultrasound Obstet Gynecol. 2005 May;25(5):464-7. doi: 10.1002/uog.1885.

DOI:10.1002/uog.1885

PMID:15816008

Abstract

OBJECTIVE

To detect the presence of a gap between the fetal nasal bones at 11 to 13 + 6 weeks of gestation and to verify if this gap could lead to the erroneous diagnosis of absent nasal bone.

METHODS

Three-dimensional (3D) ultrasound was used to assess the fetal nose in 450 singleton pregnancies, immediately after two-dimensional (2D) evaluation of the nasal bones and screening for chromosomal defects by a combination of maternal age and the measurement of fetal nuchal translucency at 11 to 13 + 6 (median, 12) weeks of gestation. A 3D volume of the fetal face was acquired and then analyzed using the multiplanar mode. A sequence of transverse views was used to confirm the presence or absence of the nasal bones and when they were present any visible gap between them was measured. A perfectly mid-sagittal plane was then examined to determine if the nasal bone was visible or not.

RESULTS

In 421/450 (93.6%) cases the nasal bone was present during 2D ultrasound. Using the multiplanar mode of 3D ultrasound, in 83/421 (19.7%) fetuses a gap between the nasal bones could be demonstrated and in 36/83 (43.4%) cases the nasal bone was found to be absent in the perfect mid-sagittal view. In 29/450 (6.4%) cases the nasal bones were absent during the 2D scan. In the 3D assessment there was absence of both bones in 25/29 (86.2%) cases and absence of one of the two bones in 4/29 (13.8%) cases. Chorionic villus sampling demonstrated that the fetal karyotype was normal in 404 and abnormal in 46 cases, including 31 cases of trisomy 21. There was absence of one or both nasal bones in three (0.7%) of the chromosomally normal fetuses, in 19 (61.3%) with trisomy 21 and in seven (46.7%) with other chromosomal defects.

CONCLUSIONS

At 11 to 13 + 6 weeks of gestation there is a gap between the nasal bones in about 20% of fetuses, and in about 40% of these cases in the perfect mid-sagittal plane the nasal bone may erroneously be considered to be absent.

摘要

目的

检测孕11至13⁺⁶周胎儿鼻骨间间隙的存在情况，并验证该间隙是否会导致鼻骨缺失的误诊。

方法

对450例单胎妊娠进行三维（3D）超声检查，在孕11至13⁺⁶周（中位数为12周）对鼻骨进行二维（2D）评估并结合孕妇年龄及胎儿颈部透明带测量进行染色体缺陷筛查后，立即使用3D超声评估胎儿鼻部。获取胎儿面部的3D容积，然后使用多平面模式进行分析。使用一系列横断视图确认鼻骨的存在与否，若鼻骨存在，则测量其间任何可见的间隙。然后检查正中矢状平面以确定鼻骨是否可见。

结果

在450例中，421例（93.6%）在2D超声检查时鼻骨存在。使用3D超声的多平面模式，在421例胎儿中有83例（19.7%）可显示鼻骨间间隙，其中36例（43.4%）在正中矢状平面检查时鼻骨被发现缺失。29例（6.4%）在2D扫描时鼻骨缺失。在3D评估中，29例中有25例（86.2%）双侧鼻骨均缺失，4例（13.8%）一侧鼻骨缺失。绒毛取样显示，404例胎儿染色体核型正常，46例异常，包括31例21三体。在染色体正常的胎儿中有3例（0.7%）一侧或双侧鼻骨缺失，21三体胎儿中有19例（61.3%），其他染色体缺陷胎儿中有7例（46.7%）。