Harvard Medical School, Boston, MA, USA.
AJR Am J Roentgenol. 2011 Jan;196(1):W83-92. doi: 10.2214/AJR.10.4434.
The objective of this study was to assess the outcomes of the prenatal diagnosis of septal leaflet abnormalities in fetuses referred for prenatal imaging with a finding of ventriculomegaly.
This study is a retrospective review of fetuses with a diagnostic code of septal leaflet abnormalities from a larger prospective study. Four hundred twenty-five pregnant women with 433 fetuses referred for ventriculomegaly were imaged with ultrasound and MRI between July 1, 2003, and May 15, 2009. Four to six radiologists independently reviewed sonographic and MR images and recorded lateral ventricular diameters at the atrium and frontal horns, ventricular configuration, and the presence of ventriculomegaly and of other CNS abnormalities. Final prenatal ultrasound, MRI, and overall diagnoses were decided by consensus. Fetuses with a diagnostic code of septal leaflet abnormalities were identified, and birth outcome, autopsy findings, postnatal imaging, and postnatal follow-up examinations were obtained. The analysis of covariance, controlling for gestational age, was used to compare ventricular dimensions between fetuses with septal leaflet abnormalities and fetuses with isolated ventriculomegaly. Interrater agreement for the detection of septal leaflet abnormalities was assessed with kappa statistics. Interrater agreement and intrarater agreement for frontal horn measurements were assessed by variance components analysis.
Twenty-three fetuses had septal leaflet abnormalities and 229 had isolated ventriculomegaly. Atrial and frontal horn diameters, adjusted for gestational age, were 77% and 98% larger, respectively, in fetuses with septal leaflet abnormalities than in fetuses with isolated ventriculomegaly (p < 0.0001). Before the consensus conference, agreement among ultrasound readers was moderate (κ = 0.54) and among MR readers, good (κ = 0.69). Additional CNS findings were seen on MRI in 12 of 23 fetuses (52%). Eleven pregnancies with septal leaflet abnormalities underwent termination and 12 progressed to livebirth; of the 12 livebirths, three neonates died. Neurodevelopmental follow-up was abnormal in all surviving children.
A septal leaflet abnormality in the setting of ventriculomegaly is most frequently associated with other CNS abnormalities and is associated with postnatal developmental delay.
本研究旨在评估因脑室扩大而接受产前影像学检查并发现隔瓣异常的胎儿的产前诊断结果。
这是一项对较大前瞻性研究中隔瓣异常诊断编码胎儿的回顾性研究。2003 年 7 月 1 日至 2009 年 5 月 15 日，425 名孕妇的 433 名胎儿因脑室扩大而接受超声和 MRI 检查。4 至 6 名放射科医生独立地对超声和 MRI 图像进行了复查，并记录了侧脑室在心房和额角的直径、脑室形态以及脑室扩大和其他 CNS 异常的存在情况。最终的产前超声、MRI 和整体诊断结果通过共识决定。确定了具有隔瓣异常诊断编码的胎儿，并获得了出生结局、尸检结果、产后影像学和产后随访检查。使用协方差分析，控制胎龄，比较了隔瓣异常胎儿和单纯脑室扩大胎儿的心室尺寸。采用 Kappa 统计评估了检测隔瓣异常的组内一致性。采用方差分量分析评估了额角测量的组内和组间一致性。
23 名胎儿有隔瓣异常，229 名胎儿有单纯脑室扩大。调整胎龄后，隔瓣异常胎儿的心房和额角直径分别大 77%和 98%（p<0.0001）。在共识会议之前，超声读者的一致性为中等（κ=0.54），磁共振读者的一致性为良好（κ=0.69）。23 名胎儿中有 12 名（52%）在 MRI 上发现了其他 CNS 异常。11 例隔瓣异常的妊娠进行了终止，12 例继续存活分娩；在 12 例存活分娩中，有 3 名新生儿死亡。所有存活儿童的神经发育随访均异常。
在脑室扩大的情况下，隔瓣异常最常与其他 CNS 异常相关，并与出生后发育迟缓相关。
