Zhu Rong, Chen Jun Ya, Hou Xin Lin, Liu Li Li, Sun Guo Yu
Department of Obstetrics & Gynecology, Peking University First Hospital, No. 1 Xi-An-Men Street, Xi-Cheng District, Beijing, 100034, China.
Department of Pediatrics, Peking University First Hospital, No. 1 Xi-An-Men Street, Xi-Cheng District, Beijing, 100034, China.
BMC Pregnancy Childbirth. 2021 Mar 10;21(1):199. doi: 10.1186/s12884-021-03692-x.
Assessments of cortical development and identifying factors that may result in a poor prognosis for fetuses with isolated mild ventriculomegaly (IMVM) is a hot research topic. We aimed to perform a constant, detailed assessment of cortical development in IMVM fetuses using ultrasound and determine whether asymmetric cortical development occurred. Moreover, we aimed to estimate the prognosis of IMVM fetuses and compare the difference in the prognosis of IMVM fetuses presenting symmetric and asymmetric cortical maturation.
IMVM was diagnosed by regular ultrasound, neurosonography and fetal MRI. Genetic and TORCH examinations were conducted to exclude common genetic abnormalities and TORCH infection of fetuses. Ultrasound examinations were conducted at an interval of 2-3 weeks to record sulcus development in IMVM fetuses using a scoring system. The neonatal behavioral neurological assessment (NBNA), the Ages and Stages Questionnaire, Third Edition (ASQ-3) and the Bayley Scales of Infant Development, First Edition (BSID-I) were performed after birth.
Forty fetuses with IMVM were included: twenty showed asymmetric cortical maturation and twenty showed symmetric cortical maturation. For IMVM fetuses presenting asymmetric cortical maturation, the mean gestational age (GA) at the first diagnosis of relatively delayed development was 24.23 weeks for the parieto-occipital sulcus, 24.71 weeks for the calcarine sulcus, and 26.43 weeks for the cingulate sulcus. All the sulci with delayed development underwent 'catch-up growth' and developed to the same grade as the sulci of the other hemisphere. The mean GA at which the two sides developed to the same grade was 29.40 weeks for the parieto-occipital sulcus, 29.30 weeks for the calcarine sulcus and 31.27 weeks for the cingulate sulcus. The NBNA, ASQ-3 and BSID-I scores of all patients were in the normal range.
IMVM fetuses may show mild asymmetric cortical maturation in the second trimester, but the relatively delayed sulci undergo 'catch-up growth'. The neurodevelopment of IMVM fetuses presenting asymmetric cortical maturation and 'catch-up growth' is not statistically significantly different from IMVM fetuses presenting symmetric cortical maturation.
评估皮质发育并确定可能导致孤立性轻度脑室扩大（IMVM）胎儿预后不良的因素是一个热门研究课题。我们旨在使用超声对IMVM胎儿的皮质发育进行持续、详细的评估，并确定是否发生不对称皮质发育。此外，我们旨在评估IMVM胎儿的预后，并比较呈现对称和不对称皮质成熟的IMVM胎儿在预后方面的差异。
通过常规超声、神经超声和胎儿磁共振成像诊断IMVM。进行基因和TORCH检查以排除胎儿常见的基因异常和TORCH感染。每隔2 - 3周进行超声检查，使用评分系统记录IMVM胎儿的脑沟发育情况。出生后进行新生儿行为神经评定（NBNA）、《年龄与发育阶段问卷》第三版（ASQ - 3）和《贝利婴儿发育量表》第一版（BSID - I）。
纳入40例IMVM胎儿：20例表现为不对称皮质成熟，20例表现为对称皮质成熟。对于表现为不对称皮质成熟的IMVM胎儿，首次诊断出相对发育延迟时的平均孕周（GA），顶枕沟为24.23周，距状沟为24.71周，扣带沟为26.43周。所有发育延迟的脑沟均经历“追赶生长”，并发育到与另一半球脑沟相同的等级。两侧发育到相同等级时的平均孕周，顶枕沟为29.40周，距状沟为29.30周，扣带沟为31.27周。所有患者的NBNA、ASQ - 3和BSID - I评分均在正常范围内。
IMVM胎儿在孕中期可能表现出轻度不对称皮质成熟，但相对延迟的脑沟会经历“追赶生长”。表现为不对称皮质成熟和“追赶生长”的IMVM胎儿的神经发育与表现为对称皮质成熟的IMVM胎儿相比，在统计学上无显著差异。
