Mappa Ilenia, Di Mascio Daniele, Carbone Luigi, Lu Jia Li Angela, Sorrenti Sara, Patelli Chiara, D'Amico Alice, Matarrelli Barbara, Giuliani Giulia Andrea, Neola Daniele, Di Girolamo Raffaella, Sarno Laura, Khalil Asma, Rizzo Giuseppe, Maruotti Giuseppe Maria, D'Antonio Francesco
Department of Obstetrics and Gynecology, Fondazione Policlinico Tor Vergata, University of Rome Tor Vergata, 00133 Rome, Italy.
Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, 00161 Roma, Italy.
Biomedicines. 2024 Jun 24;12(7):1397. doi: 10.3390/biomedicines12071397.
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.
本系统评价的目的是报告超声检查中不同胎儿脑沟的正常皮质发育情况，描述皮质发育畸形胎儿的相关异常，并评估已发表的皮质沟图表的质量。纳入标准为报告超声检查中胎儿皮质结构发育、异常及参考图表的研究。观察到的结果包括不同孕周窗口下不同皮质沟出现的时间、皮质发育畸形胎儿超声检查中检测到的相关中枢神经系统（CNS）和中枢神经系统外异常，以及孤立异常胎儿的比例。此外，我们对已发表的超声皮质发育参考图表进行了批判性评估。采用随机效应meta分析比例法合并数据。纳入了27项研究（6875例胎儿）。在妊娠18 - 19周时，97.69%（95%CI 92.0 - 100）的病例超声可显示外侧裂；20 - 21周时为98.17%（95%CI 94.8 - 99.8）；22 - 23周时为98.94%（95%CI 97.0 - 99.9）；妊娠24周及以后的所有病例均可显示。在妊娠18 - 19周时，81.56%（95%CI 48.4 - 99.3）的病例超声可显示顶枕裂；20 - 21周时为96.59%（95%CI 83.2 - 99.8）；22 - 23周时为96.85%（95%CI 88.8 - 100）；妊娠24周及以后的所有病例均可显示。而距状沟的相应数据分别为37.27%（95%CI 0.5 - 89.6）、80.42%（95%CI 50.2 - 98.2）、89.18%（95%CI 74.0 - 98.2）和96.02%（95%CI 96.9 - 100）。超声检查中，6.21%（95%CI 2.9 - 10.9）的病例皮质发育畸形被诊断为孤立性发现，而93.79%（95%CI 89.1 - 97.2）的病例与其他中枢神经系统异常相关。这些发现凸显了开展专门研究不同脑沟出现时间的大型研究的必要性。制定针对皮质发育畸形高风险胎儿的产前评估标准化算法也很有必要。
