Merz E, Weber G, Bahlmann F, Miric-Tesanic D
Department of Obstetrics and Gynecology, Johannes-Gutenberg-University, Mainz, Germany.
Ultrasound Obstet Gynecol. 1997 Apr;9(4):237-43. doi: 10.1046/j.1469-0705.1997.09040237.x.
In a total of 618 pregnant women between 9 and 37 weeks' gestation, the fetal face was evaluated by two-dimensional and three-dimensional ultrasound imaging as part of a level III screening evaluation for fetal anomalies. A three-dimensional endovaginal probe (5 MHz) was used for examinations at between 9 and 15 weeks, and an abdominal three-dimensional probe (3.5 MHz) was used after 15 weeks. Three different three-dimensional image display modes were employed: (1) the orthogonal display; (2) the surface display; and (3) the transparent display. When we studied the three-dimensional orthogonal displays in a 125 cases evaluated by abdominal ultrasound, we found that the facial profile shown in the two dimensional image represented the true mid-sagittal profile in only 69.6% of the cases. In the remaining 30.4%, the profile view deviated from a true mid-sagittal section by up to 20 degrees in one or two planes. In a total of 25 facial anomalies detected by abdominal ultrasound, 20 were clearly demonstrated by both two-dimensional and three-dimensional technology. In the remaining five cases, three-dimensional ultrasound revealed or confirmed an additional defect or abnormality: a narrow cleft lip in an unfavorable position of the fetal face (n = 2), a unilateral orbital hypoplasia (n = 1), a cranial ossification defect (n = 1) and a flat profile in the presence of marked oligohydramnios (n = 1). When transvaginal scanning was used, there were cases in which a detailed surface image of the fetal face could be obtained as early as 9 weeks' gestation. Abdominal scanning routinely yielded high-quality surface images by 20 weeks. Three-dimensional ultrasound consistently displayed facial abnormalities with greater accuracy and clarity than conventional two-dimensional imaging. This particularly applied to chromosomal aberrations and syndromes associated with subtle facial abnormalities requiring a detailed evaluation. Not only does three-dimensional ultrasound help in appreciating the severity of a fetal defect, but it can also provide more convincing evidence of a normal fetus than conventional two-dimensional sonograms.
在总共618名妊娠9至37周的孕妇中，作为胎儿异常的三级筛查评估的一部分，通过二维和三维超声成像对胎儿面部进行了评估。在9至15周时使用三维经阴道探头（5兆赫）进行检查，15周后使用腹部三维探头（3.5兆赫）。采用了三种不同的三维图像显示模式：（1）正交显示；（2）表面显示；（3）透明显示。当我们研究通过腹部超声评估的125例病例的三维正交显示时，我们发现二维图像中显示的面部轮廓在仅69.6%的病例中代表真正的正中矢状轮廓。在其余30.4%的病例中，轮廓视图在一个或两个平面上偏离真正的正中矢状切面达20度。在通过腹部超声检测出的总共25例面部异常中，20例通过二维和三维技术均得到了清晰显示。在其余5例中，三维超声揭示或确认了另外的缺陷或异常：胎儿面部不利位置的窄唇裂（n = 2）、单侧眼眶发育不全（n = 1）、颅骨骨化缺陷（n = 1）以及羊水过少时的扁平轮廓（n = 1）。当使用经阴道扫描时，早在妊娠9周时就有病例能够获得胎儿面部的详细表面图像。腹部扫描在20周时常规可获得高质量的表面图像。与传统二维成像相比，三维超声始终能更准确、清晰地显示面部异常。这尤其适用于与需要详细评估的细微面部异常相关的染色体畸变和综合征。三维超声不仅有助于评估胎儿缺陷的严重程度，而且与传统二维超声检查相比，它还能为正常胎儿提供更有说服力的证据。
