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[超声产前诊断胼胝体异常:超声检查医师的观点]

[Prenatal diagnosis of anomalies of the corpus callosum with ultrasound: the echographist's point of view].

作者信息

Maheut-Lourmière J, Paillet C

出版信息

Neurochirurgie. 1998 May;44(1 Suppl):85-92.

PMID:9757327
Abstract

Ultrasonography can identify agenesis of the corpus callosum (excluding holoprosencephaly which an be detected earlier on) in the second trimester of pregnancy (18-20 weeks gestation). Diagnosis of corpus callosum agenesis is difficult but is important as a risk factor for neurological or genetic malformations. The characteristic signs suggestive of corpus callosum agenesis are: moderate distension of the occipital ventricle and the ventricular communications; absence of the spectrum giving rise to an upward displacement of the third ventricle shown in the anterior coronal section (especially in transvaginal ultrasonography); radial position of the fissures on the internal side of the cerebral hemisphere seen on the sagittal section; the absence in color coded Doppler of the pericallosal artery normally characterised by a semicircular vessel observable on the median sagittal section. At present, color coded Doppler should give the diagnosis of corpus callosum agenesis. MRI can provide further information especially in case of late detection around 28-30 weeks gestation as is most frequently the case. The development of 3D echographic imaging should allow an even more sophisticated approach to this diagnosis giving even more precise prognosis. Isolated corpus callosum agenesis is compatible with normal intellectual development an raises an important problem with regard to pregnancy continuation and infant development. Each individual case should be discussed during the pluridisciplinary prenatal diagnostic discussion.

摘要

超声检查可在妊娠中期(妊娠18 - 20周)发现胼胝体发育不全(不包括可更早检测出的前脑无裂畸形)。胼胝体发育不全的诊断困难,但作为神经或基因畸形的风险因素很重要。提示胼胝体发育不全的特征性体征有:枕叶脑室中度扩张及脑室相通;前冠状切面显示第三脑室上移导致的频谱缺失(经阴道超声检查时尤为明显);矢状切面可见大脑半球内侧裂的放射状位置;彩色编码多普勒显示胼周动脉缺失,正常情况下在正中矢状切面上可观察到半圆形血管。目前,彩色编码多普勒应能诊断胼胝体发育不全。MRI可提供更多信息,尤其是在妊娠28 - 30周左右发现较晚的情况下,这种情况最为常见。三维超声成像技术的发展应能使诊断方法更加完善,从而得出更精确的预后结论。孤立性胼胝体发育不全与正常智力发育相符,在妊娠继续和婴儿发育方面引发了一个重要问题。在多学科产前诊断讨论中,应针对每个具体病例进行讨论。

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