侧角度照射技术在胎儿腭三维超声成像中的应用价值

目的 评价侧角度照射技术对胎儿腭的容积数据采集及三维后处理的价值.方法 选取孕20~28周进行系统胎儿超声检查的孕妇566例,胎儿颜面部正常并经产后证实.在获取颜面部标准正中矢状切面和侧角度照射的正中矢状切面后分别采集容积数据,使用4D-View软件进行后处理.对1例唇腭裂胎儿采用同样的技术进行容积采集及数据后处理.结果 566例胎儿中分别有458例和411例成功采集到标准正中矢状切面及侧角度照射正中矢状切面的容积数据.胎儿原发腭在标准组和侧角度照射组均可很好地重建显示(100%).标准组中硬腭的轴平面不能重建,只有36%的胎儿硬腭的冠状面和经口裂斜冠切面可重建出,软腭重建的显示率为87%.在侧角度照射组中硬腭轴平面、冠状面及经口裂斜冠切面重建显示率均为100%,软腭重建显示率为82%.1例唇腭裂胎儿可清楚地显示牙槽突裂累及继发腭的情况.结论 侧角度照射技术在显示继发腭的基础上采集容积数据,采用三维后处理技术,可获取全部腭任意部位的常规三正交平面及其他任意切面,从而实现对胎儿腭的完整性的评估,对唇裂合并的腭裂进行诊断和分类,并使单纯腭裂的产前诊断成为可能.

Abstract：

Objective To evaluate the value of angled insonation technique in obtaining the volumes of the fetal palate and in three-dimensional post-processing.Methods Five hundred and sixty-six cases of 20~28 weeks fetuses with normal face were confirmed by systemic ultrasound examinations and post-natal examination.The volumes in the standard midsagittal plane and angled midsagittal plane were obtained,then post-processed these data by 4D-View software.The same technology was used for volume data acquisition and processing to 1 case of cleft lip and palate fetal.Results In 566 fetuses,two groups of volume data were successfully acquired in 458 cases (standard midsagittal plane group) and 411 cases (angled midsagittal plane group).Fetal primary palate in the standard group and the angled group can be both well visualized(100%).Axial plane of hard palate can not be reconstructed in the standard group.Only 36% of the fetal hard palate's coronal plane and transoral oblique coronal plane can be reconstructed.The visualization rate of soft palate was 87% in the standard group,which was slightly higher than the angled group (82%).The visualization rate of hard palate's axial plane,coronal plane and transoral oblique coronal plane was 100% respectively in the angled group.Cleft alveolar process involving the secondary palate can be clearly visualized in 1 case of cleft lip and palate fetus.Conclusions By using the angled insonation technique,which is based on clearly visualizing secondary palate to obtain volumes,using three-dimensional post-processing technique can obtain the conventional three orthogonal planes and any other section of the whole palate.By using it we can assess the integrity of fetal palate,diagnose cleft lip with or without cleft palate and classify the cleft palate,even make prenatal diagnosis of the isolated cleft palate possible.     

三维超声自由解剖成像新技术在胎儿腭显示中的应用

目的评价三维超声自由解剖成像新技术（全方位观中任选切面）在胎儿腭部显示中的应用价值。方法应用三维超声自由解剖成像技术对100例正常胎儿经下颌颜面部正中矢状切面的容积数据进行分析,在参考切面（颜面部正中矢状切面）上描画解剖线,获取横切面（经上颌、经口裂）、冠状切面、斜冠状切面（经梨状孔、经口裂、经颏下三角）以及腭的曲面平铺成像。对5例唇腭裂胎儿按照相同技术获取容积数据并进行分析。结果 100例正常胎儿中91例（91.0%,91/100）成功采集到颜面部容积数据,经三维超声自由解剖成像技术对91例容积数据进行分析,不同成像切面上腭部显示结果：（1）经上颌横切面显示胎儿牙槽突弓91例（100%,91/91）,声像图表现为＂C＂形的弓状结构;显示硬腭91例（100%,91/91）,声像图表现为两侧牙槽骨间片状强回声;经口裂横切面显示软腭81例（89.0%,81/91）,声像图表现为条状软组织带。（2）冠状切面显示硬腭91例（100%,91/91）,声像图表现为条状强回声带,分隔口腔和鼻腔。（3）经梨状孔斜冠状切面显示硬腭91例（100%,91/91）,声像图表现为短条状强回声带;经口裂斜冠状切面显示硬腭91例（100%,91/91）;经颏下三角斜冠状切面显示硬腭91例（100%,91/91）,声像图均表现为条状强回声带,其后方为声影,不能显示其上方的鼻腔及鼻中隔。（4）经梨状孔斜冠状切面显示软腭81例（89.0%,81/91）,显示悬雍垂25例（27.5%,25/91）,声像图表现为片状软组织回声,悬雍垂为软腭下缘正中乳头状突起;经口裂斜冠状切面显示软腭81例（89.0%,81/91）;经颏下三角斜冠状切面显示软腭81例（89.0%,81/91）,声像图均表现为条状软组织带,后上方为鼻咽部无回声区。（5）腭的曲面成像显示牙槽突弓91例（100%,91/91）,显示硬腭91例（100%,91/91）,显示软腭81例（89.0%,81/91）,显示悬雍垂25例（27.5%,25/91）,声像图表现为牙槽突弓呈＂C＂形弓状结构,硬腭呈片状骨性强回声,软腭为片状软组织低回声。在15例包含唇腭裂畸形的容积数据中,分析者能全部确认其中的5例畸形病例,并能确认腭裂累及的部位及范围。结论三维超声自由解剖成像技术易于获取二维超声难以显示的胎儿腭部横切面和冠状切面图像,并可获取继发腭的特殊斜冠状切面图像;通过追踪腭的结构画线,可获取腭的曲面平铺成像,形象直观地显示腭部全景图。此方法可简化胎儿腭的超声检测,减少对操作者技术和经验的依赖,能较快评估胎儿原发腭及继发腭的完整性,确认唇裂胎儿有无腭裂,并可明确腭裂累及的部位及范围。     

Fetal cleft lip and palate detection by three-dimensional ultrasonography.

OBJECTIVES: To demonstrate a standardized approach for the evaluation of cleft lip and palate by three-dimensional (3D) ultrasonography. DESIGN: This was a retrospective study of seven fetuses with confirmed facial cleft anomalies. Post-natal findings were compared to a blinded review of 3D volume data from abnormal fetuses with seven other normal fetuses that were matched for gestational age. Upper lip integrity was examined by 3D multiplanar imaging. Sequential axial views were used to evaluate the maxillary tooth-bearing alveolar ridge contour and anterior tooth socket alignment. Alveolar ridge disruption suggested cleft palate. Premaxillary protrusion, either by multiplanar imaging or surface rendering, indicated bilateral cleft lip and palate. RESULTS: Post-natal findings confirmed bilateral cleft lip and palate (four cases), unilateral cleft lip and palate (one case), and unilateral cleft lip (two cases). Multiplanar review identified all three fetuses with unilateral cleft lip, three of four fetuses with bilateral cleft lip, one fetus with unilateral cleft palate, and three of four fetuses with bilateral cleft palate. Surface rendering correctly identified all cleft lips, with the exception of one fetus, who was thought to have a unilateral cleft lip and palate, despite the actual presence of a bilateral lesion. One cleft palate defect was directly visualized by 3D surface rendering. No false-positives occurred. CONCLUSION: Interactive review of standardized 3D multiplanar images allows one to evaluate labial defects, abnormalities of the maxillary tooth-bearing alveolar ridge, and presence of premaxillary protrusion for detecting cleft lip and palate anomalies. Surface rendering may increase diagnostic confidence for normal or abnormal studies. This technology provides an array of visualization tools that may improve the prenatal characterization of facial clefts, particularly of the palate.     

三维多层面超声显示胎儿继发腭的新技术探讨

目的评价三维多层面成像模式在显示正常胎儿及唇腭裂胎儿腭部各层结构中的临床应用价值。方法对20例正常胎儿及10例唇腭裂胎儿进行三维超声扫查并获取块体图像，应用三维多层面成像（MSV）模式进行图像后期处理及分析。20例正常胎儿中10例选用正中矢状面扫查，10例选用胎头向后仰伸30°～50°矢状面的图像。10例唇腭裂胎儿采用胎头向后仰伸30°～50°的矢状切面扫查。结果20例中18例可成功显示继发腭冠状面及轴平面图像。胎头向后仰伸与躯干成30°～50°时硬腭显示最佳。10例唇腭裂胎儿通过冠状面及轴平面均能显示腭裂部位、范围及其延伸深度。结论应用三维多层面成像模式能从冠状面与轴平面清晰显示正常及唇腭裂胎儿腭部各层图像，为产前超声诊断唇腭裂尤其是腭裂定位及腭裂程度提供了一项新的诊断方法与途径。     

Axial ultrasonographic imaging of the fetal maxilla for accurate characterization of facial clefts.

The purpose of this study was to determine whether scanning of the fetal midface in the axial plane allows accurate characterization of facial clefts. During fetal anatomic survey, facial clefts were identified in six fetuses. The midface anatomy was evaluated with ultrasonography in the coronal and axial planes, and the clefts were characterized prospectively as unilateral or bilateral and as involving the lip alone or both the lip and the palate. The integrity of the upper lip was assessed in the coronal and axial planes. The continuity of the normal C-shaped curve of the tooth-bearing alveolar ridge and the anterior six tooth sockets was assessed in the axial plane. The prospective prenatal diagnosis was correlated with postnatal findings in all cases. The clefts where characterized prospectively as unilateral cleft lip (one case), unilateral cleft lip and cleft palate (four cases), and bilateral cleft lip and cleft palate (one case). The prenatal characterization was confirmed to be correct postnatally in all cases. Prenatal sonographic evaluation of the axial view of the tooth-bearing alveolar ridge of the maxilla allows accurate determination of whether a cleft is confined to the lip or involves both the lip and the palate.     

Sonographic assessment of normal fetal palate using three-dimensional imaging: a new technique.

OBJECTIVES: The aim of this study was to describe a novel three-dimensional (3D) ultrasound rendering technique to examine the normal fetal posterior palate and to assess its correspondence with the real fetal anatomy. METHODS: A prospective longitudinal study was conducted from January to October 2005 and included 100 fetuses in a low-risk population. Fetal ultrasound examinations were performed at 17, 22, 27 and 32 weeks' gestation to determine the normal 3D ultrasound view of the fetal palate at different gestational ages. The ultrasound scans were performed using the strict anterior axial plane of the starting reconstruction volume and the underside 3D view of the fetal palate. The 3D view of the fetal palate was compared with the normal anatomical view of the fetal palate obtained by surgical fetopathological examination of fetuses at the same gestational ages. The sonographic visualization rates of seven defined anatomical landmarks of the fetal palate were computed for each gestational age. The visualization rates across gestational ages were compared by use of the Cochrane Q test. The reliability of detection of each anatomical landmark across gestational ages was determined by Cronbach's Alpha. RESULTS: In all cases a 3D ultrasound view of the fetal maxilla and secondary palate was obtained at each period of gestation and corresponded well to the fetal anatomical specimens. The seven defined anatomical landmarks of the fetal palate were identified in 42-100% of cases. The visualization rates across gestational ages were significantly different in five of these anatomical landmarks. These differences can be explained by different developmental processes of these anatomical structures. The overall reliability of visualization across the gestational ages for the anatomical landmarks was medium to very high (0.73-0.96), except for the landmark interpalatal suture which was low (0.48). CONCLUSIONS: This technique of anterior axial 3D view reconstruction of the fetal palate seen by an underside view can provide unique diagnostic information on the integrity of the secondary palate. This innovative, simple and rapid technique may become the reference technique in ultrasound investigation of the fetal palate, and should be of value in diagnosing isolated secondary cleft palate or palatal involvement when cleft lip and alveolus are diagnosed.     

胎儿硬腭的三维超声显像方法及其应用

目的探讨胎儿硬腭的三维超声显像方法及其在产前诊断胎儿腭裂中的应用价值。方法采集100胎孕13～35周正常胎儿及32胎唇裂胎儿颜面部的三维容积数据,通过旋转x、y、z轴、调节灰度阈值和片层,显示观察胎儿硬腭矢状面、冠状面和横断面声像图。结果正常胎儿硬腭矢状面显示率为93.00%(93/100),呈前后走向的带状稍强回声,表面光滑,前方与上牙槽突强回声相延续;冠状面显示率为91.00%(91/100),冠状面上硬腭位于中部,呈连续的弧形带状稍强回声,与上方鼻骨强回声构成三角关系;横断面显示率为90.00%(90/100),横断面上硬腭呈拱门形稍强回声,前方、左、右侧被上牙槽突强回声所包围;88.00%(88/100)的胎儿硬腭在3个位面上均可显示。32胎唇裂胎儿中,检出9胎合并腭裂并经随访证实,其腭裂部位、裂隙宽度、整体形态及走向显示清楚。结论应用三维超声观察胎儿硬腭简便易行。掌握正常胎儿硬腭三维超声声像图特征有助于提高胎儿腭裂的检出率及评判预后。     

Two- and three-dimensional sonographic assessment of the fetal face. 2. Analysis of cleft lip, alveolus and palate.

OBJECTIVES: To describe the sonographic appearance of cleft lip with or without cleft palate (CL +/- P) using two-dimensional and three-dimensional (3D) ultrasound imaging. Also, to evaluate the accuracy of ultrasound to delineate with precision the bony extent of facial clefts, i.e. to differentiate clefts limited to the lips, or extending to the alveolus/premaxilla or the secondary palate. METHODS: This was a retrospective study based on the examination of fetuses diagnosed with an isolated CL +/- P. Cases included were either discovered at systematic screening or referred for further investigation. Clefts were characterized by their precise anatomical location and extent. The defect could include a cleft lip (CL), a cleft alveolus (CA), or a cleft of the secondary palate (CSP). RESULTS: We analyzed 96 cases of CL +/- P. The mean gestational age at examination was 28.2 +/- 4.1 weeks. The sonographic appearance of CL, CA, and CSP was depicted. Strict concordance of the sonographic report with the anatomical defect was present in 84 cases (87.5%). In eight cases, the severity of the cleft was underestimated: three cases of CA, four of CA + CSP and one of CSP were missed. In four cases, the cleft was overestimated as CA was incorrectly suspected. CONCLUSIONS: Systematic screening with sonography to detect prenatally CL +/- P requires the imaging of at least the mid-sagittal and the anterior coronal 'nose-mouth' views. Once the presence of a facial cleft is suspected, the three reference orthogonal planes are imaged in order to characterize the anatomical defect, and for each plane, the serial scans are thoroughly examined. This protocol allows precise delineation of the defect. Inclusion of 3D and 4D ultrasound imaging in the examination protocol allows easier and more rapid screening and more precise evaluation of the different cleft constituents.     

Prenatal diagnosis of cleft palate by three-dimensional ultrasound

Prenatal diagnosis of cleft palate is very important to prenatal consultation and management after birth. To examine if three-dimensional (3-D) ultrasound (US) is an accurate diagnostic method for clinical use, we analyzed our experience in detecting cleft palate by 3-D US. From June 1996 to January 2000, 21 fetuses with facial clefts were scanned by 2-D US, as well as by 3-D US. The coronal and oblique planes were reconstructed by 3-D US to detect the cleft palate. In addition, level II US was performed to find any possibly associated anomalies. All the scans were recorded on optic disks for final analysis. In our study, the gestational age when prenatal diagnosis was made by US initially was between 20 and 34 weeks. The accuracy for prenatal diagnosis of cleft lip with or without cleft palate by 3-D US was 100%, which was superior to that by 2-D US (p < 0.05). In addition, we proposed a novel method to evaluate the cleft palate systemically by 3-D US. In conclusion, from our study, fetuses with cleft lip combined with or without cleft palate can be easily differentiated by 3-D US. The reconstruction of coronal and oblique planes by 3-D US is a powerful tool for detecting cleft palate.     

Two- and three-dimensional sonographic assessment of the fetal face. 1. A systematic analysis of the normal face.

OBJECTIVES: To detail fetal facial examination in utero using ultrasound, to distinguish between requirements for routine screening and those for precise analysis of fetal facial features, and to assess the use of three-dimensional (3D) ultrasound imaging in fetal facial examination. METHODS: This was a retrospective study, based on the examination of approximately 10,500 fetuses. The usual age at screening ultrasound examination was 22 +/- 1 gestational weeks. RESULTS: The sonographic anatomy of the normal fetal face was depicted, and the relevance of the three reference scanning planes, sagittal, coronal and axial, was specified. CONCLUSIONS: At routine screening using two-dimensional sonography, at least two selected views must be imaged: the mid-sagittal plane (search for facial dysmorphology) and the anterior 'nose-mouth' coronal plane (search for disruption in lip continuity or deformation of the narinal bend). Precise analysis of fetal facial anomalies requires visualization and thorough step-by-step analysis in the three planes. The difference between routine screening and precise facial features' analysis has been greatly decreased since 3D and 4D sonography have become readily available. Using this modality, after surface analysis of the fetal face, the three reference planes are simultaneously imaged, using the multiplanar modality, and detailed. 3D/4D ultrasound imaging allows easier, more rapid screening and more precise evaluation of the different facial features.     

孕早期超声观察腭线筛查胎儿唇腭裂

目的 评价孕早期超声观察腭线筛查胎儿唇腭裂的价值。方法 回顾性分析14 360胎接受超声颈后透明层厚度（NT）检查的孕早期胎儿,观察胎儿腭线表现,记录胎儿转归,评价孕早期超声观察腭线筛查胎儿唇腭裂的效能。结果 孕早期超声提示14 327胎（14 327/14 360,99.77%）腭线正常,其中7胎经随访证实存在唇腭裂;33胎（33/14 360,0.23%）腭线异常,其中4胎腭线为小裂隙,随访证实无唇腭裂,29胎随访证实腭线异常,包括小裂隙8胎、大裂隙4胎、前部缺失11胎及腭线变细/变短6胎。孕中期超声提示36胎唇腭裂,并于出生后或经引产证实,包括4胎单纯唇裂、10胎单纯继发性腭裂、17胎单侧唇腭裂,5胎双侧唇腭裂。超声观察腭线预测胎儿唇腭裂的敏感度为80.56%（29/36）,特异度为99.97%（14 320/14 324）,阳性预测值为87.88%（29/33）,阴性预测值为99.95%（14 320/14 327）。结论 孕早期超声观察胎儿NT平面腭线可作为筛查胎儿唇腭裂的指标,值得推广。     

二维超声及三维超声多种成像技术在胎儿唇腭裂畸形诊断中的联合应用

目的研究二维超声及三维超声多种成像技术在胎儿唇腭裂畸形诊断中的图像特征。 方法选取2016年1月至2017年12月在南京医科大学附属苏州医院产科接受中孕期结构畸形筛查发现唇腭部异常的胎儿均行三维超声表面成像、断层成像（TUI）及自由解剖成像（OmniView模式）多种成像技术联合检查,并随访至出生后或引产后。结合产前超声检查图像,研究唇腭裂胎儿颜面部三维超声图像特征。 结果产前超声筛查的19 168例中孕期胎儿中检出唇腭部结构畸形36例（0.19%）。36例唇腭裂胎儿超声征象：单纯唇裂（CL）8例,二维、TUI及OmniView模式均检出胎儿唇裂;三维表面成像漏诊1例唇红裂。二维及三维成像技术均显示胎儿上唇连续性中断,但三维成像显示更直观。唇裂合并上牙槽突裂（CLA）11例,二维超声显示8例,三维表面成像、TUI均诊断9例,漏诊2例,OmniView技术诊断10例,漏诊1例,联合检查诊断10例,漏诊1例。主要超声征像：上唇及上牙槽突连续性中断,二维超声对于牙槽突裂显示较困难,TUI及OmniView可从多角度显示牙槽突裂。唇裂合并腭裂（CLP）17例,二维超声（诊断10例）、三维超声表面成像模式（诊断13例）、TUI（诊断15例）、OmniView模式（诊断16例）均未全部检出;而17例CLP经联合检查全部检出。超声征象为上唇、原发腭及继发腭的连续中断,断层成像及OmniView可从多角度显示原发腭及继发腭,优于二维超声对于原发腭及继发腭的显示。 结论产前二维超声及三维超声能清晰显示胎儿唇裂,但对于腭裂,三维超声多种成像模式图像优于二维超声,产前超声筛查联合三维多成像技术能清晰显示胎儿颜面部异常,减少唇腭裂的漏诊。     

胎儿唇腭裂畸形的产前超声诊断现状

胎儿唇腭裂是最常见的颜面部畸形,且与妊娠结局,附加结构畸形及染色体异常均明显相关,然而产前诊断困难.超声是最常用的检测手段,通过胎儿标本实验及胚胎发育研究,使用二维超声的冠状切面和轴向切面及三维超声重建可诊断唇裂及前腭裂,对于继发腭裂,主要是寻找间接征象,直接显像困难,因此尚不能在宫内作出诊断.     

Real-time magnetic resonance imaging aids prenatal diagnosis of isolated cleft palate.

OBJECTIVE: Cleft of the secondary palate without cleft lip is difficult to visualize sonographically. This study was performed to assess the utility of sonography, standard magnetic resonance (MR) imaging, and real-time MR imaging in the diagnosis of isolated cleft palate. METHODS: We prospectively assessed 5 fetuses at risk for isolated cleft palate on the basis of family history, micrognathia, or both, using sonography and standard and real-time single-shot fast spin echo MR sequences. Written informed consent was obtained under our Institutional Review Board-approved Health Insurance Portability and Accountability Act-compliant protocol. Images were assessed for confidence in a diagnosis of cleft or normal palate. Prenatal and postnatal diagnoses were compared. RESULTS: In 3 fetuses, micrognathia was visualized by sonography and MR imaging with standard and real-time sequences. One fetus at 19 weeks had a wide cleft of the entire secondary palate, and another fetus at 33 weeks had a cleft of the soft palate; these defects were seen only with real-time MR imaging. One 35-week gestational age fetus had a cleft soft palate that was visualized on standard and real-time MR imaging. Two fetuses with no abnormalities had the normal midline secondary palate seen only on real-time MR imaging. In all fetuses, real-time images were helpful in assessing the secondary palate because the entire midline naso-oropharynx could be visualized. CONCLUSIONS: Real-time MR imaging allows for rapid assessment of the midline structures, providing accurate diagnosis of isolated cleft palate.     

唇腭裂胎儿产前超声检查诊断分析

目的探讨胎儿唇腭裂超声表现及显示切面,提高唇腭裂的产前超声诊断率。方法选取我院经引产或产后证实的唇腭裂胎儿28例,对比产前超声检查与引产后或产后唇腭裂的类型。结果 28例经引产或产后证实的唇腭裂胎儿中,单纯唇裂5例,唇腭裂22例,单纯腭裂1例;产前检出23例,其中误诊裂口类型2例,漏诊5例。结论胎儿唇裂、原发腭裂、正中腭裂经连续性颜面部三正交切面诊断准确性较高;胎儿完全腭裂及唇裂伴继发腭裂需补充特殊切面;单纯性继发腭裂产前超声诊断仍有较大困难。     

胎儿唇腭裂畸形的超声诊断及临床分析

目的探讨胎儿正常唇腭部与唇腭裂畸形的超声检查方法、最佳检查时机及声像图特征，旨在提高产前B超对唇腭裂畸形的确诊率。方法对7242例孕16周至产前的孕妇行常规超声检查，发现唇腭裂畸形声像予测量记录，并追踪随访，引产或足月产后对照。结果产前确诊唇腭裂畸形12例13胎，有对照的共10例11胎，其中产前诊断唇裂，产后见唇腭裂2胎，与产前B超诊断完全符合8例9胎，准确率82％(9／11)。结论孕20～32周是超声检查胎儿唇腭裂畸形的最佳时机。熟练掌握以胎儿头面部横切和冠状切面为主的扫查方法，有助于快捷获取和正确识别唇腭裂声像图。唇裂时唇缘线至唇根部回声中断。牙槽突以及硬腭裂时，分别见双弧形串珠状强回声、弧形强回声带及其后马蹄形不均质中、强回声区的裂隙暗带。     

Transfrontal three-dimensional visualization of midline cerebral structures.

OBJECTIVE: To compare sonographic visualization of midline cerebral structures obtained by two-dimensional (2D) imaging and three-dimensional (3D) multiplanar and volume contrast imaging in the coronal plane (VCI-C), with transfrontal 3D acquisition. METHODS: Sixty consecutive healthy fetuses in vertex presentation at a mean gestational age of 24 (range, 20-33) weeks underwent 2D and 3D ultrasound examination. Sagittal cerebral planes were reconstructed using 3D acquisition from axial planes by multiplanar analysis and by VCI-C. The reconstructed midline images of both these techniques were compared with the midline structures visualized directly in the A-plane by transfrontal 3D acquisition using a sweep angle of 30 degrees . Measurement of the corpus callosum and cerebellar vermis and visualization of the fourth ventricle and the main vermian fissures were compared. The sharpness of the images was also assessed qualitatively. Mid-sagittal tomographic ultrasound imaging (TUI) was also performed. 3D planes were compared with 2D transfontanelle median planes obtained by transabdominal or, when required, transvaginal sonography. RESULTS: The midline plane could be obtained in 88% of multiplanar, 82% of VCI-C and 87% of transfrontal analyses. Measurements of the corpus callosum and cerebellar vermis obtained by 3D median planes were highly correlated. The clearest and sharpest definition of midline structures was obtained with transfrontal acquisition. Primary and secondary fissures of the cerebellar vermis could be detected in 13-26% of multiplanar, 18-35% of VCI-C and 52-79% of transfrontal analyses. 2D visualization was superior or equal to the 3D transfrontal approach in all the parameters compared. CONCLUSION: 3D planes obtained from axial acquisitions are simpler and easier to display than are transfrontal ones. However, artifacts and acoustic shadowing are frequent in 3D axial acquisition and spatial resolution is better in the direct visualization transfrontal technique. If the standard examination includes a view of the fetal facial profile, a quick 3D acquisition through the frontal sutures provides direct visualization for assessment of the midline structures. We believe that this volumetric methodology could represent a step towards incorporating a comprehensive fetal neuroscan into routine targeted organ evaluation.     

提高产前超声诊断胎儿唇腭裂效率的方法

目的 分析临床病史结合唇腭部常规三切面、上牙槽突横切面、其他特殊切面与三维超声配合胎儿不同体位对提高产前超声诊断胎儿唇腭裂效率的协助作用。 方法 对我院2014年9月~2016年12月7000例中孕期（孕20~24+6周）胎儿行颜面部超声筛查,超声检查前常规询问病史,以规范化常规三切面、上牙槽突横切面作为筛查切面,有异常时应同时采集胎儿张口时和闭口时的二维图像,最后采集三维图像,与引产或分娩后患儿颜面部结果进行对照,比较各种方法对提高产前超声诊断唇腭裂畸形的效率与准确率的作用。 结果 7000例胎儿超声共检出唇腭裂27例,经引产和分娩证实唇腭裂29例,其中常规三切面组检出胎儿唇腭裂畸形20例,产前超声漏诊9例,超声诊断符合率为69%;常规三切面、上牙槽突横切面、其他特殊切面加三维超声组产前超声检出胎儿唇腭裂畸形27例,产前超声漏诊2例,产前超声诊断符合率为93%;对比两种方法在唇裂合并腭裂病例存在显著性差异（P<0.05）。 结论 超声医师检查前常规采集病史,检查时准确识别胎儿唇鼻部腭部正常结构和声像图特征,掌握常规三切面、上牙槽突横切面和其他特殊切面的手法和技巧,仔细观察胎儿唇鼻结构和张口闭口运动,同时应用三维超声表面成像模式,将会提高唇腭裂畸形的超声诊断率,给临床医生及孕妇提供可靠的信息。       

二维超声技术对胎儿腭部显示切面的探讨

目的总结中孕期及晚孕期胎儿腭部超声声像图特征。方法选取孕21～36周产前二维超声和产后检查证实腭部声像正常的1885例胎儿（中孕组1023例,晚孕组862例）的超声图像进行分析。检查中采用经胎儿颌下、口裂、耳前连续区域显示腭冠状切面,经口裂显示腭纵切面,连续完整显示胎儿正常腭部并统计显示率。结果产前超声经胎儿颌下、口裂至耳前区域腭冠状切面扫查两组胎儿正常硬腭显示为横带状强回声,正常软腭显示为横带状低回声;中孕组、晚孕组胎儿腭部超声显示率分别为76％（777／1023）、53％（458／862）;经口裂腭纵切面扫查胎儿正常腭部显示为连续弧形带状回声：中孕组、晚孕组胎儿腭部超声显示率分别为49％（501／1023）、13％（113／862）。冠状切面与纵切面联合扫查中孕组胎儿腭部超声显示率为94％（961／1023）,晚孕组胎儿腭部超声显示率为56％（483／862）。结论中孕期胎儿存在明显的下颌骨软骨间隙,经胎儿颌下、口裂、耳前区域腭冠状切面及经口裂腭纵切面扫查不受胎头屈曲位置影响,二维超声可较完整显示胎儿腭部声像,有助于检出单纯性继发腭裂。但由于成像过程依赖于操作者的技术和手法,尚不能作为常规筛查方法。     

Multislice Display of the Fetal Face Using 3‐Dimensional Ultrasonography

Objective. Multislice 3‐dimensional ultrasonography (3DUS) allows ultrasonographic volume data to be presented in parallel slices. Our aim was to develop a technique using a multislice display to specifically differentiate the maxilla (primary palate) from the mandible and to display the orbits in a single image in fetuses with normal anatomy and cleft lip/palate. Methods. Three‐dimensional ultrasonographic volumes of the fetal face were acquired in 142 patients (49 prospective and 93 retrospective). Fifteen patients had a confirmed diagnosis of cleft lip with or without cleft palate. Three readers manipulated volumes in a standardized fashion to show the orbits, maxilla, and mandible. The best interslice distance was determined. Image quality was assessed. Results. The mean gestational age of the fetuses was 23 weeks (range, 11–38 weeks). The mean interval distance used varied from 3 to 3.7 mm (range, 1–5.8 mm). The interval distance correlated with gestational age (Spearman ρ = 0.66; P < .0001). Image quality obtained through multislice evaluation of the orbits, maxilla, and mandible was high and did not vary with gestational age, interval distance, retrospective versus prospective acquisition, or 3DUS versus 4‐dimensional volumes. A higher image quality rating was associated with axial and sagittal planes of acquisition as opposed to coronal and oblique planes (Wilcoxon P < .002). All cases of cleft lip with or without cleft palate were correctly identified retrospectively. Conclusions. Multislice 3DUS evaluation of the fetal face can be performed successfully with high image quality. This technique can be used to consistently and accurately differentiate the fetal primary palate and mandible. Fetuses with cleft lip with or without cleft palate can be identified with confidence.