三维超声对胎儿Galen静脉动脉瘤样畸形的诊断价值及预后评估

The diagnostic value and prognostic assessment of three-dimensional ultrasound for fetal vein of Galen aneurysmal malformation

摘要

目的 利用三维超声虚拟器官计算机辅助分析(VOCAL)测量胎儿Galen静脉动脉瘤样畸形(VGAM)的体积,结合临床随诊情况,探讨VOCAL技术评估VGAM的预后价值。方法 选取2019年6月至2023年8月在十堰市妇幼保健院产前超声诊断为VGAM的10名单胎妊娠初产妇为研究对象,每两周进行一次超声随诊观察,分别采用传统测量方法和VOCAL技术获得VGAM的体积V1和V2,同时记录胎儿心血管、胸腹腔和心包腔、脐动脉频谱的情况。结果 9例VGAM范围较大的患儿,在随诊时发现心胸比进一步增大,三尖瓣反流量亦增加,同时部分患儿不同程度出现了胸、腹腔或心包腔积液,脐动脉舒张期血流频谱反向或消失;随孕周增加VGAM体积随之变大,传统测量值V1均低于三维V2,差异有统计学意义(t值介于2.88~24.86之间,P<0.05);9例患儿均进行了引产.另1例VGAM体积较小的患儿预后较好,在随诊过程中其心脏的异常情况并没有进一步进展;VGAM的体积随孕周增加较慢,V1和V2的差异无统计学意义(P>0.05);患儿出生后行介入治疗预后良好。结论 VGAM的大小影响患儿的预后,并且随病程进展可能会导致患儿颅外异常;三维超声VOCAL技术评估患儿颅内VGAM病灶的范围,对临床尽早干预及远期治疗具有重要的指导价值.

Abstract

Objective To measure the volume of fetal vein of Galen aneurysmal malformations (VGAM) using three-dimensional ultrasound Virtual Organ Computer-Aided Analysis (VOCAL) and, in combination with clinical follow-up data, explore the prognostic value of VOCAL technology in assessing VGAM. Methods Ten singleton primigravida patients diagnosed prenatally with VGAM at Shiyan Maternal and Child Health Hospital from June 2019 to August 2023 were selected as study subjects. Ultrasound follow-up observations were conducted every two weeks, using both traditional measurement methods and VOCAL technology to obtain VGAM volumes V1 and V2. Fetal cardiovascular conditions, the status of the thoracoabdominal and pericardial cavities, and umbilical artery spectral data were also recorded. Results In nine cases with larger VGAM, follow-up revealed an increased cardiothoracic ratio and greater tricuspid regurgitation. Some of these cases also showed varying degrees of effusion in the thoracic, abdominal, or pericardial cavities, with reversed or absent diastolic blood flow in the umbilical artery spectrum. VGAM volume increased with gestational age, and traditional measurement values (V1) were consistently lower than the three-dimensional VOCAL measurements (V2), showing statistically significant differences (t values between 2.88 and 24.86, P<0.05). All nine cases underwent induction of labor. In one case with a smaller VGAM volume, the prognosis was better; the cardiac abnormalities did not progress during follow-up, VGAM volume increased more slowly with gestational age, and the difference between V1 and V2 was not statistically significant (P>0.05). After birth, this infant received interventional treatment with a favorable outcome. Conclusion The size of VGAM affects the prognosis of children and leads to extracranial abnormalities as the disease progresses. Three-dimensional ultrasound VOCAL technology is valuable for assessing the extent of intracranial VGAM lesions, providing important guidance for early clinical intervention and long-term treatment.

关键词

超声 / 虚拟器官计算机辅助分析 / 产前诊断 / Galen静脉动脉瘤样畸形 / 介入治疗

Key words

ultrasound / virtual organ computer-aided analysis / prenatal diagnosis / vein of Galen aneurysmal malformation / interventional treatment

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