Outcome And Prognosis Of Fetal Ventriculomegaly

BackgroundIn routine ultrasound examination,cases of ventricular dilatation are often found,in which lateral ventricular dilatation is the most common,and its incidence varies greatly,ranging from 1‰ to 22‰^[1].The etiology of ventricular dilatation is not clear,different causes lead to different postnatal outcomes,some may lead to neurological,motor and/or cognitive disorders,and some may not have any clinical manifestations,so its prognosis and outcome is a thorny problem in clinic.Ultrasound,as an important means of prenatal evaluation of fetal development,is widely used in clinic.Affected by maternal obesity,poor fetal posture,abnormal amniotic fluid volume,multiple pregnancy,uterine malformation and so on,it is easy to cause misdiagnosis or missed diagnosis.Compared with ultrasound,MRI has high resolution,can be multi-directional plane imaging,and is not affected by pregnant women,amniotic fluid,fetus and so on.With the rapid imaging of MRI,the MRI image is almost unaffected by fetal movement.Supplementary diagnosis can be made for some minor lesions which are difficult to be observed or easily missed by B-ultrasound.When a fetus with dilated lateral ventricle is found,how should ultrasound and MRI be chosen?At present,there are many studies in this area,but there are still no clear and unified results.The standard of the width of the lateral ventricle that should be prompted by ultrasound reports at home and abroad is not unified.Some ultrasound reports in China give hints to fetuses with a width of 9-10mm or even 8-9mm,while some foreign scholars believe that fetuses with a width of 10-12mm should be regarded as normal variations[2,3].Whether the ultrasound report is indicated or not is directly related to the need for further clinical intervention.At the same time,regardless of the prognosis,pregnant women will feel worried and panicked by the hints in the report.In order to determine the relationship between the width of lateral ventricle and prognosis,and to indicate the width of lateral ventricle by prenatal ultrasound,the cases were collected and analyzed retrospectively to study the risk factors of lateral ventricular dilatation,to explore the pregnancy outcome and clinical prognosis of fetuses with lateral ventricular dilatation,and to analyze the consistency of ultrasound and MRI in the diagnosis of lateral ventricular dilatation and the diagnostic value of MRI in fetuses with lateral ventricular dilatation.The critical value of lateral ventricle width that should be suggested by ultrasound was also discussed.This topic is divided into three chapters:（1）Pregnancy outcome and clinical prognosis of fetal lateral ventricular dilatation;（2）To explore the critical value of lateral ventricular width that should be indicated by ultrasound report.（3）Consistency analysis of ultrasound and MRI in the diagnosis of fetal lateral ventricular dilatation;Chapter 1:pregnancy outcome and clinical prognosis of fetal lateral ventricular dilatationobjective:To retrospectively analyze the pregnancy outcome and prognosis of fetal lateral ventricular dilatation.Methods:A total of 100 consecutive singletons with lateral ventricular dilatation or hydrocephalus diagnosed by ultrasound in Shenzhen people’s Hospital from January 2015 to December 2016 were selected as the experimental group,they were divided into mild dilatation group（n=59）,moderate dilatation group（n=24）and severe dilatation group（n=17）according to the width of lateral ventricle.According to the problems other than lateral ventricular dilatation,the patients were divided into isolated lateral ventricular dilatation（isolated ventriculomegaly,IVM）group（n=51）and non-isolated lateral ventricular dilatation（non-isolated ventriculomegaly,NIVM）group（n=49）.Another 141 consecutive singletons in the same period were selected as the control group,and the width of lateral ventricle was 8～10mm.The clinical,laboratory,MRI data and pregnancy outcome of the above cases were recorded and retrospectively analyzed to explore the relationship between fetal lateral ventricular dilatation and pregnancy outcome and prognosis.Results:（1）in the experimental group,the birth positive rates of mild expansion group,moderate expansion group and severe expansion group were 6.5%,22.2%and 60%,respectively.The birth positive rate of the control group was 5.4%（7/129）.The birth positive rates of mild expansion group,moderate expansion group,severe expansion group and control group were statistically significant（x 2:22.148,P<=0.0501）.The birth positive rate of mild expansion group,moderate expansion group,severe expansion group and control group was significantly higher than that of mild expansion group,moderate expansion group,severe expansion group and control group（x 2=22.148,P<=0.0501）.（2）the incidence of NIVM in mild dilatation group,moderate dilatation group and severe dilatation group was 37.3%（22/59）,58.3%（14/24）and 76.5%（13/17）,respectively.（3）the termination rates of abnormal pregnancy in IVM and NIVM groups were 33.3%（17/51）and 63.3%（31/49）,respectively.There was significant difference in the outcome（x 2-8.970 P<=0.005）.Conclusion the pregnancy outcome of lateral ventricular dilatation is related to the degree of lateral ventricular dilatation.The more severe the dilatation of the lateral ventricle,the worse the prognosis of the fetus and the greater the probability of other problems,and the prognosis of the non-isolated lateral ventricle dilatation is worse than that of the isolated lateral ventricle dilatation.Chapter 2:to explore the cut-off of the width of the lateral ventricle that should be prompted by the ultrasound reportObjective:to explore the cut-off of lateral ventricle width in ultrasonic report.Methods:A total of 100 consecutive singletons with lateral ventricular dilatation or hydrocephalus diagnosed by ultrasound in Shenzhen people’s Hospital from January 2015 to December 2016 were selected as the experimental group,they were divided into mild dilatation group（n=59）,moderate dilatation group（n=24）and severe dilatation group（n=17）according to the width of lateral ventricle.According to the problems other than lateral ventricular dilatation,the patients were divided into isolated lateral ventricular dilatation（isolated ventriculomegaly,IVM）group（n=51）and non-isolated lateral ventricular dilatation（non-isolated ventriculomegaly,NIVM）group（n=9）.Another 141 consecutive singletons examined at the same time were selected as control group,and the width of lateral ventricle was 8～10mm.The prenatal ultrasonographic values of lateral ventricle and pregnancy outcome in all cases were recorded.The cut-off of lateral ventricular dilatation was analyzed by ROC curve.Results:ROC curve analysis showed that the cut-off of lateral ventricular width was 9.7mm.Conclusion:The cutoff value 9.7mm is very close to the existing standard 10mm,so we think that there is no need to prompt for the report of the width of the lateral ventricle below the 10mm;however,the width of the lateral ventricle above the 10mm should be prompted and further intervened.Chapter 3:analysis of the consistency of ultrasound and MRI in the diagnosis of fetal lateral ventricular dilatationObjective:To analyze the consistency of ultrasound and MRI in the diagnosis of lateral ventricular dilatation.Methods:A total of 100 consecutive singletons with dilated lateral ventricles or hydrocephalus diagnosed by ultrasound in Shenzhen people’s Hospital from January 2015 to December 2016 were selected as the experimental group,according to the width of lateral ventricle,they were divided into mild dilatation group（n=59）,moderate dilatation group（n=24）and severe dilatation group（n=17）.According to the problems other than lateral ventricular dilatation,the patients were divided into isolated lateral ventricular dilatation（isolated ventriculomegaly,IVM）group（n=51）and non-isolated lateral ventricular dilatation（non-isolatedventriculomegaly,NIVM）group（n=49）.Another 141 consecutive singletons examined at the same time were selected as the control group,and the width of lateral ventricle was 8～10mm.A total of 36 cases of prenatal and/or postpartum MRI were selected.The ultrasonographic values of the lateral ventricle and other abnormalities in the 36 cases were recorded,and the MRI values of the lateral ventricle in the 36 cases before and after delivery and the combined abnormalities detected by MRI were recorded.For the patients who received multiple ultrasound follow-up,the results of ultrasound with the closest time of MRI examination were selected as the comparison.Kappa test was performed with SPSS 20.0 software to analyze the consistency of ultrasound and MRI in the diagnosis of lateral ventricular dilatation.Results:A total of 36 cases underwent prenatal and/or postpartum MRI examination,and the coincidence rate of ultrasound was 77.8%,and the supplementary diagnosis was 19.4%.The consistency of ultrasound and MRI in the diagnosis of lateral ventricular dilatation was general（Kappa=0.543,P<0.001）.Conclusion:Ultrasonography is consistent with MRI in the diagnosis of lateral ventricular dilatation,but MRI has a higher detection rate for some types of abnormalities such as cortex,white matter and intracranial hemorrhage.