早期妊娠胎儿超声检查中脉络丛/侧脑室比值对开放性脊柱裂的诊断价值OA

Objective To explore the diagnostic value of the choroid plexus/lateral ventricle parameter ratios in fetuses at 11-13+6 weeks of gestation for the early detection of open spina bifida(OSB),and to provide reliable imaging indicators for clinical screening during the early pregnancy period.Methods A retrospective case-control study was conducted,inclu-ding 327 fetuses who underwent first-trimester fetal structural screening at Maternity and Child Health Care of Guangxi Zhuang Autonomous Region from January 2018 to December 2023.Among them,21 fetuses with OSB confirmed by second-trimester ultrasound and autopsy were enrolled as case group,and 306 fetuses with normal screening results and no abnormal-ities during postnatal follow-up were included as control group.Standard axial cranial views were routinely obtained to meas-ure bilateral choroid plexus length(PL),area(PA),circumference(PC),and lateral ventricle length(VL),ventricle area(VA),ventricle circumference(VC).The bilateral averages were calculated to obtain the ratios of PL/VL,PA/VA,and PC/VC.Independent samples t-test or Mann-Whitney U test were used to conduct the comparison of parameters between the two groups.Receiver operating characteristic(ROC)curves were plotted for statistically significant parameters to calcu-late diagnostic efficacy indicators including area under the curve(AUC),optimal cut-off value,sensitivity,and specificity.A combined diagnostic model was further constructed and its application value was evaluated.Results The body mass index(BMI)of pregnant women in the OSB group([22.2±3.6]kg/m2 vs[20.8±2.3]kg/m2,P=0.013),PL([13.9±1.5]mm vs[13.1±1.9]mm,P=0.046),PL/VL(0.9±0.1 vs 0.8±0.1,P<0.001),PA/VA(0.8±0.1 vs 0.6±0.1,P<0.001),and PC/VC(0.9±0.1 vs 0.8±0.1,P<0.001)were significantly higher than those in the control group,and differences were statistically significant.ROC curve analysis showed that PA/VA had the highest diagnostic efficacy,with an AUC of 0.895(95％CI:0.799-0.991).When the optimal cut-off value was 0.711,the sensitivity was 80.95％,and the specificity was 89.22％.The AUCs of the PL/VL and the PC/VC were 0.817(95％CI:0.705-0.930)and 0.797(95％CI:0.672-0.921),respectively,the sensitivities were 71.43％and 66.67％,respectively,and the specificities were 92.81％and 86.27％,respectively.Combined diagnostic model analysis showed that PA/VA combined with PL/VL or PC/VC could significantly improve diagnostic specificity.The specificity of PA/VA+PL/VL reached 96.41％,and that of PA/VA+PC/VC reached 93.46％.Compared with single PA/VA,the false positive rates were reduced by 7.19％and 4.24％,respectively,with no significant decrease in sensitivity(71.43％and 80.95％).Conclusion Choroid plexus/lat-eral ventricle area ratio(PA/VA)in first-trimester fetuses has high diagnostic efficacy for OSB,and can be used as a poten-tial imaging marker for first-trimester OSB screening.The diagnostic model of PA/VA combined with PL/VL or PC/VC can significantly reduce the false positive rate,decrease unnecessary follow-up examinations and maternal anxiety,and is suitable for popularization and application in first-trimester structural screening in primary hospitals.