Prenatal ultrasound imaging characteristics and clinical significance of abnormal development of the inferior vena cava
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摘要:
目的 总结胎儿下腔静脉（IVC）发育异常超声图像特征，探讨产前超声检查价值及临床意义。 方法 回顾性分析我院2018年1月~2023年2月产前诊断为胎儿IVC发育异常的88例孕妇的超声图像特征及合并心内外异常情况；不同类型IVC发育异常合并心内外异常构成比行多列表卡方检验，采用Bonferroni方法行组间多重比较。所有结果与产后MRA及超声心动图或尸检结果进行对比。 结果 88例IVC发育异常胎儿中，下腔静脉异常连接（ECIVC）18例，肾后段左下腔静脉（LIVC）42例，双下腔静脉（DIVC）28例。18例ECIVC胎儿胸腹斜冠状切面及四腔心切面均表现异常，其中腹部横切面异常17例，腹部横切面异常征象不典型1例；2例右心房纵切面表现异常；42例LIVC胎儿超声IVC冠状切面均呈“S”征；28例DIVC胎儿超声IVC冠状切面均呈“h”征。88例IVC发育异常胎儿分别合并心血管系统、骨骼系统、泌尿系统、消化系统、呼吸系统及感觉系统异常；不同类型IVC发育异常孤立性及合并心内外异常构成比总体差异有统计学意义（P < 0.001）；孤立性ECIVC与孤立性DIVC及孤立性LIVC构成比、ECIVC合并心内异常与LIVC及DIVC合并心内异常构成比的差异有统计学意义（P < 0.05）。88例IVC发育异常胎儿，5例经引产证实；83例随访至出生后6月，均行MRI及超声心动图检查，与产前诊断一致。 结论 胎儿IVC发育异常在超声图像上具有特异性，超声能准确识别其有无合并心内外结构异常，分析不同类型IVC发育异常合并心内外结构异常构成比可以为临床评估预后及处理提供理论依据，提高认识、及早诊断对临床具有重要指导价值。 Abstract:Objective To explore the value and clinical significance of prenatal ultrasound examination by summarizing the ultrasound image features of fetal inferior vena cava (IVC) development abnormalities. Methods A retrospective analysis was conducted on the ultrasound image characteristics and combined intracardiac and extracardiac abnormalities of 88 cases diagnosed with fetal IVC developmental abnormalities in our hospital from January 2018 to February 2023. Multiple tabular chi square tests were performed on the composition ratio of IVC developmental abnormalities with intracardiac and extracardiac abnormalities of different types. The Bonferroni method was used for multiple comparisons between groups. All the results with postpartum MRA, echocardiography, or autopsy results were compared. Results There were 88 fetuses with abnormal IVC development, including 18 ectopic connection of inferior vena cava (ECIVC) patients, 42 left inferior vena cava (LIVC) patients and 28 double inferior vena cava (DIVC) patients. 18 ECIVC fetuses showed abnormalities in both the oblique coronal and four chamber views of the chest and abdomen, with 17 cases showing abnormalities in the transverse section of the abdomen and 1 case showing atypical abnormalities in the transverse section of the abdomen; Two cases showed abnormal longitudinal section of the right atrium; 42 LIVC fetuses showed an "S" sign on the coronal section of the inferior vena cava on ultrasound; 28 cases of DIVC fetuses showed an "h" sign on the coronal section of the inferior vena cava on ultrasound. 88 fetuses with IVC developmental abnormalities were associated with abnormalities in the cardiovascular system, skeletal system, urinary system, digestive system, respiratory system, and sensory system, respectively. There was a statistically significant overall difference in the proportion of isolated and combined intracardiac and extracardiac abnormalities in different types of IVC development (P < 0.001); The ratio of isolated ECIVC to isolated DIVC and isolated LIVC, as well as the ratio of ECIVC with intracardiac abnormalities to LIVC and DIVC with intracardiac abnormalities, and it showed statistically significant differences (P < 0.05). 88 fetuses with abnormal IVC development, of which 5 were confirmed by induced labor; 83 cases were followed up until 6 months after birth, and all underwent MRI and echocardiography examinations, which were consistent with prenatal diagnosis. Conclusion Fetal IVC developmental abnormalities have specificity in ultrasound images. Ultrasound can accurately identify whether there are concomitant abnormalities in the endocardial and endocardial structures. Analyzing the composition ratio of different types of IVC developmental abnormalities combined with abnormalities in the endocardial and endocardial structures can provide theoretical basis for clinical evaluation, prognosis, and management. Improving understanding and early diagnosis have important guiding value for clinical practice. -
Key words:
- fetal /
- prenatal /
- ultrasound /
- inferior vena cava abnormality /
- dysplasia
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图 1 不同类型IVC发育异常的胎儿超声图像特征
Figure 1. Fetal ultrasound image characteristics of different types of IVC developmental abnormalities. A: Cross section of fetal abdomen: Azygos vein dilated at the right rear of the abdominal aorta, azygos vein (white arrow); B: Cross section of fetal abdomen: left posterior dilated semi azygos vein of abdominal aorta, semi azygos vein (white arrow); C: Oblique coronal section of fetal chest and abdomen: dilated azygos vein and thoracic aorta entering the chest cavity; D: Fetal four chamber view: right dilated azygos vein of thoracic aorta, azygos vein (white arrow); E: Longitudinal section of fetal right atrium: Three hepatic veins converge into the right atrium; F: The coronal section of the fetal inferior vena cava shows an "S" sign; G: The coronal section of the fetal inferior vena cava presents an "h" sign.
表 1 胎儿IVC发育异常合并系统异常明细
Table 1. Details of fetal IVC developmental abnormalities combined with systemic abnormalities
Merge exception Detailed classification Cardiovascular system (n=13) 4 cases of left atrial isomerism, 2 cases of left atrial isomerism combined with persistent left superior vena cava, 1 case of left atrial isomerism combined with dextrocardia, 2 cases of persistent left superior vena cava, 2 cases of ventricular septal defect, 1 case of right subclavian artery deviation, and 1 case of aortic arch narrowing. Skeletal system (n=3) 1 case of right foot fourth toe short and dorsally curved, 1 case of double foot varus, and 1 case of small mandible. Urinary system (n=3) 1 case of right renal accessory renal artery, 1 case of right renal polycystic renal dysplasia, and 1 case of pelvic ectopic kidney. Digestive system (n=2) Middle position of gastric acinus in 1 case, duodenal atresia in 1 case. Respiratory system (n=2) Two cases of pulmonary cystadenoma. Sensory system (n=1) A case of left cerebellar malformation. Other (n=1) One case of visceral inversion. 
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表 2 不同类型IVC发育异常孤立性及合并心内外异常结果
Table 2. Isolation of different types of IVC developmental abnormalities and results of combined extracardiac and extracardiac abnormalities[n(%)]
Group Isolation Combined intracardiac abnormalities Concomitant extracardiac abnormalities Simultaneously merging with intracardiac and extracardiac abnormalities Total (n) ECIVC 7（38.9） 7（38.9） 2（11.1） 2（11.1） 18 LIVC 34（81.0） 1（2.4） 5（11.9） 2（4.80） 42 DIVC 25（89.3） 1（3.6） 2（7.1） 0（0.0） 28 ECIVC: Ectopic connection of inferior vena cava; LIVC: Left inferior vena cava; DIVC: Double inferior vena cava.
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表 3 不同类型IVC发育异常合并心内外异常构成比组间两两比较
Table 3. Pairwise comparison of the composition of different types of IVC developmental abnormalities combined with intracardiac and extracardiac abnormalities between groups
Group Isolation Intracardiac abnormalities Extracardiac abnormalities Simultaneously merging with intracardiac and extracardiac abnormalities n P n P n P n P ECIVC 7 < 0.05 7 < 0.05 2 > 0.05 2 > 0.05 LIVC 34 1 5 2 ECIVC 7 < 0.05 7 < 0.05 2 > 0.05 2 > 0.05 DIVC 25 1 2 0 LIVC 34 > 0.05 1 > 0.05 5 > 0.05 2 > 0.05 DIVC 25 1 2 0
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