Diagnostic value of fetal intracranial hemorrhage by fetal ultrasonography in the second and third trimesters

doi:10.3877/cma.j.issn.1673-5250.2021.06.009

Objective

To explore clinical application value of diagnosis of fetal intracranial hemorrhage (FICH) by fetal ultrasonography in the second and third trimester of pregnancy.

Methods

A total of 40 fetuses diagnosed as FICH by fetal MRI during the second and third trimesters in West China Second University Hospital, Sichuan University from September 2014 to January 2020 were enrolled. The gestational age of 40 fetuses were (28.3±4.2) weeks (22-36 gestational weeks), and their maternal age was (27.5±4.4) years (19-34 years). The detection rates of FICH by fetal ultrasonography and MRI during the second and third trimesters were compared by Fisher exact probability test.The procedure followed in this study met requirements of the Helsinki Declaration of the World Medical Association revised in 2013.

Results

The prenatal imaging examination results of 40 cases of FICH by fetal ultrasonography in the second and third trimester were as follows. ①33 cases were diagnosed as FICH. Among their ultrasounic images, subependymal slightly strong echo and echoless were 3 cases and 1 case, respectively; intraventricular slightly strong echo and uneven echo were 10 and 2 cases, respectively; choroid plexus slightly strong and anechoic were 2 cases, choroid plexus weak echo was 1 case and 3 cases of uneven echo respectively; 3 cases of slightly strong brain parenchyma, 2 cases of echoless, weak echo and uneven echo of brain parenchyma. ②Among these 33 cases of FICH, 17 cases were complicated by lateral ventricle widened(slightly widened, moderately widened and hydrocephalus were 6, 6, 5 cases, respectively). ③Among 40 cases of FICH, their imaging features were intraventricular hemorrhage (15 cases), cerebral parenchymal hemorrhage (8 cases), mucous layer hemorrhage (16 cases) and subdural hemorrhage (1 case). ④The detection rate of FICH by fetal ultrasonography in the second and third trimesters of pregnancy were 94.4%(17/18), 72.7%(16/22), respectively. In the third trimester of pregnancy, the detection rate of FICH by fetal MRI was much higher than that by fetal ultrasonography, and the difference was significant (P=0.010).

Conclusions

Diagnostic of FICH by fetal ultrasonography has advantage of convenience, safety and economy, fetal ultrasonography can be used as the first choice method. If the ultrasound section of fetal head shows difficulty, fetal MRI can be used as a supplementary imaging assisted examination method to provide more accurate information for FICH.

Key words: Intracranial hemorrhages, Ultrasonography, prenatal, Magnetic resonance imaging, Prenatal diagnosis, Lateral ventricles, Fetus

表1 33例FICH胎儿超声检查的胎儿头颅声像特征(例)

头颅声像特征	例数	室管膜下	脑室	脉络丛	脑实质
稍强回声	18	3	10	2	3
无回声	5	1	0	2	2
弱回声	3	0	0	1	2
不均匀回声	7	0	2	3	2
合计	33	4	12	8	9

表1 33例FICH胎儿超声检查的胎儿头颅声像特征(例)

头颅声像特征	例数	室管膜下	脑室	脉络丛	脑实质
稍强回声	18	3	10	2	3
无回声	5	1	0	2	2
弱回声	3	0	0	1	2
不均匀回声	7	0	2	3	2
合计	33	4	12	8	9

图3 1例胎龄为26⁺³周FICH胎儿(女性)的头颅超声声像图(红色箭头示右侧侧脑室扩张伴稍强回声)

图5 1例FICH胎儿(男性)的头颅影像学检查结果(图5A：胎龄为28⁺⁶周时的头颅超声声像图，仅提示右侧侧脑室增宽，红色箭头所示；图5B：胎龄为29⁺⁵周时的胎儿头颅MRI检查示T2W少许线状低信号影，右侧侧脑室增宽伴前角少量出血，红色箭头所示)

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