胎儿透明隔腔消失的超声与MRI对比分析

Ultrasonogram vs MR image of absence of cavum septum pellucidum in fetuses

目的探讨胎儿透明隔腔消失的影像诊断意义。方法回顾性分析自2009年1月1日至2011年6月30日在青岛市妇女儿童医院系统产前超声检查中检出的透明隔腔消失的67例病例,以前脑无裂、胼胝体发育不良及孤立性透明隔腔消失将病例分为3组,分析其超声及MRI特点,比较胎儿期透明隔腔消失病例影像学诊断方法的准确情况。结果 67例超声筛查胎儿透明隔腔消失,其中胼胝体发育不良31例(46.3%),前脑无裂畸形22例(32.8%),孤立性透明隔腔消失病例14例(20.9%),同时行产前MRI检查并随访资料完整的40例病例计入统计,收集其引产后解剖病理结果或引产后标本影像学检查结果。随访至足月分娩仅3例,均为孤立性透明隔腔消失病例,其中最大者随访至2岁1个月,神经学检查均未见明显先天性结构异常。对照样本的产前MRI、超声检查与(引)产后病例诊断或标本影像学检查的诊断符合率。其中产前MRI诊断符合率均为100%,而产前超声的诊断符合率分别为胼胝体发育不良100%,前脑无裂畸形93.3%,孤立性透明隔腔消失75%。结论超声筛查中出现的胎儿透明隔腔消失,应结合孕周连续观察,并注意其与其他中枢神经系统畸形的相关性,对孤立存在的透明隔腔消失应慎重做出畸形诊断,MRI在透明隔腔的显示效果及诊断准确率较超声更精确。

Objective To analyze the value of the MRI and uhrasonography （US） in the prenatal diagnosis of absence of cavum septum pellucidum （CSP）. Methods Fetal absence of CSP was suspected in 67 pregnant women by prenatal US from January 2009 to June 2011 in Qingdao Women ＆ Children Hospital. Pre- natal systemic uhrasonography was performed. The findings of prenatal US and MR images were analyzed. Diag- nostic accuracy was compared in these 2 imaging studies through the pathological and image data obtained after postpartum/odinopoeia, Results Among the 67 fetuses, there were 31 （46.3 % ） with agenesis of corpus cal- losum （ACC）, 22 （32.8%） with holoprosencephaly, and 14 suspected to be with isolated absence of CSP. Only 3 fetuses were full-term born, and identified without any obvious congenital abnormality in nervous system. The oldest was 2 years and 1 month old. And they belonged to isolated absence of CSP. According to the patho- logical and image data after postpartum/odinopoeia, MRI had 100% accuracy in the diagnosis of prenatal CSP, 100% for ACC, 93.3% for holoprosencephaly and 75% for isolated absence of CSP. Gonclusion When the absence of CSP is found in US diagnosis, further examination should be performed continuously and analyzed with gestational weeks. And attention should be paid to its correlation with malformations in central nervous system. For isolated absence of CSP, malformation must be carefully diagnosed. MRI is more accurate in diagnosis for absence of CSP than US.