超声与磁共振成像在诊断胎儿前脑无裂畸形中的联合应用

Combination of ultrasound and MRI in the diagnosis of holoprosencephaly in fetuses

目的探讨二维超声、三维多层面超声与磁共振成像(MRI)联合诊断胎儿前脑无裂畸形的临床价值。方法对经常规二维超声诊断及怀疑前脑无裂畸形的孕妇进行三维超声扫查并获取容积图像,应用三维多层面成像(MSV)模式进行图像后期处理及分析,并同期行MRI检查,将诊断结果进行对照分析。结果二维超声明确前脑无裂畸形9例,怀疑前脑无裂畸形6例。MSV序列层面诊断前脑无裂畸形无叶型10例,半叶形5例,图像信息丰富,优于二维超声。MRI诊断无叶型11例,半叶型4例。MRI可以同时得到冠状矢状面与轴平面,且对脑灰质白质与大脑镰、脑裂隙结构显示明显优于二维超声与MSV。其中前脑无裂合并颜面畸形9例、合并心脏畸形4例、合并脊柱畸形1例,均经引产后证实。病理结果诊断15例前脑无裂中无叶型11例,半叶型4例。结论 MSV可从冠状面与轴平面通过序列切面观察前脑无裂畸形颅内结构病变特征(尤其是半叶型前脑无裂畸形),故优于二维超声。MRI则明显优于二维与MSV。二维超声对前脑无裂合并心脏畸形诊断优于MSV与MRI。多种影像方法联合应用,能使临床医师更加全面认识前脑无裂畸形病变特征与分型,并提高诊断的准确性。

Objective To explore the application of two-dimensional ultrasound （2D-US） , three- dimensional ultrasound （3D-US） multi-slice view （MSV） and magnetic resonance imaging（MRI） in diagno- sis of fetus holoprosencephaly （HPE）. Methods The fetuses suspected or diagnosed as HPE by 2D-US received 3D-US examination. The acquired volume images were analyzed by muhislices view （MSV）model and the fetuses received MRI. Then the results were compared and analysed. Results A total of 9 fetuses were diagnosed as HPE and 6 fetuses were suspected as HPE by 2D-US. Thirteen alobar HPE and 6 semilobar HPE were diagnosed by MSV. MSV could provide more information than 2D-US. Eleven alobar HPE and 4 semilobar HPE were diagnosed by MRI. MRI could provide multiple sequential coronal and axial planes of fetal brain simultaneously and be superior to 2D-US and MSV in diagnosis of brain parenchyma, cerebral falx and fissure. Of all, there were 9 cases complicated with face malformation, 4 with cardiac abnormality and 1 with spinal deformity, all of which were confirmed by autopsy. Ten alobar HPE and 5 semilobar HPE were confirmed. Conclusion The 3D-MSV model can visualize intracal structure in axial and coronal planes of HPE and be superior to 2D-US in semilobar HPE. MRI is obviously superior to 2D-US and 3D-MSV in diagnosis of HPE. But compared with MSV and MRI, 2D-US had obvious advantages in detection of the associated cardiac abnormal HPE. Combining 2D uhrasonography with 3D-MSV and MRI, rt HPE could be further assessed, therefore the diagnostic accuracy of HPE could be greatly improved.