超声和MRI联合应用诊断胎儿胸部异常

Combination of prenatal sonography and MRI in the diagnosis of fetal thoracic abnormalities

目的对比分析二维超声(2DUS)和磁共振成像(MRI)在胎儿胸部异常诊断中的应用价值及各自的优势与劣势,探讨超声和MRI联合应用诊断胎儿胸部异常的临床价值。方法 42例超声诊断为胸部异常(不包括心脏畸形)的胎儿,征得患者同意在接受超声检查后24 h内行MRI检查,最终诊断由产后尸检或生后随访证实。回顾性分析42例胎儿的超声和MRI图像,并与随访结果对照。结果 42例胸部异常包括先天性肺囊腺瘤畸形(CCAM)19例,隔离肺(BPS)9例,先天性膈疝(CDH)11例,先天性高位气道闭锁综合征(CHAOS)1例,膈膨升1例,胸腺增大1例。超声检出并正确诊断例数为38例(38/42),MRI检出并正确诊断例数为39例(39/42)。超声和MRI对胎儿胸部异常检出例数比较差异无统计学意义(P>0.05)。结论虽然超声和MRI在胎儿胸部异常检出例数方面无差异,但其各有优劣势,超声和MRI联合应用在部分病例中可综合评价胸部异常引起的继发改变,如超声可动态观测患儿心功能状态,MRI可明确病灶界限及评价肺发育情况。

Objective To compare the diagnostic value of prenatal two-dimensional ultrasound （2DUS） with magnetic resonance imaging（MRI）in fetal thoracic abnormalities, and explore their advantages and limitations ,respectively. To explore the practicality of US with MRI in diagnosing fetal thoracic abnormalities. Methods A total of 42 cases of fetal thoracic anomalies （excluding cardiac anomalies） detected by prenatal uhrasonography received MRI examination within 48 hours after ultrasound, confirmed by autopsy or clinical follow-up. The results of prenatal ultrasound and MRI were analyzed retrospectively. Results Of all 42 cases, 19 cystic adenomatiod malformation （CCAM） ,9 bronchopulmonary sequestration （ BPS）, 11 congenital diaphragmatic hernia（CDH）, 1 congenital high airway obstruction syndrome （CHAOS）, 1 eventration of diaphragm and 1 enlarged thymus gland were included. The diagnostic rates were 90.5% and 92.9% of US and MRI, respectively. No difference between US and MRI in detecting fetal thoracic anomalies was found. Conclusions Although no difference between US and MRI in detecting fetal thoracic anomalies was found, they had their own advantages and limits in different anomalies, respectively. The combination of prenatal US and MRI could evaluate the secondary change widely, including monitoring the cardiac status of fetus by ultrasound, and identifying the boundary of infection and evaluating lung development by MRI, etc.