MRI辅助诊断胎儿脑积水的价值

The value of magnetic resonance imaging in the aided diagnosis of fetal hydrocephalus

目的探讨MRI(磁共振,magnetic resonance imaging)在胎儿脑积水的早期诊断与判断预后的价值。方法对26例产前经B超检查发现或怀疑为脑积水的胎儿(轻度25例,重度1例)进行MRI扫描,予查血染色体,生后定期复查患儿脑积水变化,并根据生长发育测量指标与贝利发育量表评价生长发育情况。结果经MRI检查,确诊轻中度脑积水23例,重度2例,正常1例,其中有4例B超疑似的轻度脑积水经MRI确诊,有1例经MRI扫描未发现脑积水;继续妊娠18例,1例因"肺发育不良"死亡,存活17例;5例在生后6月或纠正胎龄6月时经贝利小儿智力发育量表测定稍低于正常,经功能锻炼和/或药物治疗后再次贝利发育量表测定均达到正常水平,12例测定正常。结论在诊断胎儿中枢神经系统畸形时,MRI具有较高的阳性率,能准确的反映脑积水的程度,未合并其他畸形且不伴有染色体异常的单纯性轻、中度胎儿脑积水预后较好,MRI可作为胎儿脑积水产前诊断的重要补充。

Objectives：To explore the value of MRI in detecting fetal hydrocephalus and evaluating its prognosis.Methods：MRI were referred for 26 hydrocephalus fetuses（25 mild cases,1 severe case） with mean age of 30.7 ± 4.9 weeks＇ gestation after diagnosed to be mild hydrocephalus by ultrasound examination.All the fetuses were undertaken chromosome examination after the diagnosis of fetal hydrocephalus,and had been monitored the change of the extent of hydrocephalus and the development of fetuses or infants.At postnatal month six or corrected age to six months,each infant was given a test with Bayley scales of Infant Development.The infants who hadn＇t got standard scores for the first time would be received another test after a period of function exercises and drug therapy.Results：Among the 26 cases,there were 23 mild to moderate fetal hydrocephalus cases,two severe cases,one normal case,in which MRI corrected the diagnosis of US in four cases and missed the diagnosis only in one case.No chromosomal abnormality was found in all the fetuses cord blood.Of all cases,18 cases were continued their pregnancies,and the rest were choosed induced abortion.Among the 18 cases continued pregnancies,four were premature delivery,14 were full-term,and one case succumb to congenital pulmonary dysplasia after birth,now seventeen cases surviving.Five infants got low scores in their first test with Bayley scales of Infant Development.However,after a period of functional exercises and/or drug therapy,the scores were significantly higher than pretreatment.Conclusions：In the diagnosis of fetal central nervous system malformation,due to its highly positive rate and accuracy response to the degree of hydrocephalus,without any other deformity in MRI and chromosomal abnormalities,mild or moderate fetal hydrocephalus always present favorable prognosis.