胎儿脑积水的MRI表现与预后关系

The relationship between magnetic resonance imaging and prognosis of fetal hydrocephalus

目的探讨磁共振成像(MRI)对胎儿脑积水的早期诊断与预后判断的价值。方法对34例产前经B超检查发现或怀疑为脑积水的胎儿(轻度27例、中度3例、重度4例)进行MRI扫描,染色体检查,生后定期复查患儿脑积水变化,并根据体格生长测量指标与贝利发育量表评价生长发育情况。结果经MRI扫描,确诊轻度脑积水22例,中度5例,重度6例,正常1例;继续妊娠23例,1例因肺发育不良死亡,1例合并胸腹腔积液放弃治疗后死亡,存活21例;在生后6个月或纠正胎龄6个月时经贝利发育量表评估,15例正常,6例低于正常,经功能锻炼和(或)营养脑细胞药物治疗3个月后再次评估5例达到正常水平,1例重度脑积水患儿仍低于正常。染色体检查均未发现异常。结论在胎儿中枢神经系统畸形的产前诊断中,MRI可作为B超产前诊断的重要补充。

Objectives To explore the clinical value of magnetic resonance imaging（MRI）in detecting fetal hydrocephalus and evaluating its prognosis.Methods MRI were performed in 34 hydrocephalus fetuses diagnosed with or suspected of hydrocephalus by ultrasound examination（27 mild cases,3 moderate cases,and 4 severe cases）.All the fetuses had chromosome examination.The extent of hydrocephalus,anthropometrics and Bayley scale of infant development were monitored after infants was born.Results Among the 34 fetuses,there were 22 mild hydrocephalus cases,5 moderate cases,6 severe cases and one normal case according to the MRI.Twenty-three infants were born.One infant died of congenital pulmonary dysplasia,and one infant died of combined splanchnocele effusion and withdrawal of treatment.Twenty-one infants survived.Six infants were assessed to have development retardational by Bayley scale of infant development at six-month-old or at correlated six-month-old.No chromosomal abnormality was found in all fetuses＇cord blood samples.Conclusions In prenatal diagnosis of fetal central nervous system malformation,MRI has become an important adjuvant technique to ultrasonography.