胎儿肝脏血管内皮瘤MRI诊断的初步探讨

Preliminary Experience with Prenatal Magnetic Resonance Imaging in Evaluation of Fetal Hepatic Hemangioendotheliomas

目的:探讨胎儿肝脏血管内皮瘤的产前MRI表现及诊断价值。方法:5例孕妇,孕龄22～37周。产前常规行超声(US)检查后24～48h内行MR检查,采用二维快速平衡稳态采集(2D FIESTA)序列、单次激发快速自旋回波(SSFSE)序列以及快速翻转恢复运动抑制(FIRM)序列,行胎儿颅脑胸腹部常规及肝脏重点冠状面、矢状面及横断面扫描,将产前MRI、US表现与出生后影像表现或手术病理结果对照。结果:5例肝脏血管内皮瘤均表现为肝脏内边界清晰的单个肿块,其中1例合并皮下多发血管瘤。在FIESTA、SSFSE序列上表现为不均匀稍高信号,在FIRM序列上表现为不均匀低信号。所有病例FIESTA序列肝脏横断面可见包块周边扩张的肝血管和远端腹主动脉变细。结论:产前MRI能提供诊断胎儿肝脏血管内皮瘤的有用信息,能提供产前US以外的补充诊断信息。

Purpose： To study the appearance of fetal hepatic hemangioendotheliomas using prenatal magnetic resonance imaging （MRI） and to conclude the diagnostic value of MRI on fetal hepatic heman- gioendotheliomas. Methods ： Five pregnant women with gestation from 22 to 37 weeks were studied with a 1.5 T superconductive MR unit within 24 to 48 hours after ultrasound studies. The imaging protocol in cluded fast imaging employing steady - state acquisition （FIESTA）, single shot fast spin echo （SSFSE） and T1 weighted fast inversion recovery motion insensitive （FIRM） sequences in the axial, coronal, and sagittal planes relative to the fetal brain, thorax, and abdomen, especially liver. Prenatal US and MR imaging findings were compared with postnatal diagnoses. Postnatal evaluation included imaging , surgery and pathology exam. Results： Five fetuses showed an isolated vascular hepatic tumour with long T1 and inhomogeneous long T2 signal intensity. In one case, multiple scalp hemangiomas were detected in the postnatal physical examination. In all cases, the transverse MRI through the fetal abdomen showed branching of the enlarged hepatic blood vessels within the liver and the thin distal abdominal aor ta. Conclusion： Prenatal MRI is effective in the assessment of fetal hepatic hemangioendotheliomas. Prenatal MRI may be a useful coml01ementary method to US in assessing fetal hepatic tumors.