产科镜像综合征的胎儿磁共振成像诊断

Diagnosis of Obstetric Mirror Syndrome by Fetal MRI

目的：探讨胎儿磁共振成像对于产科镜像综合征的诊断价值。方法：回顾性分析2013年10月-2015年5月我院收治的7例镜像综合征的胎儿MRI表现,包括胎儿水肿、胎盘水肿、合并相关畸形等,与临床引产尸检或出生后影像进行对照,并复习相关文献。结果：7例镜像综合征胎儿均表现为多处水肿,2例伴有胎盘水肿。合并的相关畸形包括胎盘绒毛膜血管瘤（1/7）、胎儿骶尾部畸胎瘤（1/7）、胎儿选择性生长受限（s IUGR,3/7）、双胎输血综合征（TTTS,2/7）。除胎儿水肿外,7例均伴有羊水过多。1例胎儿宫内死亡,3例胎儿引产,1例生后死亡,2例出生（体健）。结论：镜像综合征可引起母胎死亡率增加,早期诊断有助于提供恰当治疗并改善预后。胎儿MRI可以无辐射,软组织对比度好,视野大,可多平面成像,该综合征及其相关病变,是产科超声检查的重要补充。

Purpose： To investigate the value of fetal MRI in diagnosis of obstetric mirror syndrome. Methods： Seven cases of mirror syndrome admitted in our hospital from October, 2013 to May, 2015 were enrolled. They were all undergone fetal MRI. The MRI imaging findings includes fetal hydrops, placental edema, accompanying other abnormalities. Prenatal MR imaging findings were compared with autopsy, and postnatal MRI. Relevant literature was reviewed. Results： Fetal hydrops was presented in all 7 cases, and placental edema was found in 2 cases. One case was accompanied with placental chorioangioma（1/7）, 1 with fetal sacrococcygeal teratoma（1/7）, 3 with selected intrauterine growth restriction（3/7）, 2 with twin-to-twin transfusion syndrome（2/7）. Moreover, all 7 cases were complicated with polyhydramnios. Fetal perinatal mortality was occurred in 1 case, termination of pregnancy in 3 cases, neonatal death in 1 case, and another 2 cases were delivered healthily. Conclusion： Mirror syndrome is associated with a substantially increased risk of fetal and maternal morbidity and mortality, and early diagnosis of this condition during pregnancy is crucial for providing proper treatments and achieving better clinical outcomes. Fetal MRI can provide excellent soft tissue contrast with multiple planes reconstruction and a large field of view, which allow for better depiction of mirror syndrome in fetus and pregnant woman and without ionizing radiation,it is being increasingly used as a supplementary imaging modality to ultrasound.