胎儿颅脑磁共振检查优化及功能成像的临床研究

The Clinical Application of Combining Improved Structural and Functional MRI Examinations on Fetus Cerebral Disease

目的探讨胎儿颅脑MR序列优化联合功能成像技术的临床应用价值。方法89例胎脑具有产前超声、产前MR及产后MR检查的孕妇作为研究对象。常规序列:2D T2W-TSE及3D T1W-TFE或2D T1W Balance TFE;功能序列:DWI、SWI。结果统计分析采用以产后胎脑MR诊断结果为标准,对胎脑产前超声和产前MR诊断结果进行卡方检验(χ2=35.814,P<0.001),两组间存在显著差异。产前超声与产前MR诊断结果完全符合42例(56.0%);产前MR与产后MR诊断结果完全符合71例(94.6%)。胎脑功能成像:DWI成像测量胎脑同侧同部位白质兴趣区ADC值:24-29周胎龄约为(1.83±0.108)×10-3mm2/s;30-39周胎龄约为(1.71±0.025)×10-3mm2/s,两组ADC值差异有统计学意义(t值=3.82,P<0.05);SWI对显示脑出血量、范围、部位较其他序列更精准。结论胎儿颅脑MR技术优化联合功能成像对胎儿神经系统疾病诊断具有显著优势,可为临床提供更详细、更精准的影像学信息,减低畸形及缺陷儿出生率。

Objective To evaluate the clinical application of combining functional MRI and optimized structural MRI on clinical diagnosis of fetal brain abnormities.Methods 89 subjects （prenatal gestational woman and corresponding postnatal neonate） who have received a prenatal ultrasound examination （US）, prenatal MRI examinations and postnatal neonate MRI examinations were enrolled in this study. MRI scan protocols include general structural imaging （2D T2W-TSE and 3D T1W-TFE/2D T1W Balance TFE） and functional imaging （DWI and optional SWI）.Results The prenatal US and prenatal MRI techniques were evaluated by comparing the examination results with postnatal neonate MRI. test results showed that the there is a significant difference between them. The MRI examinations of fetuses with abnormal structures showed that 42 （56.0%） fetuses diagnosis results were consistent between prenatal US and prenatal MRI and 71 （94.6%） fetuses diagnosis results were consistent between prenatal MRI and postnatal MRI. Functional MRI examination results showed that prenatal DWI demonstrated a significant difference （t-test： t value=3.82, P〈0.05） on ADC values within ipsilateral whiter matter ROIs between younger fetuses （gestational age： 24 to 29 weeks, ADC： （1.83±0.108）×10-3mm2/s） and older fetuses （gestational age： 30 to 39 weeks, ADC： （1.71±0.025）×10-3mm2/s）. Prenatal SWI examination was more precise and sensitive than general structural MRI on the detection of volume, range, location of haemorrhage. Conclusion It could be concluded that the combination functional MRI and optimized structural MRI have obvious advantages over prenatal US on clinical diagnosis of fetal brain abnormities. Prenatal MRI could provide more precise and reliable images which can help for the treatment of clinical abnormal and handicapped fetal.