胎儿先天性肺囊腺瘤样畸形的MRI诊断

Prenatal MRI diagnosis of congenital cystic adenomatoid malformation

目的:探讨MRI在胎儿先天性肺囊腺瘤样畸形(CCAM)中的诊断价值。方法:收集我院2013年3月-2015年12月53例产前MRI诊断为CCAM的胎儿,所有胎儿出生后均行胸部低剂量CT增强检查及手术治疗,以病理结果为金标准,对胎儿CCAM的MRI特点进行回顾性分析;其中8例胎儿产前行两次MRI检查,分析病灶变化的MRI特征。结果:53例胎儿中,病理证实CCAM 52例,先天性肺气肿(CLE)1例。52例CCAM中,大囊型28例,MRI表现为边界清晰的多囊性长T_2病灶,囊内分隔呈短T_2信号,囊泡直径≥5 mm;微囊型24例,MRI表现为边界清晰的实性或微囊状长T_2病灶,囊泡直径<5 mm。8例CCAM行2次MRI检查,其中5例病灶大小及信号无明显变化;3例病灶变小,信号降低。52例CCAM中,心脏右移17例,心脏左移23例。52例胎儿均未合并胎儿水肿,合并羊水过多者3例。结论:MRI对胎儿CCAM的诊断价值较高,不仅能够清晰显示病灶部位、类型及病灶变化情况,还能够观察病灶周围器官受压程度,为胎儿临床预后提供准确信息。

Objective：To assess the value of MRI in the diagnosis of congenital cystic adenomatoid malformation（CCAM）.Methods：Fifty-three fetuses suspected of CCAM by MRI were collected from March 2013 to December 2015.All the fetuses underwent postnatal low dose enhanced CT examination and surgery.The MRI features of fetal CCAM were retrospectively analyzed,with the result of pathology as the golden standard.Among them,8 fetuses underwent MRI twice,and the change of mass size was evaluated.Results：In the 53 cases,52 cases of CCAM were confirmed by pathology,and 1 case was congenital lobar emphysema（CLE）.In the 52 cases of CCAM,28 cases were macrocystic type,showing clear border,multiple cysts with long T_2 signal in the pulmonary lobe,septa of short T_2 signal,and the diameter of the cysts was larger than 5 mm;24cases were microcystic type,showing clear border,homogeneity or microcysts with long T_2 singal in the pulmonary lobe,and the diameter of cysts was smaller than 5 mm.Eight CCAM cases underwent two MRI examinations,5 cases of which had no significant change in size and signal of the lesion,but 3 cases decreased in both size and signal.In the 53 fetuses,hearts shifted to the right in 17 cases,and to the left in 23 cases.Fifty-two fetuses were not associated with fetal hydrops,and 3fetuses had polyhydramnios.Conclusion：MRI has great diagnostic value for CCAM.It can not only correctly demonstrate the location,type and change of the lesion,but also observe the degree of compression of surrounding organs.It can provide accurate information for the clinical prognosis of the fetus.