四维超声联合磁共振成像诊断胎儿畸形的临床意义

Clinical significance of four-dimensional ultrasound combined with magnetic resonance imaging in the diagnosis of fetal malformation

目的探讨四维超声系统筛查联合磁共振成像对胎儿畸形的临床诊断价值。方法选择2015年3月—2016年2月在笔者所在医院行四维超声检查的中晚期孕妇1605例,对可疑胎儿畸形的孕妇行胎儿磁共振成像明确诊断,根据引产/上级医院进一步检查或出生后的随访结果评价其诊断符合率。结果 1605例孕妇共怀孕胎儿1623例,其中双胎18例,经临床证实畸形胎儿63例,单纯四维超声检查发现畸形58例,诊断符合率92.1%,四维超声联合磁共振成像发现胎儿畸形60例,诊断符合率95.2%,差异无统计学意义(P>0.05)。其中16例中枢神经系统发育畸形,单纯四维超声检查发现9例,诊断符合率56.2%,二者联合检查发现14例,诊断符合率87.5%,差异有统计学意义(P<0.05)。结论四维超声是胎儿畸形首选的检查方法,磁共振成像在中枢神经系统畸形的诊断中具有优势,二者联合可以提高胎儿畸形的诊断率,降低出生缺陷,提高人口素质。

Objective To explore the clinical value of four-dimensional ultrasound（4DUS） combined with magnetic resonance imaging（MRI） techniques in prenatal diagnosis of fetal malformation. Methods Totally 1605 pregnant women underwent prenatal systematic four-dimensional ultrasound（4DUS） examination during March 2015 to February 2016. Among them,the pregnant women who was suspected having malformed fetal were diagnosed by magnetic resonance imaging（MRI） techniques. At last,the diagnosis rates according to the follow-up results were evaluated. Results The 1623 fetus were labored,and 63 malformation cases were authenticated clinically,among whom 18 were twins. 58 were discovered as malformation by alone four-dimensional ultrasonography,and 60 as malformation by combined diagnosis of four-dimensional ultrasonography and MRI. Combined diagnosis accuracy rate was 95.2%,which was similar with alone four-dimensional ultrasonography（92.1%,P0.05）. Totally 16 cases were discovered as central nerve system malformation among whom only 9 were discovered by alone four-dimensional ultrasound,14 were discovered by combined diagnosis of four-dimensional ultrasound and MRI,and the combined diagnosis accuracy rate was 87.5%,which was significantly greater than that alone four-dimensional ultrasonography（56.2%,P0.05）. Conclusion Four-dimensional ultrasound（4DUS） examination is the preferred method for malformation diagnosis,MRI has the advantage in diagnosing central nerve system malformation. The diagnosis rate can be improved by the combination of two methods,so that to reduce birth defect efficiently and to enhance population diathesis.