胎儿脊柱脊髓形态发育的影像学检测方法及表现

Imaging methods and characters of fetal spinal cord development

背景:胎儿先天畸形是围生期胎儿死亡的重要原因,其中神经管畸形在产前畸形筛查中较为常见。近年来随着环境的恶化和高龄产妇数量的增多,神经管畸形患者的数量在不断增加,带来了严重社会和家庭的经济负担。因此越来越多的产科医生通过现代影像学检查方法为产前筛查神经管畸形提供理论依据。目的:借助影像学手段对胎儿脊柱脊髓形态发育的相关研究进行系统阐述,从而为产前畸形筛查的诊断提供参考价值。方法:应用计算机检索1959至2017年中国知网、万方、维普、CBM、以及Pubmed数据库关于胎儿脊柱脊髓发育的文献报道,对其不同的影像学观测研究进行归纳综述。结果与结论:(1)X射线和CT:由于对孕妇及胎儿均有辐射损害,仅用于对胎尸脊柱骨化中心及生长发育与胎龄关系的研究,X射线早已弃用,CT目前还未见有对活体的报道;(2)超声:具有操作简单,对孕妇及胎儿无创,是目前首选的检查方法;(3)MRI:已成为超声重要的补充手段,为胎儿脊髓发育产前评估及相关疾病诊断提供影像学依据;(4)为了更好的成像,针对不同的组织结构选用不同的检测方法,同时也要考虑辐射对胎儿造成的影响。

BACKGROUND： Fetal congenital malformation is an important cause of perinatal fetal death, in which neural tube defects （NTDs） in prenatal deformity screening is more common. In recent years, with the deterioration of environment and the increase in the number of elderly maternal, patients with NTDs are increasing, bringing serious social and family economic burden. Therefore, modern imaging methods are used to provide theoretical basis for prenatal screening NTDs. OBJECTIVE： To study the development of fetal spinal cord morphology by means of imaging, so as to provide reference for the diagnosis of prenatal screening. METHODS： A computer-based retrieval of CNKI, WanFang, VIP, CBM and PubMed databases was conducted for the report on the development of fetal spinal cord from 1959 to 2017, and their different imaging studies were summarized. RESULTS AND CONCLUSION： In view of the impact of radiation on pregnant women and the fetus, in order to better imaging, for different organizational structures using different detection methods. （1） X-ray and CT： due to radiation damage to pregnant women and fetuses, they are only used for the cadaveric spine ossification center development, X-ray has been abandoned, and CT has not seen a live report. （2） Ultrasound is easy to operate, and non-invasive for pregnant women and fetuses, which is the preferred method of inspection. （3） MRI, as an important supplement means of ultrasound, can provide imaging basis for the prenatal assessment of fetal spinal cord development and diagnosis of related diseases. （4） Noticeably, harm of radiation to fetus should be considered.