产前MRI在胎儿中重度肾积水评估中的作用探讨

The role of prenatal MRI in evaluating fetal moderate-to-severe hydro nephrosis

目的探讨产前MRI在评估胎儿中重度肾积水程度及病因中的作用。方法选取本院2015年4月至2017年3月间经超声筛查发现异常,行产前MRI检查诊断为胎儿中重度肾积水的患者共26例,扫描序列包括半傅立叶单次激发快速自旋回波(HASTE)序列、真稳态进动快速成像(True-FISP)序列、T1WI及DWI。将产前磁共振影像学资料与产后影像学检查及手术情况相对照。结果 26例中重度肾积水胎儿中,23例经手术或尸检病理证实,其中肾盂输尿管移行处狭窄15例,先天性巨输尿管4例,先天性巨输尿管伴重复肾3例;后尿道梗阻1例;产前MR诊断正确20例;其余3例仍在随访观察中。结论产前胎儿MRI检查作为产前筛查的一种辅助检测手段,能进一步明确肾积水的病因、严重程度及累及范围,填补超声检查的不足。同时,也可让临床医生更加直观地了解病情,为临床诊疗提供更贴切的依据。

Objective Evaluate the role of prenatal MRI in judging etiology and severity of hydronephro- sis. Methods 26 cases of fetal MRI images,which were screened by Ultrasound Scanning and prenatal MRI results indicate moderate to severe hydronephrosis ,were collected from April 2015 to May 2017. Screening se- quences include HASTE, True-FISP, T1WI and DWI sequence. Prenatal MR imaging results were compared with postpartum MR imaging and pathological results after surgery. Results 23 cases were confirmed by sur- gery pathology or autopsy out of 26 total cases ,including 15 ureteropelvic junction obstruction cases ,4 congeni- tal megaureter cases ,3 cases of congenital megaureter with duplex kidney and 1 cases of posterior urethral ob- struction. The total valid diagnoses confirmed by prenatal MR are 20 cases, and the rest of the 3 cases are still in the follow-up observation. Conclusion MRI, as an auxiliary detection method of prenatal screening, can fur- ther clarify the etiology, severity and involved extent of hydronephrosis, to fill the lack of ultrasound. Also, it al- lows clinicians to intuitively understand the patient＇s condition, and provide solid clinical diagnosis and precise treatment for patients.