超声与MRI在胎儿心脏畸形筛查中的作用

Role of Ultrasound and MRI in the Screening of Fetal Heart Malformation

目的研究超声与MRI在胎儿心脏畸形筛查中的作用,为寻找更合理有效的检查方法提供理论依据。方法选取2014年12月-2017年12月我院产前检查孕妇7438例,根据孕周分为孕中期(孕20-28周,n=5132)和孕晚期(孕28-36周,n=2306)两组,分别采用超声快速扫描、超声心动图和MRI进行检查,比较和分析三种检查方法对两组胎儿检查结果。结果 7438例胎儿中引产或出生后证实存在心脏畸形者64例(0.86%),B超常规扫描、2D FIESTA和超声心动图分别检出54例(84.38%)、57例(89.06%)和58例(90.63%),三种检查方法孕中期检出率分别为88.37%、86.05%和93.02%,孕晚期检出率分别为76.19%,90.48%和85.71%。结论B超与MRI用于胎儿心脏畸形产前筛查各有优势和不足,正常情况下,胎儿心脏超声快速扫描可基本完成筛查工作,漏诊率较低,对可疑病例可补充超声心动图确诊;MRI发展较晚,但进步迅速,2D FIESTA序列用于胎儿心脏畸形产前诊断可在多方面弥补超声检查的不足,故而可作为一种有效的补充手段。

Objective To study the role of ultrasound and MRI in the screening of fetal heart malformation and provide theoretical basis for finding more reasonable and effective inspection methods. Methods 7438 cases of pregnant women in prenatal examination in our hospital from December 2014 to December 2017 were selected and divided into two groups of second trimester（20-28 weeks, n=5132） and third trimester（28-36 weeks, n=2306） according to gestational age, and the two groups were examined by ultrasonic rapid scanning, echocardiogram and MRI respectively. The results of three inspection methods for fetuses were compared and analyzed. Results There were 64 cases（0.86%） with heart malformation in induced labor or after birthamong 7438 cases of fetuses, and 54 cases（84.38%）, 57 cases（89.06%） and 58 cases（90.63%） were detected by routine B ultrasound scan, 2 D FIESTA and echocardiogram respectively. The detection rates of three inspection methods were 88.37%, 86.05% and 93.02% respectively in the second trimester, and were 76.19%, 90.48% and 85.71% respectively in the third trimester. Conclusion B ultrasound and MRI have advantages and disadvantages in prenatal screening for fetal heart malformation. Under normal circumstances, fetal ultrasonic rapid scanning can basically complete the screening with low rate of missed diagnosis, and supplement echocardiogram for diagnosis of suspicious cases. MRI is of late development but rapid progress, and 2 D FIESTA sequence can make up for the lack of ultrasound in many ways from the perspective of prenatal diagnosis of fetal heart malformation, therfore it can be used as an effective supplementary means.