产前超声联合MRI诊断胎儿先天性食管闭锁

Prenatal ultrasound combined with MRI for diagnosing fetal congenital esophageal atresia

目的探讨产前超声联合MRI对胎儿先天性食管闭锁(CEA)的诊断价值。方法回顾性分析31胎经引产后尸体解剖或出生后手术及影像学检查证实的CEA胎儿(CEA组)的产前超声及MRI资料,并与31胎产后正常胎儿(正常对照组)进行对照。以病理结果为金标准,分析产前超声联合MRI诊断胎儿CEA的阳性率。比较2组间产前超声指标胎儿双顶径(BPD)、头围(HC)、腹围(AC)、股骨长(FL)、羊水深度(AFD)、羊水指数(AFI)、胎盘厚度、脐动脉峰谷比(S/D)、胎儿吞咽指数及估算胎儿体质量(EFW)的差异。结果产前超声联合MRI诊断胎儿CEA的阳性率为67.74%(21/31)。CEA组胎儿HC、AC、吞咽指数、EFW均低于正常对照组(P均<0.05),S/D、AFI均高于对照组(P均<0.05);2组间BPD、FL、AFD、胎盘厚度差异均无统计学意义(P均>0.05)。结论产前超声无法直接诊断胎儿CEA,当发现胃泡持续72h不显示(间隔72h复查)或羊水过多时,结合MRI对产前诊断胎儿CEA具有一定价值。产前超声指标中,胎儿HC、AC、AFI、S/D、吞咽指数、EFW可能对CEA具有一定提示作用。

Objective To investigate the value of prenatal ultrasound combined with MRI in diagnosis of congenital esophageal atresia（CEA）in fetus.Methods Prenatal ultrasound and MRI data of 31 CEA fetuses confirmed by autopsy,operation or imaging diagnosis of newborns（CEA group）were retrospectively analyzed.Meanwhile,31 normal fetuses（normal control group）were selected as controls.The positive rate of prenatal ultrasound combined with MRI for diagnosing fetal CEA was analyzed taking pathological results as gold standard.The differences of biparietal diameter（BPD）,head circum ference（HC）,abdominal circumference（AC）,femur length（FL）,amniotic fluid depth（AFD）,amniotic fluid index（AFI）,placental thickness,umbilical artery peak to valley ratio（S/D）,fetal swallowing index and estimated fetal weight（EFW）were compared between the 2 groups.Results The positive rate of prenatal ultrasound combined with MRI for diagnosing fetal CEA was 67.74%（21/31）.HC,AC,swallowing index and EFW in CEA group were lower than those in normal control group（all P〈0.05）,while S/D and AFI were higher than those in control group（both P〈0.05）.There was no statistical difference of BPD,FL,AFD nor placental thickness between the 2 groups（all P〉0.05）.Conclusion Prenatal ultrasound can not be used to directly diagnose fetal CEA.When the gastric vacuole did not continue to display（for 72 hours）or amniotic fluid is too much,combination with MRI is valuable for prenatal diagnosis of fetal CEA.Prenatal ultrasound parameters,such as fetal HC,AC,AFI,S/D,swallowing index and EFW,may have certain indication value in diagnosis of CEA.