胎儿唇腭裂磁共振成像与超声成像的对比研究

Comparative study of MRI and ultrasound in fetal cleft lip and palate

目的探讨MRI对胎儿唇腭裂畸形的诊断价值。方法经腹部超声成像诊断的10例胎儿在1～3 d内接受磁共振成像检查,孕周21～26周。MRI检查序列包括二维、三维稳态进动快速成像(2D,3D FIESTA)序列,在矢状面、冠状面和轴向层面上对胎儿的图像进行分析,重点观察轴位片,并将产前超声、MRI诊断和尸检或随访结果进行对照分析。结果最终确认单纯唇裂1例,左侧唇腭裂3例,右侧唇腭裂3例,双侧唇腭裂1例,中央唇腭裂2例。唇腭裂畸形于MRI FIESTA均表现为高信号裂隙:单纯唇裂为上唇软组织裂隙,而牙槽骨正常;单侧唇腭裂为单侧上唇及上颚裂隙;双侧唇腭裂为双侧上唇及上颚裂隙,并在上唇中央区形成游离的"息肉样"前凸。产前超声、MRI影像诊断符合率均达100%。未发现单纯腭裂的胎儿。无假阳性病例。结论磁共振成像对诊断胎儿唇腭裂的效能与产前超声相当,MRI可作为胎儿唇腭裂检查的备用方法。

Objective To explore the value of MRI in the diagnosis of fetal cleft lip and palate. Methods Ten fetuses with cleft lip and/or palate diagnosed on transabdominal ultrasound （US） underwent MRI within 1-3 days. MRI protocol included 2- and 3-dimensional steady state fast precession imaging （2-D, 3-D FIESTA） sequences. The fetal images were analyzed on sagittal, coronal and axial planes. US and MRI findings were compared with final diagnoses obtained from post-natal physical examination or fetal autopsy. Results Simple cleft lip （1）, left （3）, right （3）, bilateral （1）, and central （2） cleft lip and palate were confirmed. All cleft lip and palate deformities showed hyperintense cleft on FIESTA images. Simple cleft lip was a fissure of the upper lip with normal alveolar bone. Unilateral cleft lip and palate were left or right upper lip and maxillary fissures. Bilateral cleft lip and palate were bilateral upper lip and maxillary fissures with free central polypoid protrusions in the upper lips. The coincidence rate of prenatal US and MRI was 100%. No isolated cleft palate was found. There were no false positive cases. Conclusion MRI is comparable to US in the diagnosis of fetal cleft lip and palate.