扩散加权成像评价不同亚型胎儿生长受限胎盘价值的研究

Evaluation of the value of placenta in different types of fetal growth restriction using diffusion weighted imaging

目的:探讨MRI扩散加权成像评估正常和不同分型胎儿生长受限胎盘及临床结局的价值。方法:51例胎儿生长受限(FGR)患者和正常对照组26例,依据FGR胎儿出生体重、身长、头围将FGR分成匀称型和不匀称型两组,正常对照组与FGR组于妊娠28~35周均经MRI平扫及DWI检查,记录胎盘厚度、体积、ADC值及出生后5min Apgar评分、身长、体重、头围、新生儿并发症,FGR组与对照组各参数采用方差分析、q检验及连续校正χ~2检验比较。结果:(1)正常胎盘随着妊娠时间延长,胎盘信号不均匀,ADC值呈减低趋势。(2)匀称型FGR胎盘厚度与正常对照组无统计学差异(P>0.05),匀称型FGR胎盘体积、ADC值、新生儿出生体重、身长、头围、5min Apgar评分低于正常对照组,其中ADC值高于不匀称型FGR组,身长和头围低于不匀称型FGR组(P<0.05)。(3)不匀称型FGR胎盘厚度、体积、新生儿身长、头围与正常对照组无统计学差异(P>0.05);不匀称型FGR组胎盘ADC值、出生体重、5 min Apgar评分较正常对照组显著减低(P<0.05),新生儿并发症高于正常新生儿,低于匀称型FGR组。结论:MRI扩散加权成像能鉴别正常及不同分型FGR胎盘差异,对指导临床治疗有重要价值。

Objective:To investigation value of MRI diffusion-weighted imaging to evaluate placenta and clinical outcome in normal and subtypes of fetal growth restriction.Methods:51 cases of FGR patients and 26 cases of control were analyzed retrospectively,FGR will be divided into symmetrical and asymmetrical FGR groups by fetal birth weight,length and head circumference.The control and FGR groups were confirmed by conventional MRI and DWI in 28-35 weeks of pregnancy,measured placental thickness,volume,ADC value,recorded after the birth of the 5 min Apgar score,body length,body weight,head circumference,neonatal complications.Comparisons were made between FGR groups and the control using analysis of bariance、q test and correction of continuityχ2 test.Results:①It was inhomogeneous in the normal placenta signal and decreased in the healthy placental ADC value with the along pregnancy.②Compared with controls,the thickness of placenta in symmetrical FGR had no significant difference(P>0.05).There were significantly reduced in placental volume,ADC value,neonatal birth weight,length,head circumference and 5min Apgar score of symmetrical FGR compared with the control,especially,the ADC value were higher than the asymmetrical FGR groups,its length and head circumference were lower(P 0.05).③We find no difference in placenta thickness,volume,length and head circumference among the control、symmetrical and asymmetrical FGR groups(P>0.05).There were statistically different in placenta ADC value,birth weight and 5min Apgar score between asymmetric FGR and control(P 0.05).The complications of in the asymmetric FGR group were higher than the control,and lower than symmetrical FGR groups.Conclusion:MRI diffusion-weighted imaging can identify placenta in normal and subtypes of FGR,and has a great value to guide clinical treatment.