磁共振成像对101例超声诊断侧脑室扩张合并中枢神经系统疾病胎儿鉴别诊断

Comparison of MRI and ultrasound in 101 fetal ventriculomegaly complicated with central nervous system diseases

目的探讨磁共振成像(MRI)对超声诊断的胎儿侧脑室扩张的进一步诊断价值,以明确是否合并有其他中枢神经系统疾病。方法采用回顾法对我院妇产科2017年4月至2018年8月超声诊断的胎儿侧脑室扩张101例进行MRI检测,MRI均在超声诊断后3 d内进行,在MRI图像上测量双侧侧脑室三角区宽度及邻近脑组织厚度,并诊断是否合并其他中枢神经系统疾病。根据侧脑室扩张程度分为4组:A组10~12 mm;B组13~15 mm;C组>15 mm,邻近脑组织厚度≥3 mm;D组>15 mm,邻近脑组织厚度<3 mm。对于各组胎儿的单、双侧侧脑室扩张合并中枢神经系统疾病的合并率进行统计学处理。结果 MRI与超声对胎儿侧脑室扩张程度测量分组的一致性良好。MRI检测确诊胎儿侧脑室扩张共95例,占超声诊断的94.1%(95/101),其中诊断合并其他中枢神经系统疾病者26例,合并率为27.4%(26/95)。以胼胝体缺如或发育不良,脑室周围白质软化最为多见。经统计学处理,胎儿侧脑室扩张程度越大,胎儿中枢神经系统疾病合并率越高,差异有统计学意义(χ~2=12.321 5,P<0.01)。双侧侧脑室扩张比单侧侧脑室扩张胎儿中枢神经系统疾病的合并率高,两者比较,差异有统计学意义(χ~2=6.002 1,P<0.05)。结论对于产前超声诊断的胎儿双侧脑室中、重度扩张者,有必要进行MRI检查,以便发现合并的其他中枢神经系统疾病。

Objective To explore the value of MRI in diagnosis of fetal ventriculomegaly by ultrasound in order to determine whether there are other central nervous system disease. Methods 101 cases of fetal ventriculomegaly which diagnosed by ultrasound in our hospital from April 2017 to August 2018 were examined by MRI within 3 days after ultrasound. Measuring the width of bilateral ventricular triangle on MRI, and diagnosing other central nervous system diseases. According to the degree of ventriculomegaly, the patients were divided into 4 groups: group A 10-12 mm, group B 13-15 mm, group C >15 mm and the thickness of adjacent brain was greater than 3 mm, group D >15 mm and the thickness of adjacent brain was less than 3 mm. Statistical analysis was made on the incidence of ventriculomegaly with central nervous system diseases in each group of fetuses. Results 95 cases with fetal ventriculomegaly were confirmed by MRI, accounting for 94.1%(95/101) of the ultrasound diagnosis. Among of them,26 cases were found with other central nervous system diseases, the rate of complication was 27.4%(26/95). Absence or dyspla-sia of the corpus callosum was the most common type, Periventricular leukomalacia was followed. The greater the degree of fetal ventriculomegaly, the higher the rate of complication, the difference was obviously significant( χ~2=12.321 5,P <0.01).Bilateral ventricular dilatation had a higher incidence of complications than unilateral ventricular dilatation in fetal central nervous system diseases, and the difference was significant( χ~2=6.002 1,P<0.05).Conclusions After ultrasonography diagnosis of fetal ventriculomegaly, especially in which with bilateral moderate or severe ven-triculomegaly,MRI is necessary to detect more complications of central nervous system diseases.