出生前后侧脑室周围假性囊肿的MRI评价及预后分析

Evaluation of the neurodevelopment outcome of prenatally diagnosed periventricular pseudocysts using MRI

目的分析评价出生前后不同类型侧脑室周围假性囊肿(PVPC)的MRI特点及其变化、预后的差异。方法回顾性分析2015年6月至2018年7月山东省医学影像学研究所67例产前MRI诊断为PVPC的胎儿临床及影像资料,并进行出生后随访,其中24例失访,2例出生后死亡,将存活的41例胎儿进行预后分析,并进行Gesell量表评分。根据囊肿位置及是否伴有其他颅内外异常分为孤立性先天性囊肿、先天性囊肿伴其他异常、孤立性室管膜下囊肿及室管膜下囊肿伴其他异常4组。所有MRI图像由2名高年资放射科医师分别进行评价,包括囊肿位置、囊腔数量、囊肿大小、是否伴有其他异常及出生前后变化。采用组内相关系数(ICC)分析两名医师之间的一致性;采用卡方检验比较先天性囊肿组、室管膜下囊肿组囊肿位置(单/双侧)、囊腔数量(单/多腔)及是否伴其他异常的差异。采用独立样本t检验比较先天性囊肿组、室管膜下囊肿组囊肿平均前后径、平均高度的差异。采用单因素方差分析比较4种不同类型侧脑室周围假性囊肿Gesell量表在适应性、大运动、精细动作、语言、个人-社交发育商(DQ)评分之间的差异。结果2名医师对41例出生前后PVPC的位置、囊腔数量、囊肿大小、是否伴有其他异常及出生前后大小变化情况的一致性均为好,ICC值分别为0.865、0.931、0.798、0.904、0.879。先天性囊肿组(18例)的囊肿均于出生后变小或消失,DQ均正常。孤立性室管膜下囊肿组(14例)中,出生后囊肿变小或消失12例,大小未见明显变化2例,仅1例DQ轻度迟缓;室管膜下囊肿伴其他异常组(9例)中,出生后囊肿变小或消失6例,大小未见明显变化3例,7例DQ表现为不同程度迟缓。孤立性室管膜下囊肿与室管膜下囊肿伴其他异常组间DQ差异有统计学意义(P<0.05);孤立性室管膜下囊肿组与孤立性先天性囊肿组间的DQ差异无统计学意义(P>0.05);先天性囊肿伴有其他异常组与室管膜下囊肿伴有其他异常组间DQ差异有统计学意义(P<0.05)。结论胎儿孤立性PVPC多于生后减小或自行消失,预后较好;室管膜下囊肿伴有其他脑或形态学异常时,生后患儿发育可出现不同程度迟缓,预后较差。先天性囊肿预后较好。

Objective To evaluate alterations of periventricular pseudocysts(PVPC)on MRI before and after birth,and to assess the prognosis.Methods We retrospectively analyzed the data of 67 cases that were diagnosed with PVPC on prenatal MRI,of which 24 cases were lost to follow-up,2 died after birth.A total of 41 surviving fetuses were included in this prognosis study.The gestational ages in this group were between 23 and 39 weeks,with an average of(33±3)weeks.All the subjects underwent brain MRI examinations and Gesell Developmental Scale(GDS)testing between 0-3 years of age.According to the location of cysts and with or without other intracranial and extracranial malformations(dilated ventricles orcerebella medulla,hypoxic-ischemic encephalopathy,TORCH virus infection,corporal hypoplasia,chromosomal malformations and nodular sclerosis),the patients were divided into four groups:isolated connatal cysts,connatal cysts with additional findings,isolated subependymal pseudocysts,and subependymal pseudocysts with additional findings.The MR images were independently reviewed by two radiologists blinded to the clinical information.Intraclass correlation efficient(ICC)was used to analyze the consistency between the two reviewers.Chi-square test was used to compare the location of cysts(single/bilateral),the number of cyst cavities(single/multi-chamber),and other abnormalities in the connatal cyst group and subependymal cyst group.The mean anteroposterior diameter and mean height of cysts between the connatal cyst group and subependymal cyst group were compared by independent sample t-test.The ANOVA test was used to compare the differences in GDS outcomes among the groups.Multiple comparisons were conducted using the LSD test.Results Inter-observer agreements between the two radiologists were good for the collected data(all ICC>0.75).Eleven isolated connatal cysts and 7 connatal cysts with additional findings became smaller or disappeared,and all had good prognosis.Of the 14 isolated subependymal cysts,12 became smaller or disappeared,2 had no change in size,and 13 had good prognosis.The subependymal cysts with additional findings group included 9 cases:6 became smaller or disappeared,only 3 showed no apparent changes,and 7 had an abnormal outcome.Subependymal cysts with additional findings were significantly reduced and patients demonstrated significant differences compared with the those with isolated subependymal cysts in the development quotients(DQ)of adaptability,large movements,fine movements,personal social interaction,and language DQ(P all<0.05).DQ between patients with isolated connatal cysts and isolated subependymal cysts was comparable(P all>0.05).When associated with additional findings,connatal cysts and subependymal cysts could induce significant different DQ outcome(P all<0.05).Conclusions Isolated PVPC usually become smaller or disappeared and have a benign presentation after birth,whereas patients with subependymal cysts with additional findings usually have a poor prognosis.Connatal cysts usually have a good prognosis.