胎儿肝血管瘤的产前超声表现及漏误诊分析

Prenatal sonographic characteristics of fetal hepatic hemangioma and analysis on its misdiagnosis and missed diagnosis

目的:探讨产前超声诊断胎儿肝血管瘤的漏误诊原因,提高产前超声对胎儿肝血管瘤的诊断率。方法:选择2016年1月至2018年10月湖南省妇幼保健院漏误诊的6例肝血管瘤胎儿为研究对象,活产儿追踪随访至出生6~24个月,引产胎儿行尸体解剖。回顾性分析6例漏误诊病例的产前超声扫查方法、声像图特征及妊娠结局。结果:产前超声误诊3例:3例产前超声首次发现肿块的时间分别为37^+3周、39^+5周、37^+4周,表现为混合回声肿块,均误诊为肝母细胞瘤。产前超声漏诊3例:1例整个孕期的产前超声检查均未发现,出生后2 d超声发现病灶;1例孕31^+6周及37^+4周产前超声均未发现,于孕40周超声发现肝血管瘤;1例孕26^+6周产前超声检查未发现,孕33周超声怀疑肝内稍低回声区,MRI提示肝血管瘤。6例中2例引产胎儿在家属知情同意的前提下行胎儿尸体解剖及病理检查证实为肝毛细血管瘤;4例活产婴儿行增强CT扫描和临床追踪观察证实为肝血管瘤。结论:产前超声对胎儿肝脏的检查应采取多角度多切面连续扫查的手法,同时观察肝静脉走行是否有改变及肝周边脏器的位置是否有移位,再进一步分析病灶超声图像及彩色多普勒血流特征,以提高胎儿肝血管瘤的诊断准确性,从而指导临床采取积极有效的干预措施。

Objective To explore the causes of misdiagnosis and missed diagnosis of fetal liver,hemangioma by prenatal ultrasound,aimed at improving the diagnostic rate of fetal liver hemangioma by prenatal ultrasound.Methods Six cases of misdiagnosed fetal liver hemangioma in Hunan Province Maternal and Child Health Hospital between January 2016 and October 2018 were selected.In these cases,live births were tracked until they were 6-24 months old,while autopsy was carried out on induced fetuses.These failed cases were analyzed retrospectively,in terms of their scanning methods,ultrasonographic features and pregnancy outcomes.Results Three cases were misdiagnosed by perinatal ultrasound:the time for the first discovery of masses in these cases was 37^+3 weeks,39^+5 weeks and 37^+4 weeks respectively.All of these tissues appeared as mixed echogenic masses and were misdiagnosed as hepatoblastoma.The other three cases were categorized as prenatal ultrasound missed diagnosis:in one case,prenatal ultrasound examination failed to detect the disease in question during the whole pregnancy,while ultrasound examination revealed lesions 2 days after birth;the other case didn't see the detection of hepatic hemangioma was not detected until the 40th week of pregnancy by ultrasound in another case,as prenatal ultrasound at 31^+6 weeks and 37^+4 weeks showed nothing abnormal;yet prenatal ultrasound examination of the third case showed no findings in which at 26^+6 weeks pregnant,but ultrasound performed at 33 weeks into gestation suspected slightly hypoechoic area in the liver,which was indicated hepatic hemangioma by MRI.Among the 6 cases,2 of the induced fetuses were confirmed as hepatic capillary tumor by autopsy and pathological examination by with the consents of their family;four live births were confirmed to be hepatic hemangioma by contrast-enhanced CT scan and clinical follow-up observation.Conclusions Multi-angle and multi-section scanning technique should be adopted in prenatal ultrasound examination of fetal liver.Mean while observations must also be made of any changes in the hepatic vein and any displacement of the peripheral organs of the liver,while ultrasonic images and color Doppler flow imaging features of the lesions are further analyzed.These actions lead to an improvement in the diagnostic accuracy of fetal liver hemangioma,which serves as a useful clinical guide to active and effective intervention measures.