产前MRI量化评价先天性心脏病胎儿脑二维径线

Prenatal MRI quantitative evaluation on two-dimensional diameter of fetal brain in congenital heart diseases

目的观察产前MRI量化评价先天性心脏病胎儿脑二维径线的价值。方法150名孕龄(GA)21~39周孕妇(150胎)接受产前胎儿MR检查,其中50胎先天性心脏病(CHD)胎儿(CHD组),GA平均(28.05±4.50)周,包括27胎<28周、23胎≥28周;100胎脑发育正常(对照组),GA平均(27.85±4.40)周,包括48胎<28周、52胎≥28周。行单次激发自旋回波(SSTSE)序列扫描,测量胎儿脑双顶径(BBD)、脑额枕径(BFOL)、骨双顶径(SBD)、骨枕额径(SOD)及头围(HC),并以快速平衡稳态梯度回波(B-FFE)序列显示胎儿心血管结构。对胎儿颅脑主要二维径线指标与GA进行相关性分析,得到拟合直线,分析2组胎儿相关指标的差异。结果2组胎儿BBD、BFOL、SBD、SOD、HC与GA均呈高度线性相关(CHD组r=0.96、0.89、0.94、0.90、0.93,P均<0.01;对照组r=0.97、0.96、0.94、0.95、0.95,P均<0.01)。<28周胎儿组间径线指标差异均无统计学意义(P均>0.05);≥28周胎儿中,CHD组BBD、BFOL、SOD和HC均小于对照组(P均<0.05),SBD差异无统计学意义(P=0.10)。结论MRI量化评价胎儿颅脑生物学指标可为宫内评估胎儿大脑生长发育情况提供参考。CHD在宫内即可影响胎儿脑发育;中晚孕期CHD胎儿BBD、BFOL、SOD和HC均相对减小。

Objective To explore the value of prenatal MRI in quantification of two-dimensional diameter of fetal brain.Methods A total of 150 pregnant women(150 fetuses)with gestational age(GA)21-39 weeks were collected for prenatal MRI.Fifty fetuses were found with congenital heart diseases(CHD group),the mean GA was(28.05±4.50)weeks,<28 weeks in 27 fetuses and≥28 weeks in 23 fetuses.One hundred fetuses were found with normal brain development(control group),with the mean GA of(27.85±4.40)weeks,48 fetuses<28 weeks and 52 fetuses≥28 weeks.Single-shot turbo spin echo(SSTSE)sequence MR scanning was performed to examine and measure the brain biparietal diameter(BBD),brain fronto-occipital length(BFOL),skull biparietal diameter(SBD),skull fronto-occipitoal diameter(SOD)and head circumference(HC),while parallel balanced fast field echo(B-FFE)sequence scanning was performed to reveal fetal cardiovascular structures.Correlation of the major two-dimensional diameter lines of fetal brain and GA was analyzed,and the fitting line was obtained.The related indexes of fetuses were compared between 2 groups.Results BBD,BFOL,SBD,SOD,HC of the fetus in both groups were highly linear with GA(CHD group:r=0.96,0.89,0.94,0.90,0.93,all P<0.01;control group:r=0.97,0.96,0.94,0.95,0.95,all P<0.01).For fetuses with GA<28 weeks,no statistically significant difference of diameter indexes was found between groups(all P>0.05),whereas for fetuses with GA≥28 weeks,BBD,BFOL,SOD and HC in CHD group were all smaller than those in control group(all P<0.05).No statistically significant difference of SBD was found between groups(P=0.10).Conclusion MRI quantitative evaluation of fetal brain biological indicators could provide new references for intrauterine observation on fetal brain growth and development.CHD could affect fetal brain development in utero,and BBD,BFOL,SOD and HC of fetus in mid-and latepregnancy reduced relatively.