先天性心脏病胎儿脑容积的磁共振3D成像研究

Three-dimentional magnetic resonance imaging study of fetal brain volume in congenital heart disease

目的:本研究基于磁共振3D成像及半自动切割技术对先天性心脏病(CHD)胎儿和正常胎儿颅脑不同结构容积测量结果进行比较,以评价CHD胎儿脑发育情况.方法:选取2018年6月—2019年12月于我院进行产前超声诊断的80例CHD胎儿为病例组,100例正常胎儿作为对照组,其中健康对照组胎儿<28周38例,≥28周62例;CHD组胎儿<28周31例,≥28周49例.分别对胎儿小脑容积(CV)、幕上脑容积(STV)进行分割及容积测量,并测量二维参数,包括双顶径(BPD)及头围(HC).CV、STV、BPD、HC及孕周的相关性采用正态分布的期望值进行比较,以均数±标准差(x±s)表示.采用Pearson相关分析法分析健康对照组胎儿颅脑三维容积(CV、STV)与孕周、BPD及HC的相关性.采用独立样本t检验比较正常胎儿组与CHD胎儿组颅脑容积之间的差异.结果:健康对照组胎儿CV、STV与孕周、BPD及HC均呈高度正相关(r=0.971、0.905,P<0.01).健康对照组与CHD组胎儿的HC间差异无统计学意义,<28周健康对照组与<28周CHD组胎儿的HC间差异亦无统计学意义.CHD组胎儿的CV、STV小于健康对照组,<28周CHD组胎儿的CV、STV小于<28周健康对照组,且差异均有统计学意义(P<0.01).≥28周CHD组胎儿HC、CV、STV均小于≥28周健康对照组,且差异均有统计学意义(P<0.01).结论:通过磁共振3D成像技术对胎儿脑容积进行测量及模型构建,可为CHD胎儿脑发育的产前定量评估、产后神经康复提供一定帮助.

Objective:Based on three-dimentional(3D)magnetic resonance imaging(MRI)and semi-automatic cutting technology,this study was to compare brain volume measurements between congenital heart disease(CHD)fetuses and normal fetuses,so as to evaluate the brain development of CHD fetuses.Methods:This study enrolled 80 CHD fetuses diagnosed by prenatal ultrasound and 100 normal fetuses from June 2018 to December 2019.There were 38 normal fetuses and 31 CHD fetuses<28 weeks,and 62 normal fetuses and 49 CHD fetuses≥28 weeks.All brain volume of fetuses were segmented and measured by 3D-FIESTA and ITK-SNAP.The parameters of 3D MRI included cerebellar volume(CV)and supratentorial brain volume(STV).Two-dimensional(2D)sonographic parameters included biparietal diameter(BPD)and head circumference(HC).CV,STV,BPD,HC and gestational week were expressed as x±s.Pearson correlation analysis was performed to evaluate the correlations between 3D fetal brain volume(CV and STV),and 2D sonographic BPD and HC,as well as gestational weeks.Independent sample t test was used to compare the difference of brain volume between the normal fetuses and the CHD fetuses.Results:In normal fetuses,fetal CV and STV were positively correlated with gestational age(r=0.971 and 0.905,P<0.01).There was no significant difference in HC between normal fetuses and CHD fetuses,and there was no significant difference between normal fetuses<28 weeks and CHD fetuses<28 weeks.CV and STV in CHD fetuses were lower than those in normal fetuses,and those in CHD fetuses<28 weeks were lower than those in normal fetuses<28 weeks,the differences were statistically significant(P<0.01).HC,CV and STV in CHD fetuses≥28 weeks were lower than those in normal fetuses≥28 weeks(P<0.01).Conclusion:Fetal brain volume constructed and measured by 3D MRI can quantitatively assess the fetal brain development of CHD fetuses,which might help postnatal nerve rehabilitation.