MRI在产前诊断胎儿唇腭裂畸形中的应用价值

The application value of magnetic resonance imaging in the prenatal diagnosis of fetal cleft lip and palate deformity

目的:探讨MRI在产前诊断胎儿唇腭裂中的应用价值。方法:搜集产前超声诊断可疑颌面部发育异常的胎儿52例,超声检查后1周内行胎儿MRI检查,分析胎儿唇部、上下牙槽突及腭部的超声、MRI影像特征。以(引)产后随访结果为金标准,将MRI、超声诊断结果与(引)产后随访结果进行对比分析。采用ROC曲线对比分析两种检查方法对唇腭裂的诊断效能。结果:52例患者中6例引产随访证实,30例出生后随访证实,16例引产未尸解而无法证实。36例随访证实病例中唇裂12例(33.33%),唇裂伴腭裂22例(61.11%),健康2例(5.56)。MRI诊断准确34例(唇裂12例,唇腭裂22例),误诊2例;超声诊断准确30例(唇裂10例,唇腭裂20例),误诊6例。MRI与超声对唇裂的诊断符合率均为94.44%(34/36)。MRI对腭裂的诊断符合率(100%,36/36)高于超声(88.89%,32/36),差异有统计学意义(χ^(2)=4.235,P<0.05)。MRI对腭裂的诊断敏感度为100%(22/22),特异度为100%(14/14);超声对腭裂的诊断敏感度为90.91%(20/22),特异度为14.29%(2/14)。MRI、超声诊断唇腭裂的ROC曲线下面积(AUC)分别为1.000、0.883。胎儿腭裂的MRI表现为胎儿腭部组织信号不连续、局部被长T_(2)高信号中断,口腔与鼻腔直接相通。结论:在诊断胎儿唇裂畸形方面MRI和超声均具有较高价值,但在诊断腭裂畸形方面MRI较超声有明显优势。MRI在产前筛查胎儿唇腭裂畸形方面具有较高的临床应用价值。

Objective:The purpose of this study was to explore the application value of magnetic resonance imaging(MRI)in the prenatal diagnosis of fetal cleft lip and palate.Methods:A retrospective analysis of 52 fetuses with suspected maxillofacial dysplasia by prenatal ultrasound was performed.All fetuses underwent MRI scan within 1 week thereafter.The ultrasonic and MRI features of fetal lip,upper and lower alveolar process and palate were analyzed.Taking the induced labour or postpartum follow-up results as the gold standard,the MRI and ultrasound diagnostic results were compared.ROC(software SPSS 23.0)curve was used to compare and analyze the diagnostic efficacy of the two examination methods.Results:In 52 patients,6 cases were confirmed by induced labour follow-ups,30 cases were confirmed by after delivery,16 cases of induced labour were not confirmed without autopsy.In the 36 confirmed cases,12 cases(33.33%)were diagnosed with cleft lip,22 cases(61.11%)with cleft lip and palate,and 2 cases(5.56)were healthy.Among them,34 cases were diagnosed accurately by MRI(12 cases of cleft lip,22 cases of cleft lip and palate),2 cases were misdiagnosed.30 cases were diagnosed accurately by ultrasound(10 cases of cleft lip,20 cases of cleft lip and palate),and 6 cases were misdiagnosed.The accuracy rate of MRI and ultrasound for diagnosing cleft lip was consistent with 94.44%(34/36),and the difference was not statistically significant.The accuracy rate of MRI in the diagnosis of cleft palate was 100%(36/36)which is higher than that of ultrasound of 88.89%(32/36),and the difference was statistically significant(χ^(2)=4.235,P<0.05).The sensitivity and specificity of MRI in the diagnosis of cleft palate were 100%(22/22)and 100%(14/14);The sensitivity and specificity of ultrasonography in the diagnosis of cleft palate were 90.91%(20/22)and 14.29%(2/14).The area under the ROC curve(AUC)of magnetic resonance and ultrasound diagnosis of cleft lip and palate were 1.000 and 0.883,respectively.The MRI findings of fetal cleft palate images showed that the signal of fetal palate tissue was discontinuous,partially interrupted by long T_(2)W high signal,and the oral cavity was directly connected with the nasal cavity.Conclusion:MRI and ultrasound have the same application value in diagnosing fetal cleft lip malformations,but MRI has obvious advantages over ultrasound in the diagnosis of cleft palate malformations.MRI has a higher clinical application value in prenatal screening of fetal cleft palate malformations.