胎儿肠管扩张的MRI诊断与临床结局分析

Fetal Bowel Dilatation:The MRI Diagnosis and Analysis of the Clinical Outcomes

目的 观察胎儿期肠管扩张MRI表现,产后追踪引起肠管扩张的不同病因,探讨MRI对胎儿期肠管扩张的诊断价值.方法 回顾性分析胎儿肠管扩张105例患者资料,胎龄为孕24-40周,均先行胎儿超声检查后再行胎儿MRI平扫.所有图像由两名胎儿MRI诊断医师在不知道最终结果的情况下阅读并评价.记录扩张肠管的内径及信号,梗阻远端肠道情况,以及一些其他异常如腹腔积液、腹腔囊性灶等.结果 105例肠管扩张胎儿中,环状胰腺20例,十二指肠闭锁17例,小肠闭锁36例(其中18例合并胎粪性腹膜炎),回肠狭窄2例(1例合并胎粪性腹膜炎),小肠扭转1例(合并胎粪性腹膜炎),肠系膜囊肿2例,淋巴管畸形1例,另外有26例出生后表现为正常.MRI能清楚显示胎儿肠梗阻部位,观测肠管扩张的程度.根据十二指肠扩张范围预测"双泡征"的梗阻原因,另外可以根据梗阻段信号的改变推测小肠梗阻的水平.结论 胎儿期肠管扩张MRI图像有特征性改变,可以判断梗阻水平、梗阻程度和合并症等,对产前诊断和出生后手术治疗有重要参考价值.

Objective To explore the diagnostic value of MRI in fetal bowel dilatation,by analyzing the imaging features and the different causes of fetal bowel dilatation.Methods This was a retrospective research including 105 cases of fetal bowel dilatation,with a gestational age of 24 to 40 weeks.MRI was performed on all fetuses subsequent to routine prenatal sonographic examinations.All images were read and evaluated by two fetal MRI radiologists without knowing the result.They recorded the inner diameter and signal of the dilated bowel,the condition of the distal intestine,and other anomalies such as ascites,abdominal cystic lesions and so on.Results Among 105 fetuses with bowel dilatation,20 cases of annular pancreas,17 cases of duodenal atresia,36 cases of small bowel atresia(18 cases with meconium peritonitis,MP),and 2 cases with ileal stenosis(1 case combined with MP),1 case of small bowel volvulus(combined with MP),2 cases of mesenteric cyst,1 case of lymphatic malformation,and 26 cases were normal after birth.MRI can clearly show the level of fetal bowel obstruction and the degree of bowel dilatation.According to which segment of the duodenum is involved,the cause of the“double bubble sign”was more easier found.In addition,the level of small bowel obstruction can be inferred based on the changes in the bowel signal.Conclusion The MRI images of fetal bowel dilatation have characteristic signs,which can help radiologists determine the level of obstruction,degree of bowel dilatation and complications,and have important reference value for prenatal diagnosis and postnatal surgical treatment.