磁共振成像在胎儿颅内出血中的应用

The application value of MRI in fetus intracranial hemorrhage

目的:探讨MRI在胎儿颅内出血(Fetal intracranial hemorrhage,FICH)中的应用价值。资料与方法:回顾性分析2014年1月—2022年5月于安徽省儿童医院经MRI检查发现的FICH 65例,观察出血灶部位、范围及信号特点,并与超声检查结果进行对比。结果:65例FICH中,MRI诊断生发基质出血8例,脑室内出血39例,脑室出血伴脑实质出血10例,伴有严重颅内疾病8例(包括脑穿通畸形5例、左侧大脑半球萎缩1例、Dandy-walker畸形1例、脑积水1例)。FICH分级:Ⅰ级8例,Ⅱ级24例,Ⅲ级15例,Ⅳ级10例,Ⅴ级8例。回顾65例FICH病例产前超声检查报告:35例发现异常病灶,其中28例怀疑FICH,1例怀疑灰质异位,2例怀疑脑实质囊性病变,1例怀疑畸胎瘤,3例怀疑脉络膜囊肿,另外30例未发现病灶,其中24例侧脑室增宽,1例后颅窝池增宽,1例耳廓畸形,1例怀疑胼胝体发育异常,3例脑积水。65例FICH病例中,产前MRI检查的异常检出率(65/65,100%)明显高于产前超声检查的检出率(35/65,54%),差异具有统计学意义(P<0.01)。在不同分级的FICH病例中,Ⅱ级、Ⅲ级及Ⅳ级的FICH产前MRI检查的检出率高于产前超声检查的检出率(P<0.05)。在多病灶FICH病例中,2处、3处病灶的FICH产前MRI检查的检出率高于产前超声检查的检出率(P<0.05)。结论:产前MRI检查对FICH的检出率明显高于产前超声检查,且对于不同分级或多灶性FICH的检出率均优于产前超声检查,在FICH严重程度的评估方面具有优势。

Objective:To investigate the application value of MRI in fetal intracranial hemorrhage(FICH).Materials and Methods:From January 2014 to May 2022,65 cases of FICH detected by MRI were retrospectively enrolled in Anhui Province Children’s Hospital.The location,range and signal characteristics of the hemorrhagic focus and the severity grading were analyzed,which were compared to that measured by ultrasound(US).Results:In the 65 cases,there were eight cases with germinal matrix hemorrhage,39 cases with intraventricular hemorrhage,ten cases with intraventricular hemorrhage and parenchymal hemorrhage,and eight cases with severe intracranial disease(including five cases with porencephaly abnormalities,one case with the left hemisphere atrophy,one case with dandy-walker deformity,and one case with hydrocephalus).In FICH grading,there were eight cases of gradeⅠ,24 cases of gradeⅡ,15 cases of gradeⅢ,10 cases of gradeⅣand 8 cases of gradeⅤ.Prenatal US reports of 65 cases showed that there were 35 cases with abnormal lesions,including 28 cases with suspected FICH,one case with suspected gray matter heterotopia,two cases with brain parenchyma cystic lesions,one case with suspected teratoma,and three cases with suspected choroidal cyst,and 30 cases without abnormal lesions,including 24 cases with lateral ventricle widening,one case with posterior fossa pool widening,one case with auricle deformity,one case with suspected corpus callosum dysplasia,and three cases with hydrocephalus.Among the 65 FICH cases,the abnormality de-tection rate of prenatal MRI(65/65,100%)was significantly higher than that of prenatal US examination(35/65,54%)(P<0.01).For severity grading of FICH,the gradeⅡ,ⅢandⅣdetection rates of prenatal MRI were higher than those of prenatal US ex-amination(P<0.05).For multi-focal intracranial hemorrhage,the two and three lesions detection rates of prenatal MRI were high-er than those of prenatal US examination(P<0.05).Conclusion:The detection rate for FICH of prenatal MRI is higher than that of prenatal US examination.The detection rate for severity grading or multi-focal lesion of prenatal MRI is higher than that of prenatal US examination,which has advantages in the evaluation of the FICH severity.