产前超声及MRI在胎儿肾上腺区病变中的诊断价值

Diagnostic values of prenatal ultrasound and MRI in fetal adrenal lesions

目的探讨产前超声及MRI在胎儿肾上腺区病变中的诊断价值,分析各病变的特征性影像表现。方法回顾性分析广东省妇幼保健院2013年3月至2022年12月间22例产前发现肾上腺区病变胎儿(平均胎龄30周,男女比为15∶7)的影像资料,所有产妇产前均行超声检查,其中14例行MRI检查。由有胎儿疾病诊断经验的超声及放射科医师各两名采用双盲法阅片,同种检查两名医师诊断结果不一致时讨论后得出一致意见。结果22例胎儿中的14例病理诊断为肾上腺神经母细胞瘤(NB);2例产前及产后多次随访复查病灶变小至消失,结合影像学表现诊断为肾上腺血肿;5例术后病理为胎儿腹腔内肺隔离症(IEPS);1例术后病理为肾上腺畸胎瘤。超声及MRI均准确诊断NB、肾上腺血肿和IEPS,均将畸胎瘤误诊为NB。肾上腺NB可呈囊性、囊实性或实性肿块,部分可见钙化,可双侧发病,且在胎儿期即可发生肝内转移;肾上腺血肿在出血初期超声表现为高回声,之后逐渐缩小液化为无回声,最后逐渐钙化或消失,MRI可见病灶分层,T1WI可见高信号影;IEPS超声表现为均匀实性或囊实性占位,实性占多数,可见体循环供血血管,单次激发快速自旋回波(single shot fast spin echo,SSFSE)序列图像中表现为均匀实性或囊实性高信号影,信号强度高于或等同于肺组织,病灶与膈肌联系紧密;畸胎瘤在超声表现为混杂回声,SSFSE序列表现为混杂信号肿块,产前乏脂肪畸胎瘤与NB鉴别困难。结论产前超声及MRI对胎儿肾上腺区病变均有较高的诊断价值,两种检查互相补充,可提高诊断准确率。

Objective To investigate the diagnostic values of prenatal ultrasound and MRI in fetal adrenal lesions and analyze the characteristic imaging features of different diseases.Methods The images of 22 fetuses(the mean gestational age was 30 weeks and the male to female ratio was 15:7)with adrenal lesions found by prenatal ultrasound in Guangdong Women and Children Hospital from March 2013 to December 2022 were retrospectively analyzed,14 of them underwent MRI examination.Two sonographers and two radiologists with experiences in diagnosing fetal diseases were used to read the images by double-blind method.When the diagnosis results of the same examination were inconsistent between two doctors,the consensus was reached after discussion.Results Adrenal neuroblastoma(NB)was diagnosed in 14 of 22 cases;the lesions of 2 cases became smaller and disappeared after prenatal and multiple postnatal follow-up,and were diagnosed as adrenal hematoma combined with imaging findings;5 cases was diagnosed as intraperitoneal pulmonary sequestration(IEPS)by postoperative pathology;1 case was adrenal teratoma.Both ultrasound and MRI accurately diagnosed NB,adrenal hematoma,and IEPS,and misdiagnosed teratoma as NB.Adrenal NB might present as cystic,complex,or solid mass with partial calcification,might be bilateral,and might develop intrahepatic metastases during the fetal period.In the initial stage of hemorrhage,adrenal hematoma showed hyperechoic on ultrasound,then gradually reduced to anechoic,and finally gradually calcified or disappeared.Lesion stratification could be seen on MRI,and high signal shadow on T1WI.The ultrasonography of IEPS showed homogeneous solid or complex mass,among which solid mass accounted for the majority,and supplied by a branch of systemic arterial.Homogeneous solid or complex high signal shadow showed in single shot fast spin echo(SSFSE)sequence images,with signal intensity higher than or equal to that of lung tissue,and the lesion closely connected with diaphragm.The teratoma showed mixed echo on ultrasound and complex signal mass on SSFSE sequence,and it was difficult to distinguish fat deficient teratoma from NB.Conclusions Prenatal ultrasound and MRI have high diagnostic values in fetal adrenal lesions.The two kinds of examinations complement each other and can improve the diagnostic accuracy.