胎儿先天性肺囊腺瘤样畸形的MRI诊断与鉴别诊断  

Diagnosis of fetal congenital cystic adenomatoid malformation of the lung by MRI

作　　者：董素贞 朱铭[1] 钟玉敏[1] 张弘[1] 潘慧红 

机构地区：[1]上海交通大学医学院附属上海儿童医学中心放射科,上海200127

出　　处：《放射学实践》2011年第2期172-175,共4页Radiologic Practice

基　　金：上海市卫生局青年科研项目(2008y116);上海高校选拔培养优秀青年教师科研专项基金(jdy08062)

摘　　要：目的:探讨MRI在胎儿先天性肺囊腺瘤样畸形(CCAM)诊断与鉴别诊断中的应用价值。方法:36例孕妇,年龄21～38岁,平均29岁;孕龄20～31周,平均24周。产前常规行超声(US)检查后24～48 h内行MR检查,采用二维快速平衡稳态采集(2D-FIESTA)序列、单次激发快速自旋回波(SSFSE)序列,行胎儿颅脑胸腹部常规及胸部重点冠状面、矢状面及横轴面扫描,将产前MRI、US表现与出生后增强CT或手术(33例胎儿)、引产后尸体解剖结果(3例胎儿)对照。结果:病变位于左侧15例,右侧21例。单个肺叶31例,单侧全肺5例。大囊型18例、微囊型18例。随访结果证实MRI误诊2例;产前US误诊6例、漏诊2例,不完全诊断1例。结论:MRI在胎儿CCAM诊断与鉴别诊断方面具有较高的应用价值,可诊断病变具体所在肺叶、病变类型、心脏移位及对侧肺受压程度预测胎儿预后。Objective：To explore the diagnostic value of MRI in fetal lung congenital cystic adenomatoid malformation（CCAM）.Methods：Thirty-six pregnant women,aged from 21 to 38 years（average 29 years） and with gestation from 20 to 31 weeks（average 24 weeks） were examined with a 1.5T MR unit within 24 to 48 hours after ultrasound studies.The ima-ging protocol included fast-imaging employing steady-state acquisition（FIESTA）,single-shot fast spin echo（SSFSE） se-quences in the axial,frontal,and sagittal planes relative to the fetal brain,thorax,abdomen,especially thorax.Prenatal US and MR imaging findings were compared with postnatal diagnoses（33 fetuses） or autopsy（3 fetuses）.Postnatal evaluation included computed tomography and surgery.Results：The lesions were in the left side in 15 cases and in the right in 21 ca-ses.There were lesions in a single lobe in 31 cases,and in unilateral whole lung in 5 cases.There were large cystic lesions in 18 cases,and microcystic in other 18 cases.Follow-up examinations confirmed 2 cases of misdiagnosis by prenatal MRI,6 cases of misdiagnosis and 2 cases of missed dignosis and one case of incomplete accuracy by prenatal US.Conclusion：MRI has a great value in diagnosis and differential diagnosis of fetal congenital pulmonary cystic adenomatoid malformation.It can correctly demonstrate location and type of the lesion and degree of shift and compression of heart and lung,so as to pre-dict fetal outcome.

关 键 词：胎儿 囊腺瘤样畸形 肺 先天性 磁共振成像 

分 类 号：R445.2[医药卫生—影像医学与核医学] R714.53[医药卫生—诊断学]