胎儿先天性肺发育异常MRI的诊断  

Diagnosis of fetal congenital lung abnormalities by MRI

作　　者：王静蕾 董素贞 朱铭[1] 钟玉敏[1] 

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：《医学影像学杂志》2011年第6期842-845,共4页Journal of Medical Imaging

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);2008年度上海儿童医学中心院基金

摘　　要：目的:探讨MRI在胎儿先天性肺发育异常诊断中的应用价值。方法:59例孕妇,孕龄16～39周,平均26周。产前常规行超声(US)检查后24～48h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)序列以及快速反转恢复运动抑制(FIRM)序列,行胎儿颅脑胸腹部常规及胸部重点冠状面、矢状面及横断面扫描,将产前MRI、US表现与出生后影像表现或手术(54例胎儿)、引产后尸体解剖结果(5例胎儿)对照。结果:先天性肺囊腺瘤样畸形34例、叶内型支气管肺隔离症1例、先天性肺囊腺瘤样畸形和BPS并存1例,先天性膈疝18例,原发性肺发育不全5例。随访证实产前MRI诊断误诊2例,产前US误诊9例、漏诊4例。结论:MRI在胎儿先天性肺肺发育异常诊断方面具有较高的应用价值,可诊断CCAM具体所在肺叶、病变类型、心脏移位及对侧肺受压程度;SSFSE序列联合FIRM序列能很好区分疝入胸腔的内容物,尤其是US易漏诊的右侧膈疝;可较好的显示发育不全的肺叶状况。Objective：To explore the diagnostic value of MRI on fetal lung congenital abnormalities.Methods：Fifty-nine pregnant women,with gestation from 16 to 39 weeks（average 26 weeks） were studied with a 1.5 T superconductive MR unit within 24 to 48 hours after ultrasound studies.The imaging protocol included fast-imaging employing steady-state acquisition（FIESTA）,single-shot fast spin echo（SSFSE） and T1-weighted fast inversion recovery motion insensitive（FIRM） sequences in the axial,frontal,and sagittal planes relative to the fetal brain,thorax,abdomen,especially thoraxs.Prenatal US and MR imaging findings were compared with postnatal diagnoses（54 fetuses） or autopsy（5 fetuses）.Postnatal evaluation included computed tomography and surgery.Results：There were 34 cases with congenital cystic adenomatoid malformation（CCAM）,1 case with bronchopulmonary sequestration（BPS）,1 case with CCAM and BPS,18 cases with congenital diaphragmatic hernia（CDH）,5 cases with primary pulmonary hypoplasia.Prenatal follow-up MRI confirmed 2 cases of misdiagnosis,prenatal US 9 cases of misdiagnosis,missed diagnosis in 4 cases.Conclusion：MRI in fetal diagnosis of congenital pulmonary malformation has a higher value,Specific location can be diagnosed lung lesions,lesion type,heart and contralateral lung compression degree of the shift.Both SSFSE and FIRM sequences can offer detailed structural information about the intrathoracic herniated organs,especially the right CDH which US can＇t recognize.It can better show the Lung hypoplasia.

关 键 词：胎儿 发育异常 先天性 肺 磁共振成像 

分 类 号：R714.5[医药卫生—妇产科学] R445.2[医药卫生—临床医学]