3DMRI诊断胎儿体表畸形的研究  

3D MRI investigation on fetal surface malformations

作　　者：庞颖[1] 夏黎明[1] 孙子燕[1] 陈欣林[2] 杨小红[2] 

机构地区：[1]华中科技大学同济医学院附属同济医院放射科,武汉430030 [2]湖北省妇幼保健院超声科,武汉430070

出　　处：《磁共振成像》2012年第3期194-199,共6页Chinese Journal of Magnetic Resonance Imaging

基　　金：湖北省科技厅"十五"攻关项目(编号:2005AA401D91)资助

摘　　要：目的研究3D MRI显示胎儿体表正常结构和畸形的临床应用价值。方法对34例孕妇行US检查和MRI检查。胎儿尸检及出生后随访证实体表畸形36例,共42处。MR扫描均采集单次激发快速自旋回波序列(SSFSE),厚层重T2WI,三维稳态进动快速成像(3D FIESTA)序列,然后对3D FIESTA序列原始数据行多平面重组(MPR)、容积重组(VR)、MR仿真内窥镜(MRVE)等三维后处理分析。将3D US、2D MRI、3D MRI的诊断结果与尸检及随访结果相比较。结果胎儿尸检和出生后的随访结果发现有42处胎儿体表畸形。3D MRI重组图不受胎儿复杂的表面曲率变化,可直观显示其体表特征和相互的空间位置关系。3D MRI正确诊断、误诊、漏诊胎儿体表畸形分别为38、0、4处;敏感度、特异度、准确度分别为90.48%、100%、99.31%。2D MRI正确诊断、误诊、漏诊胎儿体表畸形分别为29、0、13处,敏感度、特异度、准确度分别为69.05%、100%、97.74%。3D US正确诊断、误诊、漏诊胎儿体表畸形分别为39、1、2处;敏感度、特异度、准确度分别为95.12%、99.81%、99.48%。其中2D MRI与3D MRI的敏感度,准确度差异有统计学意义(P值均<0.05),而3D MRI和3D US的敏感度、特异度、准确度差异无统计学意义(P值均>0.05)。结论 3D MRI显示胎儿体表正常结构和畸形优于常规2D MRI,且视野和软组织分辨率优于US。对US难以确诊的病例,3D MRI是诊断方法上的一种有效补充。Objective： To investigate the clinical value of three dimensional magnetic resonance imaging （3D MRI） in displaying the normal and abnormal structures of fetal surface malformations. Materials and Methods： Thirty-four pregnant women were examined by conventional prenatal ultrasonography （US） and MRI, 36 fetus with surface malformations were conformed by follow-up results and autopsy. Single- shot fast spin-echo T2 weighted sequences （SSFSE） and thick-slab heavy T2WI with SSFSE were performed, 3D MRI with three dimensional fast image employing steady-state acquisition （3D FIESTA） were acquired. Volume rendering （VR）, muti- planar reconstruction （MPR） and MR virtual endoscopy （MRVE） were employed in image post-processing on workstation. The results from 2D MR, 3D MRI and US images were compared with each other as well as the autopsy and follow-up results. Results： A total of 42 fetal surface malformations were identified by autopsy and follow-up after birth. 3D MRI was not affected by the complex superficial curvature changes, and could clearly demonstrate the surface features, and spatial positions of the fetus. The sensitivity, specificity, accuracy of 3D MRI/2D MR1/3D US were 90.48%/69.05%/95.12%, 100%/100%/99.81% , 99.31%/97.74%/99.48%. There were obvious statistical difference for sensitivity and accuracy of 2D MRI and 3D MRI, and unobvious statistical difference for sensitivity, specificity, and accuracy of 3D MRI and 3D US. Conclusion： 3D MRI is better than conventional 2D MRI in displaying fetal normal surface structure and malformations, and it has lager fov and higher soft tissue resolution than US. The 3D fetal MR imaging can be used as a complementary strategy to US in diagnosing fetal surface malformations.

关 键 词：胎儿疾病 畸形 磁共振成像 超声检查 产前 

分 类 号：R445.2[医药卫生—影像医学与核医学] R714.43[医药卫生—诊断学]