血管环的产前影像学诊断与预后评估  

Prenatal imaging diagnosis and prognosis assessment of vascular ring

作　　者：徐鹏[1] 李军[1] 王音[1] 唐兴[2] 张建芳[3] 张斌[1] 徐盈[3] 王峥[1] 孙益前[1] 王云[1] 庞珅[1] 朱霆[2] 

机构地区：[1]第四军医大学西京医院超声科陕西省胎儿先天性心脏病超声诊断中心,西安710032 [2]第四军医大学西京医院放射科,西安710032 [3]第四军医大学西京医院妇产科,西安710032

出　　处：《中华超声影像学杂志》2015年第10期845-849,共5页Chinese Journal of Ultrasonography

基　　金：基金项目：国家重点基础研究发展计划“973”项目子项目（2010CB529502）;陕西省科技统筹创新工程计划项目（2012KTCL03-09）;陕西省科学技术研究发展计划项目（2012SF2-14-3）

摘　　要：目的对比分析超声与磁共振对血管环的产前诊断、染色体筛查及出生后随访结果，探讨产前诊断技术对血管环诊断与预后评估的临床价值。方法对95例孕期经胎儿超声心动图检查诊断为血管环的胎儿定期随访，其中染色体筛查72例，磁共振检查31例，并与出生后随访结果进行对比分析。结果95例血管环中右位主动脉弓、左位动脉导管型85例，肺动脉吊带和双主动脉弓型各4例，右位主动脉弓、双动脉导管和左位主动脉弓伴迷走右锁骨下动脉型各1例。本组中单纯性血管环66例，复合性29例（合并其他心血管畸形）。出生54例（2例夭折），待出生8例，失访6例，引产27例。产前超声及磁共振检查提示气管受压6例，出生5例中仅有3例出现气管受压的临床症状。结论胎儿血管环以单纯性最多见，产前超声可以明确诊断血管环并进行分型，孕期超声动态随访并结合磁共振检查有利于判断与评估血管环对气管的压迫程度及预后。Objective By comparing the results of prenatal diagnosis of vascular rings by ultrasound and MRI, chromosome screening and postnatal follow-ups, to explore the clinical significance of prenatal diagnostic technology for the diagnosis of vascular rings and prognostic assessment. Methods Ninety-five fetuses that were diagnosed by fetal echocardiography were followed up regularly, of which 72 cases had chromosome screening,31 cases had MRI examination. These results were compared with the postnatal follow-up outcome. Results Ninety-five cases of vascular rings included 85 cases of right aortic arch（RAA） and left ductus arteriosus（LDA）,4 cases of pulmonary artery sling（LPAS）, 4 cases of double aortic arch （DAA） ,1 case of RAA and double ductus arteriosus（DDA）, 1 case of left aortic arch（LAA） and aberrant right subclavian artery（ARSA）. Sixty-six cases of isolated vascular rings and 29 cases of complex vascular rings（combined with other cardiovascular abnormalities） were detecded. Fifty-four cases were born （2 infants died）, 8 cases were ongoing pregnancy, 6 cases were lost to follow-up, 27 cases were aborted. Prenatal ultrasound and MRI examination indicated 6 cases of trachea compression. However,only 3 infants showed clinical symptoms due to trachea compression from born 5 cases. Conclusions Isolated vascular ring is the most common format and its diagnosis and type can be determined by prenatal ultrasound. Dynamic follow-up using ultrasound in pregnancy combined with MRI is helpful to assess the compression degree of trachea induced by vascular ring and prognosis.

关 键 词：超声检查 产前 磁共振成像 胎儿心脏 血管环 

分 类 号：R445.1[医药卫生—影像医学与核医学] R714.5[医药卫生—诊断学]