胎儿肠梗阻的MRI诊断  

The MRI diagnosis of fetal intestinal obstruction

作　　者：周立霞[1] 卜静英[1] 耿左军[1] 李海燕[2] 刘慈[2] 李索林[3] 

机构地区：[1]河北医科大学第二医院医学影像科,石家庄050000 [2]河北医科大学第二医院妇七科,石家庄050000 [3]河北医科大学第二医院小儿外科,石家庄050000

出　　处：《磁共振成像》2017年第2期125-130,共6页Chinese Journal of Magnetic Resonance Imaging

摘　　要：目的观察胎儿期肠梗阻MRI表现,结合生后手术史及病理学诊断,探讨MRI对胎儿期肠梗阻的诊断价值。材料与方法回顾性分析胎儿期肠梗阻病例26例,胎龄为孕23~35 w,均先行胎儿超声检查后再行胎儿MRI平扫。采用2D快速平衡稳态进动序列(2D fast imaging employ steady acquisition,2D FIESTA)、单次激发快速自旋回波(single-shot fast spin echo,SSFSE)序列、快速反转恢复运动抑制序列T1WI(fast inversion recovery motion insensitive T1WI,FIRM T1WI)和弥散加权成像(diffusion weighted imaging,DWI)序列。根据梗阻部位、梗阻区肠管信号改变、梗阻远端肠道充盈情况、肠系膜血管异常等进行影像学诊断,并观察继发改变如腹水、羊水增多等,随访出生情况及手术治疗结果,分析MRI诊断的正确率及漏诊率,探讨MRI各序列在胎儿肠梗阻诊断中的优势。结果 26例肠梗阻胎儿中:十二指肠/空肠狭窄或闭锁16例,其中4例伴十二指肠和空肠旋转不良;胎粪性小肠梗阻4例,其中2例继发肠扭转致肠缺血坏死;肛门闭锁4例;结肠狭窄或闭锁1例;先天性巨结肠1例。所有胎儿均伴有不同程度羊水增多,部分病例伴腹水、心包积液及睾丸鞘膜积液;2例为单脐动脉。MRI诊断正确率为92.3%(24/26),误诊率为7.7%(2/26)。MRI能清楚显示胎儿肠梗阻部位,观测肠管扩张的程度。SSFSE序列可显示系膜血管受累,FIRM T1WI序列有助于结肠梗阻的诊断,DWI序列可提示梗阻肠管缺血和出血的改变。结论胎儿期肠梗阻MRI图像有特征性改变,可以判断受累肠管的发生部位、梗阻程度和合并症等,对产前诊断和出生后手术治疗有重要参考价值。Objective： To observe fetal intestinal obstruction with MRI, compared with the result of newborn surgery and pathology, explore the value of MRI in the diagnosis of fetal intestinal obstruction. Materials and Methods： Twenty-six cases of fetal intestinal obstruction were retrospectively analyzed, gestational age was 23—35 w, all cases were performed fetal ultrasound before fetal MRI. 4 MRI sequences were used including 2D FIESTA（2D fast imaging employ steady acquisition）, SSFSE（single-shot fast spin echo）, FIRM T1WI（fast inversion recovery motion insensitive T1WI） and DWI（diffusion weighted imaging）. According to the intestinal obstruction sites, bowel signal changes, distal intestinal filling, and mesenteric vessels changes, radiological diagnosis was made, the secondary imaging signs such as ascites and amniotic fluid were also observed. Follow-up the fetal birth and surgical treatment postnatal, analysed the MRI accuracy and the missed diagnosis rate, and investigated the advantage of each sequence in the diagnosis of fetal intestinal obstruction. Results： In the 26 cases of fetal intestinal obstruction, 16 cases were duodenum/jejunum stricture or atresia with 4 cases accompanied duodenum and jejunum malrotation, 4 cases were small intestinal meconium obstruction with 2 cases secondary volvulusand ischemia necrosis, 4 cases were anal atresia, 1 case was colonic stricture or atresia and 1 case was congenital megacolon. All fetuses were associated with amniotic fluid in different degree, some cases with pleural effusion, pericardial effusion and hydrocele testis. 2 cases with single umbilical artery. MRI diagnostic accuracy rate was 92.3%（24/26）, the misdiagnosis rate was 7.7%（2/26）. MRI can locate the fetal intestinal obstruction and observe the extent of bowel dilatation. SSFSE can clearly show mesenteric vessels, FIRM T1 WI is helpful to diagnosis of colonic ileus, DWI can detect obstruction ischemic bowel through the intestinal signal. Conclusion： Fetal intestinal obstructio

关 键 词：胎儿疾病 磁共振成像 肠梗阻 弥散加权成像 肠扭转 

分 类 号：R445.2[医药卫生—影像医学与核医学] R722.19[医药卫生—诊断学]