胎儿脊髓腰骶膨大发育宫内及标本MRI对照研究  

The contrast study of normal fetal lumbosacral enlargment with postmortem and intrauterine MRI

作　　者：李丹 赵慧[2] 肖连祥[3] 谢辉辉[3] 石岩[3] 王光彬[3] 林祥涛[3] 

机构地区：[1]山东省临沂市妇女儿童医院CT室,山东临沂276014 [2]山东大学附属山东省立医院(西院)影像科,山东济南250023 [3]山东大学附属山东省医学影像学研究所,山东济南250021

出　　处：《医学影像学杂志》2017年第7期1359-1363,共5页Journal of Medical Imaging

基　　金：国家自然科学基金(编号:31371213);山东省自然科学基金项目(编号:ZR2013HM091)

摘　　要：目的依据不同孕周胎儿标本与宫内胎儿MR扫描图像,确定脊髓圆锥末端位置及腰骶膨大最大横断面积随孕周变化的规律。方法筛选29例17~39孕周脊椎发育正常的胎儿标本行3.0T MRI脊椎扫描,随机选取142例19~39孕周健康胎儿行宫内胎儿腰椎MRI扫描。扫描序列为T2WI,矢状位、冠状位及横轴位扫描。测得脊髓圆锥末端位置及腰骶膨大与椎管面积之比。结果胎儿标本及宫内胎儿脊髓腰膨大及相应层面椎管前后径及左右径线随孕周呈线性增长关系。脊髓圆锥末端在21孕周及之前,位于L3腰椎以下水平,22~30孕周其变化范围最大,位于L1~L4水平,第31~40孕周位于L1~L2水平。结论宫内胎儿与标本MRI对照研究,能更科学的获取胎儿脊椎发育的参考值并描述其生长曲线。Objective To analyse the position of the end of the conus medullaris, left-right and anteroposterior diameter of lumbosacral enlargment and the changes of left-right and anteroposterior diameter of corresponding level spinal canal along with the gestational weeks with postmortem and intrauterine fetal MRI.Methods Postmortem MR imaging was performed on 29 fetuses ranging from 17 to 39 gestational weeks.Intrauterine MR imaging was performed on 142 fetuses randomly chosen from 500 normal fetuses ranging from 19 to 39 gestational weeks.T2-weighted MR imaging of the lumbar spine was performed in the coronal, sagittal and axial plane.The following parameters were measured： the position of the end of the conus medullaris, the position, area, left-right and anteroposterior diameter of lumbosacral enlargment, area of corresponding level spinal canal and the ratio of lumbosacral enlargment to the overall size of the vertebral canal.Results Anteroposterior and left-right diameter and area of the lumbosacral enlargment increas linearly with gestational age （P〈0.01）;the end of the conus medullaris continuously rises to L2~L3 until midtrimester, but there＇re obvious individual differences;ostmortem fetuses show that the end of the conus medullaris locate beneath L3 between 15th and 21th week.From 22th to 30th week, it may locate between L1 and L4.In the next ten weeks, it may locate between L1 and L2.Intrauterine fetuses show that the conus medullaris has already reached L2 level.Conclusion The study of normal fetal lumbosacral enlargment with postmortem and intrauterine MRI can provide correct reference values of the development of fetal spinal cord.According to this, we can describe its growth curve.Then we can provide reliable and the visualized imaging datas and pictures, which can assess fetal development and help diagnose diseases.

关 键 词：胎儿标本 腰骶膨大 生长发育 磁共振成像 脊髓圆锥 

分 类 号：R714.51[医药卫生—妇产科学] R445.2[医药卫生—临床医学]