弥散加权成像技术在孕中晚期胎儿颅内出血中的诊断价值  

Diagnostic value of nuclear magnetic resonance imaging diffusion weighted imaging in middle and late pregnancy fetal brain intracranial hemorrhage

作　　者：朱大林[1] 冯帆[2] 吴菊[2] 马强华[1] 杨来虎[1] 赵丽[1] 杨爱萍[1] 宋庆梅[2] 代维斯[2] 无 ZHU Da-lin;FENG Fan;WU Ju;MA Qiang-hua;YANG Lai-hu;ZHAO Li;YANG Ai-ping;SONG Qing-mei;DAI Wei-si(Medical Imaging Center;Prenatal Diagnosis Center;Reproductive Medicine Center,Gansu Province Maternal and Child Care Hosipital,Lanzhou,730050)

机构地区：[1]甘肃省妇幼保健院医学影像中心,兰州730050 [2]甘肃省妇幼保健院产前诊断中心,兰州730050 [3]甘肃省妇幼保健院生殖医学中心,兰州730050

出　　处：《中国优生与遗传杂志》2018年第8期55-57,F0002,共4页Chinese Journal of Birth Health & Heredity

基　　金：甘肃省科技厅自然科学基金资助项目(1308RJZA244)

摘　　要：目的探讨核磁共振弥散加权成像技术(Ddiffusion weighted imaging,DWI)在孕中晚期胎儿脑出血(FICH,fetal intracranial hemorrhage)疾病中的诊断价值研究。方法回顾性分析核磁共振常规序列确诊的22例孕中晚期胎儿颅内出血病例的影像资料及临床资料,分析病变部位、信号特点、是否合并其他异常,并对不同孕期、不同出血级别进行分析。将核磁共振(DWI)、超声检查结果对照分析。结果 DWI技术对胎儿颅内出血的检出率为86.4%(19/22),超声检出率36.4%(8/22),有显著统计学差异。DWI与超声对胎儿不同胎龄FICH检出率的对照分析中,23-27孕周和28-32孕周中的检出率有显著统计学差异(P值<0.05),33-37w无统计学差异(P值>0.05)。DWI与超声对胎儿不同级别FICH检出率的对照分析中,Ⅱ级、Ⅲ级和Ⅳ级的检出率有统计学差异(P值<0.05),Ⅰ级中的检出率无统计学差异(P值>0.05)。超声及MRI(DWI)诊断完全符合的为8例,MRI补充超声诊断4例(50%,4/8),合并胼胝体发育不良2例,合并DANDY-WALKER畸形1例,合并小脑发育不良1例。结论核磁共振弥散加权成像技术对提胎儿颅内出血的诊断率高于超声,是产前超声检查有力的补充诊断,对产前诊断工作有重要的诊断价值和治疗指导意义。Objective：To investigate the diagnostic value of magnetic resonance imaging diffusion weighted imaging in the diagnostic of fetal cerebral hemorrhage in the middle and late stages of pregnancy. Methods;Retrospective analysis of 22 routine MRI confirmed cases of second trimester fetal intracranial hemorrhage cases of imaging data and clinical data,analyzed the location of the lesion,the characteristics of the signal,whether it was combined with other abnormalities,and analyzed the different bleeding levels. Magnetic resonance imaging（DWI）and ultrasound examination results were analyzed. Results：The detection rate of fetal DWI in fetal intracranial hemorrhage（FICH）was 86.4%（19/22）,and the detection rate was 36.4%（8/22）in. ultrasound examination,there was a significant difference. DWI and ultrasound detection rate of FICH in different gestational age of fetal,23～27 gestational age and 28～32 weeks of pregnancy in the detection rate was significantly different（P〈0.05）,33～37 weeks of pregnancy in the detection rate was no significantly different MRI（DWI）and ultrasound detection rate of FICH in different levels of fetal,the detection rate of grade Ⅱ,Ⅲand Ⅳ were statistically different（P〉0.05）,the detection rate in grade Ⅰ was Statistical differences（P〈0.05）. Ultrasound and MRI（DWI）diagnosis in full compliance with 8 cases,4 cases（50%,4/8）were diagnosed by MRI supplementation,2 cases with corpus callosum dysplasia,1 case with Dandy-Walker malformation,1 case with cerebellar dysplasia. Conclusion：The DWI diagnosis of intracranial hemorrhage is higher than that of ultrasound,which is a powerful complementary diagnosis of prenatal ultrasound. It has important diagnostic value and therapeutic significance for prenatal diagnosis.

关 键 词：核磁共振 弥散加权成像 胎儿颅内出血 

分 类 号：R445.12[医药卫生—影像医学与核医学]