MRI在胎儿泌尿系统畸形中的应用  

Application of MRI in fetal urinary system malformation

作　　者：尚红磊 赵鑫[1] 张小安[1] 陆林[1] 朱功升[1] 郭亚飞 SHANG Hong-lei;ZHAO Xin;ZHANG Xiao-an;LU Lin;ZHU Gong-sheng;GUO Ya-fei(Department of Radiology, the Third Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China)

机构地区：[1]郑州大学第三附属医院放射科

出　　处：《中国临床医学影像杂志》2019年第7期499-502,共4页Journal of China Clinic Medical Imaging

摘　　要：目的:探讨MRI在胎儿先天性泌尿系统畸形中的应用价值。方法:46例产前超声检查怀疑胎儿泌尿系统畸形的孕妇,行产前MRI检查,并与产前彩超相对比。所有胎儿均为单胎。评价最终诊断以产后超声或MRI检查结果为准。结果:46例孕妇年龄为21~40岁,平均(26±4)岁,孕龄为20~39周,平均(28±3)周。46例先天性泌尿系统异常胎儿中,包括羊水量正常的30例(羊水正常组)、羊水过少16例(羊水过少组)。羊水过少组胎儿通过MRI测量胎儿肺肝信号强度比(LLSIR)评估是否存在胎儿肺发育不良。产前MRI改变产前超声检查结果 5例,产前MRI证实产前超声检查结果 4例,产前MRI进一步完善产前超声检查12例,产前超声诊断准确而MRI诊断不正确2例,产前超声及MRI诊断均不正确1例。产前超声诊断符合率为73.9%(34/46),产前MRI总诊断符合率为93.5%(43/46)。羊水过少组胎儿均合并肺发育不良,LLSIR为1.01~1.87,平均值为1.19±0.05,较正常组明显减低(P=0.000<0.05)。结论:MRI检查在胎儿泌尿系统异常的诊断中具有较高的临床应用价值,是产前超声检查的重要补充方法,特别是在胎儿肾脏异常合并羊水过少的产前诊断具有更好的发展前景。Objective: To investigate the value of MRI in the prenatal diagnosis of abnormal fetal urinary tract. Methods: Forty-six fetuses with suspected urinary anomalies detected by routine ultrasound screening were rescanned by MRI to refine the diagnosis. All examined fetuses are single fetuses. The pregnancy outcome was examined externally by postnatal ultrasonography or MRI. Results: The average gestational age of 46 pregnant women was 28 weeks (range 20~39) and the mean maternal age was 26 years (range 21~40). Among 46 fetuses with congenital urinary system abnormalities, 30 cases had normal amniotic fluid volume(normal amniotic fluid group) and 16 cases had oligohydramnios(oligohydramnios group). The ratio of lung signal intensity to liver signal intensity (LLSIR) of oligohydramnios grpup was assessed by MRI to determine if there was fetal lung dysplasia. MRI diagnosis changed the preceding US diagnosis in 5 cases and added information in 12 cases. MRI confirmed US diagnosis in 4 fetuses. The prenatal US diagnosis was accurate and MRI diagnosis was incorrect in 2 cases, and prenatal US and MRI diagnosis were both not correct in 1 case. MRI showed 93.5%(43/46) accuracy in diagnosis while US showed 73.9%(34/46) accuracy. Oligohydramnios group were all complicated with pulmonary dysplasia and had a mean LLSIR of 1.01 ~1.87 and was obviously less than that in normal fetuses of similar gestational age (P =0.000 <0.05). Conclusion: MRI is valuable in evaluating suspected fetal urinary tract abnomalies, especially when ultrasound is inconclusive owing to oligohydramnios.

关 键 词：泌尿生殖系统畸形 胎儿疾病 羊水过少 磁共振成像 

分 类 号：R714.53[医药卫生—妇产科学] R445.2[医药卫生—临床医学]