产前MRI对法洛四联症胎儿心血管结构和脑发育的评估  

Prenatal assessment of the cardiovascular structure and brain development of fetuses with tetralogy of Fallot on fetal MRI

作　　者：张霞[1] 朱铭[1] 董素贞 Zhang Xia;Zhu Ming;Dong Suzhen(Department of Radiology,Shanghai Children's Medical Center,School of Medicine,Shanghai Jiao Tong University,Shanghai 200127,China)

机构地区：[1]上海交通大学医学院附属上海儿童医学中心放射科,上海200127

出　　处：《中华放射学杂志》2022年第5期488-493,共6页Chinese Journal of Radiology

基　　金：国家自然科学基金(81971582,81571628);上海市自然科学基金(19ZR1476700);上海市浦江人才计划(2019PJD030);上海市卫生和计划生育委员会资助项目(201540048)。

摘　　要：目的探讨产前MRI量化评价法洛四联症(TOF)胎儿心血管结构及脑发育的价值。方法回顾性收集2011年8月至2021年4月在上海交通大学医学院附属上海儿童医学中心确诊的30例TOF胎儿,孕周为18~33(25±3)周,孕周≤25周17例、>25周13例。收集同期孕周匹配、心脑发育正常的60例胎儿为对照组。于快速平衡稳态梯度回波序列图像上测量胎儿主动脉弓峡部(AoI)、主肺动脉(MPA)直径及TOF胎儿室间隔缺损(VSD)长径,计算MPA/AoI。于单次激发快速自旋回波序列图像上测量胎儿脑双顶径(BBD)、脑额枕径(BFOL)、骨双顶径(SBD)、骨额枕径(SOD)和头围(HC)。上述测量指标与孕周的相关性分析采用Pearson相关性分析,在孕周≤25周和>25周胎儿中,以独立样本t检验比较TOF组与对照组胎儿各测量值的差异。结果孕周≤25周TOF胎儿的VSD长径为(3.5±1.1)mm,>25周为(4.4±0.6)mm。TOF胎儿与正常胎儿的AoI直径、MPA直径、BBD、BFOL、SBD、SOD、HC均与孕周呈正相关,TOF胎儿r=0.80、0.50、0.92、0.93、0.91、0.84、0.91(MPA直径P=0.005,余P均<0.001);对照组r=0.90、0.87、0.96、0.95、0.93、0.95、0.96(P均<0.001)。孕周≤25周胎儿中,TOF组17例、对照组34例,TOF组胎儿AoI直径大于对照组(t=10.00,P<0.001),MPA直径、MPA/AoI、BFOL均小于对照组,差异有统计学意义(P均<0.05);2组BBD、SBD、SOD、HC差异无统计学意义(P均>0.05)。孕周>25周胎儿中,TOF组13例,对照组26例,TOF组胎儿AoI直径大于对照组(t=3.36,P=0.002),MPA直径、MPA/AoI、BBD、BFOL、SOD、HC均小于对照组,差异有统计学意义(P均<0.05);2组SBD差异无统计学意义(P=0.068)。结论产前MRI能够量化评价TOF胎儿心血管结构和脑发育,TOF胎儿均存在不同程度VSD,MPA狭窄、AoI增宽,中孕期TOF胎儿大脑发育已经开始出现一定程度异常改变。Objective To explore the value of prenatal MRI in assessing the cardiovascular structure and brain development of fetuses with tetralogy of Fallot(TOF).Methods From August 2011 to April 2021,30 fetuses of TOF with gestational age(GA)18-33(25±3)weeks were retrospectively enrolled in Shanghai Children′s Medical Center,School of Medicine,Shanghai Jiao Tong University.Sixty normal fetuses were selected with matched GA of TOF fetuses as control group.In 30 fetuses with TOF,the GA of 17 fetuses were less than 25 weeks and of 13 fetuses were more than 25 weeks.The balanced fast field echo sequence MRI was performed to measure the diameter of the aortic arch isthmus(AoI),the main pulmonary artery(MPA)and the ratio was calculated(MPA/AoI).The size of ventricular septal defect(VSD)was measured in TOF group.The single-shot turbo spin echo sequence MRI was performed to measure fetal brain biparietal diameter(BBD),brain frontal-occipital length(BFOL),skull biparietal diameter(SBD),skull fronto-occipital diameter(SOD)and head circumference(HC).The Pearson analysis was used to evaluate the correlation of the above indicators with GA.The independent sample t test was used to compare the differences in various indicators between TOF and control groups in both GA≤25 and GA>25 weeks.Results The sizes of VSD in TOF fetuses were(3.5±1.1)mm(GA≤25 weeks)and(4.4±0.6)mm(GA>25 weeks).The AoI,MPA,BBD,BFOL,SBD,SOD,HC were positively associated with GA(TOF group:r=0.80,0.50,0.92,0.93,0.91,0.84,0.91,MPA P=0.005,others all P<0.001;control group:r=0.90,0.87,0.96,0.95,0.93,0.95,0.96,all P<0.001).For fetuses with GA≤25 weeks,there were 17 fetuses in TOF group and 34 fetuses in control group,and the AoI in TOF group was larger than that in control group(t=10.00,P<0.001),the MPA,MPA/AoI,BFOL were smaller than those in control group(all P<0.05).No statistical significant differences of BBD,SBD,SOD,HC were found between the groups(all P>0.05),For fetuses with GA>25,there were 13 fetuses in TOF group and 26 fetuses in control group,and the

关 键 词：胎儿 法洛四联症 磁共振成像 脑发育 

分 类 号：R714.5[医药卫生—妇产科学] R445.2[医药卫生—临床医学]