早孕期超声联合中晚孕期MRI筛查胎儿前脑无裂畸形的价值  

Application of Ultrasonography in the First Trimester Combined with MRI in the Second and Third Trimesters in Fetal Holoprosencephaly

作　　者：吴林桦 杨海燕[2] 田博[1] 骆磊 李志敏 李健 陈兵[1] WU Linhua;YANG Haiyan;TIAN Bo;LUO Lei;LI Zhimin;LI Jian;CHEN Bing(Department of Radiology,General Hospital of Ningxia Medical University,Yinchuan 750004,China;不详)

机构地区：[1]宁夏医科大学总医院放射科,宁夏银川750004 [2]宁夏医科大学总医院妇产中心功能检查部,宁夏银川750004

出　　处：《中国医学影像学杂志》2023年第3期260-265,共6页Chinese Journal of Medical Imaging

基　　金：宁夏回族自治区科技惠民专项项目(2022CMG03051);宁夏医科大学总医院新入职硕士培养项目(YKDZY2022013)。

摘　　要：目的探讨早孕期超声联合中晚孕期MRI筛查胎儿前脑无裂畸形(HPE)的应用价值。资料与方法回顾性纳入2015年12月—2022年5月宁夏医科大学总医院早孕期超声、中晚孕期胎儿颅脑MRI诊断为HPE的69例胎儿,观察其颅脑结构在超声和MRI上的表现,并追踪妊娠过程及临床结局。结果早孕期超声及中晚孕期MRI检出HPE 69例,其中叶型20例,半叶型21例,无叶型28例。MRI表现:19例叶型表现为双侧脑室融合,1例额角形态失常,9例丘脑未正常分裂;8例半叶型表现为双侧脑室融合,侧脑室额角缺失,深部核团未正常分裂;1例无叶型表现为双侧脑室融合,深部核团显著融合。超声表现:1例叶型表现为脉络丛蝴蝶征消失;13例半叶型表现为脑中线部分显示不清,脉络丛蝴蝶征消失,丘脑部分融合;27例无叶型表现为脑中线显示不清,26例脉络丛蝴蝶征消失,20例丘脑融合。结论胎儿HPE在早孕期超声中表现为脉络丛蝴蝶征消失,在中晚孕期MRI中表现为双侧脑室融合。早孕期超声联合中晚孕期MRI可更有效地筛查胎儿HPE,提高HPE的产前检出率。Purpose To explore the application value of ultrasonography in the first trimester combined with MRI in the second and third trimesters for fetal holoprosencephaly(HPE).Materials and Methods From December 2015 to May 2022,a retrospective study was conducted in 69 fetuses diagnosed as HPE by ultrasound in the first trimester and MRI of the fetal brain in the second/third trimester in General Hospital of Ningxia Medical University,focusing on observing the brain structure on ultrasound and MRI performance,and tracked the pregnancy process and clinical outcomes.Results Among 69 cases with HPE detected by ultrasound in the first trimester and MRI in the second/third trimester,there were 20 cases with lobe HPE,21 cases with semilobar HPE,and 28 cases with alobar HPE.On MRI images,the lobar HPE(n=19)showed fusion of bilateral ventricles,1 case with abnormal frontal horns of lateral ventricles,and 9 cases with fusion of thalamus.The semilobar HPE(n=8)showed bilateral ventricle fusion,loss of frontal horn of lateral ventricle,and part of deep nuclei did not divide normally.The alobar HPE(n=1)showed fusion of bilateral ventricles and fusion of deep gray matter nuclei.On the ultrasonography,the lobar HPE(n=1)showed the disappearance of the butterfly sign of the choroid plexus.The semilobar HPE(n=13)showed that the midline of the brain was unclear,the butterfly sign of the choroid plexus disappeared,and the thalamus was partially merged;the alobar HPE(n=27)showed that the midline of the brain was unclear,26 cases with the butterfly sign of the choroid plexus disappeared,and 20 cases with the thalamus merged.Conclusion Fetal HPE shows disappearance of the butterfly sign of the choroid plexus on ultrasound in the first trimester,and fusion of bilateral ventricles on MRI in the second/third trimester.Ultrasound in the first trimester combined with MRI in the second/third trimester can more effectively screen fetal HPE and improve the prenatal detection rate of HPE.

关 键 词：前脑无裂畸形 早孕期 中晚孕期 磁共振成像 超声检查 

分 类 号：R714.43[医药卫生—妇产科学] R445.1[医药卫生—临床医学] R445.2