MRI对胎儿Chiari畸形的产前诊断价值  

Prenatal diagnostic value of MRI in fetal Chiari malformation

作　　者：庄严 陈长安 张鹤 黄晓微 张国福 ZHUANG Yan;CHEN Chang-an;ZHANG He;HUANG Xiao-wei;ZHANG Guo-fu(Department of Radiology,Obstetrics and Gynecology Hospital,Fudan University,Shanghai 200011,China;Department of Radiology,Shanghai Children's Medical Center,Shanghai Jiao Tong University School of Medicine,Shanghai 200127,China;Department of Medical Ultrasonics,Obstetrics and Gynecology Hospital,Fudan University,Shanghai 200011,China)

机构地区：[1]复旦大学附属妇产科医院放射科,上海200011 [2]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 [3]复旦大学附属妇产科医院超声科,上海200011

出　　处：《复旦学报（医学版）》2024年第2期191-197,217,共8页Fudan University Journal of Medical Sciences

摘　　要：目的 评价磁共振成像(magnetic resonance imaging,MRI)对胎儿Chiari畸形的产前诊断价值。方法 回顾性研究复旦大学附属妇产科医院2010年2月至2022年2月经随访证实的27例Chiari畸形的产前MRI表现,并与超声结果对比。结果 共纳入27例孕妇,年龄16~36岁,平均28.0岁,孕龄15.3~38.4周,平均24.3周;27例胎儿,包括ChiariⅡ型(Chiari malformation typeⅡ,CMⅡ型)18例、ChiariⅢ型(CMⅢ型)3例和ChiariⅣ型(CMⅣ型)6例;CMⅡ型及CMⅢ型MRI表现均有小脑扁桃体疝、桥脑下移,后颅窝池、第四脑室变窄或消失,蛛网膜下腔间隙消失,其中合并脑积水17例,脑脊液消失2例,柠檬头征及香蕉小脑征17例,脑膨出4例,开放性脊柱裂15例,脊髓低位3例,脊髓空洞2例,脊柱成角畸形4例,伴发其他畸形6例;CMⅣ型小脑未发育2例,小脑及脑干发育不全4例,脑积水5例,后颅窝池增宽4例,伴发其他畸形4例。MRI对后颅窝结构及脊髓的显示较超声更清晰,可发现超声未能发现的病变。结论 产前MRI可作为超声的补充检查,提高诊断Chiari畸形的准确率,降低漏诊率,并可明确Chiari畸形的分型。Objective To evaluate the value of magnetic resonance imaging(MRI)in prenatal diagnosis of fetal Chiari malformation.Methods The prenatal MRI findings of 27 cases of Chiari malformation confirmed by follow-up in Obstetrics and Gynecology Hospital,Fudan University from Feb 2010 to Feb 2022 were retrospectively analyzed and compared with ultrasound findings.Results Twenty-seven pregnant women,aged from 16-36 years(average 28.0 years)and 27 fetuses with gestation from 15.3-38.4 weeks(average 24.3 weeks)were studied.There were 18 cases of ChiariⅡ(Chiari malformation typeⅡ,CMⅡ),3 cases of ChiariⅢ(CMⅢ),6 cases of ChiariⅣ(CMⅣ).CMⅡand CMⅢimages showed brain herniation,descending pons,narrowing or disappearance of the posterior fossa cistern and the fourth ventricle,the subarachnoid space disappears.There were 17 cases of hydrocephalus,2 cases of cerebrospinal fluid loss,17 cases of“lemon head”and“banana cerebellar”signs,4 cases of encephalocele,15 cases of spinal bifida,3 cases of lower spinal cord and 2 cases of spinal cavity,4 cases of spinal angular deformity and 6 cases of other malformations.In CMⅣ,there were 2 cases of undeveloped cerebellum and 4 cases of cerebellum and brainstem dysplasia,hydrocephalus in 5 cases,posterior fossa cistern widening in 4 cases,and other malformations in 4 cases.MRI showed the posterior fossa structure and spinal cord more clearly than ultrasound, and could find lesions not detected by ultrasound.Conclusion Prenatal MRI can be used as a complementary examination of ultrasound, which can improvethe accuracy of diagnosis of Chiari malformation, reduce the rate of missed diagnosis, and clarify theclassification of Chiari malformation.

关 键 词：胎儿 CHIARI畸形 磁共振成像(MRI) 

分 类 号：R814.4[医药卫生—影像医学与核医学]