产前磁共振在先天性肺囊性疾病胎儿预后评估中的应用研究  

Application of Fetal Magnetic Resonance Imaging in Prognosis Assessment of Fetuses With Congenital Pulmonary Cystic Diseases

作　　者：贾阳 鲍莉[1,2] 徐蓉 谢林均 叶璐 郭应坤 陈慧[2,4] JIA Yang;BAO Li;XU Rong;XIE Linjun;YE Lu;GUO Yingkun;CHEN Hui(Department of Radiology,West China Second University Hospital,Sichuan University,Chengdu 610041,China;Key Laboratory of Birth Defects and Related Diseases of Women and Children of the Ministry of Education,Ministry of Education,Chengdu 610041,China;Department of Ultrasound,West China Second University Hospital,Sichuan University,Chengdu 610041,China;Department of Reproductive Endocrinology,West China Second University Hospital,Sichuan University,Chengdu 610041,China)

机构地区：[1]四川大学华西第二医院放射科,成都610041 [2]出生缺陷与相关妇儿疾病教育部重点实验室(四川大学),成都610041 [3]四川大学华西第二医院超声科,成都610041 [4]四川大学华西第二医院生殖内分泌科,成都610041

出　　处：《四川大学学报（医学版）》2024年第3期717-723,共7页Journal of Sichuan University(Medical Sciences)

基　　金：四川省重点研发计划(No.2023YFS0020)资助。

摘　　要：目的 回顾性分析先天性肺囊性疾病胎儿产前磁共振(magnetic resonance imaging, MRI)图像,探讨产前MRI检查评估胎儿先天性肺囊性疾病的可行性,初步探索产前MRI对先天性肺囊性疾病胎儿预后的预测价值。方法 收集2018年5月–2023年3月四川大学华西第二医院经产前超声怀疑胎儿先天性肺囊性疾病并行MRI检查确诊者。测量胎儿肺部肿块的体积及肺头比(cystic volume ratio, CVR)、双侧肺肝信号强度比值,结合随访结果分析MRI评估胎儿先天性肺囊性疾病的可行性。采用logistic回归模型评价病灶体积、CVR、患侧-健侧肺肝信号强度比值差值与不良预后是否有关。采用受试者工作特征(receiver operating characteristic, ROC)曲线评估MRI参数对于预测胎儿预后的价值。结果 最终纳入47例先天性肺囊性疾病胎儿,其中预后良好30例,预后不良17例。预后良好组与预后不良组间胎儿患侧-健侧肺肝信号强度比值差值的差异有统计学意义(P<0.05),且健侧肺肝信号强度比值高于患侧肺肝信号强度比值。CVR[比值比(odds ratio, OR)=1.058,95%置信区间(confidence interval, CI)为1.014~1.104]、患侧-健侧肺肝信号强度比值差值(OR=0.814,95%CI为0.700~0.947)与先天性肺囊性疾病胎儿出生不良预后相关。此外,ROC曲线分析结果显示,联合应用病灶体积/患侧肺体积及患侧-健侧肺肝信号强度比值差值观察预测先天性肺囊性疾病胎儿预后较单一参数判断更为准确,其曲线下面积为0.988,截断值为0.33,对应的敏感度为100%,特异度为93.3%,95%CI为0.966~1。结论 基于产前MRI获得的病灶体积、病灶体积/患侧肺体积、病灶体积/总肺体积、CVR、患侧-健侧肺肝信号强度比值差值预测先天性肺囊性疾病胎儿的不良预后有一定价值,但在联合指标中病灶体积/患侧肺体积及患侧-健侧肺肝信号强度比值差值的预后效能更好。Objective The aim of this study is to explore the practical value of prenatal magnetic resonance imaging(MRI)in the assessment of congenital cystic lung disease in fetuses,to evaluate the relative size of the lesion and the status of lung development,and to make an attempt at utilizing the strength of MRI in post-processing to obtain assessment indicators of the size of the lesion and the status of lung development,with which predictions can be made for the prognosis that these fetuses may face after birth.We retrospectively collected and analyzed the data of fetuses diagnosed with congenital cystic lung disease.Prenatal ultrasound examination of these fetuses led to the diagnosis that they were suspected of having congenital cystic lung disease and the diagnosis was confirmed by subsequent prenatal MRI.The fetuses were followed up to track their condition at birth(postnatal respiratory distress,mechanical ventilation,etc.),whether the fetuses underwent surgical treatment,and the recovery of the fetuses after surgical treatment.The recovery of the fetuses was followed up to explore the feasibility of prenatal MRI examination to assess fetal congenital pulmonary cystic disease,and to preliminarily explore the predictive value of prenatal MRI for the prognosis of fetuses with congenital pulmonary cystic disease.Methods MRI fetal images were collected from pregnant women who attended the West China Second University Hospital of Sichuan University between May 2018 and March 2023 and who were diagnosed with fetal congenital pulmonary cystic disease by prenatal ultrasound and subsequent MRI.Fetal MRI images of congenital cystic lung disease were post-processed to obtain the fetal lung lesion volume,the fetal affected lung volume,the healthy lung volume,and the fetal head circumference measurements.The signal intensity of both lungs and livers,the lesion volume/the affected lung volume,the lesion volume/total lung volume,the cystic volume ratio(CVR),and the bilateral lung-liver signal intensity ratio were measured.The f

关 键 词：先天性肺囊性腺瘤样畸形 支气管肺隔离症 支气管囊肿 磁共振成像 

分 类 号：R714.5[医药卫生—妇产科学]