目的 探讨超声发现的脑室扩张胎儿行MRI检查的临床价值,并观察脑室扩张胎儿的预后.方法 选择2006年3月至2008年7月在中国医科大学附属盛京医院行超声检查发现有胎儿脑室扩张的孕妇135例,产前检查孕周平均为32周.为进一步明确诊断行MRI检查.MRI检查发现胎儿单侧或双侧侧脑室三角区宽度为10～15 mm者诊断为轻度脑室扩张,16～20 mm者诊断为中度脑室扩张,>20 mm者诊断为重度脑室扩张.采用病例对照研究方法,对MRI诊断为单纯轻度脑室扩张胎儿和无异常胎儿,在出生后半年至1年进行丹佛智能发育筛查量表(DDST)检测,以判断单纯轻度脑室扩张胎儿在婴幼儿期的智力及生长发育状况.结果 (1)MRI诊断胎儿脑室扩张的准确率:135例超声诊断的脑室扩张胎儿中,MRI检查无明显异常56例(41.5%,56/135),单纯脑室扩张60例(60/135,44.4%),脑室扩张合并脑出血5例(3.7%,5/135),脑室扩张合并胼胝体异常12例(8.9%,12/135),脑室扩张合并小脑发育不良2例(1.5%,2/135).MRI诊断胎儿脑室扩张共79例,其中合并胼胝体异常率为15.2%(12/79).(2)MRI检查胎儿脑室扩张的分度:MRI诊断胎儿单纯脑室扩张60例,其中55例(91.7%,55/60)为轻度脑室扩张,5例为中度脑室扩张(8.3%,5/60);脑室扩张合并脑出血的5例胎儿中,1例为轻度脑室扩张、4例为中、重度脑室扩张;脑室扩张合并胼胝体异常的12例胎儿中,8例(66.7%,8/12)为中度脑室扩张,4例为重度脑室扩张(33.3%,4/12);脑室扩张合并小脑发育不良的2例胎儿均为中度脑室扩张.(3)DDST检测结果:55例单纯轻度脑室扩张胎儿中,符合随访条件的30例为病例组.无异常的56例中随访到38例,同期因其他原因行MRI检查无异常的胎儿42例,共计80例为对照组.病例组婴儿中DDST检测结果为可疑或异常4例(13.3%,4/30),正常26例(86.7%,26/30);对照组婴儿中DDST检测结果为可疑或异常10例(12.5%,10/80),正常70例(87.5%,70/80).两组分别比较,差异均无统计学意义(P>0.05).(4)MRI检查确诊的79例单纯脑窜扩张胎儿的临床结局:79例脑室扩张胎儿中,30例轻度脑室扩张胎儿及5例中度脑室扩张胎儿均妊娠至足月,出生后随访未发现婴儿异常;另有7例拒绝合作,6例孕妇坚决要求引产,失访12例.合并胼胝体发育异常的12例胎儿中,3例继续妊娠,胎儿出生后复查MRI,其诊断结果与胎儿期的MRI检查结果相同;8例孕妇坚决要求引产,失访1例.合并脑出血的5例胎儿均按孕妇意愿选择引产,尸体检查结果均证实MRI诊断正确.合并小脑发育不良的2例胎儿,1例要求继续妊娠,足月分娩,生后半年婴儿确诊为脑瘫,另有1例引产.结论 对超声发现的脑室扩张胎儿进一步行MRI检查有重要的临床验证和补充诊断价值;胎儿单纯轻度脑室扩张在出生后6～12个月期间,智力及生长发育与同龄儿无异.
目的 探討超聲髮現的腦室擴張胎兒行MRI檢查的臨床價值,併觀察腦室擴張胎兒的預後.方法 選擇2006年3月至2008年7月在中國醫科大學附屬盛京醫院行超聲檢查髮現有胎兒腦室擴張的孕婦135例,產前檢查孕週平均為32週.為進一步明確診斷行MRI檢查.MRI檢查髮現胎兒單側或雙側側腦室三角區寬度為10～15 mm者診斷為輕度腦室擴張,16～20 mm者診斷為中度腦室擴張,>20 mm者診斷為重度腦室擴張.採用病例對照研究方法,對MRI診斷為單純輕度腦室擴張胎兒和無異常胎兒,在齣生後半年至1年進行丹彿智能髮育篩查量錶(DDST)檢測,以判斷單純輕度腦室擴張胎兒在嬰幼兒期的智力及生長髮育狀況.結果 (1)MRI診斷胎兒腦室擴張的準確率:135例超聲診斷的腦室擴張胎兒中,MRI檢查無明顯異常56例(41.5%,56/135),單純腦室擴張60例(60/135,44.4%),腦室擴張閤併腦齣血5例(3.7%,5/135),腦室擴張閤併胼胝體異常12例(8.9%,12/135),腦室擴張閤併小腦髮育不良2例(1.5%,2/135).MRI診斷胎兒腦室擴張共79例,其中閤併胼胝體異常率為15.2%(12/79).(2)MRI檢查胎兒腦室擴張的分度:MRI診斷胎兒單純腦室擴張60例,其中55例(91.7%,55/60)為輕度腦室擴張,5例為中度腦室擴張(8.3%,5/60);腦室擴張閤併腦齣血的5例胎兒中,1例為輕度腦室擴張、4例為中、重度腦室擴張;腦室擴張閤併胼胝體異常的12例胎兒中,8例(66.7%,8/12)為中度腦室擴張,4例為重度腦室擴張(33.3%,4/12);腦室擴張閤併小腦髮育不良的2例胎兒均為中度腦室擴張.(3)DDST檢測結果:55例單純輕度腦室擴張胎兒中,符閤隨訪條件的30例為病例組.無異常的56例中隨訪到38例,同期因其他原因行MRI檢查無異常的胎兒42例,共計80例為對照組.病例組嬰兒中DDST檢測結果為可疑或異常4例(13.3%,4/30),正常26例(86.7%,26/30);對照組嬰兒中DDST檢測結果為可疑或異常10例(12.5%,10/80),正常70例(87.5%,70/80).兩組分彆比較,差異均無統計學意義(P>0.05).(4)MRI檢查確診的79例單純腦竄擴張胎兒的臨床結跼:79例腦室擴張胎兒中,30例輕度腦室擴張胎兒及5例中度腦室擴張胎兒均妊娠至足月,齣生後隨訪未髮現嬰兒異常;另有7例拒絕閤作,6例孕婦堅決要求引產,失訪12例.閤併胼胝體髮育異常的12例胎兒中,3例繼續妊娠,胎兒齣生後複查MRI,其診斷結果與胎兒期的MRI檢查結果相同;8例孕婦堅決要求引產,失訪1例.閤併腦齣血的5例胎兒均按孕婦意願選擇引產,尸體檢查結果均證實MRI診斷正確.閤併小腦髮育不良的2例胎兒,1例要求繼續妊娠,足月分娩,生後半年嬰兒確診為腦癱,另有1例引產.結論 對超聲髮現的腦室擴張胎兒進一步行MRI檢查有重要的臨床驗證和補充診斷價值;胎兒單純輕度腦室擴張在齣生後6～12箇月期間,智力及生長髮育與同齡兒無異.
목적 탐토초성발현적뇌실확장태인행MRI검사적림상개치,병관찰뇌실확장태인적예후.방법 선택2006년3월지2008년7월재중국의과대학부속성경의원행초성검사발현유태인뇌실확장적잉부135례,산전검사잉주평균위32주.위진일보명학진단행MRI검사.MRI검사발현태인단측혹쌍측측뇌실삼각구관도위10～15 mm자진단위경도뇌실확장,16～20 mm자진단위중도뇌실확장,>20 mm자진단위중도뇌실확장.채용병례대조연구방법,대MRI진단위단순경도뇌실확장태인화무이상태인,재출생후반년지1년진행단불지능발육사사량표(DDST)검측,이판단단순경도뇌실확장태인재영유인기적지력급생장발육상황.결과 (1)MRI진단태인뇌실확장적준학솔:135례초성진단적뇌실확장태인중,MRI검사무명현이상56례(41.5%,56/135),단순뇌실확장60례(60/135,44.4%),뇌실확장합병뇌출혈5례(3.7%,5/135),뇌실확장합병변지체이상12례(8.9%,12/135),뇌실확장합병소뇌발육불량2례(1.5%,2/135).MRI진단태인뇌실확장공79례,기중합병변지체이상솔위15.2%(12/79).(2)MRI검사태인뇌실확장적분도:MRI진단태인단순뇌실확장60례,기중55례(91.7%,55/60)위경도뇌실확장,5례위중도뇌실확장(8.3%,5/60);뇌실확장합병뇌출혈적5례태인중,1례위경도뇌실확장、4례위중、중도뇌실확장;뇌실확장합병변지체이상적12례태인중,8례(66.7%,8/12)위중도뇌실확장,4례위중도뇌실확장(33.3%,4/12);뇌실확장합병소뇌발육불량적2례태인균위중도뇌실확장.(3)DDST검측결과:55례단순경도뇌실확장태인중,부합수방조건적30례위병례조.무이상적56례중수방도38례,동기인기타원인행MRI검사무이상적태인42례,공계80례위대조조.병례조영인중DDST검측결과위가의혹이상4례(13.3%,4/30),정상26례(86.7%,26/30);대조조영인중DDST검측결과위가의혹이상10례(12.5%,10/80),정상70례(87.5%,70/80).량조분별비교,차이균무통계학의의(P>0.05).(4)MRI검사학진적79례단순뇌찬확장태인적림상결국:79례뇌실확장태인중,30례경도뇌실확장태인급5례중도뇌실확장태인균임신지족월,출생후수방미발현영인이상;령유7례거절합작,6례잉부견결요구인산,실방12례.합병변지체발육이상적12례태인중,3례계속임신,태인출생후복사MRI,기진단결과여태인기적MRI검사결과상동;8례잉부견결요구인산,실방1례.합병뇌출혈적5례태인균안잉부의원선택인산,시체검사결과균증실MRI진단정학.합병소뇌발육불량적2례태인,1례요구계속임신,족월분면,생후반년영인학진위뇌탄,령유1례인산.결론 대초성발현적뇌실확장태인진일보행MRI검사유중요적림상험증화보충진단개치;태인단순경도뇌실확장재출생후6～12개월기간,지력급생장발육여동령인무이.
Objective To evaluate the diagnostic value of magnetic resonance imaging (MRI) on fetal ventriculomegaly identified through prenatal ultrasonography and the outcomes of these newborns were followed up. Methods From March 2006 to July 2008, MRI was performed on 135 pregnant women whose fetuses diagnosed as fetal ventriculomegaly at an average of 32 gestational weeks in Shengjing Hospital Affiliated to China Medical University. Mild ventriculomegaly was defined when the width of unilateral or bilaeral fetal cerebral ventricle triangle was 10-15 mm, moderate ventriculomegaly 16-20 mm and severe ventriculomegaly >20 mm. We introduced the Denver developmental screening test(DDST) to follow-up the mild ventriculomegaly and normal babies, confirmed by MRI, at 6-12 months after birth and a case-control study was conducted. The intelligence and growth of these infants were analyzed. Results (1) Diagnostic rate of fetal ventriculomegaly through MRI: Among the 135 gravidas, 60 (44.4%) showed isolated ventriculomegaly, 5 (3.7%) complicated with ventricular hemorrhage; 12 (8.9%) complicated with agenesis of corpus callosum (ACC) and 2 (1.5%) complicated with cerebellar hypoplasia, while 56 (41.5%) were normal. Seventy-nine cases had fetal ventriculomegaly on MRI and 15.2% (n=12) of them complicated with ACC. (2) Degree of fetal ventriculomegaly on MRI: Among the 60 isolated ventriculomegaly cases, 55 (91.7%) were mild and 5 (8.3%) moderate ones. Among the 5 cases complicated with ventricular hemorrhage, one was mild ventriculomegaly, and 4 moderate or severe cases. Among the 12 cases with ACC, 8(66.7%) were moderate ventriculomegaly and 4 (33.3%) severe cases. The 2 cases with cerebellar hypoplasia were both moderate ventriculomegaly fetuses. (3) Follow-up at 6-12 months after birth : thirty out (case group) of the 55 isolated ventriculomegaly cases, 38 out of the 56 normal babies and 42 babies with normal MRI results were followed up, and the later 80 cases were taken as control. Four infants (13.3%) in the case group and 10 (12.5%) in the control group showed abnormal or suspected results in DDST (P>0.05), the rest babies were all normal. (4) Clinical outcomes of the 79 ventriculomegaly fetuses diagnosed by MRI: thirty mild ventriculomegaly babies and 5 moderate ones were born at term and showed normal at follow ups. However, 7 gravidas were not compliant, 6 pregnancies were terminated, and 12 were last. Three of the 12 cases with ACC continued the pregnancy, and postnatal MRI of the babies showed the same with the prenatal MRI, 8 pregnancies were induced and one was lost. All of the 5 fetuses with ventricufar hemorrhage were induced and the prenatal diagnosis was confirmed by autopsy. One of the 2 fetuses with cerebellar hypoplasia was term delivered and diagnosed as cerebral palsy at the age of 6 months, and the other one was induced. Conclusions MRI is an indispensable complementary diagnostic method for fetal ventriculomegaly diagnosed through ultrasound. The development of intelligence and growth of babies born with mild isolated ventriculomegaly is the same as normal ones.
