CAJ | 학술논문

目的探讨MRI在诊断胎儿肠梗阻中的临床应用价值.方法回顾性分析2009年10月至2013年10月间经产前超声、产后手术和引产胎儿尸检病理结果证实为肠梗阻,且产前MRI资料完整的23个胎儿.MRI检查在超声检查后1～2 d内进行,扫描序列采用快速平衡稳态采集(FIESTA)序列、单次激发快速自旋同波(SSFSE)序列及扰相梯度回波序列(SPGR)T1WI,重点扫描胎儿腹部.将产前MRI、超声、经引产病理检查、产后影像检查及手术结果进行对照分析.结果 23个胎儿肠梗阻中,MRI显示十二指肠闭锁4个胎儿,均呈T1WI低信号、T2WI高信号的“双泡征”;空回肠闭锁10个胎儿,表现为肠管扩张和T1WI呈高信号的细小结肠,其中扩张的末段回肠内有T1WI高信号胎粪影(5个胎儿);结肠闭锁1个胎儿;肠旋转不良1个胎儿,表现为“双泡征”和“漩涡征”;环状胰腺3个胎儿,表现为“双泡征”及“反括号状压迹”;胎粪性腹膜炎4个胎儿,表现为肠管扩张、腹水及假性囊肿(2个胎儿).结论 MRI利用羊水和胎粪在胃肠道中的信号特点与分布规律,可判定胎儿肠梗阻的梗阻水平及其梗阻远端肠管发育状况,弥补超声的不足,对胎儿产前诊断、胎儿外科、产时外科手术以及优生优育具有重要的临床意义.
목적 탐토MRI재진단태인장경조중적림상응용개치.방법 회고성분석2009년10월지2013년10월간경산전초성、산후수술화인산태인시검병리결과증실위장경조,차산전MRI자료완정적23개태인.MRI검사재초성검사후1～2 d내진행,소묘서렬채용쾌속평형은태채집(FIESTA)서렬、단차격발쾌속자선동파(SSFSE)서렬급우상제도회파서렬(SPGR)T1WI,중점소묘태인복부.장산전MRI、초성、경인산병리검사、산후영상검사급수술결과진행대조분석.결과 23개태인장경조중,MRI현시십이지장폐쇄4개태인,균정T1WI저신호、T2WI고신호적“쌍포정”;공회장폐쇄10개태인,표현위장관확장화T1WI정고신호적세소결장,기중확장적말단회장내유T1WI고신호태분영(5개태인);결장폐쇄1개태인;장선전불량1개태인,표현위“쌍포정”화“선와정”;배상이선3개태인,표현위“쌍포정”급“반괄호상압적”;태분성복막염4개태인,표현위장관확장、복수급가성낭종(2개태인).결론 MRI이용양수화태분재위장도중적신호특점여분포규률,가판정태인장경조적경조수평급기경조원단장관발육상황,미보초성적불족,대태인산전진단、태인외과、산시외과수술이급우생우육구유중요적림상의의.
Objective To investigate the clinical value of prenatal MRI in the diagnosis of fetal bowel obstruction.Methods Pregnant women suspected to have fetal abdominal abnormalities by ultrasonography were suggested to undergo MRI examinations within two days.Scanning sequence included FIESTA,SSFSE and T1WI SPGR sequence,with field of view focused on the fetal abdomen.After the final diagnoses of the cases were obtained by induced labor pathological examination or postpartum imaging or operation,the imaging data and the clinical data were reviewed and analyzed retrospectively.Results A total of 23 cases with bowel obstruction were included in the study.Four fetuses with duodenal atresia showed low T1 signal,high T2 signal characterized by "double-bubble" sign on MRI.There were 10 fetuses with jejunoileal atresia,showing bowel dilatation and hyperintense micro-colon on T1WI.Five cases of them depicted expansion of the terminal ileum with high T1 meconium signal.One each fetus had colonic atresia,intestinal malrotation with "double-bubble" and whirl sign.Annular pancreas with "double-bubble" sign and pressure trace of the bracket shape was detected in 3 fetuses.Meconium peritonitis was present in 4 fetuses,with 2 of them showing dilatation of intestine,ascites and pseudocysts.Conclusions According to the signal characteristics of amniotic fluid and meconium in the gastrointestinal tract on MRI,the obstructive level and development status of the distal bowel can be determined with MRI.It can provide additional information to ultrasonography,which brings clinical significance to prenatal diagnosis and intrapartum surgical operation.