CAJ | 학술논문

目的：探讨MRI在诊断胎儿主动脉弓畸形中的价值。方法回顾性分析2013年3月至2014年10月产前超声检查提示有发育异常，然后行MRI检查，并经引产尸检和生后随访证实为主动脉弓畸形胎儿10例。重点观察MRI图像中主动脉弓位置及头臂动脉有无畸形，以及肝脏、胃腔在胎儿腹腔中的位置，腹部大血管毗邻关系等，并与产前超声和随访结果进行比较。结果10例胎儿中， MRI表现为右位主动脉弓（简称右弓）伴迷走左锁骨下动脉7例，其中1例还合并颈主动脉弓；右弓伴镜像分支1例，左位主动脉弓（简称左弓）伴迷走右锁骨下动脉1例，双主动脉弓1例。尸检和生后MRI随访与产前胎儿心脏MRI诊断均一致，产前超声诊断主动脉畸形漏诊5例，包括诊断右弓漏诊迷走左锁骨下动脉2例、镜像分支1例，诊断右弓伴迷走左锁骨下动脉漏诊颈主动脉弓1例，诊断左房异构漏诊左弓伴迷走右锁骨下动脉1例。此外，超声将1例双主动脉弓误诊为右弓伴迷走左锁骨下动脉。结论胎儿心脏MRI在诊断胎儿主动脉弓畸形中可作为超声的一种有效的补充检查手段。
목적：탐토MRI재진단태인주동맥궁기형중적개치。방법회고성분석2013년3월지2014년10월산전초성검사제시유발육이상，연후행MRI검사，병경인산시검화생후수방증실위주동맥궁기형태인10례。중점관찰MRI도상중주동맥궁위치급두비동맥유무기형，이급간장、위강재태인복강중적위치，복부대혈관비린관계등，병여산전초성화수방결과진행비교。결과10례태인중， MRI표현위우위주동맥궁（간칭우궁）반미주좌쇄골하동맥7례，기중1례환합병경주동맥궁；우궁반경상분지1례，좌위주동맥궁（간칭좌궁）반미주우쇄골하동맥1례，쌍주동맥궁1례。시검화생후MRI수방여산전태인심장MRI진단균일치，산전초성진단주동맥기형루진5례，포괄진단우궁루진미주좌쇄골하동맥2례、경상분지1례，진단우궁반미주좌쇄골하동맥루진경주동맥궁1례，진단좌방이구루진좌궁반미주우쇄골하동맥1례。차외，초성장1례쌍주동맥궁오진위우궁반미주좌쇄골하동맥。결론태인심장MRI재진단태인주동맥궁기형중가작위초성적일충유효적보충검사수단。
Objective To explore the value of MRI in the diagnosis of fetal aortic arch anomalies. Methods We retrospectively collected 10 fetuses with aortic arch anomalies indicated by prenatal ultrasound and underwent MR examination and were subsequently proven by autopsy or post-birth follow-up from 320 pregnant women. We focused on the observations of the location of the aortic arch and brachiocephalic artery anomalies, the locations of the liver and stomach in the abdominal cavity, and the large vessels in abdomen. The above-mentioned finding were compared with prenatal ultrasound and follow-up findings. Results Of 10 cases, right aortic arch with aberrant left subclavian artery was seen in 7 cases, right aortic arch with the mirror branch, left aortic arch with aberrant right subclavian artery, right aortic arch with aberrant left subclavian artery combined with cervical aortic arch and double aortic arch was seen in 1 case, respectively. All aortic arch anomalies detected by MRI were consistent with post-birth or autopsy findings. Ultrasound misdiagnosed aortic branch malformation in 5 places, which included right aortic arch but misdiagnosed aberrant left subclavian artery in 2 cases, right aortic arch never diagnosed mirror branch anomaly in 1 case, right aortic arch with left subclavian artery misdiagnosed cervical aortic arch in 1 case, left atrial isomerism but misdiagnosed left aortic arch with aberrant right subclavian artery in 1 case;One double aortic arch was misdiagnosed as right aortic arch with aberrant left subclavian artery in ultrasound. Conclusion Fetal cardiovascular MRI is an effective and supplementary examination to complement ultrasound in diagnosis of fetal aortic arch anomalies.