胎儿肝血管瘤的产前影像学诊断和管理

目的: 探讨胎儿肝血管瘤的产前诊断和处理方法。方法: 回顾性分析浙江大学医学院附属妇产科医院2014年2月至2018年9月产前诊断并随访的14例胎儿肝血管瘤病例，观察胎儿产前超声和MRI表现，总结其影像学特征，随访其结局。结果: 14例胎儿肝血管瘤病例均为单发病灶，多位于肝右叶（13例），超声表现以低回声为主，内部回声不均，9例患儿的病灶内见“蜂窝状”或“网格状”无回声，病灶周边见环状血流，或可见分支进入内部，测得低至中等血流阻力指数。MRI表现为T1加权像呈低信号、稍低信号，T2加权像呈高信号、稍高信号。14例胎儿中引产8例；继续妊娠6例，均足月分娩，患儿出生后经影像学方法诊断肝血管瘤，其中2例患儿口服普萘洛尔，4例患儿未予治疗，定期复查。随访结果显示，6例患儿生长发育情况与同龄儿无异，3例患儿肝血管瘤病灶无明显变化，3例患儿病灶逐渐缩小，其中1例完全消失。结论: 胎儿肝血管瘤有相对典型的影像学特征，结合超声和MRI检查结果可实现产前诊断。如无并发症，肝血管瘤胎儿可足月分娩，并且预后良好。

Prenatal diagnosis and management of fetal hepatic hemangioma

Objective: To review the application of medical imaging in diagnosis and management of fetal hepatic hemangioma. Methods: Clinical data and imaging findings of 14 cases of fetal hepatic hemangioma, who were diagnosed prenatally and followed up in Women's Hospital of Zhejiang University School of Medicine from February 2014 to September 2018 were retrospective reviewed. Results: The fetal hepatic hemangiomas were single lesions in all 14 cases, and most of them were located in the right lobe of the liver (13/14). Ultrasound images were mainly hypoechoic with heterogeneity, the honeycomb-like or grid-like anechoic regions were presented in 9 lesions and circumferential blood flow was observed with low to moderate blood flow resistance index. MRI findings showed well-defined lesions with low signal intensity on T1WI, and high or slightly high signal intensity on T2WI. Among 14 cases, there were 8 cases of induced labor and 6 cases of continuing pregnancy. In 6 cases of successful delivery, 2 were treated with propranolol, 4 cases were followed-up without treatment. The growth and development of 6 children were normal. The lesions of hepatic hemangioma showed no significant changes in 3 children and were reduced in the other 3 children, of whom the lesion was complete disappeared in 1 case. Conclusions: Fetal hepatic hemangiomas present relatively typical imaging characteristics, and prenatal diagnosis can be made with ultrasound and MRI. If there are no complications, the fetus with hepatic hemangioma can be delivered at full term with a good outcome.