胎儿肾脏积水的MR影像及预后评估

目的利用1．5T高场强扫描机，对胎儿肾脏积水的MR影像及预后进行评估。方法利用B超筛查发现胎儿肾脏积水并进行MR进一步检查的病例34例，胎龄24～37周。结果在34例胎儿中，MR诊断单侧重复肾伴上半肾积水3例（1例产后MR证实，2例引产），盆腔内囊性病灶致双侧肾脏积水2例（1例产后证实为盆腔巨大畸胎瘤致双肾积水，1例失访），脑室扩张且单侧肾脏积水2例（1例引产，1例失访），双侧’肾脏及输尿管扩张积水且肺发育不良1例（产后MR证实，放弃治疗），双侧肾脏积水伴脐膨出1例（产后证实为脐肠瘘并行手术治疗，双侧肾脏积水随访改善），双侧肾脏积水伴左肾周积液1例（引产），单纯性肾脏积水24例（产后确诊左侧UPJ进行手术3例，左侧肾脏积水随访中2例，6例左侧、2例右侧及5例双侧肾脏积水产后超声随访正常，失访6例）；产后确诊UPJ的3例胎儿肾脏皮质厚度平均2mm，随访正常的13例胎儿肾脏皮质厚度平均3．5mm。结论MR影像能够对胎儿肾脏积水的病因进一步评估，有利于胎儿肾脏积水的预后判断。

Magnetic resonance imaging study in fetal hydronephrosis

Objective The purpose is to evaluate the importance of MR imaging in fetal hydronephrosis for clinical appli cation. Methods MRI was performed in 34 patients. All images of the patients were retrospectively analyzed. Results The duplex anomaly was found in 3 cases and postnatal MR imaging proved in one case. Bilateral hydronephrosis with pel vic cystic lesion was found in 2 cases and postnatal CT imaging proved teratoma in one case. Bilateral hydronephrosis with dilated ureter and postnatal MR imaging proved in one case, bilateral hydronephrosis with perinephral effusion in one case and with postnatal proved umbilical enteric fistula in one case. Unilateral hydronephrosis with cerebral ventrical dilation was found in 2 cases. Simple hydronephrosis were shown in 24 cases and postnatal proved PUJO in 3 cases. 13 cases were normal on postnatal US imaging, 2 cases were on follow-up, and 6 cases were lost to follow up. Conclusion MRI is of great value in judging the pathogenesis and the prognosis of the fetal hydronephrosis.