MRI在胎儿中枢神经系统中的临床应用

目的探讨MRI在胎儿中枢神经系统发育异常中的应用价值。方法24例孕妇，年龄25～34岁，平均28岁；孕龄20～39周，平均30周。产前例行超声检查后24h内行MR检查，T2WI采用半傅立叶单激励快速自旋回波(HASTE)快速扫描序列，T1WI采用二维快速小角度激励(FLASH)序列。将超声、MRI结果与出生后或引产后随访结果对照。结果24例孕妇共检出胎儿24个。MR T2WI可清楚、直观地显示出大脑实质、脑回、脑沟裂、胼胝体、丘脑、小脑、脑干及脊髓等解剖结构，T1WI质量差于T2WI。超声共显示病灶27个，MRI显示31个。MRI证实超声怀疑的诊断2例，进一步完善诊断10例，与超声诊断一致12例。结论MRI对胎儿中枢神经系统解剖结构的显示优于超声，而且不受孕妇体型、羊水量多少、胎儿颅骨及母体骨盆骨骼影响。在超声检查基础上进行胎儿MR检查，有助于弥补超声的不足，甚至更正超声诊断，可作为产前胎儿检查的辅助措施。

Clinical application of MRI to fetal central nervous system

Objective To explore the value of MRI on fetal central nervous system. Methods Twenty-four women with complicated pregnancies , aged from 22 to 32 years (average 27 years) and with gestation from 23-39 weeks (average 30 weeks) were studied with a 1.5 T superconductive MR unit within 24 hours after ultrasound studies. T_2-weighted MR imaging was performed using HASTE and T_1-weighted MR imaging was using FLASH. Comparison of the diagnosis of MRI and ultrasound were done with autopsy or postnatal follow-up MRI. Results Of the 24 cases, 24 fetus were found. The fetal brain, gyrus, sulcus, corpus callosum, thalamus, cerebellum, brain stem, and spinal cord were shown more clearly on MR T_2-weighted images.T_1-weighted images were not as good as T_2-weighted images. Twenty-seven lesions were visualized by ultrasound and thirty-one by MRI in these twenty-four fetuses. By MRI study, two cases were conformed their ultrasound diagnosis, ten cases were completed their ultrasound diagnosis, and twelve cases were made the same diagnosis as ultrasound. Conclusion MR has advantages in displaying fetal central nervous system anatomy over ultrasound, the quality of MR images is not affected by maternal somatotype, volume of amniotic fluid, fetal skull and the pelvic skeleton of pregnant women. Based on ultrasound, MR imaging is a valuable complement to sonography in difficult cases, it can conforming, completing, even more correcting the diagnosis made by ultrasound.