超声联合MRI诊断孤立性血管环及预后分析

目的探讨产前超声联合MRI对孤立性血管环的诊断及预后情况。方法选取我院经产前超声心动图检查诊断为孤立性血管环的胎儿82例作为观察对象,其中13例进行胎儿心脏MRI检查,观察走行于血管环内的气管有无受压,并以Kappa法对超声检出气管受压及MRI检出气管受压间的一致性进行评定,并随访出生后情况。结果82例孤立性血管环包括右位主动脉弓伴左锁骨下动脉迷走(RAA+ALSA组)63例(76.83%,63/82),双主动脉弓(DAA组)16例(19.51%,16/82),肺动脉吊带(PAS组)3例(3.66%,3/82)。产前超声诊断气管受压结果和MRI诊断结果一致性好(Kappa=0.83)。随访DAA组生后10例(62.50%,10/16)患儿出现呼吸道症状;RAA+ALSA组生后1例(1.67%,1/60)患儿出现呼吸道症状;PAS组胎儿生后均出现呼吸道症状。血管环胎儿染色体检查检出异常3例(5.56%,3/54)。结论产前超声心动图检查可明确诊断血管环并进行分型,MRI对于评估血管环气管通畅性有很好的补充作用。不合并染色体异常的孤立性血管环预后良好。

Diagnosis and prognosis of isolated vascular ring by ultrasound combined with magnetic resonance imaging

Objective To investigate the diagnosis and prognosis of isolated vascular ring by prenatal ultrasound combined with magnetic resonance imaging.Methods Eighty-two fetuses diagnosed as isolated vascular ring by prenatal echocardiography in our hospital were selected as the research objects,of whom 13 underwent fetal cardiac magnetic resonance(MRI)to observe whether the trachea running in the vascular ring was compressed.Kappa method was used to evaluate the consistency between the ultrasonic detection of trachea compression and the MRI detection of trachea compression.The postnatal conditions were followed up.Results Eighty-two cases of isolated vascular rings included 63 cases(76.83%,63/82)of right aortic arch with aberrant left subclavian artery(RAA+ALSA),16 cases(19.51%,16/82)of double aortic arch(DAA)and 3 cases(3.66%,3/82)of pulmonary artery sling(PAS).The results of prenatal ultrasound diagnosis of tracheal compression were consistent with those of MRI diagnosis(Kappa=0.83).In DAA group,10 cases(62.50%,10/16)occurred respiratory symptoms after birth.In RAA+ALSA group,1 case(1.67%,1/60)occurred respiratory symptoms after birth.All PAS fetuses occurred respiratory symptoms after birth.Abnormalities were detected in 3 cases(5.56%,3/54)by chromosomal examination in vascular ring fetuses.Conclusion Prenatal echocardiography can clearly diagnose the vascular ring and classify it.MRI is a good supplement for evaluating the patency of vascular ring trachea.The prognosis of isolated vascular ring without chromosomal abnormalities is good.