超声与磁共振成像诊断胎儿脊柱与脊髓发育异常的对照研究

目的 比较产前超声检查、磁共振成像(MRI)用于诊断胎儿脊柱与脊髓发育异常的临床价值.方法 选择产前超声检查显示胎儿脊柱与脊髓发育异常的30例孕妇(其中脊柱排列不规则19例、椎管局部增宽7例、脊柱曲度异常4例),年龄22～41岁,孕龄23～38周,在超声检查后72 h内行MRI检查.30例孕妇中选择引产者25例,选择继续妊娠者5例.经患者知情同意,对引产后患儿行尸体解剖(尸解,22例)或尸体影像学检查(3例);对选择继续妊娠者,新生儿出生后12个月内行MRI随访.结果 (1)诊断符合率:19例产前超声显示脊柱排列不规则的胎儿中,产前超声正确诊断8例,分别为3例脊膜膨出、1例隐形脊柱裂、1例脊髓脊膜膨出、3例半椎体,产前超声诊断正确率为42%(8/19);而MRI正确诊断17例,只有1例半椎体和1例蝴蝶椎未能明确诊断,MRI诊断符合率为89%(17/19).7例超声显示椎管局部增宽的胎儿中,产前超声正确诊断0例,符合率为0,MRI正确诊断7例,符合率为7/7.4例超声显示脊柱曲度异常的胎儿中,产前超声正确诊断2例,为尾退化综合征和颈椎过度反曲各1例,符合率为2/4,MRI正确诊断3例,只有1例背侧皮毛窦未能正确诊断,MRl诊断符合率为3/4.(2)MRI的优势:MRI与超声诊断一致9例、纠正超声诊断6例、确诊超声可疑的诊断1例、完善超声诊断11例,MRI和超声均漏诊半椎体、蝴蝶椎和背侧皮毛窦各1例.超声漏诊病例多为脊髓病变,且声像图表现无特异性.结论 MRI可直接显示脊髓及其病变,在评价胎儿脊柱与脊髓发育异常方面是对超声显像的补充,能显著提高诊断的准确性.

Comparative study on diagnosis of fetal dysplasia of spine and spinal cord between B ultrasonography and magnetic resonance imaging

Objective To compare the value of ultrasound and magnetic resonance imaging (MRI) in detecting fetal spine and spinal cord dysplasia Methods Thirty women with complicated pregnancies,age from 22 to 41 years,gestation from 23 - 38 weeks,were studied with MRI within 72 hours after ultrasound studies and revealed 19 cases of fetal spine with irregular,7 cases of vertebral canal widened partly and 4 cases of anomalies of spinal curvature.Autopsy or imaging was conducted when pregnancy was terminated.A close follow-up was given for cases continuing pregnancy within 12 months after delivery.Results (1)Nineteen cases of fetal spine with irregular in ultrasound,the coincidence of antenatal sonographic diagnosis was 42% (8/19),the coincidence of antenatal MRI diagnosis was 89% (17/19).Seven cases of vertebral canal widened partly in ultrasound,the coincidence of antenatal sonographic diagnosis was 0,the coincidence of antenatal MRI diagnosis was 7/7.Four cases of anomalies of spinal curvature in ultrasound,the coincidence of antenatal sonographic diagnosis was 2/4,the coincidence of antenatal MRI diagnosis was 3/4.(2)By MRI study,one cases were conformed their ultrasound diagnosis,eleven cases were completed their ultrasound diagnosis,nine cases were made the same diagnosis as ultrasound and six cases were corrected diagnosis.By MRI and ultrasound study one case of hemivertebra,one case of butterfly vertebra and one case of dorsal dermal sinus were missed diagnosis.Ultrasond had limits and low specificity especially in fetal spinal cord.Conclusions MRI can show the spinal cord and its lesion intuitively and has advantages in displaying fetal anomaly of spine and spinal cord.MRI is a valuable complement to sonography in difficult cases and diagnostic accuracy can be significantly improved.