产前超声联合MRI诊断胎儿先天性食管闭锁
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摘要
目的探讨产前超声联合MRI对胎儿先天性食管闭锁(CEA)的诊断价值。方法回顾性分析31胎经引产后尸体解剖或出生后手术及影像学检查证实的CEA胎儿(CEA组)的产前超声及MRI资料,并与31胎产后正常胎儿(正常对照组)进行对照。以病理结果为金标准,分析产前超声联合MRI诊断胎儿CEA的阳性率。比较2组间产前超声指标胎儿双顶径(BPD)、头围(HC)、腹围(AC)、股骨长(FL)、羊水深度(AFD)、羊水指数(AFI)、胎盘厚度、脐动脉峰谷比(S/D)、胎儿吞咽指数及估算胎儿体质量(EFW)的差异。结果产前超声联合MRI诊断胎儿CEA的阳性率为67.74%(21/31)。CEA组胎儿HC、AC、吞咽指数、EFW均低于正常对照组(P均<0.05),S/D、AFI均高于对照组(P均<0.05);2组间BPD、FL、AFD、胎盘厚度差异均无统计学意义(P均>0.05)。结论产前超声无法直接诊断胎儿CEA,当发现胃泡持续72h不显示(间隔72h复查)或羊水过多时,结合MRI对产前诊断胎儿CEA具有一定价值。产前超声指标中,胎儿HC、AC、AFI、S/D、吞咽指数、EFW可能对CEA具有一定提示作用。
Objective To investigate the value of prenatal ultrasound combined with MRI in diagnosis of congenital esophageal atresia(CEA)in fetus.Methods Prenatal ultrasound and MRI data of 31 CEA fetuses confirmed by autopsy,operation or imaging diagnosis of newborns(CEA group)were retrospectively analyzed.Meanwhile,31 normal fetuses(normal control group)were selected as controls.The positive rate of prenatal ultrasound combined with MRI for diagnosing fetal CEA was analyzed taking pathological results as gold standard.The differences of biparietal diameter(BPD),head circum ference(HC),abdominal circumference(AC),femur length(FL),amniotic fluid depth(AFD),amniotic fluid index(AFI),placental thickness,umbilical artery peak to valley ratio(S/D),fetal swallowing index and estimated fetal weight(EFW)were compared between the 2 groups.Results The positive rate of prenatal ultrasound combined with MRI for diagnosing fetal CEA was 67.74%(21/31).HC,AC,swallowing index and EFW in CEA group were lower than those in normal control group(all P<0.05),while S/D and AFI were higher than those in control group(both P<0.05).There was no statistical difference of BPD,FL,AFD nor placental thickness between the 2 groups(all P>0.05).Conclusion Prenatal ultrasound can not be used to directly diagnose fetal CEA.When the gastric vacuole did not continue to display(for 72 hours)or amniotic fluid is too much,combination with MRI is valuable for prenatal diagnosis of fetal CEA.Prenatal ultrasound parameters,such as fetal HC,AC,AFI,S/D,swallowing index and EFW,may have certain indication value in diagnosis of CEA.
Objective To investigate the value of prenatal ultrasound combined with MRI in diagnosis of congenital esophageal atresia(CEA)in fetus.Methods Prenatal ultrasound and MRI data of 31 CEA fetuses confirmed by autopsy,operation or imaging diagnosis of newborns(CEA group)were retrospectively analyzed.Meanwhile,31 normal fetuses(normal control group)were selected as controls.The positive rate of prenatal ultrasound combined with MRI for diagnosing fetal CEA was analyzed taking pathological results as gold standard.The differences of biparietal diameter(BPD),head circum ference(HC),abdominal circumference(AC),femur length(FL),amniotic fluid depth(AFD),amniotic fluid index(AFI),placental thickness,umbilical artery peak to valley ratio(S/D),fetal swallowing index and estimated fetal weight(EFW)were compared between the 2 groups.Results The positive rate of prenatal ultrasound combined with MRI for diagnosing fetal CEA was 67.74%(21/31).HC,AC,swallowing index and EFW in CEA group were lower than those in normal control group(all P<0.05),while S/D and AFI were higher than those in control group(both P<0.05).There was no statistical difference of BPD,FL,AFD nor placental thickness between the 2 groups(all P>0.05).Conclusion Prenatal ultrasound can not be used to directly diagnose fetal CEA.When the gastric vacuole did not continue to display(for 72 hours)or amniotic fluid is too much,combination with MRI is valuable for prenatal diagnosis of fetal CEA.Prenatal ultrasound parameters,such as fetal HC,AC,AFI,S/D,swallowing index and EFW,may have certain indication value in diagnosis of CEA.
引文
[1]刘雨函,蔡爱露,姜红霞,等.先天性食管闭锁的产前超声诊断现状与进展.中国医学影像技术,2009,25(9):1714-1716.
[2]Chalouhi GE,Kagan KO,Raine-Fenning NJ,et al.ISUOG Practice Guidelines:Performance of first-trimester fetal ultrasound scan.Ultrasound Obstet Gynecol,2013,41(1):102-113.
[3]罗德清,陈欣林,朱霞,等.产前超声和MRI在诊断胎儿畸形中的应用.中国医学影像技术,2016,32(4):586-590.
[4]Bowie JD,Clair MR.Fetal swallowing and regurgitation:Observation of normal and abnormal activity.Radiology,1982,144(4):877-878.
[5]仇利,罗红.产前超声筛查中孕期胎儿心脏畸形对诊断染色体异常价值的Meta分析.中国介入影像与治疗学,2016,13(12):747-752.
[6]李樱子,陈永卫.先天性食管闭锁并气管食管瘘病因的胚胎学探讨.中华小儿外科杂志,2005,26(7):382-385.
[7]Spaggiari E,Faure G,Rousseau V,et al.Performance of prenatal diagnosis in esophageal atresia.Prenat Diagn,2015,35(9):888-893.
[8]Gary F,John C,Kenneth J,et al.Williams obstetrics.22nd ed.New York:MCGraw-Hill,2005:91-121.
[9]Ibrahim AHM,Malki TAA.Congenital esophageal stenosis associated with esophageal atresia//Till H,Thomson M,Foker JE,et al.Esophageal and gastric disorders in infancy and childhood.Heidelberg:Springer Berlin,2017:211-215.
[10]刘雨函,蔡爱露,姜红霞,等.产前超声诊断先天性食管闭锁.中国医学影像技术,2010,21(9):528-528.
[11]林开武,周作福,吴典明,等.MSCT及后处理技术诊断食管闭锁并气管食管瘘.中国介入影像与治疗学,2013,10(7):393-396.
[12]Sfeir R,Bonnard A,Khendunlop N,et al.Esophageal atresia:Data from a national cohort.J Pediatr Surg,2013,48(8):1664.
[13]卢丹,陈欣林,陈常佩.产前超声诊断胎儿食管闭锁的探讨.中国医学影像技术,2008,24(5):718-720.
[14]Salomon LJ,Sonigo P,Ou P,et al.Real-time fetal magnetic resonance imaging for the dynamic visualization of the pouch in esophageal atresia.Ultrasound Obstet Gynecol,2009,34(4):471-474.
[2]Chalouhi GE,Kagan KO,Raine-Fenning NJ,et al.ISUOG Practice Guidelines:Performance of first-trimester fetal ultrasound scan.Ultrasound Obstet Gynecol,2013,41(1):102-113.
[3]罗德清,陈欣林,朱霞,等.产前超声和MRI在诊断胎儿畸形中的应用.中国医学影像技术,2016,32(4):586-590.
[4]Bowie JD,Clair MR.Fetal swallowing and regurgitation:Observation of normal and abnormal activity.Radiology,1982,144(4):877-878.
[5]仇利,罗红.产前超声筛查中孕期胎儿心脏畸形对诊断染色体异常价值的Meta分析.中国介入影像与治疗学,2016,13(12):747-752.
[6]李樱子,陈永卫.先天性食管闭锁并气管食管瘘病因的胚胎学探讨.中华小儿外科杂志,2005,26(7):382-385.
[7]Spaggiari E,Faure G,Rousseau V,et al.Performance of prenatal diagnosis in esophageal atresia.Prenat Diagn,2015,35(9):888-893.
[8]Gary F,John C,Kenneth J,et al.Williams obstetrics.22nd ed.New York:MCGraw-Hill,2005:91-121.
[9]Ibrahim AHM,Malki TAA.Congenital esophageal stenosis associated with esophageal atresia//Till H,Thomson M,Foker JE,et al.Esophageal and gastric disorders in infancy and childhood.Heidelberg:Springer Berlin,2017:211-215.
[10]刘雨函,蔡爱露,姜红霞,等.产前超声诊断先天性食管闭锁.中国医学影像技术,2010,21(9):528-528.
[11]林开武,周作福,吴典明,等.MSCT及后处理技术诊断食管闭锁并气管食管瘘.中国介入影像与治疗学,2013,10(7):393-396.
[12]Sfeir R,Bonnard A,Khendunlop N,et al.Esophageal atresia:Data from a national cohort.J Pediatr Surg,2013,48(8):1664.
[13]卢丹,陈欣林,陈常佩.产前超声诊断胎儿食管闭锁的探讨.中国医学影像技术,2008,24(5):718-720.
[14]Salomon LJ,Sonigo P,Ou P,et al.Real-time fetal magnetic resonance imaging for the dynamic visualization of the pouch in esophageal atresia.Ultrasound Obstet Gynecol,2009,34(4):471-474.