胎儿肺囊性病变的磁共振表现
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摘要
目的:探讨产前MRI在诊断胎儿肺囊性病变中的应用价值。方法:回顾性分析30例产前诊断为胎儿肺囊性病变(主要为先天性肺气道畸形、肺隔离症、支气管源性囊肿、先天性支气管闭锁)的MRI表现,并与超声、随访结果进行对照分析。结果:30例病变MRI定位于左肺18例,右肺12例;诊断为先天性肺气道畸形23例,肺隔离症5例,左侧胸腔积液伴左肺信号不均1例,先天性肺气道畸形合并肺隔离症1例;均表现为快速稳态场回波序列或单次激发快速自旋回波序列高信号、快速翻转恢复运动抑制序列低信号。出生后手术病理证实的16例病灶中,7例先天性肺气道畸形,边缘多呈分叶状,内部多为大小不一的囊;4例肺隔离症均位于左肺下叶,3例可见体循环血管分支进入病灶;3例支气管源性囊肿中部分病变与气管或支气管关系密切;1例纵隔淋巴管畸形,向纵隔内胸腺前后间隙延伸,呈爬行性生长;1例先天性支气管闭锁,呈团状,边缘光整,内部信号均匀;以病理结果为标准,MRI产前定位准确率为87.50%,定性准确率为62.50%,而超声产前定位准确率为87.50%,定性准确率为43.75%。3例在产前超声随访中病灶自行消退;11例在随访中的病灶未自行消退且未行手术治疗。结论:产前MRI是胎儿超声有效的补充手段,能多方位地显示胎儿肺囊性病变,有助于鉴别诊断。
Objective:To illustrate the value of prenatal MRI in diagnosing fetal cystic lung diseases.Methods:MR manifestations of thirty cases with cystic lung diseases in fetuses were analyzed retrospectively,including congenital pulmonary airway malformation,pulmonary sequestration,congenital atresia of bronchus and bronchogenic cyst.Prenatal ultrasound(US)and MR imaging findings were compared with pathological results.Results:Among the 30 cases,18 cases were on the left side and 12 cases were on the right side;with 23 cases of congenital pulmonary airway malformation,5 cases of pulmonary sequestration,one case of pleural effusion and one case of pulmonary sequestration with congenital pulmonary airway malformation,respectively.MRI singal features of the thirty cases were hypointense signal on fast IR motion insensitive and hyperintense signal on fast imaging employing steady-state acquisition or single shot FSE.Among them,16 cases were confirmed as cystic lung diseases by the operation pathology:7 cases were congenital pulmonary airway malformation which had a lobulated margin and multiple cysts;4 cases were pulmonary sequestration on the left lower lobe,3 cases were supplied with arterial system blood originating from the aorta;3 cases were bronchogenic cyst,one of the lesions was close to the windpipe;one case was lymphatic malformation centered in the mediastinum and extended into the anterior and posterior spaces of the thymus;and one case was congenital atresia of bronchus with the smooth margin.Compared with surgical and pathological results,MRI was 87.50% accurate in antenatal location and 62.50% accurate in antenatal diagnosis,while US was 87.50%and 43.75%respectively.3 cases disappeared in the follow-up of US,while 11 cases remained and performed no surgical treatment.Conclusion:MRI plays an important role in displaying and diagnosing cystic lung diseases as a complemental method,which can provide more information for clinical diagnosis and treatment.
Objective:To illustrate the value of prenatal MRI in diagnosing fetal cystic lung diseases.Methods:MR manifestations of thirty cases with cystic lung diseases in fetuses were analyzed retrospectively,including congenital pulmonary airway malformation,pulmonary sequestration,congenital atresia of bronchus and bronchogenic cyst.Prenatal ultrasound(US)and MR imaging findings were compared with pathological results.Results:Among the 30 cases,18 cases were on the left side and 12 cases were on the right side;with 23 cases of congenital pulmonary airway malformation,5 cases of pulmonary sequestration,one case of pleural effusion and one case of pulmonary sequestration with congenital pulmonary airway malformation,respectively.MRI singal features of the thirty cases were hypointense signal on fast IR motion insensitive and hyperintense signal on fast imaging employing steady-state acquisition or single shot FSE.Among them,16 cases were confirmed as cystic lung diseases by the operation pathology:7 cases were congenital pulmonary airway malformation which had a lobulated margin and multiple cysts;4 cases were pulmonary sequestration on the left lower lobe,3 cases were supplied with arterial system blood originating from the aorta;3 cases were bronchogenic cyst,one of the lesions was close to the windpipe;one case was lymphatic malformation centered in the mediastinum and extended into the anterior and posterior spaces of the thymus;and one case was congenital atresia of bronchus with the smooth margin.Compared with surgical and pathological results,MRI was 87.50% accurate in antenatal location and 62.50% accurate in antenatal diagnosis,while US was 87.50%and 43.75%respectively.3 cases disappeared in the follow-up of US,while 11 cases remained and performed no surgical treatment.Conclusion:MRI plays an important role in displaying and diagnosing cystic lung diseases as a complemental method,which can provide more information for clinical diagnosis and treatment.
引文
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[18]Yu-Peng Liu,Chih-Ping Chen,Shin-Lin Shih,et al.Fetal cystic lung lesions:evaluation with magnetic resonance imaging[J].Pediatric Pulmonology,2010,45(6):592-600.
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[20]Lu D,Wang Y,Zeng W,et al.Giant fetal lymphangioma at chest wall and prognosis:case report and literature review[J].Taiwan J Obstet Gynecol,2015,54(1):62-65.
[21]Durukan H,Ilay G9zükara,Cevikoglu M,et al.Isolated fetal lymphatic malformation of the thigh:prenatal diagnosis and followup[J].Autopsy&Case Reports,2017,7(1):49-53.
[22]王颖,李晓艳.小儿头颈部淋巴管畸形的诊断及治疗进展[J].临床耳鼻咽喉头颈外科杂志,2015,29(11):1049-1052.
[23]Kyncl M,Koci M,Ptackova L,et al.Congenital bronchopulmonary malformation:CT histopathological correlation.[J].Biomedical Papers of the Medical Faculty of the University Palacky Olomouc Czechoslovakia,2016,160(4):533-537.
[2]潘知焕,金微瑛,翁翠叶,等.先天性肺囊性腺瘤样畸形15例临床、影像及病理特点[J].中华实用儿科临床杂志,2016,31(4):299-301.
[3]汪颖南,顾依群,张晓波,等.胎儿先天性肺气道畸形的临床病理分析[J].中华病理学杂志,2015,4(4):266-269.
[4]Victoria T,Srinivasan AS,Pogoriler J,et al.The rare solid fetal lung lesion with T2-hypointense components:prenatal imaging findings with postnatal pathological correlation[J].Pediatric Radiology,2018,48(11):1-11.
[5]舒艳,朱坤,汤宏峰,等.儿童先天性肺气道畸形73例临床病理分析[J].临床与病理杂志,2015,35(10):1773-1777.
[6]沈敏,江魁明,谭昱,等.胎儿先天性肺囊腺瘤样畸形的MRI诊断[J].中国临床医学影像杂志,2016,27(7):502-505.
[7]刘锋,关键,刘树学,等.胎儿肺隔离症的MRI诊断[J].放射学实践,2014,29(05):560-563.
[8]肖祎炜,洪淳,尚宁,等.胎儿支气管源性囊肿的产前超声诊断探讨[J].中国超声医学杂志,2016,32(8):761-764.
[9]Maurin S,Hery G,Bourliere B,et al.Bronchogenic cyst:clinical course from antenatal diagnosis to postnatal thoracoscopic resection[J].J Minimal Access Surgery,2013,9(1):25-28.
[10]杨朝湘,陈文俊,沈敏,等.胎儿纵隔型支气管源性囊肿的MRI诊断(3例报道并文献复习)[J].中国产前诊断杂志:电子版,2016,8(2):34-38.
[11]Biyyam DR,Chapman T,Ferguson MR,et al.Congenital lung abnormalities:embryologic features,prenatal diagnosis,and postnatal radiologic-pathologic correlation[J].Radiographics,2010,30(6):1721-1738.
[12]Poupalou A,Varetti C,Lauron G,et al.Perinatal diagnosis and management of congenital bronchial stenosis or atresia:4cases[J].J Thoracic&Cardiovascular Surgery,2011,141(1):e11-e14.
[13]Kuhn C,Kuhn JP.Coexistence of bronchial atresia and bronchogenic cyst:diagnostic criteria and embryologic considerations[J].Pediatric Radiology,1992,22(8):568-570.
[14]Alamo L,Vial Y,Gengler C,et al.Imaging findings of bronchial atresia in fetuses,neonates and infants[J].Pediatric Radiology,2016,46(3):383-390.
[15]杨朝湘,沈敏,陈文俊,等.MRI诊断胎儿支气管闭锁1例并文献复习[J].中国产前诊断杂志:电子版,2016,8(4):76-77.
[16]Coakley FV,Lopoo JB,Lu Y,et al.Normal and hypoplastic fetal lungs:volumetric assessment with prenatal single-shot rapid acquisition withrelaxation enhancement MR imaging[J].Radiology,2000,216(1):107-111.
[17]Kasprian G,Balassy C,Brugger PC,et al.MRI of normal and pathological fetal lung development[J].Eur J Radiol,2006,57(2):261-270.
[18]Yu-Peng Liu,Chih-Ping Chen,Shin-Lin Shih,et al.Fetal cystic lung lesions:evaluation with magnetic resonance imaging[J].Pediatric Pulmonology,2010,45(6):592-600.
[19]HadchouelduvergéA,Lezmi G,De BJ,et al.Congenital lung malformations:natural history and pathophysiological mechanisms[J].Revue Des Maladies Respiratoires,2012,29(4):601-611.
[20]Lu D,Wang Y,Zeng W,et al.Giant fetal lymphangioma at chest wall and prognosis:case report and literature review[J].Taiwan J Obstet Gynecol,2015,54(1):62-65.
[21]Durukan H,Ilay G9zükara,Cevikoglu M,et al.Isolated fetal lymphatic malformation of the thigh:prenatal diagnosis and followup[J].Autopsy&Case Reports,2017,7(1):49-53.
[22]王颖,李晓艳.小儿头颈部淋巴管畸形的诊断及治疗进展[J].临床耳鼻咽喉头颈外科杂志,2015,29(11):1049-1052.
[23]Kyncl M,Koci M,Ptackova L,et al.Congenital bronchopulmonary malformation:CT histopathological correlation.[J].Biomedical Papers of the Medical Faculty of the University Palacky Olomouc Czechoslovakia,2016,160(4):533-537.