MRI在胎儿肾积水诊断中应用.docVIP

MRI在胎儿肾积水诊断中应用 　　【摘要】目的：探讨磁共振成像（MRI）对胎儿肾积水的诊断价值。方法：回顾性分析60例肾积水随访胎儿的MRI,孕龄21～37周,平均29周, 并将MRI、US结果与引产后或出生后随访结果对照。结果：双侧11例、单侧49例；轻度肾积水31例，中度肾积水12例，重度肾积水17例，其中双侧重度肾积水2例引产，余58例均出生，轻度积水的胎儿中有22例产后随访积水消失。结论：MRI是胎儿肾积水较有价值的产前影像诊断方法。能提供超声以外的信息,发挥超声的重要补充作用,尤其是超声显示不清时。 　　【关键词】胎儿；肾；肾积水； 磁共振成像 　　【中图分类号】R445.1 【文献标识码】A 【文章编号】1008-6455（2011）12-0518-02 　　Diagnosis of fetal hydronephrosis by MRI 　　Shi Meihua Zhu Ming Dong Suzhen Zhong Qingwen 　　【Abstract】Objective：To explore the diagnostic value of MRI on fetal hydronephrosis. Methods：Sixty pregnant women,with gestation from 21to 37 weeks（average 29 weeks）were studied with a 1.5 T superconductive MR unit after ultrasound studies. Prenatal US and MR imaging findings were compared with postnatal diagnoses or autopsy. Results：60 cases of fetal hydronephrosis include 11 cases of bilateral hydronephrosis and 49 cases of unilateral hydronephrosis;31 cases with mild hydronephrosis,moderate hydronephrosis in 12 cases and 17 cases of severe hydronephrosis. 2 cases of severe fetal hydronephrosis were induced, other 58 fetuses were born. 22 cases of mild hydronephrosis disappeared by postnatal follow-up.Conclusion：Prenatal MRI is effective in the assessment of fetal hydronephrosis. It can provide additional information to the US-determined diagnosis. Preatal MRI is an additional means of ultrasound,especially when the ultrasound showed unclear. 　　【Key words】Fetus; kidney; hydronephrosis; Magnetic resonance imaging 　　胎儿肾积水相对常见，据文献报道超声产前筛选胎儿肾积水发病率为0.2%～2.2%〖1〗，国内尚缺乏此方面确切报道。超声是胎儿肾积水首选产前影像学诊断方法,但超声由于存在声衰减、视野小、需羊水无回声衬托等局限性，当母体肥胖、合并子宫肌瘤、双胎及多胎、羊水过少等时难以清晰显示胎儿〖2〗。快速磁共振技术的发展使得磁共振成像（Magnetic resonance imaging,MRI）逐渐应用于胎儿,因其具有较大的视野、较好的软组织对比度、不受羊水多少的影响,已有研究表明其在胎儿中枢神经系统异常诊断方面优于超声。本研究回顾性对照分析60例肾积水胎儿的产前MRI,分析MRI在诊断胎儿肾积水方面的应用。 　　1 临床资料和方法 　　1.1 临床资料:回顾性分析2005年8月～2010年8月我院60例肾积水胎儿的MRI,并将胎儿出生后MRI（US、CT）与产前MRI、产前US对照。孕妇年龄21～37岁,平均28岁；孕龄21周～39周,平均29周。全部病例US筛查后48 h内行MR检查。 　　1.2 MRI检查方法:产前例行超声检查发现肾积水后24h内行MR检查,使用GE Echospeed 1.5T MR成像仪,梯度场强度33mT?m-1?s-1，采