胎儿肠梗阻的MRI诊断

发布时间：2018-04-16 17:56

本文选题：胎儿疾病 + 磁共振成像　；参考：《磁共振成像》2017年02期

【摘要】：目的观察胎儿期肠梗阻MRI表现,结合生后手术史及病理学诊断,探讨MRI对胎儿期肠梗阻的诊断价值。材料与方法回顾性分析胎儿期肠梗阻病例26例,胎龄为孕23~35 w,均先行胎儿超声检查后再行胎儿MRI平扫。采用2D快速平衡稳态进动序列(2D fast imaging employ steady acquisition,2D FIESTA)、单次激发快速自旋回波(single-shot fast spin echo,SSFSE)序列、快速反转恢复运动抑制序列T1WI(fast inversion recovery motion insensitive T1WI,FIRM T1WI)和弥散加权成像(diffusion weighted imaging,DWI)序列。根据梗阻部位、梗阻区肠管信号改变、梗阻远端肠道充盈情况、肠系膜血管异常等进行影像学诊断,并观察继发改变如腹水、羊水增多等,随访出生情况及手术治疗结果,分析MRI诊断的正确率及漏诊率,探讨MRI各序列在胎儿肠梗阻诊断中的优势。结果 26例肠梗阻胎儿中:十二指肠/空肠狭窄或闭锁16例,其中4例伴十二指肠和空肠旋转不良;胎粪性小肠梗阻4例,其中2例继发肠扭转致肠缺血坏死;肛门闭锁4例;结肠狭窄或闭锁1例;先天性巨结肠1例。所有胎儿均伴有不同程度羊水增多,部分病例伴腹水、心包积液及睾丸鞘膜积液;2例为单脐动脉。MRI诊断正确率为92.3%(24/26),误诊率为7.7%(2/26)。MRI能清楚显示胎儿肠梗阻部位,观测肠管扩张的程度。SSFSE序列可显示系膜血管受累,FIRM T1WI序列有助于结肠梗阻的诊断,DWI序列可提示梗阻肠管缺血和出血的改变。结论胎儿期肠梗阻MRI图像有特征性改变,可以判断受累肠管的发生部位、梗阻程度和合并症等,对产前诊断和出生后手术治疗有重要参考价值。
[Abstract]:Objective to investigate the diagnostic value of MRI in fetal intestinal obstruction by observing the MRI manifestations of fetal intestinal obstruction and combining with postnatal surgical history and pathological diagnosis.Materials and methods 26 cases of fetal intestinal obstruction at the gestational age of 2335 weeks were retrospectively analyzed. Fetal MRI scan was performed after fetal ultrasound examination.2D fast imaging employ steady acquisition sequence (2D fast imaging employ steady acquisition sequence), single-shot fast spin echo (SSFSE) sequence, T1WI(fast inversion recovery motion insensitive T1WII (FIRM T1WI) sequence and diffusion weighted imaging weighted imaging (DWI) sequence were used.According to the location of obstruction, the changes of intestinal tract signal, the filling of distal intestinal tract, the abnormality of mesenteric vessels, and so on, the secondary changes such as ascites, amniotic fluid were observed, and the results of birth and operation were observed.The diagnostic accuracy and missed diagnosis rate of MRI were analyzed, and the advantages of MRI sequences in diagnosis of fetal intestinal obstruction were discussed.Results among 26 cases of intestinal obstruction, 16 cases were duodenal / jejunal stenosis or atresia, 4 cases were accompanied with duodenal and jejunal malrotation, 4 cases were meconium small bowel obstruction, 2 cases were secondary intestinal torsion, 4 cases were anal atresia.One case was colonic stenosis or atresia and one case was Hirschsprung's disease.All fetuses were accompanied with amniotic fluid increase of varying degrees. In some cases, ascites, pericardial effusion and testicular hydrocele were diagnosed correctly in 2 cases as single umbilical artery. MRI was 92. 3% 24 / 26%. Misdiagnosis rate as 7.7%(2/26).MRI could clearly show the location of fetal intestinal obstruction.Observing the degree of intestinal dilatation. SSFSE sequence can show that the T1WI sequence of Mesangial vascular involvement can be helpful to the diagnosis of colonic obstruction.Conclusion the MRI images of fetal intestinal obstruction have characteristic changes, which can be used to judge the location, degree of obstruction and complications of the involved intestinal duct. It has important reference value for prenatal diagnosis and postnatal surgical treatment.
【作者单位】：河北医科大学第二医院医学影像科;河北医科大学第二医院妇七科;河北医科大学第二医院小儿外科;
【分类号】：R445.2;R714.5

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