上海交通大学学报（医学版）

›› 2011, Vol. 31 ›› Issue (9): 1299-.doi: 10.3969/j.issn.1674-8115.2011.09.020

• 论 著 • 上一篇    下一篇

胎儿胸腔异常心脏位置的产前磁共振成像诊断

董素贞1, 朱 铭1, 李 奋2, 钟玉敏1, 张 弘1, 潘慧红1   

  1. 上海交通大学 医学院附属上海儿童医学中心 1.放射科, 2.心内科, 上海 200127
  • 出版日期:2011-09-28 发布日期:2011-09-27
  • 通讯作者: 李 奋, 电子信箱: lifen_88@yahoo.com.cn。
  • 作者简介:董素贞（1979—）, 女, 主治医师, 博士生；电子信箱: dongsuzhen@126.com。
  • 基金资助:

    国家自然科学基金（30970795）；上海高校选拔培养优秀青年教师科研专项基金（jdy08062）

Prenatal magnetic resonance imaging in evaluation of fetal cardiac malposition

DONG Su-zhen1, ZHU Ming1, LI Fen2, ZHONG Yu-min1, ZHANG hong1, PAN Hui-hong1   

  1. 1.Department of Radiology, 2.Department of Pediatric Cardiology, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai 200127, China
  • Online:2011-09-28 Published:2011-09-27
  • Supported by:

    National Natural Science Foundation of China, 30970795；Special Fund for Outstanding Young Teachers in Colleges of Shanghai, jdy08062

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摘要：

目的 探讨产前磁共振成像(MRI)在胎儿胸腔异常心脏位置诊断中的应用价值。方法 57例孕妇，孕龄20～36周。产前常规行超声检查后24～48 h内行MRI检查，采用二维快速平衡稳态采集(2D FIESTA) 序列、单次激发快速自旋回波（SSFSE）序列、快速反转恢复运动抑制（FIRM）序列以及动态FIESTA序列，行胎儿颅脑、胸部腹部常规及胸部（肺、心脏）重点冠状面、矢状面及横断面扫描，将产前MRI、超声表现与出生后影像表现或手术（n=49）、引产后尸体解剖结果（n=8）对照。结果 原发性心脏位置异常即右位心5例；继发性心脏位置异常52例，其中右肺发育不良7例、先天性膈疝（CDH）18例、先天性肺囊腺瘤样畸形（CCAM）24例、支气管肺隔离症（BPS）2例和纵隔占位1例。结论 MRI各序列综合应用在胎儿胸腔异常心脏位置及病因诊断方面具有一定的应用价值；FIESTA序列同一切面能同时显示异常心脏位置和导致其异常的胸部其他病变，动态FIESTA序列能动态显示较明显的心脏血流异常；SSFSE和FIRM序列能较好显示引起心脏位置异常的其他胸部病变。

关键词: 胎儿, 心脏, 位置异常, 磁共振成像

Abstract:

Objective To explore the diagnostic value of magnetic resonance imaging (MRI) on fetal cardiac malposition. Methods MRI examinations were performed 24 to 48 h after routine ultrasound examinations on 57 pregnant women with gestation of 20 to 36 weeks. The imaging protocols included 2 dimension fast imaging employing steady-state acquisition (2D FIESTA), single-shot fast spin echo (SSFSE), T1-weighted fast inversion recovery motion insensitive (FIRM) and dynamic FIESTA sequences in the axial, frontal and sagittal planes relative to the fetal brain, thorax, abdomen, especially lung and heart. Prenatal ultrasound and MRI findings were compared with postnatal diagnoses (n=49) or autopsy (n=8). Postnatal evaluation included a variety of imaging and surgery. Results There were 5 cases of primary fetal cardiac malposition (dextrocardia) and 52 cases of secondary fetal cardiac malposition. The causes of secondary cardiac malposition included right pulmonary hypoplasia (n=7), congenital diaphragmatic hernia (CDH, n=18), congenital cystic adenomatoid malformation (CCAM, n=24), bronchopulmonary sequestration (BPS, n=2) and mediastinal mass (n=1). Conclusion Prenatal MRI is effective in the assessment of fetal cardiac malposition and its causes with the integrated application of sequences. The same section of FIESTA sequence can reveal the abnormal position of fetal heart and other chest lesions causing changes in fetal heart position. Dynamic FIESTA sequence can demonstrate obvious abnormal cardiac blood flow. Both SSFSE and FIRM sequences can well display other chest abnormalities causing changes in fetal heart position.

Key words: fetus, heart, malposition, magnetic resonance imaging