本文關(guān)鍵詞：MRI定量分析胎兒后顱窩結(jié)構(gòu)的臨床價(jià)值　出處：《寧夏醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 胎兒 磁共振 正中矢狀面 后顱窩畸形

【摘要】：目的:應(yīng)用MRI獲得通過胎兒蚓部的正中矢狀面,觀察胎兒后顱窩結(jié)構(gòu),測(cè)量胎兒小腦蚓部上下徑、前后徑、面積及BV角、BT角,研究其隨孕周進(jìn)展的變化規(guī)律,為MRI評(píng)估胎兒后顱窩結(jié)構(gòu)的發(fā)育提供影像學(xué)參考標(biāo)準(zhǔn)。分析常見后顱窩畸形胎兒的上述測(cè)值與正常胎兒的差異性,探討胎兒顱腦MRI正中矢狀面后顱窩測(cè)值在常見后顱窩畸形診斷及鑒別診斷中的臨床應(yīng)用價(jià)值。方法:選擇2013年1月至2016年12月在我院行胎兒產(chǎn)前超聲篩查及MRI檢查,未發(fā)現(xiàn)中樞神經(jīng)系統(tǒng)異�；騼H側(cè)腦室輕度擴(kuò)張,追蹤至分娩后無(wú)明顯異常的中晚孕周胎兒123例。應(yīng)用胎兒顱腦MRI觀察后顱窩結(jié)構(gòu)及相鄰結(jié)構(gòu)間的毗鄰關(guān)系,將原始MRI圖像傳至隨機(jī)后處理工作站ADW4.4,選擇通過蚓部的正中矢狀面,利用測(cè)量工具手動(dòng)描繪并分別測(cè)量胎兒小腦蚓部上下徑、前后徑、面積及BV角、BT角,分析以上測(cè)量指標(biāo)與孕周的關(guān)系。選擇同期產(chǎn)前超聲及MRI檢查,擬診為后顱窩畸形(包括DWM、IVH、MCM)的中晚孕胎兒25例。應(yīng)用相同方法觀察后顱窩結(jié)構(gòu)和測(cè)量后顱窩各觀察指標(biāo),同時(shí)注意觀察是否合并其他畸形,分別與正常組后顱窩測(cè)量值對(duì)比觀察。結(jié)果:1.正常組胎兒顱腦MRI后顱窩結(jié)構(gòu)示:小腦蚓部連接兩側(cè)小腦半球,覆蓋第四腦室,正中矢狀面上幾乎與腦干平行,外形飽滿、略呈“心”形,第四腦室頂部呈銳角,小腦蚓部原裂顯示清晰,大致位于正中矢狀面蚓部2點(diǎn)鐘位置,次裂在25周后見,較原裂顯示清晰度差,約在正中矢狀面蚓部5點(diǎn)鐘位置,在孕30周后小腦蚓部各分葉清晰可見,原裂、次裂及其它小裂隙可辨。2.123例正常胎兒顱腦MRI正中矢狀面上小腦蚓部各觀察指標(biāo)(上下徑、前后徑及面積)的測(cè)值與孕周呈高度正相關(guān)(R2=0.911、0.839、0.947,P均0.01),正常胎兒BV角、BT角平均值分別為5.77°±2.73°、28.58°±6.60°,BV角及BT角的測(cè)值與孕周均不相關(guān)(R2=0.011、0.043,P均0.05)。3.異常組25例,其中DWM胎兒3例(全部引產(chǎn))、IVH胎兒7例(6例引產(chǎn)、1例出生后1歲隨訪智力低下)和MCM胎兒15例(出生后3個(gè)月至2歲隨訪正常)。3例DWM胎兒的小腦蚓部各測(cè)量指標(biāo)的Z分?jǐn)?shù)均小于-5,BV角的Z分?jǐn)?shù)均大于10,BT角的Z分?jǐn)?shù)均大于2;7例IVH胎兒的小腦蚓部各測(cè)量指標(biāo)的Z分?jǐn)?shù)均小于-3,BV角的Z分?jǐn)?shù)均大于5,BT角的Z分?jǐn)?shù)均1.96;15例MCM胎兒的后顱窩各測(cè)量指標(biāo)(上下徑、前后徑、面積、BV角及BT角)的Z分?jǐn)?shù)在-1.96~1.96之間。結(jié)論:1.胎兒顱腦MRI獲得的正中矢狀面能清晰顯示小腦蚓部、第四腦室、后顱窩池的大小、形態(tài)及腦干、小腦幕與小腦蚓部的毗鄰關(guān)系,為后顱窩畸形的診斷提供更多直接征象。2.正常胎兒小腦蚓部各觀察指標(biāo)隨孕周增長(zhǎng)而增大,測(cè)量這些指標(biāo)并建立孕周參考值,可幫助定量評(píng)估胎兒后顱窩小腦蚓部的發(fā)育狀況。正常胎兒BV角、BT角平均值分別為5.77°±2.73°、28.58°±6.60°,BV角11.12°時(shí)可以認(rèn)為小腦蚓部上旋,BT角41.51°時(shí)可以認(rèn)為小腦幕上抬。3.DWM胎兒顱腦MRI正中矢狀面后顱窩各觀察指標(biāo)測(cè)值提示小腦蚓部發(fā)育不良程度重,小腦蚓部上旋嚴(yán)重,小腦幕輕度上抬;IVH胎兒顱腦MRI正中矢狀面后顱窩各觀察指標(biāo)測(cè)值提示小腦蚓部發(fā)育不良程度較輕,小腦蚓部輕度上旋,小腦幕上抬不明顯;MCM胎兒顱腦MRI正中矢狀面后顱窩各觀察指標(biāo)測(cè)值提示小腦蚓部發(fā)育、小腦蚓部及小腦幕位置與正常組無(wú)顯著差異。4.在胎兒顱腦MRI正中矢狀面上仔細(xì)觀察后顱窩結(jié)構(gòu)及相鄰結(jié)構(gòu)間的毗鄰關(guān)系,測(cè)量胎兒后顱窩各觀察指標(biāo)可幫助定量評(píng)估小腦蚓部的發(fā)育情況,用于常見后顱窩畸形的診斷與鑒別診斷。
[Abstract]:Objective: the application of MRI obtained by fetal vermis median sagittal plane, fetal posterior fossa structures, measurement of fetal cerebellar vermis on diameter, anteroposterior diameter, area and BV angle, BT angle, the research progress of its changes with gestational weeks, MRI assessment of fetal posterior fossa structures for development the imaging reference standard. The measured value of normal fetal sex differences and analysis of common posterior fossa malformations of the fetus, fetal brain MRI on the median sagittal plane of posterior fossa measurements in common posterior fossa malformations in diagnosis and differential diagnosis of clinical value. Methods: from January 2013 to December 2016 in our hospital for prenatal ultrasonography and MRI examination, no central nervous system abnormalities or only mild ventriculomegaly, to track after delivery with no obvious abnormality in the late gestation fetal 123 cases. Application of fetal brain MRI observation of posterior fossa structure and adjacent relationship between two adjacent structures, the The original MRI images were randomly selected by ADW4.4 postprocessing workstation, vermis of the midsagittal plane, manual and description of fetal cerebellar vermis on diameter and anteroposterior diameter were measured using measurement tools, area and BV angle, BT angle, analysis the above measurement index relationship with gestational age. Selected prenatal ultrasound and MRI, diagnosed as posterior fossa malformations (including DWM, IVH, MCM) in 25 cases of late pregnancy fetus. To observe the application of the same method of posterior fossa and posterior fossa structure measurement of the observed indicators, and observe whether associated with other malformations, compared with normal posterior fossa measurements were compared. Results: 1. fetal brain MRI group of posterior fossa structures in the cerebellar vermis cerebellum connected, covering the fourth ventricle, the median sagittal plane almost parallel with the brain stem, plump shape, slightly "heart shaped", at the top of the fourth ventricle was acute, cerebellar vermis primary fissure shows clear, large 鑷翠綅浜庢涓煝鐘墮潰铓撻儴2鐐歸挓浣嶇疆,嬈¤鍦，

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