【摘要】：目的： 依據不同孕周胎兒標本與宮內胎兒MR掃描圖像,尋找脊髓圓錐末端位置、腰骶膨大左右徑、前后徑及相應層面椎管左右徑及前后徑隨孕周變化的規(guī)律,對比標本圖像與宮內圖像的差異。了解胎兒腰骶膨大發(fā)育狀況及脊髓移行過程與孕周的關系,從而,制定各孕周胎兒脊髓腰骶膨大發(fā)育及脊髓移行生長曲線及參考值,對評估胎兒發(fā)育及早期發(fā)現先天脊椎發(fā)育畸形及椎管內病變提供可靠、直觀的影像數據及圖譜。 材料和方法： 1.胎兒標本選擇與MR數據獲取本課題共篩選了29例脊椎發(fā)育正常的胎兒標本作為研究對象,胎齡大小范圍自17孕周至39孕周,所有研究對象均接受3.0TMR(general electric, GE)脊椎掃描,以腰椎為中心,獲取標準橫、矢、冠三方位斷層圖像。掃描序列為T2WI (TR:11000ms, TE:93ms)。觀察及測量內容： (1)結合全脊椎椎體特點確定腰椎； (2)在矢狀位上確定腰骶膨大及圓錐末端位置與腰椎的位置關系； (3)結合橫軸位、矢狀位及冠狀位測得腰骶膨大左右及前后最大徑線、最大橫斷面積,同時測得同一水平椎管面積,得出腰骶膨大與椎管面積之比； (4)用回歸分析處理所得數據與孕周間的關系。 2.宮內胎兒數據獲取 從500例超聲檢查顯示脊椎及脊髓發(fā)育正常的胎兒中,隨機選取142例為研究組,行宮內胎兒腰椎MRI檢查,孕周范圍為20孕周～38孕周。成像使用1.5TMR(GE Echo speed)掃描儀,采用2D FIESTA序列(TR：3.6-4.2ms,TE：1.0-1.8ms),以L2椎體為中心行橫、矢、冠三方位掃描。 觀察及測量內容： (1)結合脊椎全長不同椎體特點確定腰椎序列； (2)以腰椎矢狀位為參考,確定腰骶膨大中心位置及圓錐末端位置； (3)結合橫軸位、矢狀位及冠狀位測得腰骶膨大左右及前后最大徑線、最大橫斷面積,同時測得同一水平椎管面積,得出腰骶膨大與椎管面積之比； (4)對所得數據行回歸分析,得到與孕周間的關系。 結果： 胎兒標本及宮內胎兒均顯示：脊髓腰膨大及相應層面椎管前后徑及左右徑線隨孕周呈線性增長關系。脊髓圓錐末端位置的移行規(guī)律為：隨孕周增長脊髓圓錐末端位置亦呈上升趨勢,但個體差異明顯,這種上升并非一直持續(xù)到出生,而是在孕中期即已快速上升至相對穩(wěn)定位置即第L1-2椎體水平。標本數據顯示：在21孕周及之前,脊髓圓錐末端均位于L3腰椎以下水平,22～30孕周其變化范圍最大位于L1～L4水平,第31～40孕周位于L1～L2水平,因此,如果31孕周以后脊髓圓錐末端仍位于L2水平以下,可以認為是異常低位。與標本數據不同,宮內胎兒在26孕周時,脊髓圓錐末端位置即達第二腰椎水平,較標本時間段前移,但在之后時間段內兩種檢測數據仍表現出較好一致性。標本圖像更穩(wěn)定,獲得層厚更小、結構更清晰、數據更準確。 結論： 宮內胎兒MRI真實反應自然狀態(tài)下胎兒脊髓腰骶膨大的發(fā)育變化規(guī)律及圓錐位置,但,對椎體骨化中心、椎間盤及脊髓信號顯示欠佳；標本圖像能清晰顯示椎體、椎間盤形態(tài)及脊髓信號改變,兩種方法同時研究,能更科學的獲取胎兒脊椎發(fā)育的參考值并描述其生長曲線,對判斷胎兒脊椎生長發(fā)育狀況及疾病診斷提供影像數據及圖像參考。
[Abstract]:Objective:
According to the MR scanning images of fetal specimens and intrauterine fetuses at different gestational weeks, the position of the end of conus medullaris, the left and right diameters of lumbosacral enlargement, the anterior and posterior diameters of spinal canal and the corresponding layers were found out. Thus, the development of lumbosacral enlargement and spinal cord transitional growth curves and reference values of fetuses at each gestational week can provide reliable and intuitive image data and maps for evaluating fetal development and early detection of congenital vertebral malformations and intraspinal lesions.
Materials and methods:
1. Fetal specimens were selected and MR data were obtained. Twenty-nine fetal specimens with normal vertebral development were selected as the subjects. The gestational age ranged from 17 weeks to 39 weeks. All the subjects underwent 3.0TMR (general electric, GE) spinal scan. The standard transverse, sagittal and coronal three-dimensional tomograms were obtained with the lumbar spine as the center. Listed as T2WI (TR:11000ms, TE:93ms). Observations and measurements:
(1) determine the lumbar spine with the characteristics of the entire vertebral body.
(2) determine sagittal position of the lumbosacral enlargement and the position of the conus end with the position of the lumbar spine.
(3) Combined with transverse axis, sagittal and coronal position, the maximum diameter and cross-sectional area of lumbosacral enlargement were measured, and the ratio of lumbosacral enlargement to spinal canal area was obtained.
(4) regression analysis was used to deal with the relationship between the data and gestational age.
2. intrauterine fetal data acquisition
Among 500 fetuses with normal vertebral and spinal cord development, 142 cases were randomly selected as the study group and examined by intrauterine fetal lumbar MRI, ranging from 20 to 38 gestational weeks. Azimuth scanning.
Observation and measurement contents:
(1) determine the lumbar vertebrae sequence according to the characteristics of different vertebrae.
(2) to determine the location of the lumbosacral enlargement and the position of the conus end, based on the sagittal sagittal position of the lumbar spine.
(3) Combined with transverse axis, sagittal and coronal position, the maximum diameter and cross-sectional area of lumbosacral enlargement were measured, and the ratio of lumbosacral enlargement to spinal canal area was obtained.
(4) regression analysis of the data was carried out to get the relationship with gestational age.
Result:
Fetal specimens and intrauterine fetuses showed that the anterior and posterior diameters and the left and right diameters of the spinal canal linearly increased with gestational age. Sample data show that the end of the conus medullaris is located below the L3 lumbar vertebrae at and before 21 weeks of gestation. The maximum range of change is at the L1-L4 level at 22-30 weeks of gestation and the L1-L2 level at 31-40 weeks of gestation. Therefore, if the end of the conus medullaris medullaris is located after 31 weeks of gestation. Unlike the original data, the end of the conus medullaris reached the level of the second lumbar vertebra at 26 gestational weeks and moved forward compared with the specimen time, but the two data showed good consistency in the subsequent period. Clearer and more accurate data.
Conclusion:
The development and cone position of lumbosacral enlargement of fetal spinal cord in natural state are reflected by intrauterine fetal MRI, but the signal of ossification center of vertebral body, intervertebral disc and spinal cord is not well displayed; the image of specimen can clearly show the change of vertebral body, the shape of intervertebral disc and the signal of spinal cord. The two methods can be studied simultaneously to obtain the fetal vertebral column more scientifically. The development reference value and the growth curve are described to provide the image data and the image reference for judging the fetal vertebral growth and the disease diagnosis.
【學位授予單位】：山東大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R714.5;R445.2

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