李旭医生的科普号

Background: We report on two different types of left pulmonary artery sling (LPAS), types IA and IIB, diagnosed by fetal MRI. We suggest that fetal MRI is an effective tool for accurately diagnosing LPAS and helping guide its perinatal management.Reason to report: Fetal MRI is relatively unaffected by the conditions that limit visualization by echocardiogram. When prenatal ultrasound detects either a possible anomalous origin of the left pulmonary artery or a tracheobronchial anomaly, fetal MRI may provide additional information to confirm the LPAS diagnosis and classify its type.What was unique: To our knowledge, these are the first reports of prenatally diagnosed LPAS by fetal MRI.

目的 探讨MRI在诊断胎儿肾上腺占位中的应用价值并分析其预后,为产前咨询提供指导意见.方法 回顾性分析2009年10月至2014年12月进行影像检查的约4000例孕妇,均由超声发现胎儿肾上腺区占位后3d内行MRI检查,共发现11例胎儿肾上腺占位.MRI检查序列包括快速稳态平衡梯度回波(B-FFE)序列、单次激发快速自旋回波(SSFSE)序列、T1WI及DWI,行横断面、矢状面及冠状面扫描,重点观察胎儿腹部情况,将产前MRI、超声结果与手术病理进行对照分析.结果 11例肾上腺占位,右侧3例、左侧8例;囊性1例、囊实性3例、实性7例.囊性病变表现为TtWI低信号、T2WI高信号,囊实性占位为混杂T1WI、混杂T2WI信号,实性病变为T1WI等信号、T2WI稍高信号.胎儿MRI诊断神经母细胞瘤(NB)10例、肾上腺血肿1例;出生后随访8例确诊为NB(手术病理证实7例,1例通过MYCN基因扩大伴肝转移确诊,治疗过程中死亡),2例病灶自行消退,1例胎儿引产未尸检.11例病变超声准确定位在肾上腺区域6例,其中产前超声给予正确诊断NB 1例,误诊为畸胎瘤、肾上腺血肿和隔离肺各1例,另7例给予描述性诊断.11例中9例胎儿生后现仍随访中,目前生长发育良好.结论 MRI在诊断胎儿肾上腺占位中可提供更多有用的诊断信息.胎儿肾上腺占位多数为NB,部分病灶有自愈倾向,总体预后良好.李旭胡克非朱铭董素贞尹传高胡俊汪晓波陆忠斌中华放射学杂志2015年49卷11期863-867页