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目的评估 MRI 在胎儿泌尿系统畸形诊断中的价值。方法对34例泌尿系统畸形的胎儿 MRI 结果,结合超声诊断以及部分产后或术后结果进行分析。结果胎儿肾脏积水12例,包括7例随访积水消失;2例失访;产前 MRI 诊断的1例梗阻性右肾发育不良正在随访中,1例右双肾盂输尿管畸形在产后 MRI 随访中证实,1例肾盂输尿管连接处异常产后超声随访证实。双侧性泌尿系统畸形胎儿7例,显示羊水量减少,肺信号减低,其中双侧性多囊性肾发育不良3例(均引产),双肾发育不良2例(1例失访,1例尸检),双侧。肾不发育1例(引产后尸检证实),右肾缺如伴左肾发育不良1例(失访),1例尸检胎儿产前 MRI 诊断正确,1例 MRI 上清晰显示双侧下肢合并成团块状。单侧性泌尿系统畸形胎儿15例,包括单侧肾发育不良9例(3例随访中,2例引产,1例失访,3例产后超声或MRI 证实),单侧肾脏不发育4例(2例引产,2例产后超声或 MRI 证实),异位肾1例产后经超声证实,脐尿管囊肿1例引产,产前 MRI 对于得到随访结果的6例胎儿均诊断正确。结论 MRI 可以不受羊水量的影响,多方位清晰显示各类泌尿系统畸形及其伴发的其他系统畸形,并作出准确诊断,作为产前超声的重要补充检查手段具有很高的临床应用价值。
Objective To assess the value of MRI in the diagnosis of fetal urinary malformations. Methods Fetal MRI results of 34 cases of urinary system malformations were analyzed with ultrasound diagnosis and some postpartum or postoperative outcomes. Results Fetal hydronephrosis in 12 cases, including 7 cases of follow-up hydronephrosis disappeared; 2 cases of loss of follow-up; 1 case diagnosed by prenatal MRI obstructive right renal dysplasia are being followed up, 1 case of right ureteropelvic deformity in postpartum MRI follow-up Confirmed, 1 case of ureteropelvic junction abnormalities confirmed by postpartum ultrasound follow-up. Bilateral urinary system malformation fetus in 7 cases, shows reduced amniotic fluid volume, reduced lung signal, including bilateral polycystic kidney dysplasia in 3 cases (both induced abortion), renal dysplasia in 2 cases (1 case lost, 1 case Autopsy), bilateral. 1 case of kidney failure (confirmed by autopsy after autopsy), 1 case of right kidney deficiency accompanied by dysplasia of left kidney (lost to follow-up), 1 case of autopsy prenatal MRI was correctly diagnosed, 1 case of MRI clearly showed bilateral lower limbs merged into groups Blocky. Unilateral unilateral urinary malformation fetus 15 cases, including unilateral renal dysplasia in 9 cases (3 cases were followed up, 2 cases of induced labor, 1 case of lost, 3 cases confirmed by postpartum ultrasound or MRI), unilateral renal development in 4 cases ( 2 cases of induced abortion and 2 cases of postpartum ultrasound confirmed by MRI). One case of ectopic kidney was confirmed by ultrasound and one case of urachal cyst was induced by abortion. Prenatal MRI was correctly diagnosed in 6 fetuses with follow-up results. Conclusion MRI can be independent of the amount of amniotic fluid, multi-directional clear display of various urinary system malformations and other associated system deformities, and make accurate diagnosis, as an important prenatal ultrasound supplementary examination has a high clinical value.