胎儿并腿畸形下肢骨骼异常三维超声骨骼成像技术、MRI与3D-HCT诊断研究

摘要

目的：探讨胎儿三维超声骨骼成像技术、胎儿磁共振成像（MRI）及引产后三维螺旋CT（3-HCT）在并腿畸形胎儿下肢骨骼异常诊断中的临床应用价值。方法应用胎儿超声骨骼成像技术与磁共振成像对7例并腿畸形胎儿进行分型诊断，并与引产后胎儿三维螺旋CT及病理检查结果对照，分析三维超声骨骼成像技术、MRI、三维螺旋CT在并腿畸形胎儿下肢骨骼异常产前与产后诊断中的应用结果。结果与终止妊娠后三维螺旋CT及病理检查结果对照，产前三维超声骨骼成像均正确显示7例并腿畸形胎儿（6例单胎，1例联体双胎）下肢股骨异常、胫腓骨异常及单足6例，无足1例。其中绒毛和（或）脐血染色体检查（5例）与生后病理检查提示男性3例，女性4例。根据Stocker并腿畸形分型标准，产前与引产胎儿标本影像学检查诊断并腿畸形Ⅲ型1例；Ⅳ型2例；Ⅴ型3例；Ⅵ型1例。7例胎儿MRI正确显示股骨异常4例、胫腓骨异常1例，足异常均未显示。结论产前三维超声骨骼成像技术与产后三维螺旋CT骨骼成像技术均为胎儿骨骼异常影像诊断新技术，可清晰显示胎儿骨骼声像，对下肢畸形胎儿正确诊断有重要临床应用价值。%ObjectiveTo explore the clinical value of three-dimensional (3D) skeletal ultrasound mode imaging, 3D helical computer tomography (3D-HCT) and MRI in diagnosing lower limb skeletal malformations of fetal sirenomelia.MethodsSeven fetuses were suspected of sirenomelia with routine prenatal ultrasonography examination. Three-dimensional skeletal ultrasound mode imaging and MRI were used to conifrm the diagnosis, and the results were compared to those of pathology, 3D spiral CT or X-ray after termination. Five of them underwent chromosome examination including chorionic villus or umbilical cord biopsy.ResultsSix fetuses were singletons and one fetus was a conjoined twin. Three fetuses were male, while four fetuses were female. All fetuses with sirenomelia showed varying degrees of skeletal abnormalities: 1 case of typeⅢ, 2 cases of typeⅣ, 3 cases of typeⅤ and 1 case of typeⅥ. No foot was detected in one case and only single foot was detected in other 6 cases. In 7 cases, 3D skeletal ultrasound mode imaging could demonstrate all the lower limb skeletal malformations, including abnormal femur and tibioifbula, single foot or no feet. Prenatal MRI could demonstrate abnormal femur in 4 cases, abnormal tibioifbula in 1case, and no foot malformation. The results of 3D spiral CT after termination were consistent with X-ray and pathological examination results.ConclusionsAs a new imaging technology for detecting fetal skeletal malformations, prenatal 3D skeletal ultrasound mode imaging and postnatal 3D spiral CT both can display fetal bone clearly. They both have important clinical value in diagnosing lower limb skeletal malformations.