探讨产前超声联合磁共振成像（MRI）诊断胎儿颅内出血（ICH）的临床意义。

2012年7月至2014年6月在广州市妇女儿童医疗中心产前超声检查的胎儿31 200例，对应用标准化超声切面和磁共振扫描两种影像学检查方法最终确诊为颅内出血的20例胎儿超声声像图特征及磁共振图像进行分析，并对出血胎儿行脐血病原检测及染色体检查，追踪胎儿妊娠结局。

20例胎儿颅内出血均于中、晚孕期发现，产前及产后影像检查、脐血病原检测和染色体检查结果：（1）产前超声表现：20例胎儿中超声显示室管膜区囊状或筛网状回声3例，脑室内团状、片状或条状高回声9例，脑室内不规则低回声2例，脑实质区见异常不规则稍低回声2例，小脑半球内高回声伴发小脑半球脑组织液化1例，脉络丛回声欠均匀1例，合并单侧或双侧脑室增宽17例，合并脑组织受压或脑中线偏移各1例。（2）胎儿磁共振影像检查16例，其表现为：16例胎儿脑室内团状、斑片状或线状T₂W1低信号影，T₁W1高信号影，其中5例合并脑皮质占位或发育异常。（3）超声和磁共振检出胎儿颅内出血合并其他结构异常6例，其中合并唇腭裂畸形1例，脊柱畸形2例，其他部位脑发育畸形3例。（4）脐血及染色体检查结果：20例胎儿中2例脐血检查诊断为巨细胞病毒感染阳性；20例胎儿染色体检查结果均未见异常。胎儿妊娠结局：经随访，超声及磁共振检查后孕妇选择引产16例，产后存活3例，其中1例出现神经系统并发症；2例正常，1例失访。

胎儿颅内出血有特征性超声及磁共振表现，超声多显示颅内筛网状、团片状高回声，合并脑室增宽，MRI T₂W1示团片状或线状低信号影，T₁W1示高信号影。MRI有助于出血定位诊断，定期超声监测有助于产前明确诊断及临床干预治疗。

To investigate the diagnostic value of prenatal ultrasonography and magnatic resonance imaging in the fetal intracranial hemorrhage.

The 20 antenatal diagnosed ICH cases was collected from 31 200 prenatal diagnosis units in Guangzhou Women and Children′s Medical Center from July 2012 to June 2014. Maternal characteristics, ultrasound, and magnetic resonance imaging findings, clinical course, and postnatal outcome were reviewed.

Twenty consecutive cases of fetal ICH were evaluated. All cases were diagnosed at mid or third trimester. Transabdominal ultrasound showed 9 cases of hyper echoic lesions in the lateral ventricle, 2 cases of hypoechonic lesions, 2 cases of irregular mixed echo in the parenchyma, 1 case of hyperechoic cerebellar hemisphere with infarction, and 1 case of abnormal choroid plexus. Seventeen cases were associated with ventriculomegaly, brain compression or brain midline displacement. MRI showed the nodular, patchy or linear low signal on T₂WI and high signal on T₁WI. Some cases were combined with cortex lesions or abnormal parenchyma. ICH was complicated with other structural abnormalities: 1 case of cleft palate, 2 cases of spinal deformity and 3 cases of other cerebral cortical malformations. Prenatal diagnosis results were: 2 cases diagnosed as positive cytomegalovirus infection and no chromosome abnormalities found in all cases. The follow up results were: 1 case was lost, 16 cases were terminated after prenatal diagnosis. Among the 3 survival cases, 1 case has the neurological complication and the other two were normal till now.

Fetal intracranial hemorrhage has some image features on ultrasound and magnetic resonance. Ultrasound showed hyper echoic lesions with ventriculomegaly. MRI showed the nodular, patchy or linear low signal on T₂WI and high signal on T₁WI. MRI may contribute to the accuracy of diagnosis, particularly in bleeding site. The regular ultrasonic monitoring is helpful to improve the detection rate.