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中华医学超声杂志(电子版) ›› 2024, Vol. 21 ›› Issue (03) : 275 -280. doi: 10.3877/cma.j.issn.1672-6448.2024.03.005

妇产科超声影像学

产前超声和MRI诊断胎儿硬脑膜窦畸形的联合应用
谢峰1, 伍玉晗1,(), 赵胜1, 杨小红1, 王玉波1, 石珍1, 范建华1, 章敏1   
  1. 1. 430070 武汉,湖北省妇幼保健院超声诊断科
  • 收稿日期:2023-03-09 出版日期:2024-03-01
  • 通信作者: 伍玉晗
  • 基金资助:
    湖北省卫生健康委员会重点项目(WJ2023Z007); 湖北省妇幼保健院院内课题项目(220936023)

Combined use of prenatal ultrasound and magnetic resonance imaging in diagnosis of fetal dural sinus malformation

Feng Xie1, Yuhan Wu1,(), Sheng Zhao1, Xiaohong Yang1, Yubo Wang1, Zhen Shi1, Jianhua Fan1, Min Zhang1   

  1. 1. Department of Ultrasonography, Maternal and Child Health Hospital of Hubei Province, Wuhan 430070, China
  • Received:2023-03-09 Published:2024-03-01
  • Corresponding author: Yuhan Wu
引用本文:

谢峰, 伍玉晗, 赵胜, 杨小红, 王玉波, 石珍, 范建华, 章敏. 产前超声和MRI诊断胎儿硬脑膜窦畸形的联合应用[J]. 中华医学超声杂志(电子版), 2024, 21(03): 275-280.

Feng Xie, Yuhan Wu, Sheng Zhao, Xiaohong Yang, Yubo Wang, Zhen Shi, Jianhua Fan, Min Zhang. Combined use of prenatal ultrasound and magnetic resonance imaging in diagnosis of fetal dural sinus malformation[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2024, 21(03): 275-280.

目的

探讨产前超声及MRI在诊断胎儿硬脑膜窦畸形(DSM)中的临床应用价值。

方法

对2014年9月至2022年5月在湖北省妇幼保健院经产前超声及MRI诊断的8例DSM胎儿影像学资料进行回顾性分析,分析产前超声、MRI诊断DSM的特征性表现并追踪随访临床结局。

结果

(1)DSM累及部位:累及窦汇区7例,未累及窦汇区1例(累及右侧横窦、乙状窦)。(2)静脉窦血栓位置:窦汇区7例,右侧横窦、乙状窦1例。(3)合并颅内异常:小脑延髓池增宽2例,侧脑室增宽2例,左额叶白质水肿、左额叶出血及蛛网膜下腔血肿1例。(4)合并颅外及全身异常:无。(5)8例中7例引产(2例尸检证实为DSM合并静脉窦血栓,1例行穿颅术后颅脑结构破坏,4例未尸检),1例出生(电话追踪至孩子7个月,无明显神经后遗症)。

结论

产前超声可作为筛查胎儿DSM的首选方法;MRI可作为确诊的主要方式,产前超声与MRI联合应用可准确、全面评估胎儿DSM,有助于产前临床决策和胎儿预后评估。

Objective

To assess the clinical application of prenatal ultrasound and magnetic resonance imaging (MRI) in fetal dural sinus malformation (DSM).

Methods

A series of 8 fetuses with DSM diagnosed by prenatal ultrasound and MRI at Hubei Maternal and Children's Hospital from September 2014 to May 2022 were included. The fetal imaging data were retrospectively analyzed to summarize the characteristic prenatal ultrasound and MRI manifestations of DSM. The clinical outcomes of the fetuses were followed.

Results

(1) The torcular herophili was involved in 7 cases, and the right transverse sinus and sigmoid sinus were affected in 1 case. (2) The locations of venous sinus thrombosis included the thetorcular herophili in 7 cases, and the right transverse sinus and sigmoid sinus in 1. (3) Regarding intracranial abnormalities combined, 2 cases had cerebellomedullary cistern enlargement, 2 had lateral cerebral ventricular enlargement, and 1 had white matter oedema in the left frontal lobe, bleeding in the left frontal lobe, and subarachnoid hematoma. (4) No combined extracranial and systemic abnormalities occurred. (5) Of the 8 cases included, 7 underwent induced labor (2 cases were confirmed to have dura mater sinus malformation with venous sinus thrombosis by autopsy, 1 was confirmed to have craniocerebral structure destruction after craniotomy, and 4 did not undergo autopsy), and 1 was born (telephone follow-up to 7 months after the delivery found no neurological sequelae).

Conclusion

Prenatal ultrasound can be the preferred method for screening fetal DSM, while MRI can be the main diagnostic method. The combination of prenatal ultrasound and MRI can accurately and comprehensively evaluate fetal DSM, which is helpful for prenatal clinical decision-making and fetal prognosis evaluation.

表1 8例硬脑膜窦畸形胎儿产前超声、MRI表现及结局
例序 孕妇年龄(岁) 发现孕周(周) 胎儿性别 产前超声表现 MRI表现 MRI诊断累及静脉窦 合并颅内异常 合并颅外异常 结局
1 27 26.3 胎儿小脑延髓池增宽,后颅窝增宽,窦汇扩张,内可见高回声团,范围累及上矢状窦、直窦,高回声内未见血流信号 胎儿小脑延髓池增宽,窦汇扩张,上矢状窦扩张明显,内可见类圆形短T1短T2信号,DWI上该病灶呈高信号弥散受限改变 窦汇、上矢状窦 小脑延髓池增宽 引产,未检查
2 30 14.5 胎儿右侧侧脑室后角及后颅窝增宽,内可见高回声团,范围累及右侧横窦及乙状窦,高回声内未见血流信号 胎儿右侧侧脑室颞角增宽,右侧横窦及乙状窦增宽,内可见类圆形肿块,T1加权成像呈中等信号,T2加权成像呈低信号 右侧横窦、乙状窦 右侧侧脑室后角区增宽 引产(行颅脑穿刺术)
3 26 24.5 胎儿小脑延髓池增宽,后颅窝增宽,窦汇扩张,内可见高回声团,累及上矢状窦及直窦,高回声内未见血流信号 胎儿小脑延髓池增宽,窦汇扩张,内可见类圆形肿块,T1加权成像呈低信号,T2加权成像呈高信号 窦汇、上矢状窦、直窦 小脑延髓池增宽 引产,未检查
4 29 24.2 胎儿窦汇扩张,直窦横窦交界处可见混合性回声,内可见高回声及无回声,内未见血流信号 胎儿窦汇区及直窦明显增宽,并可见类圆形短T1短T2信号 窦汇、直窦 引产,未检查
5 33 22.0 胎儿脑中线右偏,左侧侧脑室增宽,左侧蛛网膜下腔可见混合性回声,周边呈高回声,内呈低回声及无回声,未见血流信号。胎儿窦汇扩张,内可见高回声团,高回声内未见血流信号 胎儿左额叶见斑片状短T2信号,T1呈高信号,周围白质呈高信号;左侧侧脑室扩张;左颞部蛛网膜下腔增宽,见片状短T2高信号;窦汇区增宽,累及上矢状窦、直窦及双侧横窦,内可见类圆形短T1短T2信号 窦汇、上矢状窦、直窦、双侧横窦 左侧侧脑室增宽,左额叶出血、白质水肿,左侧颞部蛛网膜下腔血肿可能 引产后病检:左侧颞部蛛网膜下腔血肿形成,窦汇、上矢状窦及直窦呈瘤样扩张伴血栓形成
6 30 23.0 胎儿小脑幕上抬,窦汇扩张,内可见高回声,高回声内未见血流信号 胎儿窦汇呈三角形扩大,内可见类圆形短T1短T2信号,DWI呈稍高信号 窦汇、上矢状窦后部、直窦、横窦 引产后病检:颅内窦汇区扩张伴血栓形成
7 29 22.5 胎儿窦汇扩张,内可见稍高回声团,高回声内未见血流信号 胎儿小脑后上方、枕顶部窦汇呈三角形扩大,内可见类圆形稍短T1稍短T2信号,DWI呈高信号 窦汇、上矢状窦后部、直窦、横窦 孩子出生,一般情况可
8 30 23.4 胎儿窦汇扩张,内可见低回声,低回声内未见明显血流信号 胎儿枕顶部窦汇呈三角形扩大,内呈稍短T2信号,T1加权成像呈稍高信号,DWI呈低信号 窦汇、上矢状窦后部、左侧横窦 引产,未检查
图1 女性,30岁,孕23周,胎儿硬脑膜窦畸形合并静脉窦血栓超声声像图。图a,超声提示胎儿窦汇区呈三角形扩张,内可见一高回声;图b,窦汇区及高回声均未见血流信号;图c,超声显示小脑受压向前、向下移位;图d,上矢状窦扩张,颅顶下方可见扩张的大脑间裂,内可见点状液性无回声区
图2 女性,30岁,孕23周,胎儿硬脑膜窦畸形合并静脉窦血栓MRI图像。图a,T1加权成像横轴位,显示窦汇扩张,呈等高信号,可见偏心圆高信号;图b,T2加权成像横轴位,显示窦汇扩张,呈等低信号,可见偏心圆低信号;图c,矢状位示上矢状窦后部、窦汇及直窦扩张
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