摘要
目的分析产前超声(US)、磁共振成像(MRI)对胎儿先天性膈膨升(EOD)的诊断结果并探讨诊断价值。方法选取2016年4月至2019年4月我院产前检查疑似孕有EOD胎儿的52例孕妇的临床资料进行回顾性分析,均有完整的产前US及MRI影像资料及胎儿随访结果(产后胸片、手术或尸检病理结果)。以随访结果为"金标准",使用Kappa一致性检验评价产前US和MRI在EOD胎儿产前诊断中的应用价值。结果52例疑似EOD胎儿,经随访结果证实EOD 32例,疝囊型膈疝13例,胸骨后疝7例。产前US诊断EOD阳性46例,误诊16例,产前US诊断EOD与随访结果一致性差(Kappa=0.252),US诊断EOD的灵敏度、特异度和准确度分别为96.88%、25.00%和69.23%;产前MRI诊断EOD阳性34例,误诊2例,MRI诊断EOD与随访结果一致性较好(Kappa=0.917),MRI诊断EOD的灵敏度、特异度和准确度分别为100.00%、90.00%和96.15%。22例单纯性EOD和EOD合并患侧肺不张胎儿出生后经保守治疗或手术治疗后预后良好。结论产前US诊断EOD灵敏度高,可作为筛查的首选,但US特异度较低,易造成误诊,对于US发现的异常情形,结合MRI检查评估膨出物范围及膈肌连续性有助于提高EOD产前诊断的准确性。
Objective To analyze the diagnostic results of fetal eventration of the diaphragm(EOD)by prenatal ultrasound(US)and magnetic resonance imaging(MRI),and explore their diagnostic value.Methods From April 2016 to April 2019,the clinical data of 52 pregnant women in the hospital whose fetuses were suspected with EOD in the prenatal examination were collected for retrospective analysis.There were complete prenatal US and MRI imaging data,and fetal follow-up results(postpartum X-ray,surgery,or autopsy pathology)in all pregnant women.Taking follow-up results as the golden standa rd,the application value of prenatal US and MRI in the prenatal diagnosis of EOD fetuses was evaluated by the Kappa consistency test.Results Of the 52 fetuses with suspected EOD,there were 32 cases with EOD,13 cases with hernial sac diaphragmatic hernia and 7 cases with posterior sternal hernia confirmed by follow-up results.Prenatal US diagnosis showed that there were 46 cases with EOD positive and 16 cases misdiagnosed.The consistency between prenatal US and follow-up was poor for diagnosis of EOD(Kappa=0.252).The sensitivity,specificity,and accuracy of US for diagnosis of EOD were 96.88%,25.00%,and 69.23%,respectively.Prenatal MRI diagnosis showed that there were 34 cases with EOD positive and 2 cases misdiagnosed.The consistency between MRI and follow-up was good for diagnosis of EOD(Kappa=0.917).The sensitivity,specificity,and accuracy of M RI for diagnosis of EOD were 100.00%,90.00%,and 96.15%,respectively.The 22 fetuses with simple EOD and EOD combined with atelectasis all gained a good prognosis after conservative treatment or surgical treatment.Conclusion The sensitivity of prenatal US is high for diagnosis of EOD,which can be the first choice for screening.However,the specificity of the US is low,which is easy to cause misdiagnosis.The abnormal conditions found by the US combined with the bulging range and diaphragmatic continuity evaluated by MRI are beneficial to improve prenatal diagnosis accuracy of EOD.
作者
田树娟
李丰华
孔莉
赵慧
TIAN Shu-juan;LI Feng-hua;KONG Li;ZhAO Hui(Ultrasound Room,Panjin Liaoyou Baoshihua Hospital Maternity and Infant District,Panjin 124010,Liaoning Province,China)
出处
《中国CT和MRI杂志》
2021年第4期72-74,共3页
Chinese Journal of CT and MRI
关键词
先天性膈膨升
产前检查
超声
磁共振成像
诊断
Eventration of Diaphragm
Prenatal Examination
Ultrasound
Magnetic Resonance Imaging
Diagnosis
