| Objective Detect the anomaly of fetal central nervous system using ultrasonography and MRI technology, aims to explore the value of combined application of ultrasonography and MRI technology in the fetal central nervous system.Method Between January 2013 and November 2014,151 pregnant women were enrolled in this study after informed consents from each of the participants in Department of Obstetrics and Gynecology of Kunming Medical University-affiliated No.1 Hospital. These women were found to have a fetus with abnormal or suspiciously abnormal ultrasound imaging in the central nervous system during routine prenatal ultrasonography examination and required further MRI assessment. Those women were 27.6 years old on average (27.6±3.8) with the range from 19 to 37 years. The gestational age averaged 31.2 (31.2±2.1) weeks with the range from 28 to 37 weeks. The pregnancy of all women was single. All were healthy with no previously diagnosed diseases and with regular period in medical history. Pregnant women took supine position during both ultrasound and MRI examination. Fetal cerebellum, ventricle and thalamus plane were detected in ultrasonography. Within the 48 hours of ultrasound test, MRI was conducted. In MRI, fetal head coronal, sagittal and transverse scans were performed using a single-shot fast echo T2W1 (SSFSE) after routine position of fetal brain as the center. The MRI scanning time lasted approximately 20 minutes. The widths of unilateral and bilateral ventricles in a fetal brain were measured. Imaging results were compared between ultrasonography and MRI. Chi-square or fisher’s exact test was appropriately used in the analyses for categorical variables.Results1. Ultrasound and MRI in the completion of the fetal central nervous system. Ultrasound examination revealed fetal central nervous system abnormalities 151 cases of suspicious or abnormal, MRI imaging examination successfully completed 148 cases 98% (148/151); unfinished three cases of 2%(3/151), including one case of too much amniotic fluid fetal frequently, claustrophobia one case, one case of pregnant women have metal dentures.2. Ultrasound and MRI findings in the fetal central nervous system. Ultrasound and MRI in the completion of the fetal central nervous system 148 cases of ultrasound combined with MRI examination,129 cases of ultrasound and MRI diagnosis consistent with 87.2%(129/148),8 cases of ultrasound diagnosis by MRI supplement of 5.4%(8/148),11 cases of ultrasound diagnosis by MRI correction of 7.4%(11 /148).After central nervous system disorders MRI additions and amendments to the ultrasound diagnosis include:cerebral hemorrhage two cases, the corpus callosum two cases, corpus callosum agenesis three cases, arachnoid cyst 7, gyrus less one case, Blake’s cyst, cerebellar hypoplasia 2 cases of variant Dandy-walker1 cases.3. Ultrasound and MRI findings in fetal widened in the lateral ventricle Of 63 cases with widened lateral ventricle,56 (89%) were widened lateral ventricles only, and 7 (11%) had the complications of abnormalities. There were 75%(47/63) unilaterally widened ventricles, and of whom 45 (95.7%) were unilaterally widened ventricles only, and 2 (4.3%) had the complications of abnormalities. In contrast, of 16 (25%) bilaterally widened ventricles,11 (68.8%) were widened ventricles only, and 5 (31.2%) with abnormality complications. The cases with bilaterally widened ventricles showed significantly higher frequencies of abnormality complications than those with unilateral widened ventricles (p< 0.05). Two groups were classified based on the inner diameters of the posterior horn of lateral ventricle. The cutoff value of the inner diameters was 12 mm. The cases with the inner diameters ranging from 10 to 12 mm were assigned as group 1, and those with the inner diameters greater than 12 mm were group 2. Group 1 had 51 cases, of whom 50 were widened lateral ventricles only, and 1 with the abnormality complication. Group 2 had 12, of whom 6 were widened lateral ventricles only, and 6 with the abnormality complications. Astatistically significant difference in the abnormality complications between the groups 1 and 2 (p<0.05).Conclusions1. Ultrasonography is the first choice in prenatal screening, and MRI, as a complementary technique, can provide additional information for ultrasound imaging particularly for suspicious cases in prenatal brain examination.2. The frequencies of other abnormal complications of central nervous system were significantly higher in bilaterally widened ventricles than unilaterally widened ones. The cases with the inner diameters of the posterior horn of lateral ventricles greater than 12 mm had significantly higher frequencies of other abnormalities of central nervous system than those with the inner diameters ranging from 10 to 12 mm. Studies suggest that fetal ultrasound found that bilateral lateral widened and (or) lateral ventricle horn diameter greater than 12mm for further MRI examination can reduce misdiagnosis and missed diagnosis of fetal central nervous system diseases. |
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