胎儿磁共振成像-胎儿头颅MRI检查.ppt

单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,2021/10/10,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,胎儿磁共振成像,MRImagingoftheFetus,2021/10/10,1,超声,Ultrasound,-,母体肥胖,-,羊水过少,-,妊娠中晚期胎头增大,-,胎儿颅骨骨化,MRI,Ultrafast MRI,-,单次激发快速序列,-,大,FOV,-,安全性？,MRI,仅适用于当产前超声不足以解决临床问题时,2021/10/10,2,MRI,检查技术,1.5,T,及以下,MR,机,体部相共振线圈,序列：单次激发,FSE(0.5NEX,）,FIASTA,序列,常规轴、冠、矢扫描,2021/10/10,3,胎儿头颅,MRI,检查,2021/10/10,4,胎儿头颅,MR,检查主要观察,-,脑室扩大,-,可疑,后颅窝异常,-,胼胝体发育不良,2021/10/10,5,Limperopoulos C,et al.AJR Am J Roentgenol 2008;190:16371643.,Total fetuses MRI abnormal,90 60(67%),Comparison of antenatal and postnatal MR findings in 39 of 42 live born infants,Complete agreement 23(59%),Disagreement 16(41%),Excluded fetal MRI 6(15%),Revealed additional,abnormalities 10(26%),2021/10/10,6,枕大池,(,cisterna magna),正常值,2,11mm,侧脑室体部,10mm,异常表现：,Dandy-Walker,畸形，小脑蚓部发育不良，大枕大池，蛛网膜囊肿,2021/10/10,7,小脑蚓部的发育,11,12W,，,小脑及原始蚓部从第四脑室嘴侧发生,13,14W,，原始顶点可见（第四脑室顶部裂缝）,14,16W,，小脑蚓部原裂出现,16W,，小脑蚓部向尾侧发育，于顶点处“折叠”覆盖四脑室顶，第四脑室“闭合”,16,17W,，锥前裂、顶前裂等可见,18,19W,，蚓部颅尾方向长度与小脑半球相等,2021/10/10,8,11,12W 13,14W 16W 18W,2021/10/10,9,17.5w 21w 22w 24w 27w,2021/10/10,10,Assessment of Vermian Maturity,小脑原裂,primary fissure,顶点,fastigial point,顶蚓角,tengmento-vermian angle,，,TVA,颅尾径,craniocaudal diameter,，,CCD,2021/10/10,11,Normal Abnormal,Tengmento-vermian angle,2021/10/10,12,22,week fetus,A.axial sonography showed a large cystic posterior fossa with small cerebellar hemispheres.,B.the tegmento-vermian angle is increased with the fourth ventricle uncovered.The vermis is very small;there is no primary fissure or fastigial point.,C.Diagrammatic representation of DWC.,D.the cerebellar hemispheres are small.The ventricular system is dilated,resulting in large temporal horns,2021/10/10,13,22,week fetus,Sonography and MRI findings are similar to the previous case except that the cerebellar hemispheres seems larger and vermian tisse can be seen in the midline.,2021/10/10,14,Craniocaudal diameter,Craniocaudal diameter(perpendicular to fastigial point-declive line),2021/10/10,15,2021/10/10,16,28-week fetus,The craniocaudal diameter of vermis measures 10.9mm(equivalent of 22 weeks).The expected measurement is 14.8mm.,The transcerebellar diameter is also small.,2021/10/10,17,孕,28,3,周，,B,超提示胎儿脑室扩张,14.9mm,12.3mm,9.8mm,2021/10/10,18,上下蚓比,小脑蚓部胚胎期呈线性协调发育,以顶点为分界上下蚓比例为,47,和,53,，不随生长发育变化,2021/10/10,19,23-week fetus,2021/10/10,20,36-week fetus,大枕大池,2021/10/10,21,枕大池蛛网膜囊肿,29-week fetus,5-month,2021/10/10,22,孕,32,周，外院超声提示左脑室扩张、枕大池积水,2021/10/10,23,孕,31,周，超声提示：可疑侧脑室增宽,2021/10/10,24,知识回顾,Knowledge Review,