胎儿磁共振成像胎儿头颅MRI检查(课堂PPT).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,*,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,MR Imaging of the Fetus,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,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,3,胎儿头颅,MRI,检查,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,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%),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,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,8,11,12W 13,14W 16W 18W,9,17.5w 21w 22w 24w 27w,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,11,Normal Abnormal,Tengmento-vermian angle,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,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.,14,Craniocaudal diameter,Craniocaudal diameter(perpendicular to fastigial point-declive line),15,16,28-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.,17,孕,28,3,周，,B,超提示胎儿脑室扩张,14.9mm,12.3mm,9.8mm,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,19,23-week fetus,20,36-week fetus,大枕大池,21,枕大池蛛网膜囊肿,29-week fetus,5-month,22,孕,32,周，外院超声提示左脑室扩张、枕大池积水,23,孕,31,周，超声提示：可疑侧脑室增宽,24,知识回顾,Knowledge Review,