Malinger G, Ben-Sira L, Lev D, Ben-Aroya Z, Kidron D, Lerman-Sagie T
Fetal Neurology Unit, Prenatal Diagnosis Unit, The Edith Wolfson Medical Center, Holon, Israel.
Ultrasound Obstet Gynecol. 2004 Apr;23(4):333-40. doi: 10.1002/uog.1016.
To evaluate whether fetal brain magnetic resonance imaging (MRI) adds useful clinical information to that obtained by dedicated fetal neurosonography using a combined transabdominal and transvaginal approach in fetuses with suspected brain anomalies.
In the 2-year period between January 2000 and January 2002, 42 fetuses underwent neurosonographic and MRI examinations of the brain. The referral indications were: asymmetric ventriculomegaly (13), ventriculomegaly (7), periventricular cysts (2), suspected midline findings (7), agenesis of the corpus callosum (3), infratentorial pathology (3), cytomegalovirus (CMV) infection (2) and miscellaneous indications (5).
Neurosonography and MRI produced similar diagnoses in 29 fetuses: normal examination (10), isolated asymmetric ventriculomegaly (11), isolated ventriculomegaly (3), periventricular cysts (2), agenesis of the corpus callosum (1), pericallosal lipoma (1) and cerebellar hemorrhage (1). The neurosonographic diagnoses were more accurate in seven patients: hemimegalencephaly, pericallosal lipoma, signs of CMV infection, brain anomalies associated with agenesis of the corpus callosum and three fetuses with a normal ultrasound scan in which MRI suggested a parenchymal abnormality. MRI provided a more accurate diagnosis in three patients: a third ventricular dilatation was ruled out, normal ventricles in a fetus with an ultrasonographic finding of asymmetric ventricles, and diagnosis of progression of asymmetric ventriculomegaly. In three patients the identified pathologies were differently interpreted, each examination provided another aspect of the anomaly or a definitive diagnosis was not possible.
Our study demonstrated that dedicated neurosonography is equal to MRI in the diagnosis of fetal brain anomalies. In most of the cases MRI confirmed the ultrasonographic diagnosis; in a minority of cases each modality provided additional/different information. The major role of MRI was in reassurance of the parents regarding the presence or absence of brain anomalies.
评估胎儿脑磁共振成像（MRI）是否能为采用经腹和经阴道联合超声检查法对疑似脑异常胎儿进行的专门胎儿神经超声检查所获临床信息增添有用内容。
在2000年1月至2002年1月的两年期间，42例胎儿接受了脑部神经超声和MRI检查。转诊指征包括：不对称性脑室扩大（13例）、脑室扩大（7例）、脑室周围囊肿（2例）、疑似中线病变（7例）、胼胝体发育不全（3例）、幕下病变（3例）、巨细胞病毒（CMV）感染（2例）及其他指征（5例）。
神经超声和MRI对29例胎儿作出了相似诊断：检查正常（10例）、孤立性不对称性脑室扩大（11例）、孤立性脑室扩大（3例）、脑室周围囊肿（2例）、胼胝体发育不全（1例）、胼胝体旁脂肪瘤（1例）和小脑出血（1例）。神经超声诊断在7例患者中更准确：半侧巨脑畸形、胼胝体旁脂肪瘤、CMV感染迹象、与胼胝体发育不全相关的脑异常以及3例超声扫描正常但MRI提示实质异常的胎儿。MRI在3例患者中提供了更准确的诊断：排除了第三脑室扩张、超声检查发现不对称脑室的胎儿脑室正常以及不对称性脑室扩大进展的诊断。在3例患者中，所识别的病变得到了不同解读，每项检查都提供了异常的另一个方面或无法作出明确诊断。
我们的研究表明，在胎儿脑异常诊断方面，专门的神经超声检查与MRI相当。在大多数情况下，MRI证实了超声诊断；在少数情况下，每种检查方式都提供了额外的/不同的信息。MRI的主要作用是让父母对是否存在脑异常放心。
