Wedegärtner Ulrike, Schröder Hobe J, Adam Gerhard
Department of Diagnostic and Interventional Radiology, Universitätsklinikum Hamburg-Eppendorf, Martinistrasse 52, 20251 Hamburg, Germany.
Eur J Radiol. 2006 Feb;57(2):271-7. doi: 10.1016/j.ejrad.2005.11.026. Epub 2006 Jan 6.
Congenital diaphragmatic hernia (CDH) is associated with a high mortality, which is mainly due to pulmonary hypoplasia and secondary pulmonary hypertension. In severely affected fetuses, tracheal occlusion (TO) is performed prenatally to reverse pulmonary hypoplasia, because TO leads to accelerated lung growth. Prenatal imaging is important to identify fetuses with pulmonary hypoplasia, to diagnose high-risk fetuses who would benefit from TO, and to monitor the effect of TO after surgery. In fetal imaging, ultrasound (US) is the method of choice, because it is widely available, less expensive, and less time-consuming to perform than magnetic resonance imaging (MRI). However, there are some limitations for US in the evaluation of CDH fetuses. In those cases, MRI is helpful because of a better tissue contrast between liver and lung, which enables evaluation of liver herniation for the diagnosis of a high-risk fetus. MRI provides the ability to determine absolute lung volumes to detect lung hypoplasia. In fetal sheep with normal and hyperplastic lungs after TO, lung growth was assessed on the basis of cross-sectional US measurements, after initial lung volume determination by MRI. To monitor fetal lung growth after prenatal TO, both MRI and US seem to be useful methods.
先天性膈疝（CDH）与高死亡率相关，这主要归因于肺发育不全和继发性肺动脉高压。在严重受影响的胎儿中，产前进行气管闭塞（TO）以逆转肺发育不全，因为TO可促进肺生长。产前成像对于识别肺发育不全的胎儿、诊断将从TO中获益的高危胎儿以及监测手术后TO的效果非常重要。在胎儿成像中，超声（US）是首选方法，因为它广泛可用、成本较低且比磁共振成像（MRI）耗时更少。然而，US在评估CDH胎儿方面存在一些局限性。在这些情况下，MRI很有帮助，因为肝脏和肺之间的组织对比度更好，这有助于评估肝脏疝出以诊断高危胎儿。MRI能够确定绝对肺容量以检测肺发育不全。在TO后肺正常和增生的胎羊中，在通过MRI初步确定肺容量后，根据超声横断面测量评估肺生长情况。为了监测产前TO后的胎儿肺生长，MRI和US似乎都是有用的方法。
