Appasamy M, Roberts D, Pilling D, Buxton N
Department of Fetal Medicine, Liverpool Women's Hospital, Liverpool, UK.
Ultrasound Obstet Gynecol. 2006 May;27(5):530-6. doi: 10.1002/uog.2755.
To compare prenatal ultrasonography and magnetic resonance imaging (MRI) in the diagnosis of spina bifida with postnatal MRI/surgical findings and to study the postnatal outcome in relation to the level of lesion and head signs on antenatal imaging.
A retrospective study of babies referred to a tertiary neurosurgical unit with a diagnosis of spina bifida in the years 2000-2002 was performed. The levels of lesions and head signs diagnosed using antenatal ultrasonography and MRI were compared with postnatal MRI and operative findings. The levels of lesions and head signs diagnosed pre- and postnatally were used to study the correlation with neurological outcome at a mean follow-up period of 12 months.
Twelve antenatally diagnosed and five postnatally diagnosed cases of spina bifida were seen. The level of lesion as identified by antenatal ultrasound correlated with that observed postnatally in 8/12 cases and the antenatal ultrasound diagnosis of ventriculomegaly was confirmed postnatally in all cases. The level of lesion as identified by antenatal MRI correlated with that observed postnatally in 4/8 cases (50%) and the antenatal MRI diagnosis of ventriculomegaly was confirmed postnatally in 5/8 (63%) cases. 12/17 babies were found to have residuals in the immediate postnatal urodynamic studies, of which 83% (n = 10) required intermittent catheterization of the bladder at 12 months of age. Low spinal lesions were associated with increased bladder morbidity when compared to high spinal lesions (8/10 vs. 4/7, P < 0.05) (odds ratio (OR) = 10.0; 95% CI, 1.05-95.01). The level of spinal lesion and the presence of ventriculomegaly did not have any statistically significant correlation with motor functions, morbidity and developmental milestones.
Antenatal ultrasonography is a good tool in the diagnosis of spina bifida. We could not demonstrate any advantage of antenatal MRI over ultrasonography. There is better correlation of ultrasonography than MRI with postnatal MRI/operative findings in terms of level of lesion and head signs. Low spinal lesions appear to be associated with increased bladder morbidity.
比较产前超声检查和磁共振成像（MRI）在脊柱裂诊断中的应用，并与产后MRI/手术结果进行对比，同时研究产前影像检查中病变水平和头部体征与产后结局的关系。
对2000年至2002年间转诊至三级神经外科单位、诊断为脊柱裂的婴儿进行回顾性研究。将产前超声检查和MRI诊断的病变水平及头部体征与产后MRI及手术结果进行比较。利用产前和产后诊断的病变水平及头部体征，研究其与平均随访12个月时神经学结局的相关性。
共观察到12例产前诊断和5例产后诊断的脊柱裂病例。产前超声确定的病变水平与产后观察到的病变水平在8/12例中相符，且产前超声诊断的脑室扩大在所有病例中均得到产后证实。产前MRI确定的病变水平与产后观察到的病变水平在4/8例（50%）中相符，产前MRI诊断的脑室扩大在5/8例（63%）中得到产后证实。12/17例婴儿在产后即刻尿动力学研究中发现有残余问题，其中83%（n = 10）在12个月大时需要间歇性膀胱插管。与高位脊柱病变相比，低位脊柱病变与膀胱发病率增加相关（8/10 vs. 4/7，P < 0.05）（比值比（OR）= 10.0；95%可信区间，1.05 - 95.01）。脊柱病变水平和脑室扩大的存在与运动功能、发病率及发育里程碑之间无统计学显著相关性。
产前超声检查是诊断脊柱裂的良好工具。我们未能证明产前MRI优于超声检查。在病变水平和头部体征方面，超声检查与产后MRI/手术结果的相关性优于MRI。低位脊柱病变似乎与膀胱发病率增加相关。
