Garel C, Dreux S, Philippe-Chomette P, Vuillard E, Oury J-F, Muller F
Department of Imagerie Pédiatrique, Hôpital Robert Debré, AP-HP, Paris, France.
Ultrasound Obstet Gynecol. 2006 Sep;28(3):282-91. doi: 10.1002/uog.2799.
To analyze the contribution of fetal magnetic resonance imaging (MRI) and amniotic fluid digestive enzyme (AFDE) assays to the evaluation of gastrointestinal tract abnormalities.
This was a prospective study involving 24 fetuses suspected of having gastrointestinal tract abnormalities on ultrasound examination. MRI was used to analyze the location of the obstruction, the visibility of the small bowel not involved in the obstruction, and the visibility and size of the colon and rectum. Abnormalities were further evaluated by AFDE assays. The final diagnosis was based on postnatal or fetopathological examination.
In duodenojejunal obstructions, MRI (6/6) and AFDE assays (4/4) correctly identified the level of obstruction, but were less accurate for small bowel obstructions (MRI, 10/11; AFDE assays, 7/11). The small bowel not involved in the obstruction was correctly evaluated by MRI as being viable in six cases and as abnormal in eight cases (multiple obstructions or necrosis). However, it was thought antenatally to be abnormal by MRI in four cases in which it was found to be normal on postnatal findings. Three cases in which the colon was found to have abnormal echogenicity were considered normal both by MRI and AFDE assay, in agreement with postnatal findings. Two cases of microcolon-megacystis-intestinal hypoperistalsis syndrome (MMIHS) were diagnosed both by MRI and AFDE assay. Of the three anorectal malformations, two were overlooked by ultrasonography and one by MRI. MRI also overlooked 2/3 associated rectourethral fistulas.
MRI and enzyme analysis are good complementary tools to ultrasonography for identifying the level of gastrointestinal obstruction and diagnosing MMIHS. MRI can assess the normality of the intestinal tract not involved in the obstruction, but not multiple obstructions, necrosis and small urodigestive fistulas.
分析胎儿磁共振成像（MRI）和羊水消化酶（AFDE）检测对胃肠道异常评估的贡献。
这是一项前瞻性研究，纳入了24例超声检查怀疑有胃肠道异常的胎儿。采用MRI分析梗阻部位、未受累小肠的可视性以及结肠和直肠的可视性与大小。通过AFDE检测进一步评估异常情况。最终诊断基于产后或胎儿病理学检查。
在十二指肠空肠梗阻中，MRI（6/6）和AFDE检测（4/4）能正确识别梗阻水平，但对小肠梗阻的准确性较低（MRI，10/11；AFDE检测，7/11）。MRI正确评估了6例未受累小肠为存活，8例为异常（多发梗阻或坏死）。然而，在4例产后发现正常的病例中，MRI产前认为是异常的。3例结肠回声异常的病例，MRI和AFDE检测均认为正常，与产后结果一致。2例微结肠-巨膀胱-肠蠕动减弱综合征（MMIHS）通过MRI和AFDE检测均得以诊断。在3例肛门直肠畸形中，2例被超声漏诊，1例被MRI漏诊。MRI还漏诊了2/3的相关直肠尿道瘘。
MRI和酶分析是超声检查用于识别胃肠道梗阻水平和诊断MMIHS的良好补充工具。MRI可评估未受累肠道的正常情况，但对多发梗阻、坏死和小泌尿生殖道瘘的评估效果不佳。
