Danzer Enrico, Hubbard Anne M, Hedrick Holly L, Johnson Mark P, Wilson R Douglas, Howell Lori J, Flake Alan W, Adzick N Scott
The Center for Fetal Diagnosis and Treatment, Department of Radiology, The Children's Hospital of Philadelphia, Philadelphia, PA 19104-4399, USA.
AJR Am J Roentgenol. 2006 Oct;187(4):W350-6. doi: 10.2214/AJR.05.0152.
The purpose of this study was to determine whether prenatal MRI provides additional information about fetal sacrococcygeal teratoma compared with prenatal sonography.
Twenty-two pregnant women with fetal sacrococcygeal teratoma underwent prenatal MRI (mean gestational age, 23 weeks). The size, location, mass characteristics, and compressive effects of the tumors were determined and correlated with sonography and postnatal findings.
Based on the MRI findings, the following American Academy of Pediatrics, Surgical Section classifications were assigned: type I in six patients, type II in 12, and type III in four. No type IV tumors were found. The sacrococcygeal teratoma appeared entirely cystic in five fetuses, microcystic in one, mixed cystic and solid in 12, and solid in four. The diagnosis of sacrococcygeal teratoma was accurate in all cases assessed at our center using both MRI and sonography. Two additional patients initially referred with the diagnosis of sacrococcygeal teratoma had a different diagnosis at reevaluation at our institution (healthy, n = 1; myelomeningocele, n = 1). MRI was superior to sonography for detecting displacement of the colon (n = 11), urinary tract dilatation (n = 9), hip dislocation (n = 4), intraspinal extension (n = 2), and vaginal dilation (n = 1). In fetuses with sacrococcygeal teratoma types II and III, MRI better showed the cephalic extent of the tumor compared with sonography. MRI findings were confirmed at surgery or autopsy in all patients. Three fetuses with high output cardiac physiology underwent open fetal resection of the tumor at 21-, 24-, and 26-weeks' gestational age with two surviving.
Our results show that ultrafast fetal MRI is a useful adjunct to the prenatal evaluation of fetal sacrococcygeal teratoma. Compared with sonography, MRI more accurately characterized the intrapelvic and abdominal extent of the tumors and provided more information on compression of adjacent organs. The additional anatomic resolution provided by MRI resulted in more accurate prenatal counseling and improved preoperative planning for surgical resection.
本研究的目的是确定与产前超声检查相比，产前磁共振成像（MRI）是否能提供有关胎儿骶尾部畸胎瘤的更多信息。
22例患有胎儿骶尾部畸胎瘤的孕妇接受了产前MRI检查（平均孕周23周）。确定肿瘤的大小、位置、肿块特征和压迫效应，并与超声检查及产后结果进行对比。
根据MRI检查结果，进行了以下美国儿科学会外科分会的分类：6例为I型，12例为II型，4例为III型。未发现IV型肿瘤。骶尾部畸胎瘤在5例胎儿中表现为完全囊性，1例为微囊性，12例为囊实性混合，4例为实性。在本中心使用MRI和超声检查评估的所有病例中，骶尾部畸胎瘤的诊断均准确。另外两名最初诊断为骶尾部畸胎瘤的患者在本机构重新评估时诊断不同（健康，1例；脊髓脊膜膨出，1例）。在检测结肠移位（11例）、泌尿道扩张（9例）、髋关节脱位（4例）、脊柱内延伸（2例）和阴道扩张（1例）方面，MRI优于超声检查。在II型和III型骶尾部畸胎瘤胎儿中，与超声检查相比，MRI能更好地显示肿瘤的头侧范围。所有患者的MRI检查结果均在手术或尸检中得到证实。3例患有高输出量心脏生理改变的胎儿在孕21周、24周和26周时接受了胎儿肿瘤开放性切除术，2例存活。
我们的结果表明，超快胎儿MRI是胎儿骶尾部畸胎瘤产前评估的有用辅助手段。与超声检查相比，MRI能更准确地描述肿瘤在盆腔和腹部的范围，并提供有关相邻器官受压的更多信息。MRI提供的额外解剖分辨率有助于进行更准确的产前咨询，并改善手术切除的术前规划。
