Kandula Tejaswi, Fahey Michael, Chalmers Rebecca, Edwards Andrew, Shekleton Paul, Teoh Mark, Clark Jenni, Goergen Stacy K
Monash Childrens, Monash Health, Melbourne, Victoria, Australia.
J Med Imaging Radiat Oncol. 2015 Apr;59(2):154-62. doi: 10.1111/1754-9485.12287. Epub 2015 Mar 2.
Cerebral ventriculomegaly is one of the most commonly detected fetal anomalies at the midtrimester ultrasound. Current evidence suggests that magnetic resonance imaging (MRI) is indicated when the isolated ventriculomegaly (IVM) on ultrasound is severe (>15 mm), but there is less agreement when IVM is mild or moderate (10-15 mm). The current study aimed to determine the frequency and nature of additional findings on MRI in IVM and their relationship to the severity of VM and gestational age.
Data were gathered prospectively from all pregnant women with ultrasound-diagnosed IVM referred for MRI between November 2006 and February 2013. Cases with IVM and no other suspected cranial abnormality on a tertiary ultrasound performed at our institution, at or after 20 weeks gestation, were included.
Of the 59 fetuses with unilateral or bilateral IVM, additional findings were seen on MRI in 10 cases (17%) and half of these findings were identified in fetuses with mild IVM. Five of 40 (12.5%) fetuses with mild IVM had additional findings and 3/5 (60%) were potentially clinically significant. No additional abnormalities were identified in fetuses less than or equal to 24 weeks gestation with mild or moderate IVM. There was no statistically significant relationship between gestational age and additional findings on MRI in mild IVM. Callosal and septum pellucidum lesions, periventricular abnormalities and malformations of cortical development accounted for all of the significant additional findings.
This study helps to inform referral of pregnant women with a fetus who has IVM for prenatal MRI.
脑室扩大是孕中期超声检查中最常发现的胎儿异常之一。目前的证据表明，当超声检查发现孤立性脑室扩大（IVM）严重（>15毫米）时，建议进行磁共振成像（MRI）检查，但对于轻度或中度IVM（10 - 15毫米），意见分歧较大。本研究旨在确定IVM胎儿MRI检查中其他发现的频率和性质，以及它们与脑室扩大严重程度和孕周的关系。
前瞻性收集2006年11月至2013年2月期间因超声诊断IVM而转诊进行MRI检查的所有孕妇的数据。纳入在我院妊娠20周及以后进行的三级超声检查中发现IVM且无其他可疑颅脑异常的病例。
在59例单侧或双侧IVM胎儿中，10例（17%）MRI检查有其他发现，其中一半在轻度IVM胎儿中发现。40例轻度IVM胎儿中有5例（12.5%）有其他发现，其中3/5（60%）可能具有临床意义。孕周小于或等于24周的轻度或中度IVM胎儿未发现其他异常。轻度IVM中，孕周与MRI检查的其他发现之间无统计学显著关系。胼胝体和透明隔病变、脑室周围异常以及皮质发育畸形占所有重要的其他发现。
本研究有助于为患有IVM胎儿的孕妇转诊进行产前MRI检查提供参考。
