OB/GYN and Women's Health Institute, Cleveland Clinic, Cleveland, OH, USA.
Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA.
J Perinat Med. 2019 Sep 25;47(7):771-774. doi: 10.1515/jpm-2019-0177.
Background Spina bifida affects 0.5-1 in 1000 pregnancies in the United States and is often diagnosed in the mid-second trimester. The objective of the study was to directly compare ultrasounds (US) and magnetic resonance imaging (MRI) obtained in the antenatal period in the diagnosis and localization of fetal myelomeningocele (MMC) and compare these with the postnatal outcomes of these infants Methods A retrospective analysis of patients referred to the Fetal Care Center at the Cleveland Clinic from 2005 to 2017. US and MRIs were obtained from the Cleveland Clinic electronic medical record. Infants were followed-up at an interdisciplinary myelomeningocele pediatrics clinic. Results MRI and US varied in correlation with physical exam at the time of birth and surgery. While no differences were detected in demographics, pregnancy outcomes or pediatric outcomes, it was noted that the majority of patients developed neurogenic bladders irrespective of the lesion level. Conclusion MRI is not superior to US in the diagnosis of MMC. Pregnancies complicated by MMC do not vary in morbidity, and pediatric outcomes remain similar regardless of the lesion level. This data provides additional information for the counseling of patients when faced with this antenatal diagnosis.
背景 在美国，每 1000 次妊娠中就有 0.5-1 次会受到脊柱裂的影响，并且通常在妊娠中期进行诊断。本研究的目的是直接比较产前获得的超声（US）和磁共振成像（MRI）在胎儿脊髓脊膜膨出（MMC）的诊断和定位中的作用，并将这些结果与这些婴儿的产后结果进行比较。
方法 这是一项对 2005 年至 2017 年期间在克利夫兰诊所胎儿护理中心就诊的患者进行的回顾性分析。US 和 MRI 均从克利夫兰诊所的电子病历中获得。婴儿在多学科脊髓脊膜膨出儿科诊所进行随访。
结果 MRI 和 US 在出生时和手术时与体格检查的相关性不同。尽管在人口统计学、妊娠结局或儿科结局方面没有差异，但值得注意的是，大多数患者无论病变水平如何，均发展为神经原性膀胱。
结论 MRI 在 MMC 的诊断中并不优于 US。并发 MMC 的妊娠在发病率方面没有差异，并且儿科结局也相似，与病变水平无关。这些数据为面对这种产前诊断的患者咨询提供了更多信息。
