From the Departments of Radiology (H.A., S.N., T.C., M.M.), Laboratory Medicine and Pathology (G.H.D.), and Neurological Surgery (S.R.B.), University of Washington Medical Center, 1959 NE Pacific St, Seattle, WA 98195; Departments of Radiology (S.N., T.C.), Laboratory Medicine and Pathology (G.H.D.), and Neurological Surgery (S.R.B.), Seattle Children's Hospital, Seattle, Wash; Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (M.V.R.); and Department of Radiology, NYU Long Island School of Medicine, Mineola, NY (D.S.K.).
Radiographics. 2021 Nov-Dec;41(7):2176-2192. doi: 10.1148/rg.2021210066.
Congenital anomalies of the spine are associated with substantial morbidity in the perinatal period and may affect the rest of the patient's life. Accurate early diagnosis of spinal abnormalities during fetal imaging allows prenatal, perinatal, and postnatal treatment planning, which can substantially affect functional outcomes. The most common and clinically relevant congenital anomalies of the spine fall into three broad categories: spinal dysraphism, segmentation and fusion anomalies of the vertebral column, and sacrococcygeal teratomas. Spinal dysraphism is further categorized into one of two subtypes: open spinal dysraphism and closed spinal dysraphism. The latter category is further subdivided into those with and without subcutaneous masses. Open spinal dysraphism is an emergency and must be closed at birth because of the risk of infection. In utero closure is also offered at some fetal centers. Sacrococcygeal teratomas are the most common fetal pelvic masses and the prognosis is variable. Finally, vertebral body anomalies are categorized into formation (butterfly and hemivertebrae) and segmentation (block vertebrae) anomalies. Although appropriate evaluation of the fetal spine begins with US, which is the initial screening modality of choice, MRI is increasingly important as a problem-solving tool, especially given the recent advances in fetal MRI, its availability, and the complexity of fetal interventions. RSNA, 2021.
脊柱先天畸形在围产期与较高的发病率相关，并可能影响患者的余生。在胎儿影像学检查中准确地早期诊断脊柱异常可以进行产前、围产期和产后的治疗规划，这可以极大地影响功能预后。最常见和具有临床意义的脊柱先天畸形可分为三大类：脊柱脊膜膨出、脊柱分节和融合异常，以及骶尾部畸胎瘤。脊柱脊膜膨出进一步分为两种亚型之一：开放性脊柱脊膜膨出和闭合性脊柱脊膜膨出。后者进一步分为伴有和不伴有皮下肿块的类型。开放性脊柱脊膜膨出是一种急症，必须在出生时关闭，因为存在感染的风险。一些胎儿中心也提供宫内闭合。骶尾部畸胎瘤是最常见的胎儿盆腔肿块，预后不一。最后，椎体异常分为形成（蝴蝶椎和半椎体）和分节（椎体块）异常。虽然对胎儿脊柱的适当评估始于 US，它是首选的初始筛查方式，但 MRI 作为一种解决问题的工具变得越来越重要，尤其是考虑到胎儿 MRI 的最新进展、其可用性以及胎儿干预的复杂性。RSNA，2021 年。
