超声联合MRI在多胎合并双胎反向动脉灌注序列征中的初步探讨

朱向阳; 陈欣林; 杨小红; 杨文忠; 孙子燕; 冯倩; 葛倩

中国临床医学影像杂志 ›› 2014, Vol. 25 ›› Issue (8) : 579-583.

论著

超声联合MRI在多胎合并双胎反向动脉灌注序列征中的初步探讨

朱向阳1，陈欣林1，杨小红1，杨文忠1，孙子燕2，冯倩1，葛倩1

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Preliminary study of MRI and ultrasound in multi-pregnancies complicated by twin reversed arterial perfusion sequence

ZHU Xiang-yang1, CHEN Xin-lin1, YANG Xiao-hong1, YANG Wen-zhong1, SUN Zi-yan2, FENG Qian1, GE Qian1

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摘要

目的：超声联合MRI初步探讨多胎合并双胎反向动脉灌注（Twin reversed arterial perfusion，TRAP）序列征的影像学表现。方法：收集我院2005—2013年超声诊断为TRAP序列征并行MRI检查的12例病例，对比分析同期存留的超声及MRI图片，影像结果对照4例无心儿及3例泵血儿标本。结果：12例无心儿畸形表现为无头畸胎5例，头发育不良畸胎4例，其他未分型3例。11例有水肿，除3例血流自然阻断外，均为单脐动脉，血流反向灌注。超声有2例早期误诊，但对无心儿畸形辨别较细致，能对血流方向及泵血儿心功能进行评价并发现3例泵血儿心功能不全，超声显示了MRI显示不满意的1例妊娠晚期无心儿呈纸样儿，1例16周无心儿的异常上下肢和1例24周无心儿双足足趾的异常。MRI除1例纸样儿外，无心儿及泵血儿轮廓清晰，空间方位清楚，能显示无心儿严重结构异常，MRI显示了1例超声不能显示的两胎儿的关系及脐带和2例超声难以显示的无心儿肢体。结论：超声和MRI均能客观评价TRAP序列征的结构异常。超声实时动态重复性强，对无心儿较细致畸形的识别与诊断具有优势，能提供无心儿血流方向及循环特点，可以评估泵血儿心功能不全。MR反应了大影像的优势，可以显示泵血儿与无心儿结构与空间方位、胎盘羊水及脐带与胎盘连接关系。两种影像技术结合将更加客观全面反应TRAP序列征结构、功能及其附属物的病理改变，对宫内诊断与干预有重要意义。

Abstract

Objective: To preliminarily study ultrasound and MRI in multi-pregnancies complicated by twin reversed arterial perfusion sequence(TRAP). Methods: Twelve TRAP cases from 2005 to 2013 diagnosed by ultrasound and additionally examined by MRI were included in this study. The imaging of ultrasound and MRI were reviewed retrospectively and at the same time the imaging findings were correlated with autopsy specimens of 4 acardiac twins and 3 pump twins. Results: The 12 TRAP cases had acardia and the complications included 5 acephalus, 4 anceps(some cranial structures and brain tissue is present), 3 undecided type malformations. Eleven cases had subcutaneous edema, 9 cases had single umbilical artery. Ultrasound can make the diagnosis of acardia clearly except misdiagnosis in 2 cases at the beginning. Color flow Doppler ultrasound can estimate the direction of blood flow of the acardiac twin and the cardiac function of the pump twin, and 3 pump twins had cardiac dysfunction. Ultrasound displayed cases not diagnosed by MRI included 1 case of paper fetus, 1 GA 16 weeks acardiac twin with anomalies of upper and lower limbs and 1 GA 24 weeks acardiac twin with anomaly toes. MRI can display the profile of the acardiac and pump twin clearly with good spatial resolution, also can demonstrate severe malformation of the acardiac twin. MRI displayed the relationship of the twin fetuses and the umbilical cord in one case and the limbs of the acardiac twin in 2 cases which can not be showed by ultrasound. Conclusion: Ultrasound and MRI are both available to assess TRAP objectively. Ultrasound has advantages in real-time dynamic and repeatability which can distinguish the detailed deformity, provide the blood circulation characteristics of the acardiac twin and estimate the cardiac function of the pump twin. MRI has advantages in large view which can display the spatial orientation of the twin clearly, placenta/amniotic fluid and the relationship of the umbilical cord with the placenta. Combining the two imaging technology will further display the structure, function of TRAP and the pathological changes which are important for prenatal diagnosis and treatment.

导出引用

朱向阳;陈欣林;杨小红;杨文忠;孙子燕;冯倩;葛倩. 超声联合MRI在多胎合并双胎反向动脉灌注序列征中的初步探讨[J]. 中国临床医学影像杂志. 2014, 25(8): 579-583

ZHU Xiang-yang;CHEN Xin-lin;YANG Xiao-hong;YANG Wen-zhong;SUN Zi-yan;FENG Qian;GE Qian. Preliminary study of MRI and ultrasound in multi-pregnancies complicated by twin reversed arterial perfusion sequence[J]. Journal of China Clinic Medical Imaging. 2014, 25(8): 579-583

中图分类号： Ｒ714.23 Ｒ714.53 Ｒ445.1 Ｒ445.2