Fetal imaging

胎儿影像学
  • 文章类型: Journal Article
    今天,与所有领域中成像模式的使用同时增加,孕妇使用的成像方法正在增加。影像学已成为常规妊娠随访的组成部分。影像为家长提供了一个早期了解现状的机会,包括异常或疾病的产前检测,病因学,预后,以及产前或产后治疗的可用性。各种成像模式,尤其是超声检查,常用于母体和胎儿成像。这篇综述的目的是在有用性和安全性方面讨论成像方式,以及提供疾病的示范性例子。这篇综述提供了有关选择安全的成像方式来评估孕妇和胎儿的最新信息,造影剂使用的安全性,并总结了主要的病理情况与演示超声图像,以协助放射科医生和产科医生在日常实践。
    Today, in parallel with the use of imaging modalities increases in all fields, the use of imaging methods in pregnant women is increasing. Imaging has become an integral component of routine pregnancy follow-up. Imaging provides parents with an early opportunity to learn about the current situation, including prenatal detection of anomalies or diseases, etiology, prognosis, and the availability of prenatal or postnatal treatments. Various imaging modalities, especially ultrasonography, are frequently used for imaging both maternal and fetal imaging. The goal of this review was to address imaging modalities in terms of usefulness and safety, as well as to provide demonstrative examples for disorders. And this review provides current information on selecting a safe imaging modality to evaluate the pregnant and the fetus, the safety of contrast medium use, and summarizes major pathological situations with demonstrative sonographic images to assist radiologists and obstetricians in everyday practice.
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  • 背景:胎儿超声检查是妊娠随访的常规部分,轨道结构的检查也是常规评估的一部分。尽管眼眶发育异常在新生儿期很常见,在子宫内的诊断并不常见。据我们所知,文献报道了三例诊断为先天性眼眶表皮囊肿的病例,其中两人有胎儿影像学检查结果。在这篇文章中,我们介绍了1例胎儿期诊断为眼眶囊肿,新生儿期组织病理学诊断为表皮囊肿的产前影像学表现。
    方法:一名25岁女性在妊娠22周时进行超声检查。引起眼球突出的35x45毫米囊性病变,没有固体成分和血管,在左眼眶观察到视神经周围并导致视神经变薄。在胎儿磁共振成像(MRI)中,眶内囊性病变,在T2W图像上是高强度的,在T1W图像上是低信号,与颅内结构没有关系,也没有固体成分。病人的病变,采取多学科方法,出生后的计算机断层扫描(CT)和磁共振成像(MRI)显示类似。随后,病人接受了保球手术,病理诊断为表皮囊肿。
    结论:眼眶表皮囊肿很少见,胎儿期的检测甚至更罕见。在胎儿和新生儿期引起眼球突出的眼眶囊性病变的鉴别诊断中应考虑。
    Fetal ultrasonographic evaluation is a routine part of pregnancy follow-up, and examination of orbital structures is also part of the routine evaluation. Although orbital developmental anomalies are common in the neonatal period, diagnosis in the intrauterine period is not common. To our knowledge, three cases with a diagnosis of congenital orbital epidermal cysts have been reported in the literature, and two of them had fetal imaging findings. In this article, we present the prepostnatal imaging findings of a case diagnosed with orbital cyst in the fetal period and histopathologically diagnosed as epidermal cyst in the neonatal period.
    A 25-year-old woman applied for ultrasonography (USG) examination at 22 weeks of gestation. A 35x45 mm cystic lesion causing proptosis, without solid component and vascularity, surrounding the optic nerve and causing its thinning was observed in the left orbit. In fetal magnetic resonance imaging (MRI), the intraorbital cystic lesion, which was hyperintense on T2W images and hypointense on T1W images, had no relationship with intracranial structures and no solid component. The lesion of the patient, followed up with a multidisciplinary approach, was shown similarly with computed tomography (CT) and magnetic resonance imaging (MRI) in the postnatal period. Subsequently, the patient underwent globe-sparing surgery, and the pathological diagnosis was made as the epidermal cyst.
    Orbital epidermal cysts are rarely seen, and detection in the fetal period is even rarer. It should be considered in the differential diagnosis of orbital cystic lesions that cause proptosis in fetal and neonatal periods.
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  • 文章类型: Journal Article
    先天性感染代表了一种具有挑战性和多样化的临床情况,其中大脑经常涉及。因此,胎儿和新生儿神经成像在准确诊断和预测临床结局方面起着关键作用.先天性脑感染的特点是临床表现多样,从几乎无症状的疾病到综合征,常伴有严重的神经症状.脑损伤是由感染因子之间复杂的相互作用引起的,其特定的细胞向性,以及母体感染时中枢神经系统的发育阶段。因此,神经放射学检查结果差异很大,是复杂事件的结果。早期检测对于建立正确的诊断和预后至关重要。并保证最佳和及时的围产期治疗管理。最近,新兴的感染因子(即,寨卡病毒和SARS-CoV2)与可能的产前和围产期脑损伤有关,从而扩大了先天性脑部感染的范围。本图片综述的目的是概述临床实践中使用的先天性脑感染中胎儿和新生儿脑神经影像学模式的最新知识。
    Congenital infections represent a challenging and varied clinical scenario in which the brain is frequently involved. Therefore, fetal and neonatal neuro-imaging plays a pivotal role in reaching an accurate diagnosis and in predicting the clinical outcome. Congenital brain infections are characterized by various clinical manifestations, ranging from nearly asymptomatic diseases to syndromic disorders, often associated with severe neurological symptoms. Brain damage results from the complex interaction among the infectious agent, its specific cellular tropism, and the stage of development of the central nervous system at the time of the maternal infection. Therefore, neuroradiological findings vary widely and are the result of complex events. An early detection is essential to establishing a proper diagnosis and prognosis, and to guarantee an optimal and prompt therapeutic perinatal management. Recently, emerging infective agents (i.e., Zika virus and SARS-CoV2) have been related to possible pre- and perinatal brain damage, thus expanding the spectrum of congenital brain infections. The purpose of this pictorial review is to provide an overview of the current knowledge on fetal and neonatal brain neuroimaging patterns in congenital brain infections used in clinical practice.
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  • 文章类型: Journal Article
    目的:描述两个胎龄早期(GA)的胎儿(体内和体外)与神经病理学之间的相关性一个罕见的发现,其病理意义和神经病理学数据很少。
    方法:两名胎儿在21周时接受了胎儿MRI(fMRI)检查,怀疑是超声检查(US)的call骨异常。功能磁共振成像结果出来后,终止妊娠(TOP)并进行死后MRI(pmMRI).神经病理学相关性包括用苏木精-伊红和免疫组织化学染色制备的切片进行宏观和微观评估。
    结果:在两种情况下,胎儿成像均证实在相同的GA下,相对于参考标准存在较短和较厚的CC,它的不同部分没有明确的区别。此外,在pmMRI上,在两种情况下,沿CC的上下表面都发现了异常的T2加权高强度层。在组织病理学上,这些发现与白质束数量的增加相对应,但也与促进CC发育的胚胎结构的异常表现相对应。命名“call骨吊带”的神经胶质细胞(IG)和胶质上皮(GL)。“在查阅文献资料后,我们证实了最近关于CC发育的胚胎学理论,并为异常病例的病理生理学提供了新的见解。
    结论:胎儿早期异常厚的CC可能与中线神经胶质结构的异常表现有关,从而导致call骨形成的轴突引导机制的潜在干扰,并最终导致CC发育不全。
    OBJECTIVE: To describe the correlation between fetal imaging (in vivo and ex vivo) and neuropathology in two fetuses at early gestational age (GA) with isolated thick corpus callosum (CC), a rare finding whose pathological significance and neuropathology data are scarce.
    METHODS: Two fetuses at 21-week GA underwent fetal MRI (fMRI) for suspected callosal anomalies at ultrasound (US). After fMRI results, termination of pregnancy (TOP) was carried out and post-mortem MRI (pmMRI) was performed. Neuropathology correlation consisted in macro and microscopic evaluation with sections prepared for hematoxylin-eosin and immunohistochemistry staining.
    RESULTS: Fetal imaging confirmed in both cases the presence of a shorter and thicker CC with respect to the reference standard at the same GA, without a clear distinction between its different parts. Moreover, on pmMRI, an abnormal slightly T2-weighted hyperintense layer along the superior and inferior surface of CC was noted in both cases. At histopathology, these findings corresponded to an increased amount of white matter tracts but also to an abnormal representation of embryological structures that contribute to CC development, naming induseum griseum (IG) and the glioepithelial layer (GL) of the \"callosal sling.\" After reviewing the literature data, we confirmed the recent embryological theory regarding the CC development and provide new insights into the pathophysiology of the abnormal cases.
    CONCLUSIONS: An abnormally thick CC at the early fetal period could be associated to an abnormal representation of the midline glia structures, so to result in potential disturbance of the axon guidance mechanism of callosal formation and eventually in CC dysgenesis.
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  • 文章类型: Journal Article
    目的:产前肾上肿块(SRMs)的鉴别诊断广泛,包括神经母细胞瘤,肾上腺出血,和膈下叶外肺隔离症(SEPS)。我们试图阐明发现患有SRM的胎儿的适当产后管理。
    方法:我们在1998年至2018年间对我们机构的产前诊断为SRM的患者进行了回顾性回顾。产前特征,成像,并收集新生儿结局。我们还进行了PubMed文献检索,并对所有先前在文献中描述的产前诊断为SRM的患者进行了汇总分析。
    结果:文献综述产生了32项研究,其中19例为单例报告。在我们的案例系列中,包括12名患者。七名患者经阴道分娩,一个被终止了。产后诊断包括:SEPS(n=5),肾上腺出血(n=3),多囊肾(n=2),脾囊肿(n=1),对一个病人来说是未知的。除两项最终诊断外,其他所有诊断都是在最初的诊断鉴别上。除了终止的胎儿,今天所有人都还活着。在汇总分析中,接受手术治疗的患者分别在32周和24周之后诊断,且左侧病变占显著优势(59.5%和39.2%).已发表的文献显示了在过去30年中观察与切除的趋势。
    结论:产前诊断为SRM的患者预后良好。我们的系列展示了SEPS的高发率,都被切除了,肾上腺出血,用重复成像观察。在决定适当的治疗之前,可以对这些患者进行连续的产后超声检查以确定诊断。
    OBJECTIVE: The differential diagnosis for prenatal suprarenal masses (SRMs) is broad and includes neuroblastoma, adrenal hemorrhage, and subdiaphragmatic extralobar pulmonary sequestration (SEPS). We sought to elucidate the appropriate postnatal management for fetuses found to have an SRM.
    METHODS: We conducted a retrospective review of patients prenatally diagnosed with SRM at our institution between 1998 and 2018. Prenatal characteristics, imaging, and neonatal outcomes were collected. We also performed a PubMed literature search and pooled analysis of all patients with a prenatally diagnosed SRM previously described in the literature.
    RESULTS: The literature review yielded 32 studies, of which 19 were single case reports. In our case series, 12 patients were included. Seven patients were delivered vaginally, one was terminated. Postnatal diagnoses included: SEPS (n = 5), adrenal hemorrhage (n = 3), polycystic kidney (n = 2), splenic cyst (n = 1), and unknown for one patient. All but two of the final diagnoses had been on the initial diagnostic differential. With the exception of the terminated fetus, all remain alive today. On pooled analysis, patients who underwent operative management were diagnosed later 32 versus 24 weeks and had a significant predominance of left-sided lesions (59.5 versus 39.2%). The published literature demonstrates a trend toward observation versus resection over the past 30 years.
    CONCLUSIONS: Patients prenatally diagnosed with an SRM have an excellent prognosis. Our series demonstrates a high incidence of SEPS, which were all resected, and adrenal hemorrhage, which were observed with repeat imaging. These patients can be followed with serial postnatal ultrasounds to determine the diagnosis prior to deciding the appropriate treatment.
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