■这项研究的目的是探讨产前磁共振成像(MRI)在评估胎儿先天性囊性肺病中的实用价值,评估病变的相对大小和肺发育状况,并尝试在后处理中利用MRI的强度来获得病变大小和肺部发育状况的评估指标,可以预测这些胎儿出生后可能面临的预后。我们回顾性收集并分析了诊断为先天性囊性肺病的胎儿数据。这些胎儿的产前超声检查导致诊断他们怀疑患有先天性囊性肺病,并且随后的产前MRI证实了诊断。对胎儿进行随访以跟踪其出生时的状况(产后呼吸窘迫,机械通气,等。),胎儿是否接受了手术治疗,以及手术治疗后胎儿的恢复。随访胎儿的恢复情况,探讨产前MRI检查评估胎儿先天性肺囊性疾病的可行性,初步探讨产前MRI对先天性肺囊性疾病胎儿预后的预测价值。
■MRI胎儿图像收集自2018年5月至2023年3月在四川大学华西第二医院就诊的孕妇,通过产前超声和随后的MRI诊断为胎儿先天性肺囊性疾病。对先天性囊性肺病胎儿MRI图像进行后处理,获得胎儿肺部病变体积,胎儿受累的肺容积,健康的肺容量,和胎儿头围测量。肺和肝脏的信号强度,病变体积/受影响的肺体积,病变体积/总肺体积,囊性体积比(CVR),并测量双侧肺-肝信号强度比。结合胎儿出生后6个月的随访结果,进一步分析MRI后处理采集指标对先天性囊性肺病胎儿预后评估的可行性和价值。采用Logistic回归模型对产妇年龄、MRI时的孕周,CVR,和双侧肺-肝信号强度比,并评估这些指标是否与不良预后相关。受试者工作特征(ROC)曲线用于评估单独通过MRI计算获得的参数以及与预测出生后不良预后的多种指标相结合的参数的价值。
■我们收集了2018年5月至2023年3月间通过胎儿MRI诊断为先天性囊性肺病的胎儿共67例,并排除了6例受影响肺部无正常肺组织的病例,11例胎儿诱导,3例失孕。最后,纳入47例先天性囊性肺病胎儿,其中30例预后良好,17例预后不良。预后良好组与预后不良组胎儿患侧和健侧肺、肝的信号强度比值差异有统计学意义(P<0.05),健康侧肺和肝脏的信号强度比高于患侧肺和肝脏的信号强度比。进一步分析表明,CVR(比值比[OR]=1.058,95%置信区间[CI]:1.014-1.104),患侧和健康侧的肺-肝信号强度比之间的差异(OR=0.814,95%CI:0.700-0.947)与先天性囊性肺病胎儿的出生预后不良相关。此外,ROC曲线分析显示,联合应用病变体积/受累肺体积和观察到的受累肺与健康肺和肝脏之间信号强度比值的差异,比单参数判断更准确地预测先天性囊性肺病患儿的预后。曲线下面积为0.988,截止值为0.33,对应灵敏度为100%,特异性为93.3%,95%CI为0.966-1.000。
■基于先天性囊性肺病胎儿的MRI,我们获得了病变体积的信息,病变体积/受影响的肺体积,病变体积/总肺体积,CVR,和双侧肺-肝信号强度比值差异,所有这些都在预测先天性囊性肺病胎儿的不良预后方面显示出一定的临床价值。此外,在组合指数中,病变体积/受累肺体积和双侧肺-肝信号强度比差异是先天性囊性肺病胎儿预后不良的更有效预测因子。在预测先天性囊性肺病胎儿的不良预后方面有较好的疗效。这为进一步评估先天性囊性肺病胎儿的肺发育提供了一种新的有效的预测方法。有助于提高对先天性囊性肺病胎儿预后的评估和预测。
UNASSIGNED: The aim of this study is to explore the practical value of prenatal magnetic resonance imaging (MRI) in the assessment of congenital cystic lung disease in fetuses, to evaluate the relative size of the lesion and the status of lung development, and to make an attempt at utilizing the strength of MRI in post-processing to obtain assessment indicators of the size of the lesion and the status of lung development, with which predictions can be made for the prognosis that these fetuses may face after birth. We retrospectively collected and analyzed the data of fetuses diagnosed with congenital cystic lung disease. Prenatal ultrasound examination of these fetuses led to the diagnosis that they were suspected of having congenital cystic lung disease and the diagnosis was confirmed by subsequent prenatal MRI. The fetuses were followed up to track their condition at birth (postnatal respiratory distress, mechanical ventilation, etc.), whether the fetuses underwent surgical treatment, and the recovery of the fetuses after surgical treatment. The recovery of the fetuses was followed up to explore the feasibility of prenatal MRI examination to assess fetal congenital pulmonary cystic disease, and to preliminarily explore the predictive value of prenatal MRI for the prognosis of fetuses with congenital pulmonary cystic disease.
UNASSIGNED: MRI fetal images were collected from pregnant women who attended the West China Second University Hospital of Sichuan University between May 2018 and March 2023 and who were diagnosed with fetal congenital pulmonary cystic disease by prenatal ultrasound and subsequent MRI. Fetal MRI images of congenital cystic lung disease were post-processed to obtain the fetal lung lesion volume, the fetal affected lung volume, the healthy lung volume, and the fetal head circumference measurements. The signal intensity of both lungs and livers, the lesion volume/the affected lung volume, the lesion volume/total lung volume, the cystic volume ratio (CVR), and the bilateral lung-liver signal intensity ratio were measured. The feasibility and value of MRI post-processing acquisition indexes for evaluating the prognosis of fetuses with congenital cystic lung disease were further analyzed by combining the follow-up results obtained 6 months after the birth of the fetus. Logistic regression models were used to quantify the differences in maternal age, gestational week at the time of MRI, CVR, and bilateral lung-to-liver signal intensity ratio, and to assess whether these metrics correlate with poor prognosis. Receiver operating characteristic (ROC) curves were used to assess the value of the parameters obtained by MRI calculations alone and in combination with multiple metrics for predicting poor prognosis after birth.
UNASSIGNED: We collected a total of 67 cases of fetuses diagnosed with congenital cystic lung disease by fetal MRI between May 2018 and March 2023, and excluded 6 cases with no normal lung tissue in the affected lungs, 11 cases of fetal induction, and 3 cases of loss of pregnancy. In the end, 47 cases of fetuses with congenital cystic lung disease were included, of which 30 cases had a good prognosis and 17 cases had a poor prognosis. The difference in the difference between the signal intensity ratios of the affected and healthy sides of the lungs and livers of the fetuses in the good prognosis group and that in the poor prognosis group was statistically significant (P<0.05), and the signal intensity ratio of the healthy side of the lungs and livers was higher than the signal intensity ratio of the affected side of the lungs and livers. Further analysis showed that CVR (odds ratio [OR]=1.058, 95% confidence interval [CI]: 1.014-1.104), and the difference between the lung-to-liver signal intensity ratios of the affected and healthy sides (OR=0.814, 95% CI: 0.700-0.947) were correlated with poor prognosis of birth in fetuses with congenital cystic lung disease. In addition, ROC curve analysis showed that the combined application of lesion volume/affected lung volume and the observed difference in the signal intensity ratio between the affected and healthy lungs and liver predicted the prognosis of children with congenital cystic lung disease more accurately than the single-parameter judgment did, with the area under the curve being 0.988, and the cut-off value being 0.33, which corresponded to a sensitivity of 100%, a specificity of 93.3%, and a 95% CI of 0.966-1.000.
UNASSIGNED: Based on the MRI of fetuses with congenital cystic lung disease, we obtained information on lesion volume, lesion volume/affected lung volume, lesion volume/total lung volume, CVR, and bilateral lung-to-liver signal intensity ratio difference, all of which showing some clinical value in predicting the poor prognosis in fetuses with congenital cystic lung disease. Furthermore, among the combined indexes, the lesion volume/affected lung volume and bilateral lung-to-liver signal intensity ratio difference are more effective predictors for the poor prognosis of fetuses with congenital cystic lung disease, and show better efficacy in predicting the poor prognosis of fetuses with congenital cystic lung disease. This provides a new and effective predictive method for further assessment of pulmonary lung development in fetuses with congenital cystic lung disease, and helps improve the assessment and prediction of the prognosis of fetuses with congenital cystic lung disease.