单纯性侧脑室扩张胎儿产前MRI检查诊断的临床价值及出生后随访

摘要

目的 探讨单纯性侧脑室扩张胎儿的产前MRI检查诊断的价值,随访其出生后神经系统发育状况.方法 收集2013年5月至2015年6月在浙江省湖州市妇幼保健院,经产前MRI检查诊断为单纯性侧脑室扩张且活产无异常的胎儿126例为扩张组,并纳入同期50例正常胎儿为对照组.扩张组胎儿的亚组分析:(1)单侧或双侧侧脑室扩张:单侧侧脑室扩张组98例(77.8%,98/126),双侧侧脑室扩张组28例(22.2%,28/126).(2)侧脑室扩张宽度:宽度>10.0 mm,双侧均扩张者,取扩张较重一侧的宽度,分为3个亚组,分别为扩张A组(侧脑室宽度为10.0~12.0 mm)88例(69.8%,88/126)、扩张B组(侧脑室宽度为12.1~15.0 mm)29例(23.0%,29/126)、扩张C组(侧脑室宽度>15.0 mm)9例(7.1%,9/126).全部176例胎儿出生后,分别于3、6、12、18个月定期随访(早产儿校正月龄后随访),并采用Gesell发育量表(GDS)评估中枢神经系统的功能,以比较其出生后的神经系统发育状况.结果 (1)扩张组胎儿出生后MRI复查结果:扩张组胎儿有21例出生后复查MRI.扩张A组复查11例,其中9例正常(出生后MRI复查示,侧脑室宽度<10.0 mm),2例稳定(出生后侧脑室宽度仍≥10.0 mm,且首次MRI测量的侧脑室宽度与出生后MRI测量的宽度变化≤2.0 mm);扩张B组复查4例,其中1例正常,2例缩小(出生后侧脑室宽度仍≥10.0 mm,且出生后MRI测量的宽度较首次MRI测量的侧脑室宽度缩小>2.0 mm),1例稳定;扩张C组复查6例,其中3例缩小,3例稳定.(2)总体的GDS评价结果:扩张组胎儿出生后3、6、12、18个月的GDS评价结果分别与对照组比较,差异均无统计学意义(P均>0.05).(3)亚组的GDS评价结果比较:扩张A组胎儿出生后3、6、12、18个月的GDS评价结果分别与对照组比较,差异均无统计学意义(P均>0.05).扩张B组胎儿出生后3、6个月的GDS评价结果较对照组均较差(P均<0.05);12、18个月的GDS评价结果分别与对照组比较,差异均无统计学意义(P均>0.05).扩张C组胎儿出生后3、6、12、18个月的GDS评价结果与对照组分别比较,差异均有统计学意义(P均<0.05).(4)扩张组胎儿出生后不同时间点的总体GDS评价结果比较:扩张组胎儿出生后3个月的GDS评价结果,与6个月的比较,差异无统计学意义(P>0.05);与12、18个月的结果分别比较,差异均有统计学意义(P均<0.05).出生后6个月的GDS评价结果与12、18个月的比较,差异无统计学意义(P>0.05).出生后12个月的GDS评价结果与18个月的比较,差异无统计学意义(P>0.05).(5)单侧侧脑室扩张与双侧侧脑室扩张胎儿的GDS评价结果比较:出生后18个月,98例单侧侧脑室扩张者中,GDS评分正常(>85分)86例(87.8%,86/98),GDS评分临界(75~85分)8例(8.2%,8/98),落后(<75分)4例(4.1%,4/98);28例双侧侧脑室扩张者中,GDS评分正常23例(82.1%,23/28),临界3例(10.7%,3/28),落后2例(7.1%,2/28);两组间比较,差异无统计学意义(P>0.05).结论 单纯性侧脑室扩张胎儿的侧脑室宽度≤12.0 mm时,临床上可不特殊处理;宽度为12.1~15.0 mm时,临床应密切随访,出生后应进行针对性的康复训练;宽度>15.0 mm时,出生后中枢神经系统发育落后的风险明显增高,应尽早干预,以期改善预后.%Objective To explore the value of prenatal MRI in the diagnosis of fetal simple expansion of lateral ventricle(ventriculomegaly), and follow up the nervous system development status after birth. Methods Simple expansion of the lateral ventricle fetus by prenatal MRI examination were collected in Huzhou Maternal and Child Care Hospital from May 2013 to June 2015, 126 cases of live births in expansion group, 50 normal cases were recruited in the same period as the control group. In expansion group, fetal subgroup analysis was done:(1) unilateral or bilateral lateral ventricle expasion:one group was 98 cases was lateral ventricle expansion (77.8%, 98/126), expansion of bilateral ventricle group was 28 cases (22.2%, 28/126). (2) Prenatal MRI in the diagnosis of the lateral ventricle of expansion: expansion of the lateral ventricle width was greater than 10.0 mm, if both sides were expanding, the expand width was the heavier one side, divided into 3 subgroups: ①Expansion in group A (lateral ventricle width 10.0-12.0 mm) were 88 cases (69.8%, 88/126).②Expansion in group B (lateral ventricle width 12.1-15.0 mm) were 29 cases (23.0%, 29/126). ③Expansion of group C (lateral ventricle width> 15.0 mm) were 9 cases (7.12%, 9/126). All 176 cases were followed up after birth at the 3rd, 6th, 12th, 18th month (corrected age was used for premature babies), and Gesell developmental schedules (GDS) were used to evaluate the neurobehavioral development. Results (1) The MRI results after birth:21 cases were followed up by MRI after birth. In group A, 11 cases had MRI and 9 were normal (the ventricular width<10.0 mm after birth) , the other 2 cases were stable (the ventricular width measured first time after birth was ≥10.0 mm, but the difference was within 2.0 mm from the MRI before birth). In group B, 4 cases had MRI, 1 was normal, 1 was stable, and 2 cases were getting better (the ventricular width measured first time after birth was ≥10.0 mm, but the width decreased more than 2.0 mm from the MRI before birth). In group C, 6 cases had MRI. 3 cases were getting better and 3 cases were stable. (2) Overall GDS results:expansion group after the birth of the 3rd, 6th, 12th, 18th month GDS evaluation results compared with control group, respectively, the differences were not statistically significant (all P>0.05). (3) The GDS results among the subgroups:in each evaluation after birth, there were no statistically significant differences between group A and the control group (all P>0.05). The GDS results of group B at the 3rd and 6th month were lower than those of the control group (P<0.05); while there were no statistically significant differences between the 2 goups at the 12th and 18th month (P>0.05). And for group C, statistically significant differences were found compared to the control group at each follow-up time (all P<0.05). (4) GDS results at different times after birth in the expansion group:there was no statistically significant difference between the results at the 3rd and 6th month (P>0.05). But when the result at the 3rd month was compared to the results of the 12th or 18th month, the differences were statistically significant (P<0.05). GDS result of 6th months after birth compared with 12th and 18th months, respectively, there were no statistically significant differences (P>0.05). There was no statistically significant difference between the results at the 12th and 18th month (P>0.05). (5) The GDS results in unilateral and bilateral ventricle expansion:at the 18th month, among the 98 unilateral cases, 86 (87.8%, 86/98) had normal GDS results(>85 scores);8 (8.2%, 8/98) had borderline results (75-85 scores);4 (4.1%, 4/98) had delayed results (<75 scores). Among the 28 bilateral cases, 23 (82.1%, 23/28) had normal GDS results;3 (10.7%, 3/28) had borderline results; 2 (7.1%, 2/28) had delayed results. There was no statistically significant difference (P>0.05). Conclusions Among the simple expansion of lateral ventricle, those whose ventricular width are≤12.0 mm may not need clinical treatment. If the width is between 12.1 to 15.0 mm, closely follow-up and targeted rehabilitation training after birth are recommended. When the width is more than 15.0 mm, the risk of the central nervous system function delay is significantly increased, and early intervention might improve the prognosis.