【摘要】 目的:探讨胎儿三维MRI结合仿真内窥镜重组(MRVE)技术在显示胎儿面部结构和畸形中的应用价值。方法:回顾性对87例胎儿的三维MRI数据采用半自动阈值MRVE技术进行图像后处理。胎儿MRI检查序列包括SSFSE和三维稳态进动快速成像(3DFIESTA)。应用Bland-Altman分析法对两位医师(A和B)在胎儿面部结构的图像重建中选择阈值的一致性进行比较。将超声、二维MRI和三维MRI MRVE的诊断结果与随访结果进行对比分析,并采用ROC曲线分析3种方法的诊断效能。结果:3D-FIESTA图像上,羊水呈高信号,胎儿面部软组织、子宫壁和胎盘呈中等信号,组织对比度良好。两位医师确定的测量阈值分别为797.7±12.6(95%置信区间为795.0～800.4)和796.9±11.4(95%置信区间为794.4～799.3),一致性好(P<0.05)。MRVE可以从不同角度直观显示胎儿的面部结构。二维MRI、US和MRVE诊断胎儿面部异常的ROC曲线下面积(AUC)分别为0.891(95%置信区间为0.813～0.968)、0.930(95%置信区间为0.861～0.999)和0.935(95%置信区间为0.866～1.000),差异有统计学意义(P<0.05),以MRVE的诊断效能最高。结论:三维MRI仿真内窥镜处理技术在显示胎儿面部结构和畸形方面具有较高的应用价值。更多还原

【Abstract】 Objective:To investigate the ability of 3D MRI combined with 3Dsurface-rendered magnetic resonance virtual endoscopy(MRVE)technique in visualization of the normal and abnormal fetal face.Methods:87pregnant women were included in the study.Single-shot fast spin-echo sequence(SSFSE)and fast image employing steady-state acquisition(FIESTA)sequence was used for 2Dand3 D MRI scanning respectively.Bland-Altman analysis was used to compare the consistence of the threshold value selected in reconstruction the fetal face between doctor A and B.According to the follow-up results( " gold standard"),The diagnostic results from 2D-MRI,US and MRVE images were compared,and receiver operation characteristic(ROC)curve was used to analyze the diagnostic efficacy.Results:On 3D-FIESTA images,the amniotic fluid presented as strikingly higher signal intensity than the fetal facial soft tissue,uterine wall and placenta,thus the tissue contrast was high.The mean threshold value in virtual endoscopy reconstruction was 797.7±12.6(95%CI:795.0～800.4)for doctor A and 796.9±11.4(95%CI:794.4～799.3)for doctor B.The area under ROC curve(AUC)of2D-MRI,US and MRVE in diagnosing abnormality of fetal face was 0.891(95%CI:0.813～0.968),0.930(95%CI:0.861～0.999)and 0.935(95%CI:0.866～1.000),respectively,there was statistically significant difference(P<0.05),the diagnostic efficacy of MRVE was the largest.Conclusion:3D MRI with MRVE technique can clearly display the structure of fetal face,and has great value in diagnosing the abnormality of fetal face.更多还原