产前MRI技术在产时胎儿手术中的应用价值的初步分析

为研究产前MRI技术在产时胎儿手术中的应用价值,收集2014年12月至2015年8月在广东省佛山市妇幼保健院实施的4例产时胎儿手术的临床及影像资料,回顾性分析产前MRI对产时胎儿手术的实施所起到的作用及存在的不足。4例患者中胎儿脐膨出2例左侧先天性膈疝2例,产前MRI检查均明确了胎儿出生缺陷的种类及严重程度,对产时胎儿手术的制定发挥了重要的指导作用;但MRI对胎儿合并的支气管软化症及肺动脉高压未能进行有效评价,对合并的胎盘植入未能在产前检出,也给手术增加了风险。由此得出结论,产前MRI需与超声检查联合应用才能更好地提高胎儿宫内缺陷的检出率和临床应用价值。     

MRI的临床应用进展

磁共振成像(magnatic resonance imaging,MRI)是现代影像医学的重要组成部分之一。随着硬件和软件方面的不断改进和发展,MRI日益得到广泛的临床应用。MRI的临床应用主要有五个方面：磁共振水成像、磁共振血管成像、磁共振功能成像、磁共振波谱以及磁共振造影介入技术。MRI可提供病变组织在形态学改变和生理功能方面的信息,因此MRI已成为进行疾病诊断和鉴别诊断的重要工具,亦是介入技术导引的手段。由于MRI具有无创性和信息容量多等点,使其能在生物学医学领域内作深入的研究。MRI将提供生物化学的信息。总之,MRI是现代医学的新领域,代表着影像医学的发展方向。     

MRI的临床应用进展

磁共振成像(magnatic resonance imaging.MRI)是现代影像医学的重要组成部分之一。随着硬件和软件方面的不断改进和发展,MRI日益得到广泛的临床应用。MRI的临床应用主要有五个方面:磁共振水成像、磁共振血管成像、磁共振功能成像、磁共振波谱以及磁共振造影介入技术。MRI可提供病变组织在形态学改变和生理功能方面的信息,因此MRI已成为进行疾病诊断和鉴别诊断的重要工具,亦是介入技术导引的手段。由于MRI具有无创性和信息容量多等点,使其能在生物学医学领域内作深入的研究。MRI将提供生物化学的信息。总之,MRI是现代医学的新领域,代表着影像医学的发展方向。     

三维超声在高海拔地区出生缺陷筛查中的应用

本研究的目的是探讨产前系统超声检查在胎儿出生缺陷早期筛查过程中应用价值及意义,为胎儿出生缺陷的早期筛查提供参考依据。我们选取2016年1~4月来青海省红十字医院行产前系统超声检查的403例孕妇为研究对象,记录胎儿异常情况。研究发现青海省红十字医院对出生缺陷的阳性筛查率为1.8%;筛查的出生缺陷时间分布以孕中期为主,占62.5%。本研究认为产前系统超声筛查可有效地筛查出孕中期胎儿异常情况,可为临床诊断胎儿出生缺陷提供参考依据,降低出生缺陷发生率,把孕中期的结构筛查提前到孕早期,使一些畸形或严重畸形在孕早期早发现、早诊断、早干预,具有重要临床意义及社会意义,值得临床推广和进一步研究。     

编者按

<正>器官正常发育是器官行使正常生理功能的基础,组织器官发育异常会导致出生缺陷、器质性疾病甚至胚胎期死亡,心脑血管疾病、代谢性疾病、免疫相关疾病等与器官发育异常也有密切关系。因此,深入研究和解析器官发育的细胞和分子基础意义重大,是生命科学的研究热点,对于保障人类健康具有重要意义。     

出生缺陷与细胞再生专栏导读

<正>预防出生缺陷是提高人口质量的重要手段。出生缺陷是新生儿先天机体或功能的异常,表现在身体、智力或对社会的影响。中国儿童人口基数庞大,随着国家生育政策的调整,预防出生缺陷显得尤为重要。多数出生缺陷的致病原因及发病机制还没有明晰,有效的治疗和干预策略更亟待研究与开发。     

恒河猴正常子宫及妊娠后期胎儿的MRI研究

目的研究恒河猴正常子宫及妊娠后期胎儿的MRI表现。方法对3只未妊娠和3只妊娠135d的恒河猴分别进行磁共振成像（MRI）扫描,观察子宫及胎儿的影像学特点。结果未妊娠恒河猴的子宫T1WI冠状位呈椭圆形,子宫体各层呈中等信号,矢状位呈葫芦形。在T2WI上,冠状位显示宫体可见2～3层不同的信号带,在矢状位子宫体肌层的信号高于子宫颈,信号的移行区是体颈的交界处。妊娠恒河猴的子宫肌层变薄,胎盘及胎儿的脑、脊柱、肝、肺等结构显示清楚。结论MRI能很好地显示恒河猴子宫的形态、胎儿各部分的结构。对人畸形胎儿的产前诊断有一定的参考价值。     

无创产前DNA检测可有效筛查唐氏综合症降低出生缺陷

为了探究无创产前DNA检测筛查唐氏综合症降低出生缺陷的效果,本研究选择2012年4月至2017年12月我院收治的孕期产检6 192例孕妇作为研究对象,应用DNA测序方法对孕妇血浆中胎儿游离DNA进行染色体非整倍体检测,并检测其灵敏度和特异性,同时采用羊水核型分析两种结果。研究显示,阳性共73例,69例做了进一步检查,显示40例胎儿染色体检查核型正常继续妊娠,29例染色体异常。比较不同年龄组的孕妇血清学筛查唐氏综合征高风险情况,研究表明随着孕妇年龄的增加,DS阳性率逐渐降低(p0.05);血清学筛查后胎儿游离DNA (cffDNA)检测与染色体核型分析的阳性例数基本一致(p0.05)。本研究表明,采用产前无创检测胎儿游离DNA操作方便,检测灵敏度和特异性高,不会对胎儿的正常发育造成不良影响,且阳性检测率与羊水核染色体核型结果基本相同,是无创产前诊断唐氏综合征的重要方法,值得在临床上推广使用。     

CT灌注成像在创伤性颅脑损伤中的临床应用

创伤性颅脑损伤是常见的外伤类型,其住院率、死亡率及致残率均居各类创伤之首。目前诊断颅脑损伤的主要影像学检查手段有头颅平片、CT以及磁共振成像(MRI),他们均用于颅脑损伤的形态学评价。创伤性颅脑损伤后即有血流动力学的改变,因此早期了解脑微循环动力学和血液流变学的改变,对治疗颅脑损伤有重要意义,近年来,随着功能成像技术迅速发展,CT灌注成像作为一种功能成像技术研究证实,在临床诊疗中起到越来越重要的作用,本文复习以往资料,总结了CT灌注成像在颅脑损伤中的临床应用。     

印迹基因Igf2 对胎盘发育和胎儿生长的影响

基因组印迹是哺乳动物正常生长发育和行为的基础。印迹基因胰岛素样生长因子2(insulin-like growth factors II,Igf2)对胎盘及胎儿的营养供应起着不可或缺的影响。它影响胎盘的大小、形态和营养转运功能,进而影响胎儿生长的营养供应。因此Igf2表达的变化对发育编程具有重要意义,对胎盘发育和胎儿生长起着重要的作用。     

Comparative ultrasound and magnetic resonance diagnosis of fetal CNS malformations

The study was undertaken to optimize the diagnosis of fetal CNS and facial malformations, by using a complex of ultrasound (US) and magnetic resonance imaging (MRI) studies. A hundred and forty-four fetuses with suspected CNS and facial malformations were examined. The US study conducted by a specially developed protocol was supplemented by MRI (48 fetuses) also made by a specially developed protocol. Various fetal CNS malformations, such as neural tube defects, congenital endbrain malformations, cystic lesions, tumors, ventricular complex anomalies, defects of the face and eyes, multiple defects, including CNS and facial anomalies, were detected. With MRI, the diagnosis was changed in 33% of cases. The application of a complex of US and MRI studies enhances the efficiency of diagnosis of congenital CNS and facial malformations in the fetus. MRI in the diagnosis of fetal CNS and facial malformations has a number of advantages and should be used if there is some difficulty in establishing a diagnosis when an US study is performed.     

Placental invasiveness and brain-body allometry in eutherian mammals

Brain growth is a key trait in the evolution of mammalian life history. Brain development should be mediated by placentation, which determines patterns of resource transfer from mothers to fetal offspring. Eutherian placentation varies in the extent to which a maternal barrier separates fetal tissues from maternal blood. We demonstrate here that more invasive forms of placentation are associated with substantially steeper brain-body allometry, faster prenatal brain growth and slower prenatal body growth. On the basis of the physiological literature we suggest a simple mechanism for these differences: in species with invasive placentation, where the placenta is bathed directly in maternal blood, fatty acids essential for brain development can be readily extracted by the fetus, but in species with less invasive placentation they must be synthesized by the fetus. Hence, with regard to brain-body allometry and prenatal growth patterns, eutherian mammals are structured into distinct groups differing in placental invasiveness.     

Current Perspectives on Umbilical Cord Abnormalities Including Blood Flow Parameters Based on Ultrasound Observations

The umbilical cord is a vital structure between the fetus and placenta for the growth and well-being of the fetus. Although the umbilical cord may be the only organ that dies at the beginning of life, it is one of the most important parts of the feta-placental unit and plays a role in determining how life begins. In general, the prenatal examination of the umbilical cord is limited to the observation of the number of vessels and the evaluation of umbilical artery blood flow parameters. Pathologists have done more research on the morphological characteristics of the umbilical cord and linked them to perinatal outcomes. The introduction of advanced imaging technology makes it possible to study the characteristics of fetal umbilical cord from early to late gestation. Many studies have shown that the changes of umbilical cord structure may be related to pathological conditions, such as preeclampsia, fetal growth restriction. Prenatal morphometric umbilical cord characteristics and arterial blood flow parameters in normal and pathologic conditions are discussed in this review.     

Study of Lead Level During Pregnancy by Application of Synchrotron Radiation Micro XRF

In order to study the daily Pb absorption in fetus and to monitor the main Pb sources in prenatal fetus, we have investigated several cases of Pb distribution along the longitudinal axis of fetal hair. The changes of Pb levels in the pregnancy period, even the daily changes of Pb levels can be detected in the hair. Therefore, by analyzing the Pb distribution curves in the fetal hair and the living habits of their mothers, the main sources of Pb in the prenatal fetus can be evaluated. In our study, the main sources of Pb in the two cases of prenatal fetus studied here should be from the polluted aquatics.     

Potentialities of magnetic resonance imaging in the complex of prenatal radiation diagnosis of fetal malformations

The purpose of the study was to investigate the potentialities of magnetic resonance imaging (MRI) in the complex of prenatal radiation diagnosis of fetal malformations. Twenty-eight female patients with suspected fetal malformations were examined. Ultrasound study was supplemented by MRI according to a specially developed protocol. Various fetal CNS malformations were diagnosed. These included the Arnold-Chiari syndrome, the Dandy-Walker syndrome, occlusive hydrocephaly, lobular holoprosencephaly, porencephaly, diaphragmatic hernias, anomalies of the abdomen and retroperitoneal space, as well as anomalies of facial structures, including median clefts, and dacryocystocele. The use of MRI in the complex prenatal radiation diagnosis makes it possible to visualize fetal malformation more clearly, contributes to the more adequate prediction of the outcome of pregnancy and to the choice of a management policy for a female patient.     

Correlations between pregnancy pathology, study of the placenta, antenatal echography and examination of the product of conception in a series of 175 congenital malformations

In order to verify the hypothesis that during pregnancy in a woman without peculiar history, signs could be discovered when the fetus is malformed we have reviewed the files of 175 women who had a malformed child and of 300 controls. All of these women had at least one clinical examination and one ultrasonographic examination during pregnancy. Two clinical symptoms were more often discovered in the mother of the malformed fetus (p less than 0.001): decrease of fetal movements and small for date fetus. The placenta is never abnormal in the mother with normal fetus. Placenta is abnormal in 31% of the mother with malformed fetus but the abnormalities are not specific. Ultrasonographic examinations allowed more often the discovery of a malformation when hydramnios (p less than 0.001) or fetal hypotrophy (p less than 0.01) or an anomaly of the morphology of the fetus is discovered. Accuracy of prenatal diagnostic is considered for the different categories of congenital malformations.     

Large-scale double-staining of rat fetal skeletons using Alizarin Red S and alcian blue

A critical component in the conduct of a prenatal developmental toxicity study is the evaluation of fetal skeletal development. As the developing rodent fetus is typically evaluated at gestation day 20, at a time when ossification of the skeleton is incomplete, a thorough assessment of skeletal development would include both ossified and cartilaginous structures. Current methods to double-stain the fetal skeleton using Alizarin Red S and Alcian Blue are typically described for small sample sizes or using time allotments for each processing step that are unsuitable for industry. In an industrial setting, there is a need for an effective means to double-stain fetal skeletons on a large scale (i.e., hundreds of fetuses simultaneously). This article describes a method used in our laboratory to stain both fetal bone and cartilage using solutions and procedures on an industrial scale.     

Magnetic resonance microscopy of prenatal dolphins (Mammalia, Odontoceti, Delphinidae) - Ontogenetic and phylogenetic implications

The structure of two preserved prenatal dolphins were visualized by 3D MR microscopy (isotropic nominal resolution up to 78.1 μm), which is a high-resolution 3D magnetic resonance imaging (MRI) technique. To determine the benefits and limitations of this method, the acquired 3D datasets were segmented manually and compared to histological sections of different specimens in corresponding developmental stages. The MR images visualize the external and internal morphology of both prenatal dolphins in detail. Various organ systems with their main components are clearly documented in the images, allowing a complete segmentation of the specimens and the calculation of volumes and surface areas of different organ systems. Due to its non-invasive character and the detailed imaging within its resolution range, MR microscopy proves to be a valuable tool in developmental biology for the visualization of the inner architecture of rare and delicate museum specimens, such as the small dolphin embryo and fetus examined. In these two prenatal dolphins, the profound structural modifications at the transition from the embryonic to the fetal stage reflect the adaptations of the mammalian bauplan to the requirements of a holaquatic cetacean life-style. However, the developmental pattern and sequence of the emerging tissues and organs in prenatal life do not resemble the hypothesized evolution of the structural and functional adaptations found in the fossil record.