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目的探讨扩散加权成像(DWI)对正常胎儿脑发育的评估价值。方法回顾性分析40例正常胎儿脑DWI表现,孕周19~39周,平均33.6周。在ADC图上分析总结正常胎儿脑表现特征,并测量脑干、双侧小脑半球、基底节区、丘脑、颞叶白质、额叶白质、枕叶白质、半卵圆中心及顶叶白质的ADC值,分析不同部位ADC值随孕周变化的规律。结果在ADC图上,胎儿幕上脑实质表现为信号强度不同的分层状结构,随孕周增加分层减少。双侧大脑半球间对称部位ADC值无显著性差异。幕上深部白质平均ADC值高于小脑半球、脑干及深部灰质核团,顶叶ADC值最高(1.62±0.17)mm/s,脑干ADC值最低(1.08±0.13)mm/s。胎儿脑干、双侧小脑半球、基底节区、丘脑、颞叶白质、枕叶白质、半卵圆中心及顶叶白质ADC值与胎龄呈负相关,小脑半球相关系数最高(r=0.78),枕叶相关系数最低(r=0.38),额叶与胎龄无线性相关(P>0.05)。小脑半球ADC值随胎龄增长下降最快(b=0.03)。结论 DWI可应用于正常胎儿脑发育的评估,为胎儿脑发育的产前诊断及预后提供重要信息。
Objective To evaluate the value of diffusion-weighted imaging (DWI) in normal fetal brain development. Methods Retrospective analysis of 40 normal fetal brain DWI performance, gestational age 19 to 39 weeks, an average of 33.6 weeks. ADC features of normal fetal brain were analyzed on ADC maps and ADCs of brainstem, bilateral cerebellar hemispheres, basal ganglia, thalamus, temporal lobe white matter, frontal white matter, occipital lobe white matter, semi-oval center and parietal white matter were measured Value, analysis of different parts of the ADC value changes with gestational age. Results In the ADC maps, the fetal supratentorial brain parenchyma showed a layered structure with different signal intensities, which decreased with the increase of gestation weeks. There was no significant difference in the ADC value between bilateral cerebral hemispheres. The mean ADC value of deep supratemporal white matter was higher than that of the cerebellum hemisphere, brain stem and deep gray matter nucleus. The ADC value of the parietal lobe was the highest (1.62 ± 0.17) mm / s and the lowest was the brainstem ADC value (1.08 ± 0.13) mm / s. The ADC value of fetal brain stem, bilateral cerebellar hemispheres, basal ganglia, thalamus, temporal lobe white matter, white matter of occipital lobe, semi-oval center and parietal white matter were negatively correlated with gestational age, and the correlation coefficient of cerebellum hemisphere was the highest (r = 0.78) , The correlation coefficient of occipital lobe was the lowest (r = 0.38), and the frontal lobe had no correlation with gestational age (P> 0.05). The cerebellar hemispheres decreased most rapidly with gestational age (b = 0.03). Conclusion DWI can be used to evaluate the development of normal fetal brain and provide important information for prenatal diagnosis and prognosis of fetal brain development.