目的

探讨胎儿生发基质-脑室内出血（GMH-IVH）的影像学特点，并评价胎儿颅脑MRI的3个序列，包括T1 容积内插梯度回波序列（THRIVE）、超快速平衡稳态自由进动序列（BTFE）、弥散加权成像（DWI），以及胎儿颅脑超声检查，对胎儿GMH-IVH 的诊断准确度。

方法

选择2014年9月至2022年4月于四川大学华西第二医院因产前超声检查提示胎儿颅内异常，并进行胎儿颅脑MRI检查，最终确诊为GMH-IVH 的40例胎儿为研究对象。采用回顾性分析方法，对胎儿颅脑MRI的3个序列THRIVE、BTFE、DWI，与胎儿颅脑超声检查的影像学特点，以及部分受试儿的影像学转归及出生后的临床功能转归进行总结分析；同时采用χ² 检验，对胎儿颅脑MRI的3个序列，分别与超声检测结果诊断GMH-IVH 的准确度进行统计学比较。本研究遵循的程序符合2013年修订的《世界医学协会赫尔辛基宣言》。

结果

①本研究40 例GMH-IVH 胎儿中，Ⅰ、Ⅱ、Ⅲ、Ⅳ级GMH-IVH 胎儿数分别为21 例（52.5%）、4 例（10.0%）、9 例（22.5%）、5 例（12.5%）。这4个级别的GMH-IVH 胎儿中，均为超声诊断的胎儿数最少，THRIVE 序列诊断的胎儿数最多。②THRIVE、BTFE、DWI序列与超声，诊断胎儿GMH-IVH 的准确度分别为97.5%（39/40）、87.5%（35/40）、65.0%（26/40）、32.5%（13/40），THRIVE、BTFE、DWI诊断胎儿GMH-IVH 的准确度均分别优于超声，并且差异均有统计学意义（χ²=37.14、P＜0.001，χ²=25.21、P＜0.001，χ²=8.46、P=0.004）。③40例GMH-IVH 胎儿结局：选择引产为22例、出生为15例、死胎为1例、失访为2例；5例于晚孕期复查颅脑MRI显示其出血均不同程度减轻。选择继续妊娠后出生的15例儿童中，5例进行颅脑MRI检查（仅3例完成检查）并完成《格里菲斯评估量表中文版（GDS-C）》测试，3例儿童的生发基质区域均无明显异常信号，但其中2 例仍有不同程度脑室扩张；2 例儿童GDS-C测试结果正常，其余3例出现不同方面临床功能落后，如运动发育迟缓等。

结论

颅脑MRI的THRIVE、BTFE、DWI序列扫描，对胎儿GMH-IVH 具有重要诊断价值。胎儿GMH-IVH 晚孕期可能被吸收，但是出生后可能有不同程度脑损伤后遗症表现。

Objective

To investigate the imaging characteristics of fetal germinal matrix hemorrhage-intraventricular hemorrhages （GMH-IVH）and evaluate the diagnostic accuracy of three sequences of fetal brain MRI，including T1 high resolution isotropic volume examination（THRIVE），balanced turbo field echo（BTFE），and diffusion weighted imaging （DWI），and fetal brain ultrasonography for fetal GMH-IVH detection.

Methods

This study enrolled 40 fetuses ultimately diagnosed with GMH-IVH in West China Second University Hospital，Sichuan University from September 2014 to April 2022.Their prenatal ultrasonography showed fetal intracranial abnormalities and followed by fetal brain MRI for final diagnosis.A retrospective analysis was conducted to summarize and analyze the imaging characteristics of three fetal brain MRI sequences，including THRIVE，BTFE and DWI，and fetal brain ultrasonography，as well as imaging outcomes and postnatal clinical functional outcomes of some subjects.The chi-square test was employed to compare the diagnostic accuracy for fetal GMH-IVH of 3 fetal brain MRI sequences versus ultrasonography results，respectively.The study protocol complied with the WorldMedicalAssociationDeclaration ofHelsinki revised in 2013.

Results

①Among 40 GMH-IVH fetuses，21 cases （52.5%），4 cases（10.0%），9 cases （22.5%），and 5 cases （12.5%）were classified as gradesⅠ-ⅣGMH-IVH respectively.Ultrasonography detected the fewest cases across all grades，while THRIVE identified the most.②The diagnostic accuracy for fetal GMH-IVH of THRIVE，BTFE，DWI sequence and ultrasonography were 97.5%（39/40），87.5%（35/40），65.0%（26/40）and 32.5%（13/40），respectively.The diagnostic accuracy of THRIVE，BTFE and DWI was higher than that of ultrasonography，respectively，and the differences were statistically significant （χ²=37.14，P ＜0.001； χ²=25.21，P＜0.001； χ²=8.46，P=0.004）.③Fetal outcomes of 40 cases of GMH-IVH showed that 22 cases were induced abortion，15 cases were born，1 case was stillbirth and 2 cases were lost to follow-up.Five cases were reexamined by brain MRI in third trimester，which showed the hemorrhage was relieved to varying degrees.Among 15 live births，5 underwent brain MRI （only 3 completed）and the GriffithsMentalDevelopmentScales-Chinese（GDS-C）assessment：there was no obvious abnormal signal in the germinal matrix area of 3 children，but 2 of them still had different degrees of ventriculomegaly；two children had normal GDS-C test results，and the other three had different aspects of clinical dysfunction，such as motor retardation，etc..

Conclusions

THRIVE，BTFE，and DWI sequence of brain MRI providing critical diagnostic value of fetal GMH-IVH.Fetal GMH-IVH may be absorbed in the third trimester of pregnancy，but postnatal neurological sequelae may persist.