| PART Ⅰ Imaging Features and Clinical Outcome in Fetus with Coronal Cleft VertebraeObjectiveTo explore the MRI features of Fetal Coronal Cleft Vertebrae,compare the efficacy of MRI and ultrasound in the diagnosis of Fetal Coronal Cleft Vertebrae and to analyze the outcome of Fetal Coronal Cleft Vertebrae.Materials and MethodsThis study is a retrospective study and has been approved by our ethics committee.From September 2019 to June 2021,40 fetuses suspected of fetal vertebral deformities by ultrasound were retrospectively collected,who were diagnosed as Coronal Cleft Vertebrae after MRI examination at Shandong Provincial Hospital.5 cases of induced labor and 14 cases lost to follow-up were excluded,and 21 fetuses underwent MRI after delivery were finally included.The gestational weeks were 25-34(29.1±2.6)weeks,and there were 19 males and 2 female.The MRI review time was 4～12,7.0(6.0,8.5)months after birth.Fetal spine MRI includes SWI sequences and true fast imaging with steady-state(True-FISP).Explore the MR]features and outcome of Fetal Coronal Cleft Vertebrae and compare the image quality scores of SWI,True-FISP and ultrasound.Friedman test and Wilcoxon test were used to compare the difference in ratings.The diagnostic accuracy of SWI,True-FISP and ultrasound in fetal coronary was calculated.Cochran test was used to compare the efficiency of SWI,True-FISP and ultrasound in the diagnosis of Fetal Coronal Cleft Vertebrae,and the modified McNemar test was used for pairwise comparison between groups.ResultsThere were 10 cases of single and 11 cases of multiple Fetal Coronal Cleft Vertebrae,16 cases of simple lumbar vertebrae,2 cases of simple thoracic vertebrae,and 3 cases of thoracolumbar vertebrae.The common SWI features of 21 cases show longitudinal strip or dot high signal on sagittal plane,and transverse fissure like high signal on axial plane.Anterior part of vertebral body is larger than posterior part in 19 cases of them,The image quality scores of SWI,True-FISP and ultrasound were 4(3,4)、2(2,2)、2(2,2),and the difference was statistically significant in general(χ2=34.24,P<0.001).Pairwise comparison showed that the image quality of SWI was better than that of True-FISP sequence and ultrasound(Z=-4.04,P<0.001;Z=-4.11,P<0.001),and there was no statistically significant difference in the image quality score between True-FISP sequence and ultrasound(Z=-0.58,P=0.388).The diagnostic accuracy of SWI.True-FISP and ultrasound was 100%(21/21)、66.7%(14/21)、47.6%(10/21).The diagnostic accuracy of SWI was better than that of True-FISP and ultrasound(χ2=5.14,P=0.008;χ2=9.09,P<0.001),and there was no statistically significant difference between True-FISP and ultrasound(χ2=0.75,P=0.194).MRI showed that Coronal Cleft Vertebrae disappeared in all 21 fetuses after birth,including 1 case of syringomyelia and 1 case of fatty filum terminal.ConclusionMRI,especially SWI,plays an important role in the diagnosis of Fetal Coronal Cleft Vertebrae.Fetal Coronal Cleft Vertebrae disappeared in the follow-up 21 cases after birth,which proved to be a normal physiological variation from the radiograghic perspective.PART Ⅱ MRI study of fetal sacrococcygeal vertebra development in middle and late gestational weeksObjectiveTo investigate the intrauterine growth and development regularity of the sacrococcygeal vertebra in the middle and late gestational weeks of fetuses,and to compare the morphological differences of the conus medullaris between low-positioned conus medullary fetuses and normal fetuses in the late gestational weeks.MethodsA total of 71 fetuses with normal development of the sacrococcygeal spine who underwent fetal spine MRI in our hospital from January 2020 to December 2021 were collected,gestational age 24.1～38.6,28.7(26.4,31.0)weeks.The appearance time of S1-S5 vertebral body was observed,the morphological parameters(height,transverse diameter,sagittal diameter)of S1 vertebral body were quantified,the length of sacrum was measured,the correlation curve between the length of sacrum and gestational age was made.From January 1,2016 to December 1,2021,41 fetuses with normal conus medullaris development(gestational age,28-35,29.4(28.4,30.4)weeks)and 41 fetuses with low conus medullary in the late stage of pregnancy were retrospectively analyzed.The MRI images of the fetus(gestational age,28～37,28.5(28.1,30.3)weeks)were evaluated by chi-square test to evaluate whether the existence of the angle between the conus medullaris/filament terminal and the anterior wall of the spinal canal was related to the low position of the conus medullaris.The sensitivity and specificity for the diagnosis of low conus Medullaris were calculated based on the presence of angle.ResultsS1-S4 vertebral bodies and vertebral arch primary ossification centers appeared in all gestational weeks,and the S5 primary ossification center is detectable in all included fetuses starting at 30 weeks..The length of sacrococcygeal vertebra and the height,transverse and sagittal diameter of S1 vertebral body are linearly correlated with gestational age.The incidence of the angle between the conus medullaris/filament terminal and the anterior wall of the spinal canal was significantly higher in fetuses with low conus medullaris than in normal fetuses with conus medullaris,and the results were significantly different(χ2==58.083,P<0.001).The angle between the conus medullaris/filament terminal and the anterior wall of the spinal canal had a sensitivity of 80.49%and a specificity of 100%in diagnosing low conus medullaris.ConclusionThe S5 primary ossification center is detectable in all included fetuses starting at 30 weeks.The length of sacrococcygeal vertebra and the height,transverse and sagittal diameter of S1 vertebral body are well correlated with gestational age.The angle between the conus medullaris/filament terminal and the anterior wall of the spinal canal is an indirect imaging sign indicating a low position of the fetal conus medullaris. |
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