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Objective:To investigate the prenatal MRI diagnosis of fetal intracranial hemorrhage (ICH) and the pregnancy outcomes.Methods:This retrospective study included 49 cases of fetal ICH diagnosed by MRI in Obstetrics and Gynecology Hospital of Fudan University from July 2011 to November 2019. Two experts with more than five years of experience in obstetric radiology determined the location, number, area, stage and grade of the hemorrhage based on the MRI findings. Maternal age, gestational age at MRI, and the site, number, stage and grade of hemorrhage as well as other intracranial and extracranial abnormalities of the fetuses were compared between women with fetal germinal matrix-intraventricular hemorrhage (GM-IVH; GM-IVH group, n=39) and those without (non-GM-IVH group, n=10). MRI and ultrasound examination results of 37 cases who had MRI within three days after the ultrasound examination were compared. Postnatal and follow-up outcomes were summarized. Statistical analysis was performed using the independent sample t-test, Mann-Whitney U test and Chi-square test. Results:There was no significant difference in the maternal age, gestational age at MRI, or the site, number or stage of hemorrhage between the GM-IVH group and non-GM-IVH group (all P>0.05). The incidence of ventriculomegaly was higher in the GM-IVH group than that in the non-GM-IVH group [87% (34/39) vs 0/10, t=24.522, P<0.001]. There were 51% (19/37) of the lesions that were missed by ultrasound found by MRI, including GM-IVH in 17 cases, right cerebellar hemisphere hemorrhage in one case and corpus callosum hemorrhage in one case. Among the 49 cases, seven were lost to follow-up, 29 terminated the pregnancy (six in non-GM-IVH group and 23 in GM-IVH group), two experienced intrauterine fetal death in late pregnancy and 11 gave live birth. Ten live births had GM-IVH, among them a relatively good prognosis was noted in fetuses with grade Ⅰ (two cases), grade Ⅱ (four cases), and grade Ⅲ (three cases) GM-IVH, while one case with grade Ⅳ GM-IVH had mental retardation at eight years old; one non-GM-IVH infant had hearing loss at birth and a cochlear was implanted with no other anomalies reported during a three-year follow-up. Conclusions:MRI can provide a more direct view of the location and grade of fetal ICH and is more accurate than prenatal ultrasound in diagnosing fetal ICH, which is a beneficial supplement to ultrasound. The prognosis of cases with grade Ⅳ GM-IVH is not good.
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Objective To analyze the correlations of commonly used biometric parameters of normal fetal brain with fetal gender and gestational age (GA) and to evaluate the feasibility of establishing MRI reference standards for normal fetal brain biometry in second and third trimesters. Methods MRI measurements of 263 fetuses without central nervous system abnormalities were retrospectively collected from the Obstetrics and Gynecology Hospital of Fudan University from June 2012 to April 2017. MRI measurements of fetal biparietal diameter (BPD), occipital-frontal diameter (OFD), head circumference cross-sectional area (HCS), transverse cerebellar diameter (TCD), anterior-posterior diameter of the vermis (APDV), vermian height (VH) and vermian cross-sectional area (VS) were obtained in every standard plane. Head circumference (HC) and (BPD+OFD)/2 were calculated. Spearman correlation analysis, independent samples t-test, Pearson correlation analysis and linear regression analysis were used for statistic analysis. Results Fetal BPD, OFD and HCS were statistically correlated with gender in second and third trimesters (r= － 0.155, － 0.149 and－ 0.159; P=0.032, 0.038 and 0.027). The mean values of BPD, OFD and HCS of male fetuses were greater than those of female ones [(7.25±1.22) vs (6.87±1.28) cm, (8.59±1.38) vs (8.18±1.41) cm, (53.62±16.82) vs (48.48±16.84) cm2; t=2.101, 2.011 and 2.102; all P<0.05] and the mean differences between them were 0.38 cm, 0.41 cm and 5.14 cm2, respectively. BPD, OFD, HCS, HC, (BPD+OFD)/2, TCD, APDV, VH and VS were positively correlated with gestational age (r=0.950, 0.947, 0.962, 0.957, 0.957, 0.976, 0.931, 0.943 and 0.960, respectively; all P<0.001). Among them, TCD (r=0.976) was the closest relating factor, followed by HCS (r=0.962) and VS (r=0.960). The linear regression equations were as follows: BPD (cm)=0.276×GA－0.453, R2=0.903; OFD (cm)=0.308×GA+0.010, R2=0.896; (BPD+OFD)/2 (cm)=0.292×GA － 0.222, R2=0.916;HC (cm)=0.473×GA － 0.359, R2=0.916; HCS (cm2)=3.795×GA － 52.232, R2=0.926; TCD (cm)=0.180× GA－1.858, R2=0.952; APDV (cm)=0.047×GA－0.353, R2=0.867; VH (cm)=0.071×GA－0.592, R2=0.890;VS (cm2)=0.143×GA－2.396, R2=0.919, all P<0.001. Conclusions Some fetal brain biometric parameters are correlated with fetal gender. It is essential and conducive to establish different reference values for male and female fetuses to achieve accurate prenatal evaluation and diagnosis. Fetal BPD, OFD, HCS, HC, (BPD+OFD)/2, TCD, APDV, VH and VS have strong linear relationship with gestational age in second and third trimester and can be served as good indicators for evaluating fetal brain growth and development. MRI quantitative measurement of fetal brain biometric parameters can provide more reliable reference data for prenatal evaluation of fetal brain growth and development. It is feasible to establish MRI reference standards for fetal brain biometry.
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Objective To compare the clinical feasibility of different methods for detecting Clostridium difficile (CD) .Methods The stool samples were collected from the patients with suspected antibiotic-related diarrhea during 2016 ,and the enzyme linked immunosorbent assay (ELISA) and identification medium culture method were used for detection .Then the sensitivity ,specificity and consistency were compared between the two methods .Results 29 cases of antigen-positive specimens were measured by ELISA ,including 25 cases of toxin-positive and 4 cases of toxin negative ;29 suspected strains were cultured by the selective identification medium ,which were identified by the mass spectrometry as 28 strains of Clostridium difficile and 1 strain of undetected species ;the sensitivity and specificity of ELISA method and identification culture medium method were 97% ,100% and 93% ,95% respectively ,both methods showed extremely good consistency (Kappa=0 .92) .Conclusion The ELISA method has the characteristics of fastness ,high efficiency ,time saving ,simple operation ,easy interpretation and so on ,and can rapidly and accurately screen CD related diarrhea diseases ;the medium culture method has a good specificity and can rapidly obtain the infectious strain ;their combined use can greatly increase the CD detection rate and has great help for late treatment .