多模态MRI评估胎儿侧脑室增宽影像学特征与胼胝体发育不良的关联性及临床价值研究OA

Objective To investigate the association between the features of fetal lateral ventriculomegaly(severity,symmetry,morphology,and associated findings)assessed by multimodal magnetic resonance imaging(MRI)and corpus callosum dysgenesis,and to clarify the predictive value of multimodal MRI parameters for corpus callosum dysgenesis,thereby providing a reference for clinical prenatal diagnosis and prognostic assessment.Methods A total of 195 pregnant women and their fetuses diagnosed with fetal lateral ventriculomegaly at the Prenatal Diagnosis Center of Handan First Hospital from January 2020 to June 2024 were enrolled as study subjects.All underwent multimodal magnetic resonance imaging(MRI),including conventional structural sequences(T1WI,T2WI)and diffusion tensor imaging(DTI).The subjects were divided into a corpus callosum dysgenesis group(case group,n=41)and a normal corpus callosum development group(control group,n=154).The association between features of lateral ventriculomegaly and corpus callosum dysgenesis was analyzed.Multivariate Logistic regression was used to identify independent risk factors,and the predictive efficacy of multimodal MRI parameters was evaluated using receiver operating characteristic(ROC)curves.Clinical outcomes and postnatal neurodevelopmental status of the fetuses were followed up.Results Multivariate Logistic regression analysis showed that severe lateral ventriculomegaly,bilateral widening,and concomitant periventricular white matter signal abnormality were independent risk factors for fetal corpus callosum dysgenesis(OR=4.35,3.24,and 2.96,respectively,P<0.05).The fractional anisotropy(FA)value and fiber bundle density of the corpus callosum in the case group were significantly lower than those in the control group,with statistically significant differences(t=13.268 and 16.145,respectively,P<0.05).Moreover,as the severity of ventriculomegaly increased,the FA value and fiber bundle density of the corpus callosum gradually decreased(F=45.382 and 61.758,respectively,P<0.05).Receiver operating characteristic(ROC)curve analysis demonstrated that the combination of lateral ventricular width and corpus callosum FA value yielded the optimal predictive performance,with an area under the curve(AUC)of 0.882(95％CI:0.825-0.939),a sensitivity of 82.9％,a specificity of 86.4％,and a Youden index of 0.693.The incidence of complete agenesis of the corpus callosum gradually increased with increasing severity of ventriculomegaly(mild,moderate,severe),and fetuses with bilateral widening showed a higher incidence of complete agenesis than those with unilateral widening,with statistically significant differences(χ2=11.483 and 7.068,respectively,P<0.05).The rates of pregnancy termination and neurodevelopmental abnormalities in live-born fetuses were significantly higher in the case group than in the control group(χ2=30.672 and 26.845,respectively,P<0.05).Conclusion Multimodal MRI can clearly visualize the features of fetal lateral ventriculomegaly and the structure of the corpus callosum.Severe or bilateral lateral ventriculomegaly and associated periventricular white matter abnormalities are high-risk factors for corpus callosum dysgenesis.The combination of multimodal MRI parameters can enhance predictive efficacy,providing an important basis for prenatal intervention decisions and neurodevelopmental prognosis assessment.