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目的:探讨MRI征象评估先天性膈疝胎儿疝囊存在与否的价值。方法:回顾性分析2016年11月至2020年12月在上海交通大学医学院附属新华医院经产后手术证实的57例先天性膈疝胎儿的MRI图像，孕周为20~40（28±5）周，产后术中判定有疝囊18例（有疝囊组）、无疝囊39例（无疝囊组）。分析7个MRI征象，包括疝外周包膜感、肺-疝交界面光滑、肺被压缩呈新月形、患侧可见残余肺组织、心脏移位、肺-疝交界面上方积液和肺-疝交界面下方积液。采用χ2检验或Fisher确切概率法比较有疝囊与无疝囊组间各MRI征象的差异并计算各个征象的诊断效能。将2组间差异有统计学意义的征象纳入预测积分模型，每出现1条征象记1分，计算每例胎儿的影像学积分，绘制受试者操作特征（ROC）曲线评估影像学积分诊断疝囊存在与否的效能。结果:有疝囊与无疝囊组间有5个MRI征象差异有统计学意义，分别为疝外周包膜感（χ2=25.74，n P<0.001）、肺-疝交界面光滑（χ2=48.20，n P<0.001）、肺被压缩呈新月形（χ2=57.00，n P<0.001）、患侧可见残余肺组织（χ2=12.14，n P<0.001）及肺-疝交界面上方积液（χ2=4.31，n P=0.022）。其中肺被压缩呈新月形具有最高的诊断效能，灵敏度、特异度、准确度均为100%。将有疝囊组与无疝囊组间差异有统计学意义的5条MRI征象纳入预测积分模型，ROC曲线下面积为0.999，灵敏度为100%，特异度为94.9%，最佳阈值为2分。n 结论:胎儿MRI征象及预测积分模型可以有效识别先天性膈疝患儿疝囊存在与否，具有一定的临床意义。“,”Objective:To explore the value of MRI signs in assessing the presence or absence of hernia sacs in fetuses with congenital diaphragm hernia.Methods:MRI images of 57 patients with congenital diaphragm hernia confirmed by postpartum surgery were analyzed from November 2016 to December 2020 in Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, with a gestational age of 20－40 (28±5) weeks. In postpartum surgery, 18 cases were found with hernia sacs (hernia sac group) and 39 cases without hernia sacs (hernia-free group). Seven MRI signs were analyzed, including hernia peripheral enveloping sensation, smooth lung-hernia interface, crescent-shaped lung compression, residual lung tissue on the affected side, heart displacement, effusion above the lung-hernia interface and effusion below the lung-hernia interface. The differences in MRI signs between the hernia sac and hernia-free groups were compared using the χn 2 test or Fisher′s exact probability method. The diagnostic efficacy of each sign was calculated. The MRI signs with statistical differences between the two groups were included in the predictive integration model, and 1 point was scored for each sign, the imaging score of each fetus was calculated, and the efficacy of imaging points in diagnosing the presence or absence of hernia sacs was assessed by the subject manipulation receiver operating characteristics (ROC) curve.n Results:There were statistically significant differences in 5 MRI signs between the hernia sac and the hernia-free groups, namely hernia peripheral enveloping sensation (χ2=25.74, n P<0.001), smooth lung-hernia interface (χ2=48.20,n P<0.001), crescent-shaped lung compression (χ2=57.00,n P<0.001), residual lung tissue on the affected side (χ2=12.14,n P<0.001) and effusion above the lung-hernia interface (χ2=4.31,n P=0.022). Among them, the sign of crescent-shaped lung compression had the highest diagnostic efficacy, and the sensitivity, specificity and accuracy all were 100%. Five statistically significant MRI signs were included in the predictive integration model, and the area under the ROC curve was 0.999, the sensitivity was 100%, the specificity was 94.9%, and the optimal threshold was 2 points.n Conclusion:Fetal MRI signs and predictive integration model can effectively identify the presence or absence of hernia sacs in fetuses with congenital diaphragm hernia, which has certain clinical significance.