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Sacrococcygeal Teratoma (Altman) 胎児 MRI
Sacrococcygeal Teratoma (Altman) 胎児 MRIの画像・臨床意思決定の枠組み。ガイドラインと施設プロトコルを優先。
根拠：Altman classification。各ノードはガイドラインの判断ロジックを要約したものであり、原文の転載ではありません。 医療従事者向けの参考情報であり、臨床判断の代替ではありません。日本の関連学会指針および施設プロトコルを優先してください。
ステップごとに回答すると、結論と対応の目安が表示されます。前の質問に戻ることもできます。
ステップ 1 · Altman type + vascularity + cardiac failure signs
Altman type + solid/vascularity + cardiac failure signs?
💡 The most common congenital tumor, 75% female, with malignant potential. Altman classification (anatomic): I mainly external + small presacral; II external + significant intrapelvic; III external + predominantly abdominopelvic; IV entirely intrapelvic/presacral, no external component. MRI assesses abdominopelvic extension (typing), cystic/solid nature, compression, excludes meningocele (especially cystic), T1 for hemorrhage.
パス全体像
- 【判断】Altman type + vascularity + cardiac failure signsAltman type + solid/vascularity + cardiac failure signs?（The most common congenital tumor, 75% female, with malignant potential. Altman classification (anatomic): I mainly external + small presacral; II external + significant intrapelvic; III external + predominantly abdominopelvic; IV entirely intrapelvic/presacral, no external component. MRI assesses abdominopelvic extension (typing), cystic/solid nature, compression, excludes meningocele (especially cystic), T1 for hemorrhage.）
- Predominantly cystic, sparse vascularity, no cardiac failure/hydrops (usually Altman I–II) → Predominantly cystic · relatively good prognosis
- Altman III–IV (abdominopelvic extension, compressing kidney/rectum) → Altman III–IV · assess abdominopelvic extent
- Solid hypervascular / TFR >0.12 (<24 weeks) / raised cardiothoracic ratio / hydrops/enlarged placenta → Solid hypervascular/high-output → fetal intervention
- 【終点】Predominantly cystic · relatively good prognosis仙尾部奇形腫。サイズ・血流・心負荷で予後。出生時出血リスクと外科計画。
- 【終点】Altman III–IV · assess abdominopelvic extentSacrococcygeal Teratoma (Altman) 胎児 MRIの当該分岐。適応・禁忌を確認し、最新ガイドラインと施設プロトコルに沿って実施。必要時専門医に相談。
- 【終点】Solid hypervascular/high-output → fetal interventionHigh-risk (solid hypervascular → high-output cardiac failure; TFR >0.12 (<24 週), raised cardiothoracic ratio, hydrops, enlarged placenta, rapid growth): critical; <27–28 週 〜あり high-output failure/hydrops → referへa fetal therapy centerへassess open fetal 手術/intervention; near term → early delivery; 帝王切開に対しa large 腫瘍へprevent 破裂・出血.
よくある質問
- Sacrococcygeal Teratoma (Altman) 胎児 MRIはどの臨床課題を扱う診療パスですか？
- Sacrococcygeal Teratoma (Altman) 胎児 MRIの画像・臨床意思決定の枠組み。ガイドラインと施設プロトコルを優先。
- Sacrococcygeal Teratoma (Altman) 胎児 MRIの主要な意思決定ステップは何ですか？
- Altman type + vascularity + cardiac failure signs
- Sacrococcygeal Teratoma (Altman) 胎児 MRIはどのような対応方針を示しますか？
- Predominantly cystic · relatively good prognosis：仙尾部奇形腫。サイズ・血流・心負荷で予後。出生時出血リスクと外科計画。；Altman III–IV · assess abdominopelvic extent：Sacrococcygeal Teratoma (Altman) 胎児 MRIの当該分岐。適応・禁忌を確認し、最新ガイドラインと施設プロトコルに沿って実施。必要時専門医に相談。；Solid hypervascular/high-output → fetal intervention：High-risk (solid hypervascular → high-output cardiac failure; TFR >0.12 (<24 週), raised cardiothoracic ratio, hydrops, enlarged placenta, rapid growth): critical; <27–28 週 〜あり high-output failure/hydrops → referへa fetal therapy centerへassess open fetal 手術/intervention; near term → early delivery; 帝王切開に対しa large 腫瘍へprevent 破裂・出血.
- Sacrococcygeal Teratoma (Altman) 胎児 MRIのうち直ちに対応が必要な状況はどれですか？
- Solid hypervascular/high-output → fetal intervention：High-risk (solid hypervascular → high-output cardiac failure; TFR >0.12 (<24 週), raised cardiothoracic ratio, hydrops, enlarged placenta, rapid growth): critical; <27–28 週 〜あり high-output failure/hydrops → referへa fetal therapy centerへassess open fetal 手術/intervention; near term → early delivery; 帝王切開に対しa large 腫瘍へprevent 破裂・出血.
- Sacrococcygeal Teratoma (Altman) 胎児 MRIはどのガイドラインに基づいていますか？
- Fetal sacrococcygeal teratoma Altman classification and MRI/TFR prognosis (AJR 2002; JPS) · 準拠：Altman classification
出典
- Fetal sacrococcygeal teratoma Altman classification and MRI/TFR prognosis (AJR 2002; JPS)