新生儿缺氧缺血性脑损伤早期的B超、CT和MRI表现比较  

Manifestations of Hypoxic-Ischemic Brain Injury in Neonates on Ultrasound,CT and MRI

作　　者：钟斌[1] 余加林[2] 孙群英[1] 陈玉蓉[1] 黄丽秀[1] 曹礼庭[3] 邵阳[4] 

机构地区：[1]川北医学院附属医院新生儿科,四川南充637000 [2]重庆医科大学儿童医院新生儿科,重庆400014 [3]川北医学院附属医院超声科,四川南充637000 [4]川北医学院附属医院风湿免疫研究所,四川南充637000

出　　处：《川北医学院学报》2008年第1期50-54,共5页Journal of North Sichuan Medical College

摘　　要：目的探讨新生儿窒息后缺氧缺血性脑损伤早期的B超、CT和MRI影像诊断特点。方法2005年12月至2006年12月期间,对入住川北医学院附属医院新生儿病区,有明确的窒息史,且临床诊断为新生儿缺氧缺血性脑病(HI E)(中、重度)的22例,在早期同一时段进行头颅B超、CT和MRI检查,并酌情复查。结果CT和MRI对整体颅脑病变的显示优于B超,其符合率分别为CT 86.36%(19/22),MRI 90.91%(20/22),B超72.73%(16/22)。但CT对颅内出血敏感度高,诊断率为90.91%(10/11),MRI为63.64%(7/11),B超仅为27.27%(3/11)。19例MRI显示脑水肿中16例B超示脑水肿,一致率84.21%,脑室周围白质软化(PVL)检出一致率50%(CT/B超或MRI=2/4)。结论B超、CT和MRI均可诊断缺氧缺血性脑损伤,B超作为初诊、随访的首选方法,对重的、脑病表现突出的缺氧缺血性脑损伤的新生儿行MRI检查,怀疑有颅内出血的新生儿行头颅CT检查。Objective To explore the image features of Cranial Ultrasound, CT scan and MRI for the diagnosis of hypoxic-ischemic brain injury（HIBI） in neonates with asphyxia. Methods 22 cases of early stage of neonates with clear history of asphyxia and the clinical diagnosis of HIE （middle or severe degree） were performed with Cranial Ultrasound, CT scan and MRI examination simultaneously. All the patients were admitted into neonatal wards in the Affiliated Hospital of North Sichuan Medical College from December 2005 to December 2006. Results CT scan and MRI are better than ultrasound in diagnosis of global brain injuries, the consistent rate of CT with clinical diagnosis is 86. 36% （19/22） ,the consistent rate of MRI is 90.91% （20/22） , and the consistent rate of Cranial Ultrasound is 72.73% （16/22）. However, CT scans have high sensitivity and specificity in diagnosis of intracranial hemorrhage（ICH） ,the positive rate of CT diagnosis is 90.91% （ 10/11 ）, but the positive rate of MRI diagnosis is 63.64% （7/11 ） and the positive rate of Cranial Ultrasound diagnosis is 27.27% （ 3/11 ） only, MRI has high sensitivity in diagnosis of hypoxic-ischemic brain injury（HIE） accordingly. Conclusion HIBI can be diagnosed by either Cranial Ultrasound, CT scan or MRI. Cranial Ultasound can be used as a preferable method of preliminary diagnosis and follow-up, those severe HIBI must be examined by MRI. Those suspected intracranial hemorrhage could be confirmed by CT scan.

关 键 词：超声 CT MRI 新生儿 窒息 缺氧缺血性脑损伤 颅内出血 缺氧缺血性脑病 

分 类 号：R722.15[医药卫生—儿科]