B超、CT在早产儿颅内出血诊断价值  

The diagostic value of type-B ultrosonic and CT about intracanial hemorrhage in perterm infants

作　　者：胡克非[1] 刘维民[2] 阮姗姗[2] 

机构地区：[1]安徽省立儿童医院放射科,230051 [2]安徽省立儿童医院新生儿科

出　　处：《中国CT和MRI杂志》2010年第2期7-9,共3页Chinese Journal of CT and MRI

基　　金：安徽省临床医学重点学科技术进步专项课题资助项目(2004Z013)

摘　　要：目的探讨床旁超声和CT对早产儿颅内出血的诊断价值。方法对42例早产儿(男25例,女17例);胎龄(28.0-36.9)周。低体重(≤2100g)4例,高龄产妇(37岁)2例、胎盘老化4例、脐带绕颈2例,双胞胎8例,肺透明膜病(RDS)3例,坏死性小肠结肠炎(NEC)1例。余18例无明确异常及危险因素。超声均在出生后3～7天内进行,CT在2周内实施。以脑脊液检测和MR结果作为标准。结果42例患儿中,经MR或脑脊液穿刺证实为出血者24例,其中蛛网膜下腔出血(SAH)12例、(IVH)10例、硬膜下血肿(SDH)2例、脑实质出血(IPH,与SAH或IVH同时存在)5例。B超正确诊断18例,漏诊5例,1例假阳性,其中SAH10例、IVH8例,IPH5例,诊断的敏感性、特异性、符合率分别为75%、94.7%和85.7%。CT正确诊断20例,漏诊4例,没有假阴性病例,其中SAH8例、IVH10例、SDH2例,IPH5例,CT诊断的敏感性、特异性、符合率分别为83.3%、100%和90.5%。结论床旁超声是监测早产儿发生脑损伤的首选方法,CT在少量IVH及SAH的诊断较好。另外,床旁超声和CT对早期的脑室旁白质软化(PVL)均不敏感。Objective To investigate the diagnostic value of CT and bedside cranium ultrasound about intractanial hemorrhage in preterm infants.Methods 42 preterm infants（25 boys and 17 girls）with gestational age（28.0~36.9 weeks）.4 patients with birth weight 2100g,the oldest woman（37years old）2cases,aging of placenta 4 cases,cord around neck 2 cases,twin 2 cases,hyaline membrane disease 3 cases,necrotizing enterocolitis 1 case,others 18 cases without definite anomalies and risk factors.All cases were monitored with bedside cranium ultrasound in 3～5days and CT within two weeks.By using results of cerebrospinal fluid and MR as gold standard.Results 24 confirmed cases were intractanial hemorrhage in 42 cases,in 12 cases of patients with subarachnoid hemorrhage（SAH）,in 10 cases of patients intraventricular hemorrhage（IVH）.in 2 cases with subdural haematoma（SDH）,5 case of with parenchymal hemorrhages.18 cases were certified by ultrasound,5 cases missed diagnosis,1 case false positive,10 cases（SAH）,8 cases（IVH）,5 cases（IPH）,The diagnostic sensitivity,respectively,and accuracy were 75%,94.7%,85.7%,espectively in results of ultrasound.20 cases were diagnosed accurately in CT,The diagnostic sensitivity,specificity,and accuracy were 75%,94.7%,85.7%,respectively in results of CT,no false negative case.Conclusion Cranium ultrasound of bedside was the first choice for the detection of cerebral injury.CT was the better method in the diagnostic IVH and SAH.The CT and bedside cranium ultrasound were low response to early periventricular leukomalacia（PVL）.

关 键 词：早产儿 脑损伤 颅内出血 颅脑超声 X线计算机 

分 类 号：R814.42[医药卫生—影像医学与核医学] R722.151[医药卫生—放射医学]