MRI在新生儿胆红素脑病中诊断价值  

Diagnostic value of MRI in neonatal bilirubin encephalopathy

作　　者：李豪刚[1] 张玉忠[1] 陈凯[2] 曾军[3] 陈家满[1] 李兴荣[1] 曹火乃[1] 杨昌云[1] 

机构地区：[1]深圳市龙华新区人民医院/南方医科大学附属深圳市龙华人民医院放射科,广东518190 [2]中山大学附属第五医院放射科,广东519000 [3]华中科技大学同济医学院附属协和医院放射科,武汉430022

出　　处：《放射学实践》2013年第10期1062-1065,共4页Radiologic Practice

摘　　要：目的:探讨新生儿胆红素脑病MRI影像特点,以提高对该病的认识。方法:搜集经临床确诊的新生儿胆红素脑病31例MR脑图像,总结其MR影像特点及MR诊断与鉴别诊断价值。结果:新生儿胆红素脑病31例血清总胆红素和非结合胆红素升高。急性期20例,15例SE T1WI双侧苍白球对称性高信号、边缘清楚,3例双侧苍白球、丘脑腹侧核和2例双侧苍白球、丘脑腹侧核、脑干腹侧核与前者类似信号,20例于TSE T2WI呈等信号,FLAIR及DWI序列未见异常信号。新生儿胆红素脑病慢性期11例,8例中6例双侧苍白球、丘脑腹侧核T1WI稍高信号,2例等信号;该8例T2WI、FLAIR和DWI(ADC)高信号;3例胆红素脑病合并新生儿缺氧缺血性脑病,双侧苍白球、丘脑腹侧核、双侧内囊与壳核尾核、双额颞顶叶散在灰白质区出现T1WI高信号、但边缘欠清楚,T2WI、FLAIR呈高信号,DWI未见明显异常信号。结论:MRI T1WI急性期双侧苍白球或/和双侧丘脑、脑干腹侧核边缘清楚高信号具有一定特点,于慢性期信号相对复杂化。胆红素脑病与新生儿缺氧缺血性脑病等鉴别诊断有一定价值。Objective：To investigate the MRI characteristics of neonatal bilirubin encephalopathy （NBE）,in order to strengthen the knowledge of the disease. Methods：The MRI of 31 cases with clinically diagnosed NBE were enrolled and ret rospectively analyzed. The MRI characteristics and the value in diagnosis and differential diagnosis were studied. Results： The level of total bilirubin and non conjugated bilirubin were elevated in all the 31 patients. In the 20 NBE cases of acute stage,high signal intensity on SE T1WI with distinct edge were assessed symmetrically in bilateral globus pallidus （15 ca ses） ;and similar features were showed in bilateral globus pallidus,ventral nuclei of thalamus （3 cases） and bilateral globus pallidus,ventral nuclei of thalamus and brainstem （2 cases）. Iso-intensity was assessed on TSE T2 WI （20 cases）,no abnormal signals were identified on FLAIR and DWI. Of the 11 cases with chronic stage NBE,high signal intensity on T2WI, FLAIR and DWI （ADC） were showed in 8 cases. On T1WI, slightly high T1 WI signal intensity was assessed in bilateral globus pallidus and ventral nuclei of thalamus （6 cases）,while the other 2 cases showed isointensity. Of 3 cases had NBE in combination with neonatal hypoxic-ischemic encephalopathy, lesions with high signal intensity on TI WI with blurred margin could be revealed in bilateral globus pallidus,ventral nuclei of thalamus,bilateral internal capsule,putamen,caudate nucleus and scattered in grey/white matter of bilateral temporal-parietal lobes, high signal intensities on T1 WI and FLAIR, yet no abnormal signals were showed on DWI. Conclusions：Characteristic high signal intensity on T1WI in bilateral globus pallidus and/or bilateral thalamus and ventral nuclei of brainstem with distinct edge could be revealed in the acute stage of NBE, the signal intensities of chronic stage were relatively complicated. MRI provided helpful information in the diagnosis and differential diagnosis of NBE and neonatal hypoxic-ischemic encephalopathy

关 键 词：高胆红素血症 苍白球 缺氧缺血 脑 磁共振成像 

分 类 号：R445.2[医药卫生—影像医学与核医学] R722.17[医药卫生—诊断学]