新生儿缺氧缺血性脑病的常规MRI和DWI表现及其与预后的相关性研究  

Detecting and predicting outcome in term neonates with hypoxic-ischemic encephalopathy： a comparison of conventional MRI and diffusion-weighted MR imaging

作　　者：伍彩云[1] 刘国瑞[2] 郭天畅 程凤燕[3] 史雪川[2] 吴毅[2] 

机构地区：[1]东莞市石龙人民医院,广东东莞523230 [2]汕头大学医学院第二附属医院 [3]广东省梅州市人民医院

出　　处：《实用放射学杂志》2014年第1期103-107,132,共6页Journal of Practical Radiology

摘　　要：目的评价常规磁共振成像（MRI）、弥散加权成像（DWI）及其表观弥散系数值（ADC）在足月新生儿缺氧缺血性脑病（HIE）早期诊断中的意义和预后评估的价值。方法对38例有围产期窒息史、临床诊断为HIE的足月新生儿进行头部常规MRI和DWI检查；对其中32例进行6个月的临床追踪随访。采用盖泽尔智能发育诊断法对患儿进行智力发育状态评估。结果常规MRI所示基底节及丘脑高信号、脑回征和T1WI内囊后肢（PLIC）高信号消失这些征象是脑损伤严重程度的表现。DWI所示1个或1个以上脑叶大片高信号、PI。1c高信号、基底节及丘脑区高信号；PLIC、大脑脚、放射冠ADC值的下降，能较常规MRI更早期预示着预后不良。DWI在深部脑白质病变的检测较常规MRI敏感。结论在HIE脑损伤的检测及预后评估方面，DWI及其ADC值可较早期敏感反映缺氧缺血性脑损伤（HIBD）和作出预测，放射冠、PLIC及大脑脚ADC值在预后评估方面有着重要的价值。Objective To prospectively evaluate magnetic resonance （MR） imaging, diffusion weight imaging{DWI） and apparent diffusion coefficient （ADC） measurements for the early diagnosis and prediction of late neurologic outcome of HIE in term neonates. Methods Conventional MRI and DWI were performed in 38 term neonates with HIE in which 32 patients got the intelligence devel- opment and neurologic outcome more than 6 months after birth. Intelligence was assessed by using the Gesell Developmental Scale. Results A poor outcome was predicted according to the following MRI features,including the basal ganglia and thalami hyperintensi- ty , loss of hyperintensity in the posterior limb of the internal capsule {PLIC） on T^WI and gyrus sign, On DWI it was predicted ac- cording to the following features,including the hyperintensity in one or more than one lobe of the brain ,the basal ganglia or thalami or PLIC,and the decrease of ADCs in the corona radiate, PLIC and the caudex eerebri,which could predict the unfavorable outcome earlier than conventional MRI. DWI was more sensitive to detect the abnormality of deep white matter than conventional MRI. Con- clusion The abnormality of DWI , and the change of ADC values can reflect the injury degree of the brain sensitively in the early phase of hypoxic-ischemic brain damage（HIBD） ,and can assess the prognosis of HIE at a certain extent. Especially, the decrease of ADCs in the corona radiate,PLIC and the caudex cerebri can evaluate the prognosis of HIBD efficaciously.

关 键 词：缺氧缺血性脑病 磁共振成像 弥散加权成像 表观弥散系数 预后 

分 类 号：R722.1[医药卫生—儿科] R445.2[医药卫生—临床医学]