应用弥散加权技术连续测定早产儿局灶性脑白质损伤的表观弥散系数及其价值初探  

Exploring the clinical significance of continuously measuring apparent diffusion coefficient values in the preterm infants with punctate white matter damage by applying diffusion weighted imaging

作　　者：佟欣[1] 薛辛东[1] 富建华[1] 

机构地区：[1]中国医科大学附属盛京医院儿科,沈阳110004

出　　处：《中华儿科杂志》2014年第4期277-281,共5页Chinese Journal of Pediatrics

摘　　要：目的 以磁共振成像（MRI）为依据,观察早产儿局灶性脑白质损伤（PWMD）的动态演变,并连续测定病灶及病灶周围区域的表观弥散系数（ADC）变化,探索其临床应用价值.方法 2010年10月至2011年6月中国医科大学附属盛京医院儿科收治的151例早产儿,全部在生后7d内完成MRI,依据扫描结果,随机选取24例PWMD患儿作为病例组（n=24）,同时针对每一个病例随机选取同时期出生胎龄相同MRI正常的早产儿作为对照组（n=24）,分别测量病例组病灶及病灶周围区域、对照组相应区域的ADC值,病例组在2～5周后复查MRI,并再次测量原病灶及病灶周围区域的ADC值,观察其变化.结果 （1）初次MRI扫描：24例PWMD患儿,全部（100％） DWI显示点簇状高信号,而常规MRI中19例（79.2％）T1加权高信号伴T2加权低信号,4例（16.6％）仅T1加权高信号不伴有T2加权低信号,1例（4.2％）未见异常.复查MRI扫描：全部（100％）DWI显示原病灶区域高信号消失,常规MRI中9例（39.1％）T1加权高信号完全消失,14例（60.9％）T1加权高信号未完全消失,但病灶面积较前缩小.（2）ADC值测定：初次MRI：PWMD病灶区域的平均ADC值为（942 ± 170）×10-3mm2/s,明显低于病灶周围区域（1 554±116）×10-3mm2/s及对照组相同区域（1 524 ±116） ×10-3mm2/s（P均＜0.05）.复查MRI：原病灶区域的平均ADC值升至（1 468±195）×10-3 mm2/s,较前显著升高（P＜0.05）,但依然低于病灶周围区域（1 586 ±97）×10-3mm2/s（P＜0.05）.而病灶周围区域的平均ADC值较初次扫描差异无统计学意义（P=0.212）.结论 连续监测PWMD患儿病灶及病灶周围区域的ADC值变化,能更加准确且微观的描述其病理改变.Objective To observe the dynamic changes of MRI in the preterm infants with punctate white matter damage （PWMD）,and to explore the clinical significance of apparent diffusion coefficient （ADC） values by continuously measuring the lesions and surrounding region by applying diffusion weighted imaging （DWI）.Method MRI,using conventional and diffusion weighted imaging,was performed in 151 preterm infants within 7 days after birth between October 2010 to June 2011 in NICU.Twenty-four preterm infants with PWMD and 24 controls were obtained according to their MRI results.The control group infants were those with normal MRI results and at the same gestational age as those with PWMDs.The ADC value was measured for the lesions and their surrounding regions,and for the same sites of the controls.All the PWMD were followed up for 2-5 weeks,and apparent diffusion coefficients were measured at the same regions.The variation of magnetic resonance imaging was observed and the apparent diffusion coefficients were compared.Result The first MRI scanning：in the 24 cases with PWMD,high signals on DWI were seen in all patients （100％）,increased signal intensity on T1-weighted images were seen in 19 （79.2％） patients,increased signal intensity on T1-weighted images and decreased signal intensity on T2-weighted images were seen in 4 （16.6％） patients.The second MRI scanning：in the 24 cases with PWMD,The high signal on DWI vanished in all patients （100％）,the increased signal intensity on T1-weighted images vanished in 9 （39.1％） patients,the increased signal intensity on T1-weighted images did not vanish but was smaller than before in 14 （60.9％） patients.The measurement of ADC values：the mean ADC value of the lesions in the group of PWMD was （942 ± 170） × 10-3 mm2/s,significantly lower than the area surrounding （1 554 ± 116） × 10-3 mm2/s and the same area of the control group （1 524 ± 116） ×10-3mm2/s （P ＜ 0.05）.The second MRI scanning：the mean ADC of the lesions

关 键 词：磁共振成像 弥散 脑损伤 早产 表观弥散系数 

分 类 号：R722.6[医药卫生—儿科] R445.2[医药卫生—临床医学]