3.0T磁共振成像在新生儿胆红素脑病早期诊断中的应用  

Application of 3.0T magnetic resonance imaging in early diagnosis of neonatal bilirubin encephalopathy

作　　者：李瑞琪[1] 王剑杰[2] 葛旭霞 任蒙蒙[1] 李楠[1] 

机构地区：[1]中国医科大学航空总医院影像中心,北京100012 [2]武警总医院核医学科,北京100069

出　　处：《中国医药导报》2016年第13期117-121,共5页China Medical Herald

摘　　要：目的探讨磁共振成像（MRI）技术在新生儿急性胆红素脑病（ABE）诊断中的应用,为临床早期诊断提供客观依据。方法回顾性分析2013年3月-2015年9月中国医科大学航空总医院新生儿科及产科因病理性黄疸收住入院的29例患儿的临床资料,根据血清总胆红素的不同升高程度,将患儿分为轻、中、重度三组,轻度组15例（TSB〉317.5-445.8μmol/L）,中度组11例（TSB〉445.8-568.3μmol/L）,重度组3例（TSB≥568.3μmol/L）,均行常规MRI检查,分析影像学特征。结果 21例患儿表现为T1WI双侧苍白球对称性高信号,轻、中、重度三组患儿T1WI双侧苍白球信号改变的阳性率分别为86.67%（13例）、54.54%（6例）、66.67%（2例）,差异有统计学意义（P〈0.05）。DWI序列均未见高信号,14例中、重度组患儿的表观扩散系数（ADC）值测量信号高于轻度组患儿;T2WI呈正常等信号,8例T1WI及常规序列脑内未见阳性征象;对9例患儿于2-6个月龄复查MRI,综合比对其影像学表现,其中1例苍白球部位T2WI呈稍高信号,8例双侧苍白球T1WI高信号消失。结论 T1WI双侧苍白球对称性高信号为特征性表现,DWI（ADC值）对诊断胆红素脑病具有参考价值,T2WI苍白球呈稍高信号多提示预后不良,磁共振成像技术在新生儿胆红素脑病早期诊断具有一定优势。Objective To investigate the value of magnetic resonance imaging（MRI） in the diagnosis of acute bilirubin encephalopathy（ABE） in neonates, and provide objective basis for early clinical diagnosis. Methods Clinical data of 29 neonatus diagnosed neonatal acute bilirubin encephalopathy from March 2013 to September 2015 in Aviation General Hospital of China Medical University were retrospectively analyzed, according to the increased degree of serum total bilirubinall, all patients were divided into three groups： mild group（TSB317.5-445.8 μmol/L）, moderate group（TSB445.8-568.3 μmol/L）, and severe group（TSB ≥568.3 μmol/L）. All patients were given the MRI scanning, and the imaging characteristics were analyzed. Results Twenty-one children had symmetrical high-signals intensity on T1 WI in bilateral pallidal. There were 13 patients mild group（86.67%）, 6 patients in moderate group（54.54%） and 2 patients in the severe group（66.67%）, the difference was statistically significant（P〈0.05）. The DWI sequences had no high-signals intensity, and the ADC value measured of bilateral pallidal of 14 cases in the moderate and severe group was higher than that in the mild group, which showed normal signal on T2 WI. 8 children had no abnormalities on T1 WI and routine sequences. 9 patients underwent MRI scanning again in 2-6 months, only 1 case still showed high signal intensity in bilateral pallidal on T2 WI. Conclusion Symmetrical high-signals intensity on T1 WI in bilateral pallidal is the characteristic for ABE, DWI（ADC value） sequence has reference value for the diagnosis of bilirubin encephalopathy.High signal intensity of bilateral globus pallidal on T2 WI is an indication of poor prognosis. MRI scanning has an important role in the early diagnosis of acute bilirubin encephalopathy in neonatus.

关 键 词：新生儿 急性胆红素脑病 磁共振成像 神经毒性损害 苍白球 

分 类 号：R722.17[医药卫生—儿科]