新生儿缺氧缺血性脑病MRI表现及其与预后的关系

MRI Findings of Neonatal Hypoxic Ischemic Encephalopathy and Their Correlation with Prognosis

目的探讨足月新生儿缺氧缺血性脑病(HIE)的早期MRI表现及其与临床分度及预后的关系。资料与方法以9例无窒息史的正常新生儿作对照,观察46例HIE患儿初期的MRI表现及28例复查病例的MRI表现。结果(1)MRI能显示HIE患儿的12种早期异常征象,其中T1WI皮层高信号、侧脑室周围深部白质高信号以及蛛网膜下腔出血(SAH)或硬膜下出血(SDH)3种征象在轻度组与中、重度HIE组差异无显著性(P>0.05);而另外6种征象(弥漫性脑水肿、T1WI双侧基底节高信号伴内囊后肢高信号消失、弥漫性脑实质出血、脑回征、灰白质分界不清及胼胝体水肿),在中、重度与轻度HIE组差异有显著性(P<0.05),说明这些征象是脑损伤严重的表现。(2)双侧基底节区广泛高信号伴内囊后肢高信号消失,弥漫性脑水肿,大面积脑梗死,脑回征以及脑实质广泛出血5种早期征象提示预后不良,常常会留下神经系统后遗症。结论MRI可以客观反映新生儿HIE早期脑损伤的严重情况,并可早期评估预后。

Objective To investigate the early MRI findings of full term neonatal HIE and their correlation with clinical grade and prognosis, Materials and Methods Early MRI findings of full term neonatal HIE in 46 cases and follow up MRI findings in 28 cases were analyzed retrospectively, 9 infants without evidence of birth asphyxia were studied as controls. Results （ 1 ） MRI showed 12 abnormal early MR features of HIE, and there was no significant difference（ P 〉 0.05 ） between mild group and moderate severe group in the incidences of 3 features including hyperintensity of cortex and deep periventricular white matter on T1WI and SAH （or SDH）. However, the incidences of the other 6 features, including diffuse brain edema, bilateral basal ganglia hyperintensity on T1WI or accompanging loss of hyperintensity in the posterior limb of internal capsule, diffuse parenchymal hemorrhage, gyros sign, loss of gray white matter differentiation and edema of the corpus callosum, were significantly higher in moderate severe group than those in mild group（ P 〈 0.05）, suggesting these features can predict the severity of brain injury in neonates with HIE. （2）5 early MRI features including bilateral basal ganglia hyperintensity on T1WI with loss of hyperintensity in the posterior limb of internal capsule, diffuse brain edema or large area of infarct, gyros sign and diffuse parenchymal hemorrhage, predicted a poor outcome. Conclusion MRI can show objectively the early brain injury in neonates with HIE, and estimate the prognosis at the early stage.