MRI在新生儿核黄疸诊断及随访中的价值

The value of MRI in the newborn infants with kernicterus

目的探讨MRI在新生儿核黄疸中的应用价值。方法选择21例经临床确诊为核黄疸的足月新生儿进行高场MRI检查。年龄2～11天,平均6.2天。对其中的8例患儿于3个月以后进行随访和复查MRI。MRI采用Philips Intera Achieva 3.0T超导型磁共振扫描系统,扫描图像包括T1 WI、T2 WI和DWI,两名放射科医师采用单盲法分析MR图像。结果①21例核黄疸的足月新生儿中有19例（19/21）T1 WI上双侧苍白球信号对称性增高,2例信号未见改变。②8例核黄疸患儿3个月以后随访和复查MR,其中有6例出现脑后遗改变,均显示T2 WI上双侧苍白球对称性高信号,另外2例信号未见改变,临床症状表现轻微。③上述病例DWI上信号均未见特殊改变。结论MRI T1 WI及T2 WI在本病的诊断及预后判定方面有重要的价值。

Objective The aim of this study was to document the magnetic resonance imaging （MRI） findings of kernicterus of newborn and provide evidences for diagnosis of kernicterus and prediction of outcome. Methods Twenty-one neonates who were admitted with jaundice, encephalopathy and indirect hyperbilirubinemia （[560. 87 ± 140.88]μmol/L） were prospectively evaluated with cranial MR imaging. The age ranged from 2 to 11 days, with median age of 6.2 days. Eight cases were reexamined with MRI at 3 months of age. The MRI was 3.0 T Intera-Achieva magnetic resonance （MR） scanner, routine T1WI, T2WI and DWI were applied. Two neuroradiologists who knew nothing about the clinical history analyzed MRI findings. Unconjugated bilirubin （UCB） in all these neonates were measured with the same methods and analyzer. Results （1）Nineteen of the 21 （19/21）neonates demonstrated bilateral, symmetric increased signal intensity in the globus pallidus on T1WI, and three neonates had symmetric hyperintense golbus pallidus on T2WI at the same time. Higher UCB （[580.95± 132.44]μmol/L） were found in 19 neonates with hyperintense globus pallidus as compared to two cases （350.3 μmol/L, 389. 9 μmol/L）without changes of globus pallidus. （2）Eight infants received the second MRI at ages of 3 months, 6 of the 8 cases showed symmetric hyperintense golbus pallidus on T2WI. （3）All cases showed no evidence of abnormality on DWI. Conclusion The symmetric involvement of globus pallidus seen as hyperintense on T1WI is a common and characteristic finding of acute kernicterus; T2WI hyperintensity is the characteristic finding of chronic kernicterus; DWI is no diagnostic value in kernicterus.