新生儿缺氧缺血性脑病的CT特征与随访意义

CT features and follow-up significance for hypoxic-ischemic encephalopathy in neonates

目的:观察不同程度新生儿缺氧缺血性脑病(H IE)CT特征并探讨随访意义。方法:对临床确诊的66例H IE患儿在生后3d内进行首次头颅CT平扫,并于出生后第14天、6个月进行复查,分析CT征象。结果:首次CT平扫全部病例均表现异常,其中轻度36例,中度20例,其中4例并发蛛网膜下腔出血;重度10例,其中6例合并不同程度的脑内出血、蛛网膜下腔出血。生后第14天复查头颅CT影像显示:36例轻度H IE患儿中全部恢复正常,20例中度患儿8例恢复正常,蛛网膜下腔出血基本吸收,其余13例脑水肿有所减轻,10例重度患儿仅有不同程度减轻,无一例恢复正常。生后6个月复查头颅CT影像显示:12例中度H IE患儿中正常6例,外部性脑积水2例,侧脑室周围白质软化4例,脑萎缩2例。10例重度H IE患儿均出现不可逆性改变,其中脑萎缩5例,脑穿通畸形2例,侧脑室周围白质软化8例。结论:头颅CT平扫对于早期诊断H IE具有重要指导意义,还可用于随访判断预后,轻度H IE患儿预后较好,中、重度预后较差。

Objective To observe CT features and evaluate the significance of follow - up study of hypoxic - ischemie eneephalopathy （HIE） in neonates. Method For 66 cases diagnosed as HIE were examined by CT scanning and the initial cranial CT scanning was performed within 3 days after birth and follow - up scannings were carried out when they were 14 days and 6 months old respectively. Results The initial cranial scanning showed that all of the 66 cases were abnormal, mild degree of encephalopathy was found in 36 eases, the pathological changes were moderately advanced in 20 cases, there was subaraehnoid hemorrhage in 4 out of the 20 eases. Severe infestations of encephalopathy occurred in 10 cases. Intracerebral bleeding occurred in 6 out of the 10 eases. The first follow - up observation with CT revealed all the mild HIE cases and 8 in 20 moderate cases returned to normal, but no severe HIE cases were normal. The last obervation showed that in the moderate lesion group, there were 6 normal cases, 2 cases of external hydrocephalus, 4 cases of periventrieular leukomalacia, 2 cases of cerebral atrophy. In the severe lesion group, irreversibility sequela occurred in 10 cases, 5 cases of cerebral atrophy, 2 case of porencephalic malformation, 8 cases of periventricular leukomalacia. Condusion In addition to the diagnosis of hypoxic - ischemic encephalopathy, CT scanning can be used to praise the prognosis of HIE. The prognosis of the mild lesions is relatively good and the prognosis of the severe lesions is relatively poor.