磁敏感成像在探测早产儿局灶性脑白质损伤中的研究

Susceptibility Weighted Imaging in detecting Focal White Matter Lesions in Premature Infants

目的应用磁敏感成像(susceptibility weighted imaging,SWI)探测早产儿局灶性脑白质损伤(punctate white matter lesions,PWML)中是否含有微出血成分,观察病灶的演变。资料与方法对27例行头颅常规MRI、扩散加权成像(DWI)表现为PWML的早产儿同期增加SWI扫描。观察PWML在SWI的相应位置上是否表现为低信号,观察随访常规MRI。结果 1例患儿MRI示左侧侧脑室下角旁簇状短T1、短T2信号,DWI示相应病灶高信号,SWI示相应病灶低信号。26例MRI示双侧半卵圆中心、侧脑室旁、后角、前角旁短T1伴或不伴有短T2信号,DWI示相应病灶处高信号,部分病灶范围增大,SWI示相应病灶高信号。其中病灶呈线状者8例,簇状者12例,混合型7例。7～22天后,随访到其中17例患儿。10例(10/17)病灶呈簇状者随访期MRI上病灶吸收、部分消失,7例(7/17)病灶呈线状、混合状者出现脑室旁白质软化灶(periventricular leukomalacia,PVL)。结论绝大多数PWML在SWI上表现为高信号,提示PWML中不含微出血成分。病灶形态呈线状、混合状者,晚期有发展成PVL的可能。

Objective Using susceptibility weighted imaging（SWI） which is highly sensitive for haemorrhage to detect whether focal white matter lesions（PWML） in premature infants contain microbleeds and to observe the evolution of PWML.Materials and Methods Twenty-seven premature infants with PWML proved by MRI and Diffusion weighted imaging（DWI） underwent SWI examination.Conventional MRI were followed up.Results One（1 /27） neonate showed a cluster pattern lesion with signal intensity loss on SWI adjacent to left inferior horn of lateral ventricle.Twenty six（26 /27） neonates with PWML located at centrum semiovale,periventricular area showed hyperintensity on SWI,which were.Eight lesions（8 /27） showed linear pattern,12 lesions showed cluster pattern and 7 lesions showed mixed pattern.The follow up examinations performed from 7 to 22 days after the initial examination.Ten（10 /17） neonates with cluster pattern lesions disappeared on follow-up MRI.Seven（7 /17） neonates with linear pattern or mixed pattern lesions were defined as periventricular leukomalacia（PVL）.Conclusion Most lesions of PWML in neonates show no microbleeds on SWI.PWML with linear or mixed pattern usually has bad prognosis.