磁敏感加权成像在早产儿伴脑室旁白质损伤中的应用研究

Susceptibility-weighted imaging findings in periventricular white matter injury in preterm infants

目的脑室旁白质损伤是早产儿围生期窒息后常见的脑损伤类型之一,其MRI表现具有特征性,但常规序列难以区分病灶内是否合并出血,而出血与否可能影响治疗和预后。该研究应用磁敏感加权成像(SWAN)来检测存在白质损伤的早产儿脑内的出血性病变。方法对临床怀疑围生期窒息后脑损伤的75例早产儿行头颅GE HDx Twin Speed 3.0T MRI检查,扫描序列包括T1FLAIR、T2FLAIR、DWI和SWAN。结果44例(58.7%)早产儿存在脑室旁白质损伤,其中4例(9.1%)存在出血性白质损伤。在这4例中有3例合并生发基质出血-脑室内出血;4例合并小脑出血;1例合并蛛网膜下隙出血。结论脑室旁白质损伤中绝大多数为非出血性损伤,当伴有生发基质出血或脑室内出血时,脑室周围白质损伤病灶中常存在出血。

Objective Periventricular white matter injury represents the most significant problem which leads to neonatal mortality and long-term neurologic deficits in preterm infants. It was difficult to distinguish hemorrhagic from non-hemorrhagic lesions by conventional MR sequences. Identification of small hemorrhages can provide useful informa- tion regarding the nature of injury, guide treatment and estimate the prognosis. The aim of the study was to detect hemor- rhagic lesions in periventricular white matter injury （PWMI） following perinatal asphyxia using the susceptibility weighted imaging, called T2 Star Weighted Angiography （SWAN） in preterm infants. Methods Seventy-five preterm infants who were suspected of brain injury following perinatal asphyxia underwent MR scanning using a GE HDx Twin Speed 3.0T MR scanner. All patients were evaluated using SWAN in addition to fluid-attenuation inversion recovery （FLAIR） and diffusion weighted imaging （DWI）. Results Imaging findings demonstrated that 44 （58.7%） infants had PWMI, among which 4 （9.1%） infants had hemorrhagic white matter injury and cerebellar hemorrhage, and 3 infants had germinal matrix hemorrhage-intraventricular hemorrhage, and 1 infent had subarachnoid hemorrhage. Conclusions PWMI is a common type of brain injuries following perinatal asphyxia among preterm infants and is non-hemorrhagic lesions in most cases. Hemor- rhagic PWMIs are often accompanied by GMH-IVH and cerebellar hemorrhage.