扩散加权成像在新生儿HIE早期诊断及预后的价值

The Value of Diffusion Weighted Imaging in the Early Diagnosis and Prognos-tic Evaluation of Neonatal HIE

目的探讨扩散加权成像(DWI)在新生儿缺氧缺血性脑病(hypoxic-ischemic encephalopathy,HIE)的早期诊断及预后方面的价值。方法搜集临床诊断为HIE的足月新生儿60例资料为病例组、正常足月新生儿10例为对照组。患儿均在生后1周内进行头部MR、DWI扫描,按临床诊断标准轻度组33例(55%),中度组18例(30%),重度组9例(15%)。随访患儿头部MRI及生长发育情况,观察患儿早期DWI上病灶的分布、数量、形状及与周围组织的关系;观察经及时对症及早期干预治疗后,病灶的演变及白质、髓鞘发育情况(后期复查时间3～36个月)。结果不同程度组患儿HIE易损区分布的区域、范围不尽相同,轻中度组HIE易损区主要位于矢状旁区皮层及皮层下白质;重度组HIE以深部灰质(壳核、丘脑腹外侧核等)和中央前回皮层为主,早期(1周内)DWI示上述病例受损区呈明显高信号,而常规T1WI未见明显异常信号或呈稍短T1信号,经及时对症或(和)早期干预治疗后,轻度组33例头部MRI示病灶吸收消失,生长发育良好;中度组6例预后良好,另外12例预后较差,其中3例头部MRI出现侧脑室旁白质软化(periventricular leukomalacia,PVL),4例出现脑室旁白质减少,5例出现脑室扩大,胼胝体变薄等;重度组9例预后差,6例MRI示多囊性脑软化,3例示PVL后遗症改变伴髓鞘发育明显落后、智低。结论 DWI能早期发现病变,和常规MRI相结合,可更客观评价HIE患儿的预后;磁共振DWI技术对新生儿HIE早期诊断及其预后评估有重要价值。

Objective To explore the value of diffusion weighted imaging （DWII in the early diagnosis and prognostic evaluation of newborn hypoxia ischemic encepha- Iopathy （hypoxic - ischemic encephalopathy, HIE）. Methods Collect the clinical materials and MRI imagings of 60 HIE newborn and l0 normal newborn. All of the newborn underwent head MR and DWI scanning, and the newborn were break into 3 groups according to the clinical diagnosis standard, 33 infants （55%） were classed as mild group, 18 infants （30%） were classed as moderately group, 9 infants （15＇~） were classed as seerely group. Observe the distribution, number, shape and the relation to surrounding tissue of the early lesions, and the development of the lesion, white matter and the medullary sheath after symptomatic treatment and early intervention （the review were 3-36 months）,. Results The distribution and the range of the vtflner- able zone was different according to the different group. The vulnerable area loc：lted mainly in the cortical and subcortical white matter of the parasagittal area mild-to- moderate group HIE, deep gray matter （Shell nuclei, ventrolateral nucleus of thalamus, etc） and precentral gyrus cortex were affected in severe HIE group patients. DWI shown significantly hyper intensity and TIWI shown iso or hypo intensity in the vulnerable zone in early stage （in I week）. The lesioin disappeared and the white matter and the medullary sheath developed well in the mild group ~fter symptomatic treatment and early intervention. 6 cases in the moderate group had a fawmrable prognosis, and the other 12 had poor prognosis, 3 cases presented periventricnlar leukomalacia, 4 cases presented decreased white matter of the periventricular, 5 cases presented ventriculomegaly and agenesis of the corpus callus. All of the cases in the severe group had poor prognosis, 6 presented polycystic encephalomalacia. 3 pre- sented PVL change with myelin sheath was developed low behind wisdom. Conclu- sions Early pathological changes can be found in DWI, and to combien with the conventional MRI, can we make more objective evaluation to the prognosis of HIE children. Magnetic resonance DWI technology is important in early diagnosis and prognosis evaluation of neonatal HIE.