儿童脑室周围白质软化的MRI诊断

MRI diagnosis of children with periventricular leukomalacia

目的探讨脑室周围白质软化(periventricular leukomalacia,PVL)的临床、病理及MRI表现特征,提高其影像学诊断的准确率。方法回顾性分析51例有完整资料的PVL的MRI及临床表现。结果 51例中48例(含9例足月儿)有宫内窘迫、感染或难产史,其中42例为早产儿,9例为足月儿。平均体重2080 g。49例可见脑室旁长T1长T2信号影,其中异常信号局限在三角区周围者25例,局限在额角旁及后角旁分别为6例和4例,累及侧脑室体部周围白质及半卵圆区分别为14例和6例,2例脑室周围无明显异常信号。39例出现侧脑室扩大变形,以后角变形为主,3例侧脑室形态无明显变化。21例合并胼胝体发育不良。结论 MRI表现为侧脑室周围白质异常信号、侧脑室形态改变和(或)胼胝体形态、体积的改变为诊断PVL的要点。同时,应结合是否是早产儿、极低体重儿及难产的临床资料,可提高该病的早期诊断率。而及早干预可改善该病的预后。

Objective To discuss the clinical, pathology and MRI features of periventricular leukomalacia （PVL） and to improve image diagnostic accuracy. Methods Retrospective analysis of 51cases of PVL in MRI and clinical practice was carried out. Results Among the 51 cases 48 （ including 9 of mature children） were with poverty - stricken in uterus, intrauterine asphyxia or difficult labor; 42 were of premature, 9 were of mature. The average birthweight was 2080 g; 49 ca- ses with long Tl long T2 signal ventricular side, whom signal was confined to the triangle anomaly around in 25, confined to the forehead near the posteriorhorn of paraneoplastic in 6 and 4, involving the white matter around the lateral body and semi - oval centers in 14 and 6, 2 had no abnormal periventricular signals, in 39 appeared lateral ventricle back expansion de- formation, 3 were with no significant changes in the form of lateral ventricle, 21 were with combined corpus callosum hypo- plasia. Conclusion Abnormal signals of the around of lateral ventricle, lateral expansion and deformation were the charac- teristics of the disease changes, also the diagnosis of PVL can be combined with corpus callosum hypoplasia. Meanwhile, the diagnosis should be also combined with premature of children, children with or without low weight and difficult labor. Early intervention must be performed which could improve the outcomes.