局灶性脑白质损伤早产儿MRI的特征演变及MRI分型与神经发育相关性分析

Evolution of MRI features of premature infants with punctate white matter damage and analysis on the correlation between MRI classification and neurodevelopment

目的：探讨局灶性脑白质损伤（PWMD）早产儿磁共振成像（MRI）的特征演变及MRI分型与神经发育的相关性。方法：选取2010年6月-2012年6月在该院及华中科技大学附属同济医院新生儿科住院的55例PWMD患儿作为观察组,并按照病灶的数量及分布将观察组分为观察1组（点状损伤,31例）、观察2组（簇状损伤,13例）和观察3组（线状损伤,11例）。对观察组各组患儿行MRI及弥散加权成像（DWI）检查,观察患儿近期MRI变化。采用第三版贝莉婴幼儿发育量表（BSID-Ⅲ）评价各组新生儿神经发育情况,并分析PWMD程度与神经发育的关系。结果：MRI首次检查,观察组共有9例DWI表现为强信号,MRI正常;34例DWI表现为强信号,MRI表现为T1强信号,伴或不伴T2低信号;12例DWI正常,MRI表现为T1强信号,伴或不伴T2低信号。21例MRI复查患儿中点状损伤5例,病灶完全消失;簇状损伤6例,其中4例病灶完全消失,2例发展成脑室周围白质软化（PVL）;线状损伤10例,其中6例病灶完全消失,4例发展成PVL。新生儿出生后观察组患儿智力发育指数（MDI）、运动发育指数（PDI）评分均低于对照组和正常组（P〈0.05）,观察1组MDI、PDI评分高于观察2组和观察3组（P〈0.05）;观察2组MDI、PDI评分高于观察3组,组间比较差异有统计学意义（P〈0.05）。结论：脑白质损伤程度与神经发育存在相关性;通过分析PWMD患儿的MRI特征,可以初步评估PWMD的预后。

Objective： To explore the evolution of MRI features of premature infants with punctate white matter damage （PWMD） and the correlation between MRI classification and neurodevelopment. Methods： Fifty-five PWMD children were selected from Department of Neonatology in the hospital from June 2010 to June 2012 as observation group, then they were divided into observatioli one group （dot damage, 31 children）, observation two group （ clusters of injury, 13 children）, and observation three group （ linear injury, 11 children） according to the number and distribution of lesions. MRI and DWI were conducted among the three observation groups, short-term MRI chan- ges of the children were observed. BSID-III was Used to evaluate neurodevelopment of the children, the relationship between degree of PWMD and neurodevelopment was analyzed. Results： Primary scan of MRI found strong DWI signal and normal MRI signal in 9 children, strong DWI signal, strong T1 signal with or without low T2 signal in 34 children, normal DWI signal, strong T1 signal with or without low T2 signal in 12 children. Among 21 children receiving MRI rescanning, 5 children were found with punctate injury, the lesions disappeared; 6 children were found with clusters of injury, the lesions of 4 children disappeared completely, and the lesions of 2 children developed into periventricular leukomalacia （PVL） ; 10 children were found with linear injury, the lesions of 6 children disappeared completely, and the lesions of 4 children developed into PVL .After birth, the scores of mental development index （ MDI） and physical development index （PDI） in observation group were statistically significantly lower than those in control group and normal group （ P〈0.05 ）, the scores of MDI and PDI in observation one group were statistically significantly higher than those in observation two group and observation three group （ P〈0. 05 ） ; the scores of MDI and PDI in observation two group were statistically significantly higher than those in observation three group （ P〈0. 05 ） . Conclusion： The degree of white matter damage is correlated with neural development, the prognosis of PWMD can be evaluated preliminarily by analyzing MRI characteristics of PWMD children.