三维容积超声在诊断新生儿颅脑损伤的应用

Application of three-dimensional ultrasonography in diagnosis of neonatal brain injury

目的探讨三维容积超声断层显像技术(TUI)和三维血管成像在新生儿颅脑损伤中的应用价值。方法选择1 028例新生儿,妊娠26+3~41周,出生体质量(3.05±1.03)kg;其中男性558例,女性470例,出生龄(4.0±0.6)d。其中妊娠<28周极早早产儿22例,28~31^(+5)周132例,32~33^(+6)周100例,34~36^(+6)周155例。进行颅脑三维容积成像,采用TUI模式、三维血管成像模式,诊断结果与传统二维实时超声比较。结果经TUI模式及三维血管成像模式诊断颅内出血Ⅰ级156例,Ⅱ级54例,Ⅲ级41例,Ⅳ级11例;非囊状脑室周围白质软化52例,囊状脑室周围白质软化21例;其合并轻度脑积水10例,中度脑积水16例,重度脑积水22例。较传统二维实时超声少诊断1例颅内出血Ⅰ级、1例非囊状脑室周围白质软化,其余疾病诊断例数及程度均一致。三维血管成像清晰显示,11例Ⅳ级颅内出血,5例大片状囊状脑室周围白质软化,22例重度脑积水因出血块压迫、脑实质囊性缺失及积水压迫作用导致的局部血流信号减少、缺失,清晰显示病变与血管的空间位置关系。三维容积数据采集时间为(5.86±1.68)min,明显短于传统二维超声全程操作的扫查时间。结论三维容积TUI诊断新生儿颅脑疾病可行,对于实现床旁快速诊断、提高超声检查在新生儿中应用的安全性有一定的实用价值。可作为二维实时超声诊断新生儿颅脑损伤的重要补充。

Objective To explore the application value of three-dimensional（3D） volume tomography ultrasound imaging（TUI） and 3D blood vessel imaging in neonatal brain injury. Methods A total of 1 028 neonates included 558 males and 470 females were enrolled, with pregnancy of 26＋3 - 41 weeks, birth body weight （3.05 ,肖崇娟 1.03） kg and birth age of （4.0 ,肖崇娟 0.6） days. Of all the infants, 22 were premature babies younger than 28 weeks, 132 were 28 - 31＋5 weeks, 100 were 32 - 33＋6 weeks and 155 were 34 - 36＋6 weeks. All of the neonates were performed 3D brain volume ultrasound in TUI and 3D blood vessel imaging mode, and diagnostic results were compared with traditional two-dimensional（2D） real time ultrasound images. Resnlts The 156 cases grade I intraeranial hemorrhage were diagnosed by TUI and 3D blood vessel imaging mode, as well as 54 of grade Ⅱ , 41 of grade Ⅲ and 11 of grade Ⅳ. Meanwhile, 52 of non-cystic periventficular leukomalacia, 21 of cystic periventficular leukomalacia, 10 of combined mild hydrocephalus, 16 of moderate hydrocephalus and 22 of severe hydrocephalus were diagnosed. Compared with traditional 2D real time ultrasound, one case of grade I intracranial hemorrhage was missed, as well as one case of noncystic ventricular leukomalaeia, while the other diagnoses were consistent in numbers and degrees. The 3D blood vessel images clearly demonstrated that focal blood flow signal decreased or vanished in 11 of intracranial hemorrhage, 5 of large patch in cystic periventricular leukomalacia and 22 of severe hydrocephalus, of which due to block oppression, parenchyma cystic missed and hydrocephalus oppression. Space position relations between the lesions and vascular were also be clearly displayed. Collection time of 3D volume data was （5.86 ± 1.68） minutes and significantly shorter than that of traditional 2D scanning. Conclusion It is demonstrated that 3D volume ultrasound is feasible in diagnosis of neonatal brain injury, which could perform rapid bedside diagnosis and improve the safety of clinical ultrasound application in newborns. It may become an important supplement for 2D real-time ultrasound in diagnosis of neonatal brain injury.