新生儿中、重度缺氧缺血性脑病的MRI评估分级价值

The value of MRI in diagnosis and assessment of moderate and severe neonatal hypoxic-ischemic encephalopathy

目的:探讨MRI对中、重度新生儿缺氧缺血性脑病(HIE)的评估分级价值。方法:回顾性分析32例经临床诊断为中、重度HIE的患儿资料,所有患儿均行MRI常规平扫及DWI扫描,采用Fisher确切概率法对中、重度HIE患儿的脑损伤部位及累及范围进行统计学比较。结果:32例患儿中,中度HIE 18例,重度HIE 14例。MRI结果显示:中度HIE累及皮层和分水岭区的损伤为12例,重度HIE为3例,两者之间差异有统计学意义(P=0.042);重度HIE损伤基底节区重要灰质核团11例,较中度HIE(4例)多见(P=0.017);中、重度HIE累及胼胝体损伤分别为6例和7例,两者之间差异无统计学意义(P=0.534);脑损伤累及范围在中、重度HIE之间差异具有统计学意义(P=0.0032)。结论:MRI是诊断和评估中、重度HIE的重要检查方法,可正确判断新生儿脑部受损伤程度和范围,对HIE准确诊断及指导治疗有着重要的参考价值。

Objective：To explore the value of magnetic resonance imaging diagnosis and grading of moderate or severe hypoxic-ischemic encephalopathy（HIE）in neonates.Methods：The clinical and imaging data of 32 neonates diagnosed as moderate and severe HIE by clinical evaluation were retrospectively analyzed.MRI scan sequence consisted of plain scan and DWI sequence in all of the neonates.The Fisher＇s Exact Test was adopted as statistical comparison method in the areas and extent of neonatal brain injury.Results：Of the 32 cases,18cases were moderate HIE,and 14 cases were severe HIE.On MRI,involvement of the cortex and watershed area was observed in 12 cases of moderate HIE and in 3cases of severe HIE,there was statistically significant difference between the moderate and severe HIE in the sites of involvement（P=0.042）.In severe HIE injuries involving the basal ganglia area grey matter nucleus（11cases）were more commonly seen than in moderate HIE（4cases,P=0.017）.In moderate and severe HIE injuries involving the corpus callosum occurred in 6and 7cases respectively,there was no statistically significant difference between the moderate and severe HIE in the sites of involvement（P=0.534）.But there was statistically significant difference in the extent of brain damage between the moderate and severe HIE（P=0.0032）.Conclusion：MRI is an extremely valuable imaging method in the diagnosis and assessment of moderate and severe HIE;it can correctly judge the degree and extent of neonatal brain damage,therefore having important application value in making accurate diagnosis and guiding treatment of neonatal HIE.