MRI平扫在足月新生儿缺氧缺血性脑病中的应用价值

Application value of MRI scan in full-term neonates with hypoxic-ischemic encephalopathy

目的探讨核磁共振(MRI)平扫在足月新生儿缺氧缺血性脑病(HIE)诊断及预后评估中的应用价值。方法选取2014年9月-2016年10月在该院分娩并确诊为HIE的足月新生儿57例,所有患儿均采用3.0T MRI进行检查,包括常规序列以及弥散序列、磁敏感序列成像,根据MRI检查结果进行诊断,并将MRI检查结果与临床确诊结果进行比较,同时将不同序列成像的诊断结果进行分析。结果 57例HIE患儿中,MRI阳性检出55例,检出率为96.49%,与临床诊断结果比较差异无统计学意义(P>0.05)。弥散加权成像(DWI)对单纯性脑水肿的检出率100%,显著高于常规序列的60%(6/10),差异有统计学意义(P=0.024);磁敏感加权成像(SWI)对脑出血及蛛网膜下腔出血的检出率为100%(9/9),显著高于常规序列的55.56%(5/9),差异有统计学意义(P=0.023)。MRI诊断单纯性脑水肿10例,广泛性脑水肿合并基底节损伤12例,局灶性脑水肿伴基底节损伤16例,脑室周围白质改变7例,脑出血及蛛网膜下腔出血9例。结论 MRI对足月HIE诊断的敏感性较高,通过MRI功能成像选择针对性扫描序列可提高阳性检出率与诊断准确率,为临床治疗提供可靠依据,并可有效评估预后。

Objective To explore the application value of magnetic resonance imaging （MRI） scan in diagnosis and prognosis evaluation of hypoxic-ischemic encephalopathy （HIE） in full-term neonates. Methods A total of 57 full-term neonates who were born and diagnosed as HIE in this hospital from September 2014 to October 2016 were selected, and these neonates were examined with 3.0 T MRI, including conventional sequences, diffusion sequences, and magnetic susceptibility imaging. The diagnosis was based on MRI findings, MRI findings were compared with the clinical findings, and the diagnostic results of different sequences were analyzed at the same time. Results Among 57 neonates with HIE, MRI positive detection rate was 96.49% （55 neonates）, compared with clinical diagnosis, the difference was not statistically significant （P〉0. 05）. The detection rate of simple encephaledema by diffusion weighted imaging （DWI） was 100%, which was statistically signifi- cantly higher than that by conventional sequence （60%, 6/10） （P=0. 024）. The detection rate of cerebral hemorrhage and subarachnoid hemorrhage by susceptibility weighted imaging （SWI） was 100% （9/9）, which was statistically significantly higher than that by conventional sequence （55.56%, 5/9） （P=0. 023）. MRI diagnosed simple cerebral edema in 10 cases, extensive encephaledema complicated with basal ganglia lesions in 12 cases, focal encephaledema complicated with basal ganglia lesions in 16 cases, periventricular white matter changes in 7 cases, cerebral hemorrhage and subarachnoid hemorrhage in 9 cases. Conclusion The sensitivity of MRI in diagnosis of HIE in full-term nenoates is high. It can improve the positive detection rate and accurate rate of diagnosis by selecting targeted scan sequence through MRI functional imaging, which provides reliable basis for clinical treatment and effective evaluation of the prognosis.