超声和CT在诊断新生儿颅内出血中的价值

The value of ultrasound and CT in the diagnosis of intracranial hemorrhage in newborns

目的探讨新生儿颅内出血中超声和CT的诊断价值。方法回顾性分析从2014年11月～2017年8月在我院出生并收治儿科ICU室临床怀疑颅内出血患儿568例,超声于生后1～7天内检查,CT于14天内检查,观察比较二者诊断价值。以MRI结果为标准或根据新生儿颅内出血的诊断标准,分别计算超声和CT的敏感性、特异性和准确性。结果 568例患儿经临床证实为颅内出血的有556例,其中,室管膜下出血340例,蛛网膜下腔出血86例,硬膜下出血51例,脑实质合并脑室内出血79例。超声诊断颅内出血506例,其中室管膜下出血340例,蛛网膜下腔出血54例,硬膜下出血40例,脑实质合并脑室内出血72例。误诊1例,漏诊51例。诊断的敏感性为90. 8%,特异性为91. 7%,准确性为90. 8%; CT诊断颅内出血534例,其中室管膜下出血318例,蛛网膜下腔出血86例,硬膜下出血51例,脑实质合并脑室内出血79例。误诊0例,漏诊22例。诊断的敏感性为96. 0%,特异性为100%,准确性为96. 1%。结论早期颅内出血超声可作为筛查手段;超声对室管膜下出血敏感性高于CT,可作为首选检查方法;对于蛛网膜下腔出血、少量脑实质出血及硬膜下出血,CT优势于超声。

Objective To explore the diagnostic value of ultrasound and CT in intracranialhemorrhage in newborns. Methods A retrospective analysis from November 2014 to August 2017 in our hospital was carried out in our hospital, and 568 cases of suspected intracerebral hemorrhage in pediatric ICU room were examined. The ultrasound was checked within 1 -7 days after birth, and CT was checked within 14 days. The diagnostic value of two patients was observed and compared. The sensitivity, specificity and accuracy of ultrasound and CT were calculated on the basis of the MR result or the diagnostic criteria of intracranial hemorrhage in the newborn. Results In 568 cases, 556 cases were clinically diagnosed as intracranial hemorrhage, including 340 cases of subependymal hemorrhage, 86 cases of subarachnoid hemorrhage, 51 cases of subdural hemorrhage, and 79 cases of intraventricular hemorrhage combined with parenchymal hemorrhage. 506 cases of intracranial hemorrhage were diagnosed by ultrasound, including 340 cases of subependymal hemorrhage, 54 cases of subarachnoid hemorrhage, 40 cases of subdural hemorrhage, and 72 cases of cerebral parenchyma complicated with intraventricular hemorrhage. 1 case was misdiagnosed and 51 cases were missed. The sensitivity, specificity and accuracy of diagnosis were 90.8% , 91.7% and 90.8% , respectively. 534 cases of intracranial hemorrhage were diagnosed by CT, including 318 cases of subependymal hemorrhage, 86 cases of subarachnoid hemorrhage, 51 cases of subdural hemorrhage, and 79 cases of intraventricular hemorrhage. None was misdiagnosed and 22 cases were misdiagnosed. The sensitivity of the diagnosis was 96% , the specificity was 100% , and the accuracy was 96.1%. Conclusion Early intracranial hemorrhage ultrasound can be used as a screening method; ultrasound sensitivity is snperior to subependymal hemorrhage than CT, which can be used as the preferred method of inspection; for subarachnoid hemorrhage, a small amount of cerebral hemorrhage and subdural hemorrhage, CT is superior to ultrasound.