新生儿缺氧缺血性脑病CT影像学表现及与临床分度的相关性

CT Imaging Manifestations of Neonatal Hypoxic Ischemic Encephalopathy and Its Correlation with Clinical Grades

目的旨在探讨新生儿缺氧缺血性脑病(HIE)CT影像学表现及与临床分度的相关性。方法将2016年5月至2018年5月于我院新生儿病房54例HIE患儿的临床病例及影像学资料进行回顾性分析,比较CT检查分度和临床分度的差异性,并整理HIE患儿CT检查中相关影像图像表现。结果CT检查对HIE轻度的诊断符合显著较低(P<0.05),而中度和重度在CT检查和临床比较上差异间均无统计学意义(P>0.05)。在CT分度轻度患儿中,其Apgar评分≤3分比例较中度和重度显著升高,而4分<Apgar评分≤6分比例显著降低(P<0.05)。临床分度轻度HIE患儿CT值显著高于重度者(P<0.05)。在CT检查中,轻度HIE主要可表现为脑室周围脑白质及灰质低密度弥漫性阴影,病灶边界模糊,脑室狭窄或消失;中度HIE可表现为多个低密度影,且脑部灰白质对比缺乏清晰,部分可表现为脑沟消失;对于重度HIE而言脑实质呈弥漫性低密度改变为其主要表现,灰白质界限消失,而基底节、背侧丘脑密度正常,部分可见脑室受压和脑沟消失。结论CT检查HIE分度与临床分度类似,但CT分度轻度诊断率显著低于临床分度,且随着CT分度的加重,Apgar评分越高,而随着临床分度的增加,CT值越小,故CT检查对于HIE分度和病情评估具有一定的临床价值,但结合临床分度标准更有利于诊断和指导临床治疗。

Objective To investigate the CT imaging manifestations of neonatal hypoxic ischemic encephalopathy (HIE) and its correlation with clinical grades.Methods The clinical and imaging data of 54 children with HIE in the neonatal ward of our hospital from May 2016 to May 2018 were retrospectively analyzed.The differences between CT grades and clinical grades were compared,and manifestations of related images was analyzed in CT examination of children with HIE.Results The coincidence rate of CT examination for the diagnosis of mild HIE was significantly lower (P<0.05).There was no significant difference in the diagnosis of moderate and severe HIE between CT examination and clinical comparison(P>0.05).Among children with mild HIE by CT grades,the proportion that the Apgar score was less than 3 points was significantly higher than that in children with moderate and severe HIE,while the proportion that the Apgar score was more than 4 points and less than 6 points significantly decreased(P<0.05).The CT value of children with mild HIE by clinical grades was significantly higher than that of severe patients(P<0.05).In the CT examination,mild HIE can show diffuse and lowdensity shadow of white matter and gray matter around the ventricles,with blurred border and narrow or disappeared ventricles.Moderate HIE can show multiple lowdensity shadows,and the contrast of gray matter in the brain is not clear,and some of them can show the disappearance of the sulci.For severe HIE,the change that brain parenchyma showed diffuse low-density was the main manifestation,the boundary of gray matter disappeared,and the basal ganglia and dorsal thalamus density are normal, and some ventricle compression and sulci disappear,the basal ganglia and density of dorsal thalamus were normal,and some of them can show that ventricle was compressed and the sulci disappeared.Conclusion HIE grades of CT examination is similar to that of clinical grades,but the diagnosis rate of CT grades for mild HIE is significantly lower than that of clinical grades,and and the Apgar score is higher with the increasing of CT grades. With the increasing of clinical grades,the CT value is smaller.Therefore,CT examination has certain clinical value for HIE indexing and disease assessment.However,it is more beneficial for the diagnosis and guidance of clinical treatment if it is combined with clinical grades.