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 Diagnosing Neonatal Intracranial Hemorrhage

目的旨在探讨超声和CT在诊断新生儿颅内出血中的临床价值。方法选取我院2016年1月~2017年12月收治的61例新生儿颅内出血患者,收集61例新生儿颅内出血患者的临床资料及影像学资料,比较不同检查对新生儿颅内出血的检出率及诊断符合率。结果 CT检查对新生儿颅内出血的的总检出率及总诊断正确率分别为88.76%、85.39%,超声检查分别为88.76%、85.39%,两者间无明显统计学差异(P>0.05);超声对脑室管膜下出血灶检出率明显优于CT(100.00%vs87.09%),超声对脑室内出血灶检出率、诊断正确率均为100%,明显高于CT检查72.22%、66.66%(P<0.05);CT检查对硬脑膜下、蛛网膜下腔出血灶检出率及诊断正确率明显高于超声检查(P<0.05);超声检查中新生儿颅内出血灶主要表现为强回声,部分患者可发生不同程度脑室增宽、脑中线结构移位;CT扫描中出血灶多数均表现为高密度影,硬脑膜下出血小脑幕多见高密度增厚,颅底出现新月形高密度区;少数患者蛛网膜下腔出血灶存在矢状窦旁"三角征"。结论超声和CT检查均可有效检出并正确诊断新生儿颅内出血,超声对脑室内、脑室管膜下出血灶显示优势较为明显,CT在检出硬脑膜下、蛛网膜下腔出血灶中优于超声,临床可根据患者个人情况,选择检查方式。

Objective To investigate the clinical value of ultrasound and CT in the diagnosis of intracranial hemorrhage in neonates. Methods 61 cases of neonatal intracranial hemorrhage admitted to our hospital from January 2016 to December 2017 were selected. Clinical data and imaging data of 61 cases of neonatal intracranial hemorrhage were collected to compare the detection rate and diagnostic coincidence rate of different examinations for neonatal intracranial hemorrhage. Results The total detection rate and the total diagnostic accuracy of CT examination on neonatal intracranial hemorrhage were 88.76% and 85.39%, respectively, and the ultrasonic examination were 88.76% and 85.39%, respectively. There was no significant difference between them(P>0.05). The detection rate of subependymal hemorrhage by ultrasound was significantly higher than that by CT(100.00%vs87.09%), and the detection rate and diagnostic accuracy of intraventricular hemorrhage by ultrasound were both 100%, significantly higher than that by CT(72.22%, 66.66%)(P<0.05). The detection rate and diagnostic accuracy of CT in subdural and subarachnoid hemorrhage lesions were significantly higher than that of ultrasound(P<0.05). In ultrasound examination, the intracranial hemorrhage foci of newborn mainly showed strong echo, and some patients may have varying degrees of ventricular widening and displacement of brain line structure. Most of the hemorrhage foci in CT scan showed high density shadow. The dense thickening of cerebellar tentorium and crescent-shaped high density area appeared in subdural hemorrhage. Subarachnoid hemorrhage foci in a few patients have the "triangle sign" of the sagittal sinus. Conclusion Both ultrasound and CT can effectively detect and correctly diagnose neonatal intracranial hemorrhage. Ultrasound has obvious advantages in displaying intraventricular and subventricular hemorrhage lesions. CT is superior to ultrasound in detecting subdural and subarachnoid hemorrhage lesions.