新生儿大脑半球深部动脉性梗死MRI特征及诊断

MRI features and diagnosis of neonatal deep cerebral arterial infarctions

目的分析新生儿大脑半球深部动脉性梗死MRI特征。方法回顾性分析2011?年1?月至2018?年12?月于首都医科大学附属北京儿童医院23?例大脑半球深部动脉性脑梗死新生儿的临床和MRI表现。男11?例,女12?例,日龄1~28 d,出现症状后2~20 d行MRI检查,分析其病变部位、形态、信号特点、增强后强化特点及其他伴随征象。结果单纯动脉性脑梗死15?例,继发于化脓性脑膜炎的动脉性脑梗死8?例,发病中位时间分别为出生后2 d和7 d。单纯动脉性脑梗死患儿均为单侧受累,病变仅位于深部脑实质11?例,合并大脑中动脉皮质支梗死4?例。MRI表现为边界模糊稍长T1稍长T2信号,伴局部短T1短T2信号。继发于化脓性脑膜炎的脑梗死患儿单侧受累5?例,双侧受累3?例。MRI均表现为边界模糊片状长T1长T2信号,其中7?例信号不均,见多发小囊状改变,边缘呈稍短T1稍短T2信号,扩散加权成像(DWI)可见结节状、点片状高信号。6?例受累区域明显肿胀。增强扫描5?例见多发点片状、环状强化。侧脑室后角内等信号并DWI高信号2?例。额颞部蛛网膜下腔DWI高信号5?例。硬膜下积液1?例。结论新生儿大脑半球深部动脉性梗死的MRI表现具有一定的特征性。继发于化脓性脑膜炎的病变可双侧受累,信号多混杂,可同时并存不同时期病变。MRI有助于鉴别诊断。

Objective To explore the MRI features of neonatal deep cerebral arterial infarctions.Methods The medical and MRI datas of 23 neonates with deep cerebral arterial infarctions from January 2011 to December 2018 in Beijing Children′s Hospital,Capital Medical University were retrospectively analyzed.Both 11 males and 12 females with ages between 1-28 d were recruited and MRI were performed within 2-20 d after symptom onset.The MRI featurs including location,morphology,signal characteristics,enhancement features and other accompanied signs were reviewed.Results A total of 15 cases with arterial infarction and 8 cases with complication of purulent meningitis were identified.The median age at presentation were 2 d and 7 d respectively.The unilateral involvement were demonstrated in all neonates with arterial infarctions.Among them,11 had deep infarcts and the main branch of the middle cerebral artery was involved in 4 neonates.MRI showed slightly hypo-intensity on T1WI and slightly hyper-intensity on T2WI with indistinct boundary and focal punctate hyper-intensity on T1WI and hypo-intensity on T2WI.In 8 cases secondary to purulent meningitis,unilateral involvement was found in 5 cases and bilateral involvement in 3 cases.All cases showed hypo-intensity on T1WI and hyper-intensity on T2WI with indistinct boundary.Among them,7 cases were heterogeneous,with small cystic changes which appeared as slightly hyper-intensity on T1WI and slightly hypo-intensity on T2WI peripherally,as well as nodular or patchy restricted diffusion.Marked swelling of the lesion was found in 6 cases.Multiple patchy or ring enhancement was revealed in 5 cases.Iso-intensity and restricted diffusion in posterior horn of the lateral ventricle were found in 2 cases.Restricted diffusion in frontotemporal subarachnoid space was found in 5 cases.One case showed subdural effusion.Conclusion Neonatal deep cerebral arterial infarctions have certain characteristic appearance on MRI.Lesions secondary to purulent meningitis can be bilateral involvement with heterogeneous MRI intensities,and different period of infarction signs could be found concurrently.MRI is beneficial to the differential diagnosis.