新生儿胆红素脑病脑损伤的MRI征象分析

MRI Signs of Brain Injury in Neonates with Bilirubin Encephalopathy

目的分析新生儿胆红素脑病脑损伤的MRI征象特征及诊断价值。方法选取2018年7月至2019年8月在我院治疗的经病理学检查确诊为胆红素脑病脑损伤患儿76例为研究对象,并以同期健康新生儿50例为对照组,回顾性分析胆红素脑病脑损伤患儿MRI、CT图像,观察其MRI征象,并比较MRI及CT对新生儿胆红素脑病脑损伤的诊断效能及诊断价值。结果76例胆红素脑病脑损伤患儿中,2例未见MRI图像异常,74例患儿的MRI图像出现异常,其中24例患儿出现双侧苍白球、底丘脑出现点状或对称性高信号,DWI序列双侧基底节区、丘脑为出现明显异常信号改变;30例患儿出现T_(2)-FLAIR稍高信号;18例患儿出现T2WI等信号,仅2例患儿中脑、桥脑、延髓出现T_(1)WI高信号;MRI诊断新生儿胆红素脑病脑损伤的特异度、准确性高于CT(P<0.05),两种检查方法诊断新生儿胆红素脑病脑损伤的灵敏度对比无明显差异(P>0.05);经ROC曲线分析,MRI诊断新生儿胆红素脑病脑损伤的AUC为0.934,大于CT(0.844,P<0.05)。结论新生儿胆红素脑病脑损伤具有典型的MRI征象,且MRI对其具有较高的诊断价值。

Objective To analyze signs and diagnostic value of MRI for brain injury in neonates with bilirubin encephalopathy.Methods Seventy-six neonates confirmed with bilirubin encephalopathy and brain injury by pathological examination and were treated in the hospital from July 2018 to August 2019 were enrolled as the research subjects.Fifty healthy neonates during the same period were enrolled as the control group.MRI and CT images were retrospectively analyzed.Their MRI signs were observed.The diagnostic efficiency and diagnostic value of MRI and CT for brain injury in neonates with bilirubin encephalopathy were compared.Results Among 76 children with bilirubin encephalopathy and brain injury,there were 2 cases without abnormal MRI images,and 74 cases with abnormal MRI images.Of them,there were 24 cases with bilateral globus pallidus,and punctiform or symmetry high signals in subthalamus.DWI sequence showed there were obvious abnormal signal changes in bilateral basal ganglia and thalamus.There were 30 cases with slightly high signals of T_(2)-FLAIR,18 cases with equal signals of T_(2)WI.There were only 2 cases with T_(1)WI high signals at midbrain,pons and medulla.The specificity and accuracy of MRI in diagnosis of neonatal bilirubin encephalopathy and brain injury were higher than those of CT(P<0.05).There was no significant difference in sensitivity between the two methods for diagnosis of brain injury in neonatal bilirubin encephalopathy(P>0.05).ROC curves analysis showed that AUC of MRI was greater than that of CT for diagnosis of brain injury in neonatal bilirubin encephalopathy(0.934 vs.0.844,P<0.05).Conclusion The brain injury in neonatal bilirubin encephalopathy is of typical MRI signs,and MRI is of high diagnostic value for it.