颅脑超声及磁共振弥散加权成像对早产儿脑白质损伤的诊断价值

Diagnostic value of brain ultrasound and magnetic resonance diffusion weighted imaging in preterm infants with white matter injury

目的分析早产儿脑白质损伤(WMI)的颅脑超声及磁共振弥散加权成像(DWI)特点,探讨其在WMI早期诊断及随访中的应用价值。方法回顾性分析我院2018年1月至2020年2月疑诊为WMI的120例早产儿临床资料,分析颅脑超声及DWI的检查结果及诊断价值。结果120例患儿,临床确诊为WMI 112例,脑积水6例,胼胝体发育不良2例。以临床诊断为标准,颅脑超声对WMI准确诊断98例(87.50%)。以脉络丛回声为参照标准,按初次检查脑室周围回声增强(PVE)程度分为Ⅰ级38例,Ⅱ级32例,Ⅲ级28例,漏误诊14例(12.50%);常规MRI对WMI准确诊断78例(69.64%),其中局灶性病变52例,弥漫性病变4例,脑室周围白质软化(PVL)22例,漏误诊34例(30.36%);常规MRI+DWI对WMI准确诊断102例(91.07%),其中局灶性病变46例,弥漫性病变34例,PVL 22例,漏误诊10例(8.93%)。结论颅脑超声及DWI均可对WMI做出准确诊断,颅脑超声检查方便,可重复性强,是WMI初筛和随访预后的首选检查方法。

Objective To analyze the characteristics of cranial ultrasound and magnetic resonance diffusion weighted imaging(DWI)in preterm infants with white matter injury(WMI),and to explore their application value in early diagnosis and follow-up of WMI.Methods The clinical data of 120 premature infants suspected with WMI in our hospital from January 2018 to February 2020 were retrospectively analyzed,and the results and diagnostic value of craniocerebral ultrasound and DWI were analyzed.Results Among the 120 children,112 were diagnosed with WMI,6 with hydrocephalus and 2 with corpus callosum dysplasia.Based on clinical diagnosis,98 cases(87.50%)of WMI were accurately diagnosed by craniocerebral ultrasound.Taking choroid plexus echo as reference standard and according to the degree of periventricular echo enhancement(PVE)in the first examination,38 cases were classified into gradeⅠ,32 cases into gradeⅡ,and 28 cases into gradeⅢ,while 14 cases were missed and misdiagnosed(12.50%).A total of 78 cases(69.64%)of WMI were accurately diagnosed by conventional MRI,including 52 cases of focal lesions,4 cases of diffuse lesions,22 cases of periventricular leukomalacia(PVL),and 34 cases of missed diagnosis or misdiagnosis(30.36%).By conventional MRI+DWI,a total of 102 cases(91.07%)of WMI were accurately diagnosed,including 46 cases of focal lesions,34 cases of diffuse lesions,22 cases of PVL,and 10 cases of missed diagnosis or misdiagnosis(8.93%).Conclusion Both craniocerebral ultrasound and DWI can make accurate diagnosis of WMI.Craniocerebral ultrasound is convenient and reproducible,and it is the first choice for preliminary screening and follow-up of WMI.