新生儿颅内出血的影像学诊断分析

Imaging diagnosis of neonatal intracranial hemorrhage

目的探讨超声和磁共振成像(MRI)2种检查方法在新生儿颅内出血诊断中的影像学特点及临床应用价值。方法对1032例新生儿在其出生后3~5 d内通过囟门进行颅脑超声检查,观察颅内出血情况。并通过部分病例对比分析超声、MRI的诊断优势。结果早产儿颅内出血阳性率为18.7%,其中胎龄≤33周早产儿颅内出血阳性率为23.3%,足月儿颅内出血阳性率为14.8%,胎龄越小的新生儿颅内出血的发病率越高。Ⅰ级颅内出血中,小胎龄早产儿以新鲜出血为主;足月儿以陈旧性出血为主,是宫内出血的残留。超声对Ⅰ级室管膜下出血、Ⅱ级脑室内小面积出血诊断率高于MRI;对Ⅲ级、Ⅳ级脑室内重度出血超声与MRI诊断无显著差异;MRI对大脑实质边缘部位、小脑斑点状出血、蛛网膜下腔和少量的硬膜下出血诊断率高于超声。结论超声与MRI各有所长。临床医生只有根据患儿的不同情况选择不同的检查方法,才能最大限度保障患儿的安全,提高诊断准确率。

Objective To investigate the imaging characteristics and clinical application value of ultrasound and magnetic resonance imaging(MRI)in the diagnosis of intracranial hemorrhage in neonates.Methods 1032 neonates were examined by cranial ultrasound through the fontanel within 3~5 days after birth to observe the intracranial hemorrhage.The diagnostic advantages of ultrasound and MRI were also compared and analyzed in some cases.Results The positive rate of intracranial hemorrhage in preterm infants was 18.7%,of which the positive rate of intracranial hemorrhage in preterm infants≤33 weeks was 23.3%,and the positive rate of intracranial hemorrhage in term infants was 14.8%.The smaller the gestational age,the higher the incidence rate of intracranial hemorrhage in neonates.In grade I intracranial hemorrhage,fresh hemorrhage occurred mainly in small gestational age premature infants,and in term infants,old hemorrhage was predominant,which was the residual of intrauterine hemorrhage.The diagnostic rate of ultrasound for grade I subependymal hemorrhage and grade Ⅱ intraventricular small area hemorrhage was higher than that of MRI.There was no significant difference between ultrasound and MRI in the diagnosis of severe ventricular hemorrhage of grades Ⅲ and Ⅳ.Moreover,the diagnostic rate of MRI was higher than that of ultrasound for marginal parts of brain parenchyma,speckled cerebellar hemorrhage,subarachnoid space,and a small amount of subdural hemorrhage.Conclusion Ultrasound and MRI have their own advantages.Only by choosing different examination methods according to the child's condition,clinicians can maximize the child's safety and improve the diagnostic rate.