新生儿脑白质损伤伴深髓静脉受累MRI分析

An MR imaging study of neonatal brain white matter damage with deep medullary vein involvement

目的:分析新生儿脑白质损伤累及深髓静脉的MRI特征及演变。方法:回顾性分析2015年-2021年本院新生儿科57例严重脑白质损伤,其中深髓静脉受累组19例(早产儿8例、足月儿11例),15例行1~8次不等的MR复查,对比分析病灶分布特征、出血部位及演变。深髓静脉未受累组38例(早产儿12例、足月儿26例),35例行1~6次不等MR复查,对比深髓静脉受累组与深髓静脉未受累组脑软化灶形成情况。结果:早产儿生发基质/侧脑室旁白质出血发生率较足月儿高(P<0.05),早产儿脑损伤评估为4等级者较足月儿高(P<0.05),其余病灶发生部位足月儿与早产儿无明显差异,顶叶(15/19)、额叶(13/19)较多见。19例患儿中7例在第1次MR检查发现侧脑室周围脑软化灶形成,7例随访患儿最后发展为脑软化灶形成,1例在复查中无软化灶形成,仅见胶质增生。38例深髓静脉未受累组中最后12例形成脑软化灶。结论:与足月儿相比,早产儿脑白质损伤伴有深髓静脉受累者侧脑室旁出血发生率更高且脑白质损伤程度更严重。相比无深髓静脉受累的严重脑白质损伤者,深髓静脉受累患儿更易形成脑软化灶。因此在新生儿脑白质损伤患儿中当深髓静脉异常时需警惕。

Objective:To analyze the MR imaging characteristics and evolution of neonatal white matter injury involving the deep medullary vein.Methods:A total of 57 cases of neonates with severe white matter damage were retrospectively analyzed from 2015 to 2021 to analyze the MR imaging characteristics.Among them,19 cases(8 premature infants and 11 full-term infants)had deep medullary vein involvement,and 15 cases underwent MR reexamination 1~8 times.The distribution characteristics,bleeding location and evolution of the lesions were compared and analyzed.Thirty-eight cases(12 premature infants and 26 full-term infants)in the deep medullary vein uninvolved group received MR reexamination 1~6 times.The formation of cerebral softening foci in the deep medullary vein uninvolved group and the deep medullary vein uninvolved group were compared.Results:The incidence of germinal matrix/intraventricular hemorrhage in premature infants was higher than that in full-term infants(P<0.05),and the incidence of grade 4 injury was higher than that in term infants(P<0.05).There was no significant difference between the premature and full-term groups in lesion distribution,but lesions in the parietal lobe(15/19)and frontal lobe(13/19)were more common.In the group of 19 patients with deep medullary vein involvement,7 patients developed encephalodialysis at the first MR examination,7 patients were followed up and finally developed encephalodialysis,and 1 full-term infant showed only local gliosis at the later stage.In the 38 cases without deep medullary vein involvement,the last 12 cases showed cerebromalacia.Conclusion:Compared with term infants,the incidence of paraventricular hemorrhage in preterm infants with white matter injury and deep medullary vein involvement was higher,and the degree of white matter injury was more severe.Compared with severe white matter injury without deep medullary vein involvement,neonates with deep medullary vein involvement are more likely to develop cerebral leukomalacia.Therefore,we should be vigilant when neonatal brain white matter damage occurs with deep medullary vein involvement,especially in premature infants.