多模态MRI在足月新生儿颅内出血中的诊断价值及预后判断效能

Diagnostic Value and Prognosis Judgment Efficacy of Multimodal MRI in Intracranial Hemorrhage in Term Newborns

目的探讨多模态MRI(mMRI)在足月新生儿颅内出血中的诊断价值及预后判断效能。方法对2018年1月至2021年1月我院收治的211例高危新生儿行颅脑超声及mMRI检查,将颅内出血患儿超声检査结果与mMRI检查结果进行对比分析,并收集患儿的一般临床资料,结合mMRI进行预后分析。结果有136例新生儿诊断颅内出血,其中脑室/室管膜下出血共66例,颅脑超声、常规MRI及mMRI检出率分别为95.4%、89.4%、98.5%;脑实质出血24例,三者检出率分别为83.3%、95.8%、100%;蛛网膜下腔出血21例,三者检出率分别为81.0%、85.7%、95.2%;硬膜下出血43例,三者检出率分别为81.4%、95.3%、97.7%,颅内出血不同部位检出率差异均无统计学意义(P>0.05);mMRI在所有颅内出血中总检出151例,颅脑超声总检出135例,两者差异有统计学意义(P<0.05)。不同部位颅内出血的预后不良率分别为脑室/室管膜下17.8%、脑实质出血18.2%、蛛网膜下腔出血6.7%、硬膜下出血18.5%、混合出血25.0%。脑微出血灶数和脑室出血患儿预后呈负相关(r=-0.712,P<0.001)。结论mMRI诊断新生儿颅内出血敏感度高,可预测患儿预后。

Objective To investigate the diagnostic value and prognostic judgment efficacy of multimodal MRI(mMRI)in term newborns.Methods 211 high-risk neonates admitted to our hospital from January 2018 to January 2021 underwent craniocerebral ultrasound and mMRI,comparing ultrasound test results with MRI results,general clinical data were collected and prognosis analysis was carried out in combination with mMRI.Results Of the 136 children with intracranial hemorrhage,A total of 66 cases of intraventricular/subependymal hemorrhage.The detection rates of craniocerebral ultrasound,conventional MRI and mMRI were 95.4%,89.4%and 98.5%,respectively;In 24 cases of cerebral parenchymal hemorrhage,the detection rate of the three was 83.3%,95.8%and 100%,respectively;Subarachnoid hemorrhage occurred in 21 cases,the detection rate of the three was 81.0%,85.7%and 95.2%,respectively;In 43 cases of subdural hemorrhage,the detection rates of the three were 81.4%,95.3%and 97.7%,respectively.There was no significant difference in the detection rate of different sites of intracranial hemorrhage(P>0.05);mMRI was detected in 151 cases of all intracranial hemorrhage and 135 cases by craniocerebral ultrasound,with significant difference(P<0.05).The poor prognosis rates of intracranial hemorrhage in different sites were 17.8%in subventricular/ependymal hemorrhage,18.2%in cerebral parenchymal hemorrhage,6.7%in subarachnoid hemorrhage,18.5%in subdural hemorrhage,and 25.0%in mixed hemorrhage.The number of cerebral microbleeding foci and the prognosis of children with intraventricular hemorrhage were inversely correlated(r=-0.712,P<0.001).Conclusion The diagnosis of mMRI has high sensitivity in neonatal intracranial hemorrhage,which can predict the prognosis of children.