新生儿缺氧缺血性脑病的MR诊断及随访观察

MR diagnosis and follow-up of neonatal hypoxic-ischemic encephalopathy

目的 :研究新生儿缺氧缺血性脑病 (hypoxic ischemicencephalopathyHIE)MR影像学表现发展规律及其预后情况。方法 :选择有围产期窒息史 ,头颅MRI诊断为不同程度的HIE新生儿 15 0例 ,3 0例患儿分别于 3、6月 ,1、2、4岁以前进行头颅MRI复查。结果 :3个月 65 %病例有头颅MR异常 ,大部分表现为外部性脑积水 ,2 8%病例有神经系统的症状和体征。 6个月时 40 %病例有MR异常 ,3 3 %病例有临床表现。 1岁后约 2 5 %病例MR异常 ,表现为局限性脑软化和脑萎缩 ,并有相应的临床表现。结论 :①HIE所致脑内小淤斑稍长T2 信号于生后 2～ 3个月内吸收消散。②HIE在3个月时有半数病例头颅MR表现异常 ,可见有髓鞘化不良 ,大部分表现为外部性脑积水 ,1岁以后外部性脑积水愈合 ,约 2 0 %病例留有局限性脑白质软化和脑萎缩等严重后遗症。③HIE的预后与MR分度密切相关 ,轻度者预后良好 ,中及重度者预后差。

Objective:To evaluate MRI changes of neonatal hypoxia ischemic encephalopathy (HIE)and its prognosis.Methods:In selective 150 cases of perinatal asphyxia with different degrees of HIE performed MRI,30 cases were followed up with MRI at the 3 month,6 month,1 year,2 year and 4 year of age.Results:19 cases appeared abnormal on follow up MRI at the 3rd month,by which most appeared extracerebral hydrocephalus,and 9 of them had symptoms and signs of nervous system. 12 were abnormal with follow up MRI at the 6th month.After one year,7 cases showed focal encephalomalacia and cerebral atrophy as well as its corresponding clinical manifestations.Conclusion:①Hyperintensity area of HIE on T 2WI will be absorbed within two or three months following onset seizure.②Half of HIE patients were abnormal on MRI at three months and most of them showed abnormal myelination and extracerebral hydrocephalus.The extracerebral hydrocephalus can be healed itself at the age of one,and the severe sequelae such as focal encephalomalacia and cerebral atrophy are present in about 20% cases.③The prognosis of HIE is closely correlated with the MRI grading. The prognosis of patients with mild HIE is good,but with moderate to severe HIE is bad.