MRI、SWI、DWI联合诊断在新生儿缺氧缺血性脑损伤中的临床应用分析
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摘要
目的:分析磁共振成像(MRI)、磁敏感加权成像(SWI)、弥散加权成像(DWI)联合扫描用于新生儿缺氧缺血性脑损伤中的作用。方法:回顾性分析笔者所在医院2015年2月-2018年6月期间收治且行MRI扫描的50例新生儿缺血缺氧性脑损伤(HIE)患儿资料,评估不同扫描序列在该病中的应用价值,分析MRI联合SWI、DWI联合应用的必要性。对比T1 FLAIR、T2WI、T2 FLATR、DWI、SWI序列下HIE病灶检出率;对比以上序列在出生1～7d和出生8～14d新生而中病灶检出率;对比不同序列联合应用诊断HIE患儿阳性率;分析不同序列下影像学特征。结果:①50例患儿共检出138枚病灶,主要分布在大脑皮质,其次以室管膜分布较多。SWI病灶检出率为83.23%,DWI为70.29%,其次为T2 FLAIR(57.25%)、T1 FLAIR(47.83%)、T2WI(29.71%),P<0.05。DWI对大脑皮质损伤的检出例数最多,SWI对室管膜、小脑、硬膜下和硬膜外损伤检出例数较多。②DWI在出生1～7d的患儿中检出率为76.68%,在出生8～14d患儿病灶检出率为65.08%,P<0.05。③常规MRI+DWI+SWI诊断HIE阳性率为90.00%,较常规MRI(46.00%)、常规MRI联合DWI或联合SWI高,P<0.05。④不同序列下病灶部位影响表现有所不同。结论:MRI联合SWI、DWI能提高HIE诊断准确性,尤其适合用于出生1～7d的新生儿HIE筛查中。
Objective:To analyze the role of magnetic resonance imaging(MRI), magnetic sensitive weighted imaging(SWI) and diffusion-weighted imaging(DWI) in the diagnosis of neonatal hypoxic ischemic brain damage.Methods:A retrospective analysis of 50 children with neonatal hypoxic-ischemic brain damage(HIE) who underwent MRI scan between February 2015 and June 2018 in the author's hospital, and evaluated the application of different scan sequences in the disease. Value, analysis of the necessity of MRI combined with SWI and DWI. The detection rate of HIE lesions in T1 FLAIR, T2WI, T2 FLATR, DWI and SWI sequences was compared. The detection rates of the above sequences were compared between 1-7 days of birth and 8-14 days of birth. The diagnosis of HIE was compared with different sequences. Positive rate; analysis of imaging features under different sequences.Results:A total of 138 lesions were detected in 150 children, mainly distributed in the cerebral cortex, followed by more distribution of the ependymal membrane. The detection rate of SWI lesions was 83.23%, DWI was 70.29%, followed by T2 FLAIR(57.25%), T1 FLAIR(47.83%), T2WI(29.71%), P<0.05. DWI has the largest number of cases of cerebral cortex injury, and SWI has more cases of ependymal [ cerebellum], cerebellum, subdural and epidural lesions. The detection rate of 2 DWI in children born 1～7 d was 76.68%, and the detection rate of children in 8～14 d was 65.08%, P<0.05.3 The positive rate of HIE in routine MRI+DWI+SWI diagnosis was 90.00%, which was higher than that of conventional MRI(46.00%), conventional MRI combined with DWI or combined with SWI, P<0.05.4 The effect of lesions on different sequences was different.Conclusion:MRI combined with SWI and DWI can improve the diagnostic accuracy of HIE, especially for newborn HIE screening 1～7 d.
Objective:To analyze the role of magnetic resonance imaging(MRI), magnetic sensitive weighted imaging(SWI) and diffusion-weighted imaging(DWI) in the diagnosis of neonatal hypoxic ischemic brain damage.Methods:A retrospective analysis of 50 children with neonatal hypoxic-ischemic brain damage(HIE) who underwent MRI scan between February 2015 and June 2018 in the author's hospital, and evaluated the application of different scan sequences in the disease. Value, analysis of the necessity of MRI combined with SWI and DWI. The detection rate of HIE lesions in T1 FLAIR, T2WI, T2 FLATR, DWI and SWI sequences was compared. The detection rates of the above sequences were compared between 1-7 days of birth and 8-14 days of birth. The diagnosis of HIE was compared with different sequences. Positive rate; analysis of imaging features under different sequences.Results:A total of 138 lesions were detected in 150 children, mainly distributed in the cerebral cortex, followed by more distribution of the ependymal membrane. The detection rate of SWI lesions was 83.23%, DWI was 70.29%, followed by T2 FLAIR(57.25%), T1 FLAIR(47.83%), T2WI(29.71%), P<0.05. DWI has the largest number of cases of cerebral cortex injury, and SWI has more cases of ependymal [ cerebellum], cerebellum, subdural and epidural lesions. The detection rate of 2 DWI in children born 1～7 d was 76.68%, and the detection rate of children in 8～14 d was 65.08%, P<0.05.3 The positive rate of HIE in routine MRI+DWI+SWI diagnosis was 90.00%, which was higher than that of conventional MRI(46.00%), conventional MRI combined with DWI or combined with SWI, P<0.05.4 The effect of lesions on different sequences was different.Conclusion:MRI combined with SWI and DWI can improve the diagnostic accuracy of HIE, especially for newborn HIE screening 1～7 d.
引文
1 梁煜坤.MRI不同序列扫描在新生儿缺氧缺血性脑损伤(HIE)诊断中的应用[J].中国CT和MRI杂志,2016,14(6):3-5.
2 许俊,刚蔷蔷,郝鹏等.西藏小型猪缺氧缺血性脑病模型的建立及病理和影像学表现[J].南方医科大学学报,2016,36(5):705-709.
3 杨阳,田志雄,曾俊杰等.S WI在早产儿缺血缺氧性脑损伤诊断中的临床应用[J].放射学实践,2015,15(7):779-782.
4 巴瑞华,毛健.新生儿缺氧缺血性脑病磁共振影像学评分与临床分度的相关性研究[J].中国当代儿科杂志,2018,20(2):83-90.
5 Aslam, Saima,Molloy, Eleanor J..Biomarkers of multiorgan injury in neonatal encephalopathy[J].Biomarkers in medicine,2015,9(3):267-275.
6 张翔亚,曹满瑞,杜牧等.DTI在足月新生儿窒息后脑损伤中的应用[J].中国CT和MRI杂志,2015,18(2):67-70.
7 余旭东,杨文忠,欧阳伟等.新生儿中、重度缺氧缺血性脑病的MRI评估分级价值[J].放射学实践,2016,31(2):175-178.
8 Massaro, An N.,Govindan, R. B.,Vezina, Gilbert et al.Impaired cerebral autoregulation and brain injury in newborns with hypoxic-ischemic encephalopathy treated with hypothermia[J].Journal of Neurophysiology,2015,114(2):818-824.
9 李艳,杜奕,陈志强等.缺氧缺血性脑病患儿表观扩散系数与行为神经测定评分的相关性研究[J].中华放射学杂志,2015,23(2):133-137.
10 关文华,孙新峰,史展等.新生儿低血糖脑损伤早期DWI表现与临床相关因素分析[J].中国妇幼保健,2015,30(28):4882-4884.
11 Garfinkle, Jarred,Sant'Anna, Guilherme M.,Rosenblatt, Bernard et al.Somatosensory evoked potentials in neonates with hypoxic-ischemic encephalopathy treated with hypothermia[J].European journal of paediatric neurology: EJPN : official journal of the European Paediatric Neurology Society,2015,19(4):423-428.
12 任世龙,李军,任勇涛等.磁敏感加权成像在轻型颅脑损伤患者中的诊断价值[J].临床神经外科杂志,2016,13(2):144-146.
13 赵晓君,周忠洁,张弦等.磁敏感加权成像技术在早产儿脑损伤诊断中的价值[J].医学影像学杂志,2016,26(12):2186-2188.
14 王宏,许建铭.多模态磁共振功能成像在早产儿脑损伤中的应用[J].磁共振成像,2016,7(12):951-956.
15 王静石,刘艳,于泓等.新生儿缺氧缺血性脑损伤中的少量出血灶在磁敏感加权序列的成像研究[J].航空航天医学杂志,2018,29(1):14-16.
2 许俊,刚蔷蔷,郝鹏等.西藏小型猪缺氧缺血性脑病模型的建立及病理和影像学表现[J].南方医科大学学报,2016,36(5):705-709.
3 杨阳,田志雄,曾俊杰等.S WI在早产儿缺血缺氧性脑损伤诊断中的临床应用[J].放射学实践,2015,15(7):779-782.
4 巴瑞华,毛健.新生儿缺氧缺血性脑病磁共振影像学评分与临床分度的相关性研究[J].中国当代儿科杂志,2018,20(2):83-90.
5 Aslam, Saima,Molloy, Eleanor J..Biomarkers of multiorgan injury in neonatal encephalopathy[J].Biomarkers in medicine,2015,9(3):267-275.
6 张翔亚,曹满瑞,杜牧等.DTI在足月新生儿窒息后脑损伤中的应用[J].中国CT和MRI杂志,2015,18(2):67-70.
7 余旭东,杨文忠,欧阳伟等.新生儿中、重度缺氧缺血性脑病的MRI评估分级价值[J].放射学实践,2016,31(2):175-178.
8 Massaro, An N.,Govindan, R. B.,Vezina, Gilbert et al.Impaired cerebral autoregulation and brain injury in newborns with hypoxic-ischemic encephalopathy treated with hypothermia[J].Journal of Neurophysiology,2015,114(2):818-824.
9 李艳,杜奕,陈志强等.缺氧缺血性脑病患儿表观扩散系数与行为神经测定评分的相关性研究[J].中华放射学杂志,2015,23(2):133-137.
10 关文华,孙新峰,史展等.新生儿低血糖脑损伤早期DWI表现与临床相关因素分析[J].中国妇幼保健,2015,30(28):4882-4884.
11 Garfinkle, Jarred,Sant'Anna, Guilherme M.,Rosenblatt, Bernard et al.Somatosensory evoked potentials in neonates with hypoxic-ischemic encephalopathy treated with hypothermia[J].European journal of paediatric neurology: EJPN : official journal of the European Paediatric Neurology Society,2015,19(4):423-428.
12 任世龙,李军,任勇涛等.磁敏感加权成像在轻型颅脑损伤患者中的诊断价值[J].临床神经外科杂志,2016,13(2):144-146.
13 赵晓君,周忠洁,张弦等.磁敏感加权成像技术在早产儿脑损伤诊断中的价值[J].医学影像学杂志,2016,26(12):2186-2188.
14 王宏,许建铭.多模态磁共振功能成像在早产儿脑损伤中的应用[J].磁共振成像,2016,7(12):951-956.
15 王静石,刘艳,于泓等.新生儿缺氧缺血性脑损伤中的少量出血灶在磁敏感加权序列的成像研究[J].航空航天医学杂志,2018,29(1):14-16.