新生儿脑梗死早期的临床表现与磁共振成像特点
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摘要
目的
磁共振成像是目前诊断新生儿脑梗死的金标准,然而常规磁共振对于新生儿脑梗死的早期显像并不敏感。为了早期诊断新生儿脑梗死,现探讨新生儿脑梗死(Neonatal cerebral infarction)患儿的早期临床表现及头部磁共振(MRI)成像学特征,包括常规MRI及弥散加权成像(DWI),并为早期诊断提供依据。
方法
回顾分析我院新生儿病房于2005年7月至2008年4月收治的16例新生儿脑梗死患儿临床资料、头部MRI检查(所有病例均于生后5天内行常规序列扫描后接受弥散加权序列扫描),其中5例于新生儿期(生后11天-17天)进行了第二次头部MRI检查。
结果
1、高危因素:产前8例(n=8,50%),产时9例(n=9,56.3%),产后0例(n=0,0%);临床表现:11例以惊厥发作为首发症状;
2、MRI扫描结果:初期(5天内)病灶部位T1稍低信号,T2加权稍高信号,相同部位弥散加权影像均表现为高亮信号,且病灶边界清晰;再次扫描时(生后11天-17天)病灶部位T1低信号、T2高信号较前明显,相同部位弥散加权均表现为低信号。
结论
1、惊厥多为新生儿脑梗死的首发表现,发作次数少且程度轻;
2、梗死早期DWI表现为高亮信号,继之常规MRI出现T1低信号、T2高信号,并随时间逐渐明显,尤以T2表现更为敏感。
Objective
Magnetic resonance imaging(MRI) is the gold standard for the diagnosis of neonatal cerebral infarction(NCI) at present.Conventional MRI is not sensitive for the detection of stroke in the early stage.The aim of this study was to characterize the clinical presentations and imaging findings in conventional MRI and diffusion-weighted MR imaging(DWI) caused by NCI,which might be useful for the early diagnosis.
Methods
Conventional MRI,diffusion-weighted imaging and clinical data from 16 neonates with NCI were retrospectively reviewed.All cases underwent DWI in addition to conventional MR imaging(T1-weighted[T1W]and T2-weighted[T2W]) within first 5 days,5 of whom repeated the imaging at the age of 11 days to 17 days.
Results
1、Risk factors:antenatal risk factors(n=8);intranatal risk factors(n=9);postnatal risk factors(n=0).Clinical presentations:seizure was the first symptom in 11 neonates;
2、early imaging(within 5 days):slightly hypointensity on T1W,slightly hyperintensity on T2W and significantly increased signal intensity with the clear boundary on DWI in the lesions;late imaging:Compared with the early imaging,more obviously hypointensity on T1W and hyperintensity on T2W,while hypointensity was shown on DWI.
Conclusion
1、Seizures characterized the low frequency and slight severity may be the first symptom for NCI.
2、Firstly,it is the abnormal imaging finding that significantly increased signal intensity in the lesions was showed on DWI in the early stage;then hypointensity on T1W and hyperintensity on T2W,which are increasing abnormal over time particularly on T2W.
磁共振成像是目前诊断新生儿脑梗死的金标准,然而常规磁共振对于新生儿脑梗死的早期显像并不敏感。为了早期诊断新生儿脑梗死,现探讨新生儿脑梗死(Neonatal cerebral infarction)患儿的早期临床表现及头部磁共振(MRI)成像学特征,包括常规MRI及弥散加权成像(DWI),并为早期诊断提供依据。
方法
回顾分析我院新生儿病房于2005年7月至2008年4月收治的16例新生儿脑梗死患儿临床资料、头部MRI检查(所有病例均于生后5天内行常规序列扫描后接受弥散加权序列扫描),其中5例于新生儿期(生后11天-17天)进行了第二次头部MRI检查。
结果
1、高危因素:产前8例(n=8,50%),产时9例(n=9,56.3%),产后0例(n=0,0%);临床表现:11例以惊厥发作为首发症状;
2、MRI扫描结果:初期(5天内)病灶部位T1稍低信号,T2加权稍高信号,相同部位弥散加权影像均表现为高亮信号,且病灶边界清晰;再次扫描时(生后11天-17天)病灶部位T1低信号、T2高信号较前明显,相同部位弥散加权均表现为低信号。
结论
1、惊厥多为新生儿脑梗死的首发表现,发作次数少且程度轻;
2、梗死早期DWI表现为高亮信号,继之常规MRI出现T1低信号、T2高信号,并随时间逐渐明显,尤以T2表现更为敏感。
Objective
Magnetic resonance imaging(MRI) is the gold standard for the diagnosis of neonatal cerebral infarction(NCI) at present.Conventional MRI is not sensitive for the detection of stroke in the early stage.The aim of this study was to characterize the clinical presentations and imaging findings in conventional MRI and diffusion-weighted MR imaging(DWI) caused by NCI,which might be useful for the early diagnosis.
Methods
Conventional MRI,diffusion-weighted imaging and clinical data from 16 neonates with NCI were retrospectively reviewed.All cases underwent DWI in addition to conventional MR imaging(T1-weighted[T1W]and T2-weighted[T2W]) within first 5 days,5 of whom repeated the imaging at the age of 11 days to 17 days.
Results
1、Risk factors:antenatal risk factors(n=8);intranatal risk factors(n=9);postnatal risk factors(n=0).Clinical presentations:seizure was the first symptom in 11 neonates;
2、early imaging(within 5 days):slightly hypointensity on T1W,slightly hyperintensity on T2W and significantly increased signal intensity with the clear boundary on DWI in the lesions;late imaging:Compared with the early imaging,more obviously hypointensity on T1W and hyperintensity on T2W,while hypointensity was shown on DWI.
Conclusion
1、Seizures characterized the low frequency and slight severity may be the first symptom for NCI.
2、Firstly,it is the abnormal imaging finding that significantly increased signal intensity in the lesions was showed on DWI in the early stage;then hypointensity on T1W and hyperintensity on T2W,which are increasing abnormal over time particularly on T2W.
引文
1 Lynch JK,Hirtz DG,DeVeber G,Nelson KB.Report of the National Institute of Neurological Disorders and Stroke workshop on perinatal and childhood stroke[J].Pediatrics,2002,109(1):116-123.
2 Laugesaar R,Kolk A,Tomberg T,Metsvaht T,Lintrop M,Varendi H,et al.Acutely and retrospectively diagnosed perinatal stroke:a population-based study[J].Stroke,2007,38(8):2234-2240.
3 Benders MJ,Groenendaal F,Uiterwaal CS,Nikkels PG,Bruinse HW,Nievelstein RA,et al.Maternal and infant characteristics associated with perinatal arterial stroke in the preterm infant[J].Stroke,2007,38(6):1759-1765.
4 Lee J,Croen LA,Backstrand KH,Yoshida CK,Henning LH,Lindan C,et al.Maternal and infant characteristics associated with perinatal arterial stroke in the infant[J].JAMA.__2005,293(6):723-729.
5 富建华,毛健,薛辛东,由凯.磁共振弥散加权成像在新生儿脑梗死早期诊断中的意义及其变化规律[J].中华儿科杂志,2007,45(5):360-364.
6 Sreenan C,Bhargava R,Robertson CM.Cerebral infarction in the term newborn:clinical presentation and long-term outcome[J].J Pediatr,2000,137(3):351-355.
7 Nelson KB.Perinatal ischemic stroke[J].Stroke,2007,38(2 Suppl):742-745.
8 Brenner D,Elliston C,Hall E,Berdon W.Estimated risks of radiation-induced fatal cancer from pediatric CT[J].AJR Am J Roentgenol,2001,176(2):289-296.
9 Johnson AJ,Lee BC,Lin W.Echoplanar diffusion-weighted imaging in neonates and infants with suspected hypoxic-ischemic injury:correlation with patient outcome[J].AJR Am J Roentgenol,1999,172(1):219-226.
10 Mader I,Sch(o|¨)ning M,Klose U,K(u|¨)ker W.Neonatal cerebral infarction diagnosed by diffusion-weighted MRI:pseudonormalization occurs early[J].Stroke,2002,33(4):1142-1145.
11 K(u|¨)ker W,M(o|¨)hrle S,Mader I.MRI for the management of neonatal cerebral infarctions:importance of timing[J].Childs Nerv Syst,2004,20(10):742-748.
12 Beauchamp NJ Jr,Barker PB,Wang PY,vanZijl PC.Imaging of acute cerebral ischemia [J].Radiology,1999,212:307-324. Lynch JK,Hirtz DG,DeVeber G,et al.Report of the National Institute of Neurological Disorders and Stroke workshop on perinatal and childhood stroke[J].Pediatrics,2002,109(1):116-123.
2 Laugesaar R,Kolk A,Tomberg T,et al.Acutely and retrospectively diagnosed perinatal stroke:a population-basedstudy[J].Stroke,2007,38(8):2234-2240.
3 Helji(?) S,Mornjakovi(?) A,Merhemi(?) Z,et al.Stroke in newborn infants[J].Med Arh,2007,61(1):62-64.
4 富建华,毛健,薛辛东,等.磁共振弥散加权成像在新生儿脑梗死早期诊断中的意义及其变化规律[J].中华儿科杂志,2007,45(5):360-364.
5 Venkataraman A,Kingsley PB,Kalina P,et al.Newborn brain infarction:clinical aspects and magnetic resonance imaging[J].CNS Spectr,2004,9(6):436-44.
6 Kirton A,Shroff M,Visvanathan T,et al.Quantified corticospinal tract diffusion restriction predicts neonatal stroke outcome[J].Stroke,2007,38(3):974-980.
7 陈惠金.新生儿脑梗死的诊断与治疗[J].中国实用儿科杂志,2006,2l(9):644-647.
8 Benders MJ,Groenendaal F,Uiterwaal CS,et al.Maternal and infant characteristics associated with perinatal arterial stroke in the preterm infant[J].Stroke,2007,38(6):1759-1765.
9 Nelson KB,Lynch JK.Stroke in newborn infants[J].Lancet Neurol,2004,3(3):150-158.
10 Lynch JK,Nelson KB.Epidemiology of perinatal stroke[J].Curr Opin Pediatr,2001,13(6):499-505.
11 Lee J,Croen LA,Backstrand KH,et al.Maternal and infant characteristics associated with perinatal arterial stroke in the infant[J].JAMA,2005,293(6):723-729.
12 Wu YW,March WM,Croen LA,et al.Perinatal stroke in children with motor impairment:a population-based study[J].Pediatrics,2004,114(3):612-619.
13 Kumar M,Avdic S,Paes B.Contralateral cerebral infarction following vacuum extraction[J].Am J Perinatol,2004,21(1):15-17.
14 Hogeveen M,Blom HJ,Van Amerongen M,et al.Hyperhomocysteinemia as risk factor for ischemic and hemorrhagic stroke in newborn infants[J].J Pediatr,2002,141(3):429-431.
15 Fox AM.Timing and etiology of neonatal cerebral infarction[J].Pediatrics,2000,106(3):614-616.
16 Sreenan C,Bhargava R,Robertson CM.Cerebral infarction in the term newborn:clinical presentation and long-term outcome[J].J Pediatr,2000,137(3):351-355.
17 K(?)ker W, M(?)hrle S, Mader I. MRI for the management of neonatal cerebral infarctions: importance of timing[J]. Childs Nerv Syst, 2004, 20(10):742-748.
18 Brenner D, Elliston C, Hall E, et al. Estimated risks of radiation-induced fatal cancer from pediatric CT[J]. AJR Am JRoentgenol, 2001, 176(2): 289-296.
19 Johnson AJ, Lee BC, Lin W. Echoplanar diffusion-weighted imaging in neonates and infants with suspected hypoxic-ischemic injury: correlation with patient outcome[J]. AJR Am J Roentgenol, 1999 , 172(1): 219-226.
20 Mader I, Sch(?)ning M, Klose U, et al. Neonatal cerebral infarction diagnosed by diffusion-weighted MRI: pseudonormalization occurs early[J]. Stroke, 2002, 33( 4):1142-1145.
21 Rutherford M, Counsell S, Allsop J, et al. Diffusion-weighted magnetic resonance imaging in term perinatal brain injury : a comparison with site of lesion and time from birth[J]. Pediatrics, 2004, 114(4): 1004-1014.
22 Fehings D, Rang M, Glazier J, et al. An evaluation of botulinum-a toxin injection to improve upper extremity function in children with hemiplegic cerebral palsy [J]. J Pediatr, 2000, 137(3): 331-337.
23 Gordon AM, Charles J, Wolf SL. Efficacy of constraint-induced movement therapy on involved upper-extremity use in children with hemiplegic cerebral palsy is not age-dependent[J]. Pediatrics, 2006 , 117(3): e363-373.
24 Boardman J P, Ganesan V, Rutherford MA, et al. Magnetic resonance image correlates of hemiparesis after neonatal and childhood middle cerebral artery stroke[J]. Pediatrics, 2005, 115(2): 321-326.
25 McLinden A, Baird AD, Westmacott R, et al. Early cognitive outcome after neonatal stroke[J]. J Child Neurol, 2007 , 22(9): 1111-1116.
26 Eyre JA, Taylor JP, Villagra F, et al. Evidence of activity-dependent withdrawal of corticospinal projections during human development[J] . Neurology , 2001 , 57(9): 1543-1554.
2 Laugesaar R,Kolk A,Tomberg T,Metsvaht T,Lintrop M,Varendi H,et al.Acutely and retrospectively diagnosed perinatal stroke:a population-based study[J].Stroke,2007,38(8):2234-2240.
3 Benders MJ,Groenendaal F,Uiterwaal CS,Nikkels PG,Bruinse HW,Nievelstein RA,et al.Maternal and infant characteristics associated with perinatal arterial stroke in the preterm infant[J].Stroke,2007,38(6):1759-1765.
4 Lee J,Croen LA,Backstrand KH,Yoshida CK,Henning LH,Lindan C,et al.Maternal and infant characteristics associated with perinatal arterial stroke in the infant[J].JAMA.__2005,293(6):723-729.
5 富建华,毛健,薛辛东,由凯.磁共振弥散加权成像在新生儿脑梗死早期诊断中的意义及其变化规律[J].中华儿科杂志,2007,45(5):360-364.
6 Sreenan C,Bhargava R,Robertson CM.Cerebral infarction in the term newborn:clinical presentation and long-term outcome[J].J Pediatr,2000,137(3):351-355.
7 Nelson KB.Perinatal ischemic stroke[J].Stroke,2007,38(2 Suppl):742-745.
8 Brenner D,Elliston C,Hall E,Berdon W.Estimated risks of radiation-induced fatal cancer from pediatric CT[J].AJR Am J Roentgenol,2001,176(2):289-296.
9 Johnson AJ,Lee BC,Lin W.Echoplanar diffusion-weighted imaging in neonates and infants with suspected hypoxic-ischemic injury:correlation with patient outcome[J].AJR Am J Roentgenol,1999,172(1):219-226.
10 Mader I,Sch(o|¨)ning M,Klose U,K(u|¨)ker W.Neonatal cerebral infarction diagnosed by diffusion-weighted MRI:pseudonormalization occurs early[J].Stroke,2002,33(4):1142-1145.
11 K(u|¨)ker W,M(o|¨)hrle S,Mader I.MRI for the management of neonatal cerebral infarctions:importance of timing[J].Childs Nerv Syst,2004,20(10):742-748.
12 Beauchamp NJ Jr,Barker PB,Wang PY,vanZijl PC.Imaging of acute cerebral ischemia [J].Radiology,1999,212:307-324. Lynch JK,Hirtz DG,DeVeber G,et al.Report of the National Institute of Neurological Disorders and Stroke workshop on perinatal and childhood stroke[J].Pediatrics,2002,109(1):116-123.
2 Laugesaar R,Kolk A,Tomberg T,et al.Acutely and retrospectively diagnosed perinatal stroke:a population-basedstudy[J].Stroke,2007,38(8):2234-2240.
3 Helji(?) S,Mornjakovi(?) A,Merhemi(?) Z,et al.Stroke in newborn infants[J].Med Arh,2007,61(1):62-64.
4 富建华,毛健,薛辛东,等.磁共振弥散加权成像在新生儿脑梗死早期诊断中的意义及其变化规律[J].中华儿科杂志,2007,45(5):360-364.
5 Venkataraman A,Kingsley PB,Kalina P,et al.Newborn brain infarction:clinical aspects and magnetic resonance imaging[J].CNS Spectr,2004,9(6):436-44.
6 Kirton A,Shroff M,Visvanathan T,et al.Quantified corticospinal tract diffusion restriction predicts neonatal stroke outcome[J].Stroke,2007,38(3):974-980.
7 陈惠金.新生儿脑梗死的诊断与治疗[J].中国实用儿科杂志,2006,2l(9):644-647.
8 Benders MJ,Groenendaal F,Uiterwaal CS,et al.Maternal and infant characteristics associated with perinatal arterial stroke in the preterm infant[J].Stroke,2007,38(6):1759-1765.
9 Nelson KB,Lynch JK.Stroke in newborn infants[J].Lancet Neurol,2004,3(3):150-158.
10 Lynch JK,Nelson KB.Epidemiology of perinatal stroke[J].Curr Opin Pediatr,2001,13(6):499-505.
11 Lee J,Croen LA,Backstrand KH,et al.Maternal and infant characteristics associated with perinatal arterial stroke in the infant[J].JAMA,2005,293(6):723-729.
12 Wu YW,March WM,Croen LA,et al.Perinatal stroke in children with motor impairment:a population-based study[J].Pediatrics,2004,114(3):612-619.
13 Kumar M,Avdic S,Paes B.Contralateral cerebral infarction following vacuum extraction[J].Am J Perinatol,2004,21(1):15-17.
14 Hogeveen M,Blom HJ,Van Amerongen M,et al.Hyperhomocysteinemia as risk factor for ischemic and hemorrhagic stroke in newborn infants[J].J Pediatr,2002,141(3):429-431.
15 Fox AM.Timing and etiology of neonatal cerebral infarction[J].Pediatrics,2000,106(3):614-616.
16 Sreenan C,Bhargava R,Robertson CM.Cerebral infarction in the term newborn:clinical presentation and long-term outcome[J].J Pediatr,2000,137(3):351-355.
17 K(?)ker W, M(?)hrle S, Mader I. MRI for the management of neonatal cerebral infarctions: importance of timing[J]. Childs Nerv Syst, 2004, 20(10):742-748.
18 Brenner D, Elliston C, Hall E, et al. Estimated risks of radiation-induced fatal cancer from pediatric CT[J]. AJR Am JRoentgenol, 2001, 176(2): 289-296.
19 Johnson AJ, Lee BC, Lin W. Echoplanar diffusion-weighted imaging in neonates and infants with suspected hypoxic-ischemic injury: correlation with patient outcome[J]. AJR Am J Roentgenol, 1999 , 172(1): 219-226.
20 Mader I, Sch(?)ning M, Klose U, et al. Neonatal cerebral infarction diagnosed by diffusion-weighted MRI: pseudonormalization occurs early[J]. Stroke, 2002, 33( 4):1142-1145.
21 Rutherford M, Counsell S, Allsop J, et al. Diffusion-weighted magnetic resonance imaging in term perinatal brain injury : a comparison with site of lesion and time from birth[J]. Pediatrics, 2004, 114(4): 1004-1014.
22 Fehings D, Rang M, Glazier J, et al. An evaluation of botulinum-a toxin injection to improve upper extremity function in children with hemiplegic cerebral palsy [J]. J Pediatr, 2000, 137(3): 331-337.
23 Gordon AM, Charles J, Wolf SL. Efficacy of constraint-induced movement therapy on involved upper-extremity use in children with hemiplegic cerebral palsy is not age-dependent[J]. Pediatrics, 2006 , 117(3): e363-373.
24 Boardman J P, Ganesan V, Rutherford MA, et al. Magnetic resonance image correlates of hemiparesis after neonatal and childhood middle cerebral artery stroke[J]. Pediatrics, 2005, 115(2): 321-326.
25 McLinden A, Baird AD, Westmacott R, et al. Early cognitive outcome after neonatal stroke[J]. J Child Neurol, 2007 , 22(9): 1111-1116.
26 Eyre JA, Taylor JP, Villagra F, et al. Evidence of activity-dependent withdrawal of corticospinal projections during human development[J] . Neurology , 2001 , 57(9): 1543-1554.