摘要
目的：结合常规磁共振成像（T1WI-T2WI）和弥散加权成像（DWI）,动态评价晚期早产儿脑白质损伤（CWMD），明确早期行 MRI 检查的最佳时间，并根据 MRI 表现客观评价其预后。方法对649例晚期早产儿行常规 MRI 和 DWI 检查，对271例确诊早产儿 CWMD 进行分析，观察不同类型 CWMD 早期 MRI 信号特点，并对其中76例随访，比较不同类型 CWMD 的动态演变规律。结果（1）高危的晚期早产儿 CWMD 占41.8%。271例确诊早产儿 CWMD 中局灶性 CWMD 170例，广泛性77例，弥漫性24例。第1次行头磁共振检查的时间为（8.3±6.4）及（1.7~14.7）天，复查时间为（19.9±5.2）及（14.7~25.1）天，36例病灶范围减少，23例病灶消失，17例发生不同程度的软化（6.3%），在3种不同类型 CWMD 之间差异有显著性（P<0.01）。（2）生后2周内，DWI 具有较高的敏感性，98%表现为高信号，T1WI 信号无变化或稍高信号，伴有或不伴有 T2WI 低信号。局灶性CWMD DWI 高信号持续时间长达3周以上，弥漫性 CWMD 持续时间较短（2周以内）。（3）局灶性CWMD 常仅累及一处损伤（65.3%），主要集中在侧脑室后脚（53.5%）；广泛性 CWMD 常累及胼胝体和内囊（79.2%）；而弥漫性 CWMD 常合并灰质损伤（50.0%）。（4）损伤类型与患儿神经发育结局有较好的相关性。损伤1~3周复查，局灶性 CWMD 有97.1%病灶消失或病灶范围减少，表现为 DWI 信号正常或稍高信号；T1WI 高信号，伴有或不伴有 T2WI 高信号；而弥漫性 CWMD100%发生软化，表现为 T2WI 高信号，T1WI 和 DWI 均为低信号。结论应该选择生后2周内（1周内最佳）对高危晚期早产儿进行 DWI 和常规 MRI 检查，以早期发现病变。局灶性 CWMD 预后较好，通常不会发生软化，而合并有灰质损伤或弥漫性 CWMD 预后极差，需要继续动态随访，并进行早期康复训练。
Objective According to the conventional magnetic resonance imaging (T1WI, T2WI) and diffusion weighted imaging (DWI), we can make sure the best time to do MRI and evaluate the prognosis for the late preterm infants. Method A total of 649 late preterm infants were enrolled and received the MRI scans with the sequences of conventional MRI and DWI. 271 cases were diagnosed CWMD. To investigate the early MRI signal characteristics of different types CWMD. And the 76 cases were followed up, to study the dynamic change rule. Result In the 271 late preterm infants with CWMD, 170 cases showed focal CWMD, 77 cases showed wide spread CWMD and 24 cases diffuse CWMD. The first time that they received magnetic resonance imaging was (8.3±6.4)(1.7-14.7)d, and the second time was (19.9±5.2)(14.7-25.1) d. There were 36 cases of lesions range reduced, and 23 cases disappeared. But 17 cases (6.3%) showed different degrees of leukomalacia. There were statistically significant differences between the different types of CWMD (P<0.05). (2) Within the first two weeks of white matter damage, DWI had high sensitivity. There were 98% characterized by high signal. T1WI also showed normal or slightly high signals, with or without low signals on T2WI. High signal on DWI of focal CWMD can last for more than 3 weeks, but diffuse CWMD had short duration (within 2 weeks). (3) Focal CWMD often only involved one site of damage (65.3%), mainly concentrated in the lateral ventricle hind feet (53.5%). Widespread CWMD often involved corpus callosum and internal capsule (79.2%), and diffuse CWMD often combined gray matter injury, accounting for 50.0%. (4) There were well correlations in damage type and the infants neurological development result. 1-3 weeks to review after damage, there were 97.1% of focal CWMD characterized by disappearing or decreasing of the lesion range. They often had normal or slightly high signal on DWI, high T1WI signal, with or without high T2WI signal. But the diffuse CWMD all developed into PVL, characterized by high T2WI signal and low signal on T1WI and DWI. Conclusion We should do MRI and DWI for the high-risk late preterm infants within 2 weeks after birth, in order to detect the damage as soon as possible. The prognosis of focal CWMD was good. However, the infants suffered from diffuse CWMD had so poor prognosis that they need follow up dynamically and receive early suitable recovery as soon as possible.
出处
《发育医学电子杂志》
2014年第1期6-12,共7页
Journal of Developmental Medicine (Electronic Version)
基金
辽宁省教育发展基金课题资助:早产儿脑白质损伤早期水分子成像特征与损伤后神经发育(2009A731)
关键词
婴儿早产
晚期
脑白质损伤
弥散加权成像
磁共振成像
Late preterm infant
Cerebral white matter damage
Diffusion weighted imaging
Magnetic resonance imaging
