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目的探讨核磁共振弥散加权成像(DWI)在重度新生儿缺氧缺血性脑病(HIE)早期诊断以及预后评价中的价值。方法 2013年1月~2015年1月,本院收治12例重度HIE患儿,均于出生后3d内行常规MRI和DWI扫描。同时对12例患儿的6个大脑区域行(表观弥散系数)ADC值测量,以同期住院的12例无神经系统疾病的足月儿为对照。6个大脑区域分别为内囊后肢、基底节区、腹外侧丘脑区、枕叶皮层、脑干和额叶皮层。结果 MRI扫描结果显示:12例重度HIE患儿3d内MRI仅2例患儿T2WI可见部分皮层信号稍微变高,余未见其他异常。DWI扫描结果显示:12例患儿均可见异常高信号,其中4例患儿出现双侧腹外侧丘脑区和基底节区异常高信号,同时有3例患儿还伴有内囊后肢和脑干信号异常;2例患儿出现双侧腹外侧丘脑区和枕叶皮层信号异常;2例患儿出现单纯双侧腹外侧丘脑区信号异常;1例患儿出现枕叶皮层和额叶皮层的信号异常。两组患儿ADC值的比较,HIE组患儿的内囊后肢、基底节区、腹外侧丘脑区、枕叶皮层、脑干和额叶皮层着6个区域的ADC值高于对照组,差异有统计学意义(P<0.05)。重度HIE组患儿预后均较差,其中伴有内囊后肢和脑干信号异常的患儿预后更差。结论在重度HIE患儿脑损伤的早期检测及预后评估方面,DWI检查比常规MRI更加敏感,可较早的反映缺氧缺血性脑损伤并对患儿的预后做出很好的预测,有着重要的临床应用价值。
Objective To investigate the value of nuclear magnetic resonance diffusion-weighted imaging (DWI) in the early diagnosis and prognosis of severe neonatal hypoxic-ischemic encephalopathy (HIE). Methods From January 2013 to January 2015, 12 patients with severe HIE were admitted to our hospital. All patients underwent MRI and DWI scan within 3 days after birth. At the same time, the ADC values of 6 brain regions (apparent diffusion coefficient) in 12 children were measured, and 12 full-term children without neurological diseases who were hospitalized in the same period were compared. The six brain regions were the posterior limb, basal ganglia, ventrolateral thalamus, occipital cortex, brainstem and frontal cortex, respectively. Results The results of MRI scan showed that the cortical signals of T2WI in 12 children with severe HIE were slightly higher than those in 2 children with MRI, and no other abnormalities were found. DWI scan results showed that all 12 cases showed abnormally high signal, in which 4 cases showed abnormally high signals of bilateral ventromedial thalamus and basal ganglia, while 3 cases also had the hindlimb and brainstem Signal abnormalities; 2 cases of bilateral ventromedial thalamic area and occipital cortex signal abnormalities; 2 cases of simple bilateral ventromedial thalamic area signal abnormalities; 1 case of children with occipital cortex and frontal cortex signal abnormal. ADC value of two groups of children with HIE group, children with hIE, basal ganglia, ventromedial thalamus, occipital cortex, brainstem and frontal cortex of the six regions of the ADC value was higher than the control group, the difference There was statistical significance (P <0.05). The prognosis of children with severe HIE group were poor, including the inner hind limbs and brainstem abnormalities in children with worse prognosis. Conclusion In the early detection and prognosis evaluation of brain injury in children with severe HIE, DWI is more sensitive than conventional MRI, which can reflect earlier the hypoxic-ischemic brain damage and make a good prediction of the prognosis of children with HIE Important clinical value.