晚期早产儿脑白质损伤临床特点及磁共振影像学发现

Clinical and imaging features in late preterm infants with cerebral white matter damage

摘要:

目的：探讨晚期早产儿脑白质损伤的临床特点及常规磁共振成像（MRI）和弥散加权成像（DWI）影像学特征。方法：总结2005年1月至2008年5月中国医科大学盛京医院收治的519例早产儿资料（277例晚期早产儿，242例早期早产儿），对其头部常规MRI和DWI特征进行分析。结果：晚期早产儿中，脑白质损伤118例，占脑损伤的71.9%（118/164），占全部晚期早产儿的42.6%（118/277）。早期早产儿脑白质损伤占脑损伤的69.2%（92/133），占全部早期早产儿的38.0%（92/242），晚期早产儿脑白质损伤发生率与早期早产儿相比无明显差异。晚期早产儿脑白质损伤中无明显临床症状者占61.9%（73/118），重症脑损伤（广泛性及弥漫性脑损伤）早期有明显临床症状者占75%（15/20）。损伤1周内，DWI表现为高信号，T1WI信号正常或稍高信号，伴或不伴T2WI高信号；弥漫性损伤者呈DWI高信号，常规MRI无明显信号改变。结论：脑白质损伤在晚期早产儿亦较常见。重症脑白质损伤患儿早期多有明显的临床表现。DWI在损伤早期的敏感度高于常规MRI。［中国当代儿科杂志，2010，12（5）：321-326］

Abstract:

OBJECTIVE: To study the clinical and imaging features demonstrated by conventional magnetic resonance imaging (MRI) and diffusion weighted imaging (DWI) in late preterm infants with white matter damage. METHODS: A total of 519 preterm infants (277 late stage, 242 early stage) from January 2005 to May 2008 at Shengjing Hospital of China Medical University were enrolled. They received the MRI scans with the sequences of conventional MRI and DWI. RESULTS: In the 277 late preterm infants, 118 (42.6%) showed white matter damage, accounting for 71.9% of 164 cases of brain injury. In the 242 early preterm infants, 92 (38.0%) showed white matter damage, accounting for 69.2% of 133 cases of brain injury. There were no significant differences in the incidence of white matter damage between the late and early preterm infants. There were 61.9% (73/118) of late preterm infants with white matter damage had no obvious clinical symptoms, but 75% of infants with severe white matter damage (widespread and diffusive lesions on MRI-DWI) presented obvious clinical symptoms. Within the first week of white matter damage, DWI showed high signals, T1WI showed normal or slightly high signals, with or without high signals on T2WI. In the infants with diffuse injury, DWI showed high signals, but conventional MRI did not show obvious signal changes. CONCLUSIONS: White matter damage is common in late preterm infants. The majority of infants with severe white matter damage on MRI-DWI have obvious clinical symptoms. DWI can reflect the lesions ahead of conventional MRI.［Chin J Contemp Pediatr, 2010, 12 (5):321-326］