MRI鉴别新生儿缺氧缺血性脑病与急性胆红素脑病的价值

Differentiation of hypoxic-ischemic encephalopathy and acute bilirubin encephalopathy with magnetic resonance imaging in neonates

摘要:

目的：新生儿缺氧缺血性脑病(HIE) 与急性胆红素脑病的脑损害部位、早期临床症状存在相似性，应用影像学方法鉴别两类疾病有一定的临床意义。该文探讨常规磁共振成像（MRI）和扩散加权成像（DWI）鉴别新生儿HIE与急性胆红素脑病的价值。方法：回顾性分析该院2006年11月至2008年6月收治住院的15例伴有基底节累及的HIE新生儿和18例急性胆红素脑病新生儿的常规MRI表现；并进一步分析其中11例HIE及10例急性胆红素脑病患儿的DWI特点。结果：5例HIE患儿T1WI出现苍白球高信号，16例急性胆红素脑病患儿表现为苍白球高信号，HIE患儿苍白球高信号的出现率低于急性胆红素脑病（P<0.01）。9例HIE患儿出现壳核高信号，急性胆红素脑病患儿壳核均无高信号。急性胆红素脑病患儿底丘脑高信号的出现率高于HIE患儿（55.6% vs 13.3%, P<0.05）。HIE组和急性胆红素脑病组分别有8例和2例患儿还出现了脑内其他部位的异常信号（P<0.05）。7例HIE患儿DWI上，基底节出现高信号，而急性胆红素脑病患儿均无基底节异常信号。结论： 常规MRI及DWI有助于鉴别新生儿HIE和急性胆红素脑病。［中国当代儿科杂志，2009，11（3）：181-184］

Abstract:

OBJECTIVE: To investigate the value of conventional magnetic resonance imaging (MRI) and diffusion weighed imaging (DWI) in the differentiation of hypoxic-ischemic encephalopathy (HIE) and acute bilirubin encephalopathy in neonates. METHODS: The MRI findings along with DWI characteristics in 15 neonates with HIE involving basal ganglia and in 18 neonates with acute bilirubin encephalopathy between November 2006 and June 2008 were retrospectively reviewed. RESULTS: On T1WI, only 5 patients presented hyperintensity in the globus pallidus in the HIE group, but 16 in the acute bilirubin encephalopathy group (P<0.01). Nine patients in the HIE group showed hyperintensity in the putamen, but the hyperintensity in the putamen was not found in the acute bilirubin encephalopathy group. The frequency of hyperintensity in the subthalamus in the acute bilirubin encephalopathy group (55.6%) was significantly higher than that in the HIE group (13.3%) (P<0.05). Eight patients in the HIE group showed abnormal signals in the other regions on T1WI, but only two patients in the acute bilirubin encephalopathy group (P<0.05). On DWI, 7 out of 11 patients with HIE presented hyperintensity in the basal ganglia, while all 10 patients of the acute bilirubin encephalopathy group presented normal in the basal ganglia. CONCLUSIONS:Conventional MRI along with DWI is useful in differentiating HIE from acute bilirubin encephalopathy in neonates.［Chin J Contemp Pediatr, 2009, 11 (3):181-184］