新生儿脑梗死早期的临床表现与磁共振成像特点

Early clinical presentations and MRI characteristics in newborns with cerebral infarction

摘要:

目的：磁共振成像（MRI）是目前诊断新生儿脑梗死的金标准，然而常规MRI对于2 d内的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，该研究探讨了新生儿脑梗死患儿的早期临床表现及头部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：回顾分析该院新生儿病房收治的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 d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11~18 d）进行了第2次头部MRI检查。结果：①高危因素：产前8例（50%），产时9例（56%），产后0例（0%）；临床表现：11例以惊厥发作为首发症状，患儿每次抽搐持续时间较短（平均为2~3 min），9例于24 h内停止抽搐；②MRI扫描结果：初期（5 d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11~18 d）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：惊厥多为新生儿脑梗死的首发表现，发作次数少且程度轻；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。［中国当代儿科杂志，2009，11（2）：96-99］

Abstract:

OBJECTIVE: The present study aimed to characterize the clinical presentations and magnetic resonance imaging including conventional MRI and diffusion-weighted imaging (DWI) in newborns with cerebral infarction. METHODS: Clinical records of 16 newborn infants with cerebral infarction were reviewed. All cases underwent DWI examination in addition to conventional MRI examination ［T1-weighted (T1W) and T2-weighted (T2W)］within 5 days after birth. Five patients received the second MRI examination at the age of 11 to 18 days. RESULTS: Eight patients had antenatal risk factors, 9 had intranatal risk factors, and no postnatal risk factors were found. Seizures as the first symptom were noted in 11 neonates, with a short duration and a low frequency. The first imaging examination (within 5 days) showed a slight hypointensity on T1W, a slight hyperintensity on T2W and significantly increased signal intensity with a clear boundary on DWI in the lesions. In the MRI re-examination, more obvious hypointensity on T1W and hyperintensity on T2W were noted, while hypointensity was shown on DWI in the lesions compared with the first imaging results. CONCLUSIONS: Seizures characterized by short duration and low frequency usually may be the first symptom in newborns with cerebral infarction. A hyperintensity on DWI was shown in the lesions at the early stage of neonatal cerebral infarction. A hypointensity on T1W and a hyperintensity on T2W were demonstrated in the lesions with increasing disease duration.［Chin J Contemp Pediatr, 2009, 11 (2):96-99］