论文部分内容阅读
目的探讨扩散加权成像(DWI)在早期诊断早产儿局灶性脑白质损伤(punctate white matter damage,PWMD)及其预后的价值。资料与方法搜集PWMD早产儿39例资料。患儿均在生后两周内进行头部MR、DWI(b=1000s/mm2)扫描且被确诊为PWMD。随访患儿头部MRI及生长发育情况。观察患儿早期DWI上病灶的数量、形状、分布;观察随访期病灶演变及对临床预后的影响。结果早期DWI上PWMD病灶数量<3个13例,3～10个10例,>10个16例;早期DWI上病灶呈“簇”状22例(“簇”状病灶组),呈“线”状11例(线状病灶组),呈混合型6例(混合型病灶组)。病灶分布只位于侧脑室旁者9例,只位于侧脑室后角旁者13例,位于半卵圆中心、侧脑室旁、后角、前角旁等部位者17例。随访0.6～22个月后,簇状病灶组22例头部MRI示病灶吸收消失,未见异常信号灶。20例智力发育指数(mental development index,MDI)>80,神经运动发育指数(psychomotor devel-opment index,PDI)>80,2例语言发育障碍,MDI<69,PDI>80;线状病灶组7例头部MRI出现侧脑室旁白质软化灶(periventricular leukomalacia,PVL),2例出现侧脑室后角变方、中央脑白质变薄等PVL后遗改变,2例轻度脑积水。MDI<50,PDI<50者5例,MDI<69,PDI<69者5例;混合型病灶组2例MRI示PVL,4例示PVL后遗症改变。结论DWI上簇状病灶多位于侧脑室或后角旁,数量<10,病灶易吸收消失,随访头部MRI及生长发育未见明显异常;线状及混合型病灶广泛分布,数量>10,病灶易演变成PVL及其后遗改变,临床多出现运动发育迟缓、认知障碍改变。DWI应作为筛查早产儿脑损伤的常用序列,并能帮助判断PWMD的预后。
Objective To investigate the value of diffusion-weighted imaging (DWI) in the early diagnosis of focal brain white matter damage (PWMD) and its prognosis in preterm infants. Materials and Methods 39 cases of preterm infants with PWMD were collected. All children underwent MR and DWI (b = 1000s / mm2) scans within two weeks after birth and were diagnosed as PWMD. The MRI and growth and development of the head were followed up. The number, shape and distribution of lesions on DWI in early childhood were observed. The evolution of lesions at follow-up and the effect on clinical prognosis were observed. Results The number of early-stage DWI DWI lesions was less than 3 in 13 cases, 3 to 10 in 10 cases, and> 10 in 16 cases. Early DWI showed 22 lesions in “cluster” (“cluster” Eleven patients (linear lesion group) showed “line” shape, and 6 were mixed (mixed lesion group). The lesions were located in the lateral ventricle only 9 cases, only located in the lateral ventricular posterior horn in 13 cases, located in the semi-oval center, lateral ventricle, posterior horn, anterior horn and other parts of the 17 cases. After 0.6 to 22 months of follow-up, the lesions of the head of 22 cases in the cluster-like lesions showed disappearance of MRI lesions and no abnormal signal lesions were found. Twenty patients with mental development index (MDI)> 80, PDI> 80 and 2 language dysplasia, MDI <69, PDI> 80; For example, PVL occurred in MRI of the head, PVL occurred in 2 cases, PVL changed in the left ventricle in 2 cases and thinned in central white matter, and 2 cases had mild hydrocephalus. There were 5 cases with MDI <50, PDI <50, 5 cases with MDI <69, and PDI <69. PVL showed MRI in 2 cases in mixed lesion group and 4 cases showed PVL sequelae change. Conclusions The clustered lesions in DWI are mostly located beside the lateral ventricle or the posterior horn. The number of lesions is easily absorbed and disappeared. There is no obvious abnormalities in the head MRI and growth and development. The linear and mixed lesions are widely distributed, the number is> 10, Easy to evolve into PVL and its aftermath changes, more clinical manifestations of motor retardation, cognitive disorders change. DWI should be used as a common screening sequence for brain injury in preterm infants and to help determine the prognosis of PWMD.