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目的探讨弥散加权成像(DWI)对新生儿脑梗死(NCI)早期的诊断价值。方法收集2004年6月至2005年10月,在我院新生儿科住院的6例 NCI 患儿的临床资料。全部病例完成了血常规、血糖、血清总钙及离子钙、C-反应蛋白、凝血酶原时间及部分凝血活酶时间、心脏彩色多普勒及头部 MRI 检查。并对其中4例进行 MRI 动态观察。结果 (1)全部病例为足月儿,1例有重度窒息史,其余5例无明显宫内窘迫及出生窒息史。(2)5例以全身惊厥为首发症状。(3)全部病例无红细胞增多症,无出血及凝血机制障碍,心内结构正常。(4)MRI 检查时间:发病后18h 至4d。常规 MRI4例异常(T_1WI 低信号,T_2WI 高信号),2例正常;DWI6例异常(全部高信号),随访(2周至15个月):常规 MRI6例异常(T_1WI 低信号,T_2WI 高信号);DWI6例异常(低信号)。梗死部位:4例左侧颞叶、顶叶和枕叶,1例左侧额叶和顶叶,1例左侧基底节。结论 NCI 早期,常规 MRI 尚未出现明显异常,DWI 即显示明显高信号,从而证实 DWI 对 NCI 早期诊断的价值。
Objective To investigate the diagnostic value of diffusion-weighted imaging (DWI) in the early stage of neonatal cerebral infarction (NCI). Methods The clinical data of 6 children with NCI who were hospitalized in neonates of our hospital from June 2004 to October 2005 were collected. All cases completed blood, blood glucose, serum total calcium and ionized calcium, C-reactive protein, prothrombin time and partial thromboplastin time, color Doppler and head MRI examination. And 4 cases of MRI dynamic observation. Results (1) All cases were full-term infants, 1 case had severe asphyxia history, and the remaining 5 cases had no history of intrauterine distress and birth asphyxia. (2) 5 cases of systemic convulsions as the first symptom. (3) All cases without polycythemia, no bleeding and coagulation disorders, normal cardiac structure. (4) MRI examination time: 18h to 4d after onset. Conventional MRI was abnormal in 4 cases (T_1WI low signal and T_2WI high signal), 2 cases were normal; DWI was abnormal in 6 cases (all high signal), followed up (2 weeks to 15 months) DWI 6 cases of abnormal (low signal). Infarct sites: left temporal lobe, parietal and occipital lobe in 4 cases, left frontal lobe and parietal lobe in 1 case, left basal ganglia in 1 case. Conclusion In the early stage of NCI, no obvious abnormality of conventional MRI has been found, and DWI shows obviously high signal, which confirms the value of DWI in the early diagnosis of NCI.