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目的探讨核磁共振(MRI)平扫在足月新生儿缺氧缺血性脑病(HIE)诊断及预后评估中的应用价值。方法选取2014年9月-2016年10月在该院分娩并确诊为HIE的足月新生儿57例,所有患儿均采用3.0T MRI进行检查,包括常规序列以及弥散序列、磁敏感序列成像,根据MRI检查结果进行诊断,并将MRI检查结果与临床确诊结果进行比较,同时将不同序列成像的诊断结果进行分析。结果 57例HIE患儿中,MRI阳性检出55例,检出率为96.49%,与临床诊断结果比较差异无统计学意义(P>0.05)。弥散加权成像(DWI)对单纯性脑水肿的检出率100%,显著高于常规序列的60%(6/10),差异有统计学意义(P=0.024);磁敏感加权成像(SWI)对脑出血及蛛网膜下腔出血的检出率为100%(9/9),显著高于常规序列的55.56%(5/9),差异有统计学意义(P=0.023)。MRI诊断单纯性脑水肿10例,广泛性脑水肿合并基底节损伤12例,局灶性脑水肿伴基底节损伤16例,脑室周围白质改变7例,脑出血及蛛网膜下腔出血9例。结论 MRI对足月HIE诊断的敏感性较高,通过MRI功能成像选择针对性扫描序列可提高阳性检出率与诊断准确率,为临床治疗提供可靠依据,并可有效评估预后。
Objective To investigate the value of magnetic resonance imaging (MRI) in the diagnosis and prognosis of full-term neonatal hypoxic-ischemic encephalopathy (HIE). Methods Fifty-seven full-term newborns with HIE who were delivered at this hospital from September 2014 to October 2016 were examined by 3.0T MRI, including routine and diffuse sequence, magnetic susceptible sequence imaging, According to the results of MRI examination for diagnosis, and the results of MRI examination and clinical diagnosis results were compared at the same time different serial imaging diagnosis results were analyzed. Results Among the 57 HIE children, 55 cases were detected by MRI, the detection rate was 96.49%. There was no significant difference between them (P> 0.05) and clinical diagnosis results. The detection rate of diffuse weighted imaging (DWI) for simple brain edema was 100%, which was significantly higher than 60% (6/10) of the conventional sequence, with significant difference (P = 0.024). Magnetic resonance weighted imaging (SWI) The detection rate of cerebral hemorrhage and subarachnoid hemorrhage was 100% (9/9), which was significantly higher than 55.56% (5/9) of the conventional sequence, the difference was statistically significant (P = 0.023). MRI diagnosis of simple brain edema in 10 cases, extensive cerebral edema and basal ganglia injury in 12 cases, focal brain edema and basal ganglial injury in 16 cases, periventricular white matter changes in 7 cases, cerebral hemorrhage and subarachnoid hemorrhage in 9 cases. Conclusion MRI is more sensitive to the diagnosis of full-term HIE. Selecting functional MRI scan can improve the positive detection rate and diagnostic accuracy, providing a reliable basis for clinical treatment and evaluating the prognosis.