新生儿胆红素脑病的MRI表现

目的 探讨磁共振成像(MRI)对新生儿胆红素脑病(NBE)诊断的价值.方法 回顾性分析28例胆红素脑病新生儿的常规MRI表现和临床资料.结果 28例患儿中27例T1WI苍白球对称性高信号.19例患儿底丘脑T1WI呈高信号,T2WI呈等信号,主要表现为底丘脑点状或"八"字形对称性短T1WI信号.8例患儿中脑、桥脑背侧、延髓T1WI呈高信号,而桥脑腹侧信号正常.扩散加权成像(DWI)显示所有胆红素脑病患儿的基底节无异常信号.结论 常规MRI及DWI有助于新生儿胆红素脑病的诊断.     

MRI在新生儿胆红素脑病中诊断价值

目的:探讨新生儿胆红素脑病MRI影像特点,以提高对该病的认识。方法:搜集经临床确诊的新生儿胆红素脑病31例MR脑图像,总结其MR影像特点及MR诊断与鉴别诊断价值。结果:新生儿胆红素脑病31例血清总胆红素和非结合胆红素升高。急性期20例,15例SE T1WI双侧苍白球对称性高信号、边缘清楚,3例双侧苍白球、丘脑腹侧核和2例双侧苍白球、丘脑腹侧核、脑干腹侧核与前者类似信号,20例于TSE T2WI呈等信号,FLAIR及DWI序列未见异常信号。新生儿胆红素脑病慢性期11例,8例中6例双侧苍白球、丘脑腹侧核T1WI稍高信号,2例等信号;该8例T2WI、FLAIR和DWI(ADC)高信号;3例胆红素脑病合并新生儿缺氧缺血性脑病,双侧苍白球、丘脑腹侧核、双侧内囊与壳核尾核、双额颞顶叶散在灰白质区出现T1WI高信号、但边缘欠清楚,T2WI、FLAIR呈高信号,DWI未见明显异常信号。结论:MRI T1WI急性期双侧苍白球或/和双侧丘脑、脑干腹侧核边缘清楚高信号具有一定特点,于慢性期信号相对复杂化。胆红素脑病与新生儿缺氧缺血性脑病等鉴别诊断有一定价值。     

MRI及1H-MRS对新生儿胆红素脑病的诊断研究进展

胆红素脑病,原称核黄疸,是新生儿时期由严重的高胆红素血症导致的中枢神经系统损伤性疾病。磁共振成像及磁共振波谱成像作为一种无创性检查手段,     

新生儿急性胆红素脑病的低场磁共振表现

目的 探讨急性胆红素脑病在低场磁共振的MRI表现.方法回顾分析15例急性胆红素脑病患儿的头颅MRI图像,同期的8例正常新生儿头颅MRI作对照.结果 15例急性胆红素脑病中,10例双侧苍白球T1WI呈对称性高信号,T2WI呈正常的稍高信号,其余5例未见明显异常.结论 低场MRI可较好地显示高胆红素血症对基底节苍白球的损伤,双侧苍白球T1WI对称性高信号是新生儿急性胆红素脑病的重要特征.     

新生儿高胆红素血症的光照疗法

新生儿高胆红素血症，是儿科急诊之一，如任其发展可致胆红素脑病，易致新生儿死亡，即使未发生胆红素脑病，高胆红素血症对新生儿的智力，听力，肝脏以及神经系统的发育亦有损害，故对高胆红素的新生儿，采取积极的消黄退胆措施，是儿科医务工作者当务之急。如何降低高胆红素血症，祖国医学早就用菌陈蒿汤治疗黄疸病，现代的茵栀黄注射液静滴，消炎利胆片等降黄胆，且取得良好的效果。现代医学根据胆红素的代谢特点，而给高胆红素血症患儿输入白蛋白、血浆，在肝细胞内葡萄糖醛酸转移酶作用下，使间接的胆红素变成直接的胆红素，而从胆道及肾脏随类便及尿排出体外。从而达到降低胆红素。     

新生儿急性胆红素脑病临床特点及MRI特征分析

目的探讨新生儿急性胆红素脑病的临床特点及MRI特征。方法选取我院诊治的急性胆红素脑病患儿60例作为观察组,同时选取高胆红素血症患儿60例作为对照组,比较两组患儿的病因及MRI特征。结果ABO血型不合溶血病、葡萄糖-6-磷酸脱氢酶(G6PD)缺乏、感染为观察组的病因前3位;原因不明、母乳性黄疸、ABO血型不合溶血病为对照组的病因前3位;观察组的病因ABO血型不合溶血病、G6PD缺乏、感染明显高于对照组,观察组的病因原因不明、母乳性黄疸明显低于对照组,差异均有统计学意义(P<0.05)。观察组MRI未见异常5例(8.33%),低于对照组57例(95.00%),T1WI苍白球对称性高信号、其他部位高信号分别为46例(76.67%)、9例(15.00%),明显高于对照组的2例(3.33%)、1例(1.67%),差异均有统计学意义(P<0.05)。结论新生儿急性胆红素脑病的主要病因为ABO血型不合溶血病、G6PD缺乏和感染,MRI主要表现为T1WI苍白球对称性高信号。     

经皮黄疸仪在诊断新生儿高胆红素血症中的应用价值

目的评价经皮黄疸仪在诊断新生儿高胆红素血症中的应用价值。方法应用经皮黄疸仪检测856例新生儿的黄疸指数,同时采集静脉血测定血清总胆红素水平。以经皮黄疸仪黄疸指数>6、>12.9、>15,血清总胆红素水平>102μmol/L、>220.6μmol/L、>255μmol/L分别作为各自诊断出生24 h内、出生24 h后足月儿、出生24 h后早产儿高胆红素血症的标准。以血清总胆红素水平作为金标准,采用Yerushalmy四格表评价模式,计算敏感度、特异度、准确度、阳性似然比、阴性似然比。结果经皮黄疸仪诊断出生24 h内新生儿高胆红素血症敏感度(55.56%)欠佳,但诊断出生24h后足月儿高胆红素血症敏感度(95.73%)及特异度(90.11%)均好,诊断出生24h后早产儿高胆红素血症敏感度(94.12%)好,特异度(85.23%)尚可。结论经皮黄疸仪用于出生24 h后新生儿高胆红素血症筛查时漏诊率低,可根据其检测结果及早采取退黄治疗,但对于出生24 h内具有高胆红素血症高危因素的新生儿,应检测血清胆红素水平,以尽早诊治。     

常规MRI定量检测对新生儿高胆红素血症诱导脑损伤的诊断价值

目的 采用MRI定量检测法,探讨T₁WI序列苍白球(GP)区相对信号强度(RSI)对新生儿高胆红素血症(HB)诱导脑损伤的诊断价值。方法 前瞻性搜集2019年4月至2021年5月住院的HB足月儿65例,根据血清总胆红素(TSB)峰值分为轻-中度增高组(n=30)、重度增高组(n=25)和极重度增高组(n=10)。根据新生儿行为神经评分(NBNA),分为脑损伤组(n=12)、非脑损伤组(n=53)。所有新生儿完成常规脑MRI检查,测量并比较T₁WI序列GP区的RSI值。选择同期正常健康足月儿10名头颅MRI作为正常影像学对照组。采用受试者工作特征(ROC)曲线分析GP区RSI值及TSB值对HB诱导脑损伤的诊断价值。结果 HB患儿常规脑MRI的T₁WI序列中GP区呈高信号,RSI值与TSB值呈正相关(r=0.483,P<0.01)。极重度增高组T₁WI序列GP区RSI值高于重度增高组(P<0.05),高于轻-中度增高组和正常对照组(P均<0.01),重度增高组RSI值高于轻-中度增高组...     

新生儿高间接胆红素血症临床探讨

高间接胆红素血症（高胆）是新生儿期最常见的症状之一。自1988年10月至1992年10月共收治此种病人141例，现将临床特点分析报告如下：1临床资料与方法1．至一般资料凡符合高胆标准，即流脉血清胆红素足月儿）205·ZUmol／L（）12mp／dl），早产儿）256umol／L（）15mg／dl）且以间接脸红素为主者均收入在内，共141例，占同期住院新生儿的30．13％，141例中男71例，女70例，早产儿＠例，剖它产41例，产钳或胎头吸引助产25例。住院期间母婴分离，均以单纯奶方喂养，母乳性黄殖基本排除在外。因全部病例肝功无异常，血清以间胆增高为主．故肝…     

胆红素脑病的MRI诊断

目的 探讨MRI对胆红素脑病的诊断和预后判断价值.方法 分析26例临床确诊为胆红素脑病患儿的MRI特点,MRI采用GE Signa EXCITE1.5T超导型磁共振扫描系统,扫描图像包括T1WI、T2WI和DWI,由2名放射科医师采用单盲法分析MR图像.结果 首次检查9例为新生儿,8例表现为双侧苍白球对称性T1WI高信号,5例伴丘脑腹外侧对称稍高信号;2例双侧苍白球对称性T2WI稍高信号.1个月以上随访的25例(25/26)均表现为双侧苍白球对称性T2WI高信号,4例T1WI呈低信号,1例T1WI呈稍高信号;25例DWI未见明显异常信号改变.1例3个月后 DWI呈高信号,而11个月时DWI高信号消失,所见双侧苍白球对称T2WI高信号也消失.结论 胆红素脑病患儿的MR影像具有特征性,可为临床早期诊断及预后判断提供重要信息.     

新生儿胆红素脑病MRI特征的研究

目的 探讨新生儿胆红素脑病(NBE)MRI特征.方法 回顾性分析17例NBE患儿的常规MRI和临床资料,评价苍白球及底丘脑信号高低,并根据底丘脑有无高信号分为底丘脑高信号组和无高信号组,对苍白球信号强度的增加值与血清总胆红素的峰值进行Pearson相关性分析,采用t检验比较底丘脑高信号组和无高信号组血清总胆红素峰值水平.结果 17例患儿中15例有T1 WI苍白球对称性高信号,1例表现为T1 WI苍白球后部对称性高信号.9例患儿底丘脑T1 WI呈高信号,T2 WI呈等信号,主要表现为底丘脑点状或八字形对称性短T1信号.4例患儿中脑、桥脑背侧、延髓T1 WI呈高信号,而桥脑腹侧信号正常.使用1.0 T MR仪扫描的12例患儿苍白球信号强度增加值为249.0～423.8,血清总胆红素峰值为366.0～983.3μmol/L,两者呈正相关(r=0.676,P＜0.05).底丘脑高信号组9例,无高信号组8例,血清总胆红素分别为(660.7±192.4)、(513.3±1cr7.5)μmol/L,2组差异无统计学意义(t=1.914,P＞0.05).结论 NBE的MRI表现有一定特征性,有助于NBE的诊断.     

Studying neonatal bilirubin encephalopathy with conventional MRI,MRS, and DWI

Introduction  The purpose of this study was to evaluate the diagnostic value of conventional magnetic resonance imaging (MRI), proton magnetic resonance spectroscopy (¹H-MRS), and diffusion-weighted imaging (DWI) for neonatal bilirubin encephalopathy. Methods  We collected conventional MRI in 24 neonates with neonatal bilirubin encephalopathy. We performed ¹H-MRS and DWI sequences to nine of the 24 patients and seven age-matched healthy control subjects. Multiple-voxel ¹H-MRS data were acquired using PRESS pulse sequence with TE = 135 ms and TR = 1500 ms. The spectroscopic regions of interest were the bilateral basal ganglia and thalamus with a 1.0 mL spatial resolution. The data from DWI were collected by using a single shot-spin echo-echo planar imaging sequence with TR/TE: 2900/98, and imaging regions were also focused on the bilateral basal ganglia and thalamus. Results  Nineteen of the 24 patients had abnormal T₁-weighted image hyperintensity in the globus pallidus, but these lesions appeared as normal T₂-weighted image intensity in the same region. Ten of the 24 patients had T₁-weighted image high signal intensity in the subthalamic nucleus and appeared as normal intensity in the region for the T₂-weighted images. The peak area ratios of NAA/Cho and NAA/Cr were significantly decreased (t-test, P < 0.05) in the patients compared to the controls in the basal ganglia. Conclusion  Conventional MR imaging and ¹H-MRS are important complementary tools in the diagnosis of neonatal bilirubin encephalopathy. The study provides important information for applying these MR modalities to evaluate neonates with bilirubin encephalopathy.     

磁共振STIR和DWI在疲劳骨折诊断中的应用价值

目的：探讨磁共振STIR和DWI对早期疲劳骨折诊断价值,以提高对该病的诊断、鉴别诊断及愈合进行评估。方法通过对43例疲劳骨折患者的X线、CT、MRI影像学资料进行对比、分析,总结疲劳骨折X线、CT、MRI的影像学表现。结果本组病例中早期仅有临床症状的病例,X线及CT检查可为阴性,中晚期病例则X线和CT的诊断价值无差别;磁共振对疲劳骨折的敏感性、特异性较X线和CT高,特别是T2WI STIR和DWI敏感性更高,可作为疲劳骨折的早期诊断及对其愈合进行评估。结论疲劳骨折在磁共振检查中STIR和DWI的影像学表现有较高的特异性和敏感性,可对早期疲劳骨折进行诊断、鉴别诊断和对其愈合进行评估。     

MRI及MRS对新生儿急性胆红素脑病的诊断效能比较

目的:探讨MRI及MRS对新生儿急性胆红素脑病的诊断效能,并进行比较。方法:回顾性分析我院收治的高胆红素血症患儿198例的临床资料,依据是否发生急性胆红素脑病分为脑病组和危险组,同期选取健康新生儿30例作为对照组。所有研究对象均行MRI及MRS分析N-乙酰天门冬氨酸(NAA)、胆碱(Cho)、肌酸(Cr),并以临床诊断为对照,统计分析MRI及MRS结果。结果:MRI示急性胆红素脑病患儿苍白球区主要以T_1WI呈高信号为特征,T_2WI呈等或高信号;DWI未见特殊变化(均呈等信号);MRS示急性胆红素脑病患儿可见Cho峰、NAA峰及Cr峰,但NAA峰普遍较低,部分患儿NAA峰明显低于Cr峰。ROC曲线显示,MRI诊断新生儿急性胆红素脑病的敏感度、特异度、准确度分别为84.33%、88.28%、86.84%,分别低于MRS的93.98%、95.17%、94.74%(均P0.05)。结论:MRI及MRS对诊断新生儿急性胆红素脑病均有良好的敏感度、特异度和准确度,但MRS诊断效能更高,有利于为临床早期干预提供更可靠证据。     

急性胆红素脑病常规MRI及1H-MR波谱表现

Objective To investigate the characterized imaging in conventional MRI, get information about the metabolites in basal ganglia from proton MR Spectroscopy(1H-MRS) of acute bilirubin encephalopathy(ABE) and find out the relationship between those changes and bilirubin levels. Methods Twenty-eight patients with acute bilirubin encephalopathy and 15 normal neonates underwent MR and 1H-MRS examinations T1 WI, T2WI and DWI were collected via conventional MRI scanning of all neonates. All patients underwent multi-voxels scanning and 15 of them had single voxel scanning. 1H-MRS used point resolved spectroscopy (PRESS) both in multi-voxels and single voxel scanning. The data of them were acquired from the ROIs placed in basal ganglia and globus pallidus, respectively. The metabolites including NAA choline, Lactate, glutamate and glutamine, myoinositol and creatine were quantitatively analyzed to compare them between the control group and the case group. Equality of variance between patient data and normal values were tested by using the two-tailed t test. The case group was divided into three groups of 342.0 μmol/L < TSB ≤ 427. 5 μmol/L,427.5 μmol/L < TSB ≤ 513.0 μmol/L, TSB > 513.0 μmol/L including 8,9,11 patients, respectively. Analysis of variance was used for statistics. Results Conventional magnetic resonance imaging showed symmetrical high signal of T1WI in globus pallidus of 23 patients. The case group and the control group were significantly different. Single voxel 1H-MRS revealed that the relative concentrations of Glx/Gr and mI/Cr in the control group were 0.95±0.23, 0.57±0.20, respectively, While those in case group were 1.45±0.37, 0.74±0.23, respectively. There were significant differences between two groups (t =2. 13,4. 40,P =0.04,0.00 respectively). Multi-voxels scanning 1H-MRS revealed that Glx / Cr were 0.51±0.36 in case group and 0.29±0.18 in control group. There was also a significant difference between two groups (t =2.17,P =0.03). And the values of Cho/Cr, NAA/Cr and Lac/Cr were not significantly different. The results were same in multi-voxels 1H-MRS. Total bilirubin level and the concentration of metabolites in the brain do not have obvious correlation. Conclusions ABE has a characteristic signature which is symmetrical high signal of T1 WI in globus pallidus on conventional MBI; The values of mI/Cr and Glx/Cr remarkably increase as detected by 1H-MRS, which is generally in agreement with what has been known about bilirubin pathology.     

DWI在新生儿低血糖脑病中的诊断价值

目的:探讨DWI在新生儿低血糖脑病诊断中的应用价值。方法:回顾性分析18例经临床确诊的新生儿低血糖患儿的临床及MRI资料,所有患儿均行常规T1WI、T2WI及DWI检查,4例严重低血糖患儿另行氢质子磁共振波谱(1 H-MRS)检查。结果:MRI显示低血糖脑病呈弥漫性脑损伤改变,主要累及顶枕部16例,占88.89%(16/18);胼胝体压部12例,占66.67%(12/18);视辐射9例,占50%(9/18);内囊后肢8例,占44.44%(8/18)。额叶(4/18)、颞叶(3/18)、丘脑(3/18)及脑干(1/18)等部位亦累及。病变多呈稍长T1、稍长T2信号,DWI呈明显高信号。DWI异常信号的出现早于常规MRI序列,显示病灶的范围较常规序列广泛全面,尤其对胼胝体、内囊后肢、视辐射、丘脑等病灶的显示较常规序列敏感。4例日龄≥9d的低血糖脑病患儿,双侧顶枕叶、基底节及视辐射出现短T1、短T2信号,考虑为亚急性早期出血所致。4例MRS显示损伤部位出现倒置乳酸(Lac)峰,谷氨酸/肌酸比值(Glx/Cr)、胆碱/肌酸比值(Cho/Cr)明显增高,而N-乙酰天门冬氨酸/肌酸比值(NAA/Cr)明显降低。结论:MRI是新生儿低血糖脑病首选影像检查方法,以DWI序列优势最突出,不仅显示典型脑损伤部位的高信号,还能显示不典型部位的高信号。