磁敏感加权成像在新生儿颅内出血的诊断价值及早产儿与足月儿间的对比研究

目的 探讨磁敏感加权成像(SWI)在新生儿颅内出血的诊断价值,并比较早产儿与足月儿间的差别。 方法 对115例怀疑脑损伤的新生儿行常规MRI、DWI和SWI检查,明确有无颅内出血并记录各序列出血灶个数,比较3种方法在颅内出血检出率、分布区域及病灶检出个数的差异,并比较早产儿与足月儿间颅内出血分布区域及病灶检出个数的差异。 结果 115例新生儿中,SWI的颅内出血检出率高于常规MRI及DWI(检出率分别为32.2%、26.1%、12.2%,P<0.05),常规MRI亦较DWI高(P<0.05)。37例颅内出血新生儿,常规MRI、DWI及SWI检出颅内出血灶分别为66、33、125个,SWI较常规MRI及DWI、常规MRI较DWI显示更多出血灶(均P<0.05)。出血灶主要位于生发基质-脑室、大小脑半球(分别为33、34、25个),SWI较常规MRI及DWI显示更多这些部位的出血灶(均P<0.05);常规MRI及SWI较DWI更敏感地显示蛛网膜下腔出血及硬膜下出血(P<0.05),但常规MRI与SWI相仿。早产儿出血灶总数及生发基质-脑室出血灶数目均多于足月儿(P<0.05),而其他部位出血灶数目差异无统计学意义(P>0.05)。 结论 SWI对新生儿颅内出血检出优于常规MRI及DWI,但各序列显示不同部位颅内出血差异存在统计学意义,对怀疑有颅内出血的新生儿,应行上述序列检查以综合判断有无颅内出血及出血数目。上述结果可为新生儿颅内出血的临床诊断、治疗及预后评估提供重要依据。 

Value of susceptibility weighted imaging in the diagnosis of neonatal intracranial hemorrhage and the hemorrhagic difference between preterm and term neonates

Objective To investigate the value of susceptibility weighted imaging (SWI) in the diagnosis of infants with intracranial hemorrhage (ICH) and the hemorrhagic difference between preterm and term neonates. Methods One hundred and fifteen cases of suspected brain injury underwent conventional MRI,DWI and SWI to determine whether they had ICH and record the numbers of each hemorrhagic lesion.The detecting rate,distribution and number of ICH were compared among these methods,and the distribution and number of ICH were compared between preterm and term neonates. Results SWI had a higher detection rate than conventional MRI and DWI (the detection rate was 32.2%,26.1% and 12.2%,respectively P<0.05) and conventional MRI also had a higher detection rate than DWI (P<0.05).Of the 37 cases of ICH,conventional MRI,DWI and SWI detected 66,33,125 hemorrhagic lesions respectively.More hemorrhagic lesions were found on SWI than conventional MRI and DWI (all P value<0.05),and more lesions were showed on conventional MRI than DWI (t=4.932,P<0.05).Hemorrhagic lesions mainly located at germinal matrix-ventricle,cerebrum and cerebellar hemispheres.SWI showed more hemorrhagic lesions than conventional MRI and DWI in these areas (all P value<0.05).SWI and conventional MRI detected more subarachnoid and subdural hemorrhage than DWI (P<0.05),but no difference was found between SWI and conventional MRI.Preterm infants had more hemorrhagic lesions than term infants (P<0.05),especially in the germinal matrix-ventricle (P<0.05).The numbers of hemorrhagic lesions were found no significant difference in other brain areas (P>0.05). Conclusion SWI is a better tool to detect neonatal ICH than conventional MRI and DWI.But differences can be found among these Methods when detecting ICH in different brain areas.The newborns with suspected ICH should undergo SWI,conventional MRI and DWI to make a comprehensive judgment whether they have ICH and the numbers of hemorrhagic lesions.Our Results provide important clues for clinical diagnosis,treatment and prognostic assessment of neonatal ICH.