磁共振弥散加权成像对早期新生儿脑梗死的诊断价值

目的：探讨新生儿脑梗死（NCI）的临床特点及磁共振弥散加权成像（DWI）的应用价值。方法：回顾性分析8例NCI的临床及MRI资料，8例均行脑部常规MRI及DWI检查，其中7例行临床随访观察，3例行MRI复查。结果：8例均为足月儿，其中4例有围产期高危因素。7例以惊厥发作为首发症状；影像学检查前8例均被临床误诊为其他疾病。5例系急性脑梗死，2例为亚急性脑梗死，1例为陈旧性梗死。8例均为单侧脑梗死，皮层受累5例，基底节区受累4例，侧脑室旁受累2例；急性期病灶在DWI表现为高信号，亚急性及慢性病灶在DWI为低信号。7例临床随访预后良好。结论：NCI最常见的首发症状为惊厥，临床易误诊，其确诊需要早期行MRI检查。DWI能早期发现病变、判断梗死累及范围，为临床预后评估提供依据。

Early diagnostic value of DWI in neonatal cerebral infarction

Objective: To explore the clinical feature and the applied value of diffusion weighted imaging (DWI) in neonatal cerebral infarction (NCI). Methods: The imaging studies and clinical records of eight newborn infants with cerebral infarction were reviewed. All patients underwent conventional MRI and DWI examination, seven patients had a follow up, three patients received a follow-up conventional MRI and DWI scan. Results: All the patients were full term infants, 4 patients had perinatal risks. Seven patients presented seizure as their major symptoms. All cases were misdiagnosed before MRI examinations. Five cases were in acute phase, 2 cases in sub-acute phase, and 1 case in chronic phase. All patients had unilateral infarction, the cortices was involved in 5 cases, the basal ganglia regions in 4 cases, periventricular areas in 2 cases, and the centrum semiovale in 1 case. The infarction areas showed hyperintensity on DWI in acute phase, and showed hypointensity in sub-acute and chronic phase. At follow-up, 7 cases had good prognosis, and the lesions of 3 cases showed persistent hypointensity on DWI. Conclusion: Seizure is the most common primary symptom of NCI, it is easily misdiagnosed without imaging studies, and the definite diagnosis requires early MRI examination. DWI can show the infarction and involvement areas in acute state, and this will provide important clue for the prognostic prediction.