3.0T核磁共振磁敏感加权成像在新生儿缺氧缺血性脑病诊断的价值

摘要

Objective To evaluate the clinical application value of susceptibility weighted imaging (SWI) in neonatal hy-poxic ischemic encephalopathy (HIE). Methods Thirty-six neonates with HIE were collected and scanned by GE 3.0 T supercon-ducting MR scanner. Routine axial T1WI, T2WI, FLAIR scan and axial SWI scan were conducted. SWI sequence was compared with conventional head MRI sequences in detection rate of distribution and quantity of intracranial hemorrhage. Meanwhile, the display condition of the dilated cerebral deep veins and cortical veins was observed on SWI image and the performance of HIE in different clinical classification on SWI was compared. Results A total of 97 intracranial hemorrhages were detected by SWI in 27 cases. Only 41, 27 and 51 hemorrhages were found by TIWI, T2WI and FLAIR sequences, respectively. SWI were significantly superior to T1WI, T2WI and FLAIR in displaying the size, scope and boundary definition of hemorrhage. A total of 50 dilated ce-rebral deep veins and cortical veins were detected by SWI in 22 cases which were not found by conventional head sequences. The detection rates of intracranial hemorrhage and intracranial hemorrhage in addition of dilated cerebral veins on SWI sequence were the lowest in mild HIE group, and highest in severe group. There was significant difference among the mild, medium and severe groups (P<0.05). Conclusions SWI sequence has higher sensitivity than conventional MRI sequence in detecting intracranial hemorrhage and dilated vein in HIE, and is useful for early diagnosis of HIE.%　　目的探讨3.0T核磁共振磁敏感加权成像（SWI）在新生儿缺氧缺血性脑病（HIE）诊断中的临床应用价值。方法搜集HIE新生儿36例，采用3.0T超导型MR扫描仪，所有病例均行横轴位常规T1WI、T2WI、FLAIR序列及横轴位SWI序列扫描。比较头颅常规MRI序列与SWI序列检查对颅内出血灶的检出率、出血灶的部位及数量；同时观察SWI序列对脑深部及皮质异常扩张静脉的显示情况；并对不同临床分度HIE患儿SWI上的表现进行比较。结果采用SWI检出的颅内出血灶数量最多，在其中27例患儿中检出出血灶共97个，TIWI、T2WI及FLAIR发现出血灶数量仅分别为41、27和51个；在出血灶大小、范围及边界清晰度显示方面，SWI均明显优于T1WI、T2WI和FLAIR。同时SWI在22例患儿中检出异常扩张的脑深部静脉及皮质静脉共50处；常规MRI序列均未见明确显示。颅内出血及颅内出血合并脑内静脉扩张在SWI序列上检出率在轻度HIE患儿组中最低，在重度组最高，三组间总体差异有统计学意义（P<0.05）。结论SWI在检出HIE患儿颅内出血及脑内静脉扩张的敏感性高于常规MRI序列，具有明显优势；SWI可以为早期诊断HIE提供参考依据。