【摘要】 目的探讨磁敏感加权成像(SWI)在新生儿颅内出血的应用价值。方法纳入2009年8月至2011年2月复旦大学附属儿科医院NICU临床疑诊脑损伤的新生儿,同时进行常规MRI和SWI扫描。分为足月儿组和早产儿组,统计常规MRI和SWI检测的出血部位、出血病灶数目和出血面积的差别。结果 596例临床疑诊脑损伤的新生儿进入分析。1常规MRI检出颅内出血117例(19.6%),早产儿组72例(61.5%);SWI检出颅内出血134例(22.5%),早产儿组81例(60.4%),包括生发基质出血40例(早产儿33例,足月儿7例),侧脑室出血68例(早产儿54例,足月儿14例),脉络丛出血30例(早产儿18例,足月儿12例),第三脑室出血6例(早产儿),中脑导水管出血3例(早产儿),第四脑室出血27例(早产儿23例,足月儿4例),大脑实质出血22例(早产儿14例,足月儿8例),小脑出血20例(早产儿11例,足月儿9例),脑干出血1例(足月儿),蛛网膜下腔出血10例(早产儿4例,足月儿6例),硬膜下出血36例(早产儿17例,足月儿19例),硬膜外出血2例(足月儿)。2生发基质-脑室内出血(6个部位)中,除了中脑导水管出血外,其他5个部位的出血病灶检出数目SWI均大于常规MRI(P均<0.05)。SWI对蛛网膜下腔出血的检出数目大于常规MRI(P<0.05);对硬膜下出血和硬膜外出血的检出数目上,SWI和MRI差异无统计学意义(P>0.05)。3SWI序列81例早产儿生发基质-脑室出血主要为生发基质出血(44个)、侧脑室出血(90个)和脉络丛出血(26个);53例足月儿生发基质-脑室出血以侧脑室出血(23个)和脉络丛出血(18个)多见。498例在SWI和常规MR同时显示出血的病例,颅内出血(生发基质-脑室内出血、大脑和小脑实质出血)面积(cm2)SWI均大于常规MRI的T2WI序列,(0.69±0.63)vs(0.49±0.48),P<0.001。结论 SWI较常规MRI在检出新生儿各种类型的颅内出血和蛛网膜下腔出血的阳性率、病灶数目和出血面积方面有明显的优势,可作为常规MRI的有力补充。更多还原

【Abstract】 Objective To evaluate neonatal intracranial hemorrhage with susceptibility weighted imaging( SWI),and to explore the value and limitation of SWI compared with conventional magnetic resonance imaging( MRI). Methods A study was conducted including 596 neonates who were suspected injury of brain. All MR examinations were performed at 1. 5 Tesla unit including conventional MR( T1 WI and T2WI) and SWI. Among 596 neonates there were 134 neonates with intracranial hemorrhage detected on routine MRI sequence and / or SWI. Among 134 cases,there were 81 preterm and 53 term neonates. The numbers and areas of hemorrhage on conventional MRI sequences and SWI were compared. Results Among 134 neonates with intracranial hemorrhage,there were only 19 cases showed extracerebral hemorrhage( 17 cases subdural hemorrhage,and 1 case extradural hemorrhage with subarachnoid hemorrhage,and 1 case extradural hemorrhage),all 19 cases showed on SWI,and 1 case with subdural hemorrhage without showing on conventional MRI sequences. 115 cases were detected with parenchymal hemorrhage,and among them 16 cases missed on conventional MRI sequences. The maximal areas of 98 cases with parenchymal hemorrhage were measured. The maximal areas of hemorrhage were larger on SWI than those on conventional MRI sequences( Z =- 8. 337,P < 0. 01). In six areas of germinal matrix hemorrhage / intraventricular hemorrhage,except the hemorrhage of aqueduct of mesencephalon,other 5 areas with hemorrhage were detected more on SWI than conventional MRI sequences( P < 0. 05). More cases with subarachnoid hemorrhage were detected by SWI than by conventional MRI sequences. There was no significant difference when compared subdural hemorrhage and extradural hemorrhage detected on SWI and conventional MRI. Conclusion SWI is a potent examination for cerebral bleeding displaying due to the higher sensitivity compared with the other conventional MRI sequences,and has predominant advantage over conventional MRI sequences in detecting intracranial hemorrhage of neonate.更多还原