【摘要】 目的分析新生儿重症监护病房(NICU)中缺血缺氧新生儿脑部磁共振成像(MRI)与CT诊断结果。方法选取2016年4月至2018年4月我院缺血性脑病新生儿124例为研究对象,均在出生后2w进行CT检查及MRI检查,分析两者诊断特点。结果 CT分度确诊正常有5例,轻度、中度、重度分别有35例、75例、9例,CT检查对缺血性脑病新生儿的诊断准确率为95.67%;MRI分度确诊轻度、中度、重度分别有44例、70例、10例,诊断准确率为100%;CT检查中发现基底核丘脑损伤9例、脑水肿79例、脑动脉梗死3例、脑室出血12例、矢状旁区损伤3例,总检出率85.48%;MRI检查中发现基底核丘脑损伤7例、脑水肿88例、脑动脉梗死5例、脑室出血17例、矢状旁区损伤5例,总检出率98.39%,两种检查方式的总检出率比较有统计学差异(P<0.05);124例患儿存在不同程度脑水肿,CT检查发现,患儿大脑半球脑白质区出现低密度灶,呈散在分布,CT值在16～20Hu之间,且边界模糊不清;MRI影像学特点:脑水肿:在T1WI上表现为低信号,在T2WI上则表现为高信号;颅内出血:在皮层及皮层下白质出血者影像学检查发现在T1WI上表现为高信号,而在T2WI上表现为低信号;在蛛网膜下腔出血者影像学检查发现在T1WI上表现为高信号或低信号,而在T2WI上表现为低信号;脑白质受损:在T1WI上表现为片状稍低信号,而在T2WI上表现为高信号;基底节区及脑干损伤:在T1WI上表现为不均匀或均匀的高信号,而在T2WI上表现为低信号。结论缺血性脑病患儿临床主要表现为嗜睡、原始反应活跃、过度兴奋等,CT检查及MRI检查均可作为诊断参考指南,但MRI对病变的检出率明显高于CT,可更早发现基底结节区损伤,CT检查可更早发现蛛网膜下损伤。更多还原

【Abstract】 Objective To analyze the diagnostic results of magnetic resonance imaging(MRI) and CT of neonates with hypoxic-ischemic encephalopathy in the neonatal intensive care unit(NICU). Methods A total of 124 neonates with ischemic encephalopathy in our hospital from April 2016 to April 2018 were selected for the study. All patients underwent CT and MRI at 2 w after birth. The diagnostic features of the two were analyzed. Results There were 5 cases of normal CT indexing, and there were 35 mild cases, 75 moderate cases and 9 severe cases. The diagnostic accuracy rate of CT examination on neonates with ischemic encephalopathy was 95.67%. MRI indexing showed there were 44 mild cases, 70 moderate cases and 10 severe cases, and the diagnostic accuracy rate was 100%. In CT examination, there were 9 cases of basal ganglia thalamic injury, 79 cases of cerebral edema, 3 cases of cerebral artery infarction, 12 cases of ventricular hemorrhage and 3 cases of parsagittal area injury, and the total detection rate was 85.48%. In MRI examination, there were 7 cases of basal ganglia thalamic injury, 88 cases of cerebral edema, 5 cases of cerebral artery infarction, 17 cases of ventricular hemorrhage and 5 cases of parsagittal area injury, and the total detection rate was 98.39%, and there was a statistically significant difference in the total detection rate of the two examination methods(P<0.05). There were different degrees of cerebral edema in 124 children patients. CT examination showed that there were low-density lesions in the white matter area of cerebral hemisphere, with diffused distribution, CT value between 16 and 20 Hu and blurred boundary. MRI imaging features showed low signal on T1WI and high signal on T2WI(cerebral edema). Imaging findings of patients cortical and subcortical white matter hemorrhage showed high signal on T1WI and low signal on T2WI(intracranial hemorrhage). Imaging findings of patients with subarachnoid hemorrhage showed high or low signal on T1WI and low signal on T2WI. Impaired white matter showed a slightly flaky low signal on T1WI and high signal on T2WI. Basal ganglia and brainstem injury showed a heterogeneous or homogeneous high signal on T1WI and a low signal on T2WI. Conclusion The clinical manifestations of children patients with ischemic encephalopathy are sleepiness, active primary reaction and excessive excitement, etc. CT and MRI can be used as a reference guide for diagnosis. However, the detection rate of MRI on lesions is significantly higher than that of CT, and MRI can earlier find basal nodule area injury, and CT can earlier detect subarachnoid damage.更多还原