磁共振多模态技术对新生儿缺氧缺血性脑病诊断价值的探讨

目的利用核磁共振弥散加权成像（DWI）联合核磁共振波谱分析（1H-MRS）及核磁共振磁敏感成像（SWI）研究HIE的MRI,探讨临床分度及预后关系。方法搜集28例经临床证实的新生儿HIE患者,行常规MRI、DWI、1H-MRS、SWI图,单体素PRESS（TE144ms）序列囊壁或囊内1H-MRS成像,测量N-乙酰天冬氨酸NAA、胆碱Cho、肌酸Cr、乳酸Lac、脂质Lip峰高,计算出Cho/Cr,Cho/NAA,NAA/Cr,并与随访结果进行比较。结果 （1）8例皮层及皮层下沿脑回迂曲点状条状高信号及或幕上幕下蛛网膜下腔少量出血;3例额叶深部白质两侧对称性点状高信号及或沿脑室壁条状高信号半局限性脑水肿;2例表现为基底节区,丘脑高信号伴内囊后肢地信号;1例脑室出血半病侧脑室扩大,皮层下囊状坏死,弥漫性脑水肿。（2）28例患者初次检查,DWI全部表现为对称性异常高信号;22例病变位于颞叶、额叶、顶叶;8例累及两侧基底节区。（3）5例NAA峰显著降低;8例Lac峰明显增高;GLx-a峰明显增高。（4）3例室管膜下斑点状低信号;6例脑室内条状低信号;1例皮层下点状低信号;5例侧脑室旁斑点状低信号。（5）随访2周,25例全部病变显示低信号,6个月和15个月持续性低信号。结论利用磁共振多模态技术能够判断超急性期,急性期的HIE,早期发现中重度HIE,指导临床判断预后。

THE ROLE OF MAGNETIC RESONANCE MULTI MODAL TECHNOLOGY ON THE VALUE OF DIAGNOSIS OF NEONATAL HYPOXIC ISCHEMIC ENCEPHALOPATHY

Objective： Using nuclear magnetic resonance diffusion-weighted imaging（DWI） analysis and nuclear magnetic resonance spectroscopy（1H-MRS） and magnetic resonance imaging（SWI） magnetic susceptibility of HIE MRI, to explore the relationship between clinical grade and prognosis. Methods：Data of 28 cases with neonatal HIE patients confirmed by clinical were collected, conventional MRI, DWI, 1H-MRS, SWI, single voxel PRESS sequence（TE144ms） cystic wall or intracapsular 1H-MRS imaging were used, the measurements of Nacetyl aspartic acid, choline, creatine, NAA, Cho, Cr, Lac, Lip lactic acid lipid peak height were done, then Cho/Cr, Cho/NAA,NAA/ Cr were calculated and compared with the results of follow-up. Results：（1） 8 cases had high signal at cortex and cortex along the gyri tortuosity punctatestrip and a small amount of bleeding or supratentorial infratentorial subarachnoid; 3 cases had high signal at frontal lobe deep white matter bilaterally symmetrical dot and/or cerebral edema along the ventricular wall strip high signal half localized; 2 cases showed basal ganglia, thalamus high signal with the posterior limb signal of the internal capsule; 1 case was of intraventricular hemorrhagesemi disease enlarged lateral ventricles, subcortical cystic necrosis, diffuse brain edema.（2） DWI of 28 patients with initial examination all showed symmetrical abnormal high signal; the lesions of 22 cases were in the temporal lobe, frontal lobe,parietal lobe, temporal lobe; 8 cases involved bilateral basal ganglia.（3） NAA peaks of 5 cases decreased significantly; Lac and GLx-a peaks of 8 cases increased significantly.（4） 3 cases were of low signal under ventricular tube punctate membrane; 6 cases were of strip low signal in ventricule; 1 case was of subcortical punctate hypointense; 5 cases were of low dot signal of lateral ventricle.（5） 2 week follow-up, 25 cases all showed low signal, persisting low signal at 6 months and 15 months. Conclusion： Using magnetic resonance multi modal technol