磁敏感加权成像在早产儿伴脑室旁白质损伤中的应用研究

摘要

目的 脑室旁白质损伤是早产儿围生期窒息后常见的脑损伤类型之一,其MRI表现具有特征性,但常规序列难以区分病灶内是否合并出血,而出血与否可能影响治疗和预后.该研究应用磁敏感加权成像( SWAN)来检测存在白质损伤的早产儿脑内的出血性病变.方法 对临床怀疑围生期窒息后脑损伤的75例早产儿行头颅GE HDx Twin Speed 3.0T MRI检查,扫描序列包括T1FLAIR、T2FLAIR、DWI和SWAN.结果 44例(58.7％)早产儿存在脑室旁白质损伤,其中4例(9.1％)存在出血性白质损伤.在这4例中有3例合并生发基质出血-脑室内出血；4例合并小脑出血；1例合并蛛网膜下隙出血.结论 脑室旁白质损伤中绝大多数为非出血性损伤,当伴有生发基质出血或脑室内出血时,脑室周围白质损伤病灶中常存在出血.%Objective Periventrirular white matter injury represents the most significant problem which leads to neonatal mortality and long-term neurologic deficits in preterm infants. It was difficult to distinguish hemorrhagio from non-hemorrhagic lesions by conventional MR sequences. Identification of small hemorrhages can provide useful information regarding the nature of injury, guide treatment and estimate the prognosis. The aim of the study was to detect hemor-rhagic lesions in periventricular white matter injury (PWMI) following perinatal asphyxia using the susceptibility weighted imaging, called T2 Star Weighted Angiography (SWAN) in preterm infants. Methods Seventy-five preterm infants who were suspected of brain injury following perinatal asphyxia underwent MR scanning using a GE HDx Twin Speed 3.0T MR scanner. All patients were evaluated using SWAN in addition to fluid-attenuation inversion recovery (FLAIR) and diffusion weighted imaging (DWI). Results Imaging findings demonstrated that 44 (58.7%) infants had PWMI, among which 4 (9.1%) infants had hemorrhagic white matter injury and cerebellar hemorrhage, and 3 infants had germinal matrix hemorrhage-inrraventricular hemorrhage, and 1 infent had subarachnoid hemorrhage. Conclusions PWMI is a common type of brain injuries following perinatal asphyxia among preterm infants and is non-hemorrhagic lesions in most cases. Hemorrhagic PWMIs are often accompanied by GMH-IVH and cerebellar hemorrhage.