目的 结合常规MRI和弥散加权成像(DWI)探讨早产儿脑白质损伤(CWMD)的较客观分类方法,动态评价不同类型CWMD的变化规律及临床意义.方法 517例早产儿行常规MRI和DWI检查,确诊早产儿CWMD212例,对其中55例随访.结果随病变累及区域数目不同,异常信号有特征性分布及形态学改变,呈现一系列动态变化,并与神经发育结局有较好的相关性.根据早期CWMD类型可以预测后期发生脑室周围白质软化(PVL)的类型,反之根据PVL类型可以推测早期CWMD类型.早期(1周内)DWI能提早发现病变,在一定程度上预示预后.常规MRI晚期(3周左右)检查能高度预测患儿预后.结论常规MRI和DWI相结合可动态观察CWMD病变受累区域,与形态学相结合可较客观评价患者预后,并对高危早产儿进行早期合理康复.%Objective To explore the classification, evoluation and clinical significance of premature infants with cerebral white matter damage (CWMD) diagnosed by MRI-DWI. Methods Conventional MRI and DW1 were performed on 517 premature infants, 212 cases were diagnosed as CWMD. Follow-up was performed on 55 cases of the 212 ones. Results Abnormal signal in MRI had its distinctive distribution and morphology. The abnormal signal presented a serial evolution. Considerable consistency occurred between the type of lesion and neurological development outcome. The type of CWMD in the earlier period could predict the type of periventricular leukomalacia (PVL) in the later period, the type of PVL could predict the type of CWMD too. In the earlier period (in the first week) , DWI could detect pathology ahead of MRI and indicate prognosis in a degree. While in the later period (about the 3th week), MRI could predict exact neurological development outcome. Conclusion MRI-DWI can be used to observe the dynamic lesion regions of CWMD, which combined with pathology can assess prognosis and perform reasonable rehabilitation on premature infants with CWMD.
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