摘要
目的：探讨足月新生儿大脑中动脉（MCA）缺血性脑梗死的早期MRI表现及其在运动预后评估中的价值。方法：回顾性分析26例MRI检查确诊的足月新生儿MCA缺血性脑梗死的早期MRI资料及随访至1岁时的运动发育情况。全部病例均采用Siemens Avanto 1.5T超导型MR机行脑部常规MRI及DWI检查，6例同时行SWI检查。采用Fisher确切检验来评价MR表现与运动预后的关系。结果：26例患儿中混合梗死12例，浅部梗死14例，常规MRI表现为MCA梗死区呈大片状稍长T1稍长T2信号，灰白质分界不清，其中6例可见皮质坏死；DWI表现为梗死区呈高信号，ADC图呈低信号，边界清晰，16例可见皮质脊髓束受累（其中混合梗死12例，浅部梗死4例），14例丘脑受累，6例胼胝体受累。混合梗死（P＜0.05）和皮质脊髓束受累（P＜0.05）高度预示偏瘫。结论：足月新生儿MCA缺血性脑梗死早期可出现梗死区皮质坏死和累及皮质脊髓束、丘脑、胼胝体，DWI能显示梗死区的范围及受累情况，可早期评估预后。
Abstract
Objective: To investigate the early MRI features of arterial ischemic stroke in middle cerebral artery(MCA) in full term neonate and evaluate their prognostic value in motor function. Methods: Early MRI appearances and clinical follow-up records of motor developments from birth to 1 year in 26 full term neonates with MCA ischemic strokes were retrospectively analyzed. All patients underwent conventional MRI and DWI examination by Siemens Avanto 1.5 Tesla scanner. SWI sequence was added in 6 cases. Correlation between MR findings and motor prognosis was assessed by Fisher exact test. Results: Among all the 26 cases, 12 had mixed infarctions, and 14 had superficial infarctions. Conventional MRI showed big patchy slight hypointensity on T1WI and slight hyperintensity on T2WI in the affected areas with poor differentiation of grey and white matter. Cortical necrosis was found in 6 cases. DWI showed hyperintense lesions and reduced ADC in the infarction. The delineation of the lesions was better in DWI than routine MRI. The corticospinal tract was involved in 16 cases (mixed infarctions in 12 cases, superficial infarctions in 4 cases), thalamus was involved in 14 cases, and corpus callosum was involved in 6 cases. Mixed infarctions(P＜0.05) and corticospinal tract involvement(P＜0.05) were highly predictive of hemiplegia. Conclusion: Cortical necrosis and involvement of corticospinal tract, thalamus and corpus callosum may be presented in the early MCA ischemic stroke in full term neonates. DWI can show the infarction and involvement areas, and estimate the prognosis at the early stage.
关键词
梗塞 /
大脑中动脉 /
婴儿 /
新生 /
磁共振成像
Key words
Infarction /
middle cerebral artery /
Infant /
newborn /
Magnetic resonance imaging
何四平;王 海;徐和平;陈 桦;汪 圣;罗韦华.
新生儿脑梗死早期MRI表现及其在预后评估中的价值[J]. 中国临床医学影像杂志. 2015, 26(3): 157-161
HE Si-ping;WANG Hai;XU He-ping;CHEN Hua;WANG Sheng;LUO Wei-hua.
Early MRI features and their prognosis value in neonatal cerebral infarction[J]. Journal of China Clinic Medical Imaging. 2015, 26(3): 157-161
中图分类号：
Ｒ722.1
R743
Ｒ445.2
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