摘要
目的 通过对低血糖患儿进行低血糖后早期、动态的MRI检查,结合临床特征探讨不同程度低血糖脑损伤患儿的MRI改变。方法 选取我院2005年5月至2013年7月以低血糖收入院,在低血糖后1周内完善首次常规MRI及弥散加权成像（diffusion-weighted imaging,DWI）检查确诊为新生儿低血糖脑损伤的患儿49例。其中34例在低血糖发生后2～3周完善第2次MRI检查,7例完善第3次MRI检查。结果 49例患儿首次MRI均有顶、枕部受累;顶、枕部受累为主33例,顶、枕部合并额叶、颞叶受累6例,弥漫性皮层及皮层下白质受累10例。均表现为受累部位DWI高信号,T1和T2加权像信号改变不明显。部分患儿合并深部脑白质及灰质受累表现。34例患儿第2次MRI检查,有20例表现为损伤部位DWI低信号,T1加权像低信号,T2加权像高信号,3例较前略吸收,11例未见异常信号。7例患儿完善第3次复查,分别出现脑软化,髓鞘发育落后,白质容积减小,胼胝体发育不良。对比不同程度脑损伤患儿的临床症状,发现临床症状较重者脑损伤也较重。结论 低血糖脑损伤具有顶、枕部易损性。低血糖后1周内完善DWI检查对急性期低血糖脑损伤有提示作用。MRI动态观察发现轻症损伤可恢复。损伤较重的患儿可出现坏死及脑软化。部分合并深部白质、灰质损伤的病例,不能除外缺氧缺血所致。
Objective To investigate the imaging features in neonates with hypoglycemic brain injury by early and serial MRI.Methods Neonates who were admitted to neonatal department from May 2005 to Jul 2013 received MRI and diffusion-weighted imaging（DWI） scan within 7 days after hypoglycemia.Fortynine neonates were diagnosed with hypoglycemic brain injury.Thirty-four neonates received second MRI scan between 2 ～3 weeks after hypoglycemia.Seven neonates received third MRI scan.Results All the 49 neonates showed hyperintensity on DWI in the regions of occipital and parietal lobe for the first MRI scan（mainly involved 33 cases）.Six cases combined frontal lobe and temporal lobe.Ten cases presented widespread cortex and white matter involvement.All the cases presented hypointensity on DWI for the affected area,T1 and T2 weighted image signal changes were not obvious.Some cases presented deep white matter and gray matter injury.Thirty-four cases received second MRI scan between 2 ～3 weeks after hypoglycemia,20 presented hypointensity on DWI,hypointensity on T1 weighted image and hyperintensity on T2 weighted image.Eleven cases with normal signals,and the other 3 were absorbing.Seven cases received third MRI scan,appeared encephalomalacia,myelin retardation,white matter volume decreased,hypoplasia of corpus callosum.The more severe the clinical symptoms was,the more severe the degree of brain injury showed.Conclusion Cerebral occipital and parietal regions are the most vulnerable in neonatal hypoglycemic brain injury.Early DWI for the imaging diagnosis of hypoglycemic brain injury should be taken within one week after hypoglycemia.Mild injury is recoverable,but severe would chang into necrosis and encephalomalacia.Some combined deep white and gray matter injury might related to hypoxia and ischemia.
出处
《中国小儿急救医学》
CAS
2014年第5期263-267,共5页
Chinese Pediatric Emergency Medicine
关键词
低血糖
脑损伤
磁共振成像
新生儿
Hypoglycemia
Brain injury
Magnetic resonance imaging
Neonate
