磁敏感加权成像在新生儿高胆红素血症颅内出血的应用研究

doi:10.12117/jccmi.2018.11.002

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摘要目的：探讨磁敏感加权成像在新生儿高胆红素血症颅内出血中的应用价值。材料和方法：对120例新生儿吸纳入组行常规MRI和SWI扫描，受试者按照早产儿和足月儿及有/无高胆红素血症分为4组，每组30例。2名放射科医师采用双盲法分析MRI和SWI图像，记录检测的出血病例数和出血灶数目；分析不同部位颅内出血在SWI上的表现。结果：①MRI和SWI对新生儿颅内出血的检出阳性率比较有统计学意义，SWI优于常规MRI（P<0.05）。②脑出血病例43例，其中足月儿16例，早产儿27例，由常规MRI和/或SWI确诊；高胆红素患儿29例，对照新生儿14例。在发生率上早产儿和足月儿差异有统计学意义（P<0.05）。比较高胆红素血症和对照新生儿，发生率差异有统计学意义（P<0.05）。③43例脑出血患儿中，14例新生儿为颅内脑外出血（8例为蛛网膜下腔出血，5例为硬膜下出血，1例为硬膜下出血合并小脑出血），14例均在MRI和SWI图像中显示。脑外出血的检出阳性病例数比较，MRI和SWI两者之间无明显差异（P>0.05）。④SWI图像上，29例新生儿存在脑内出血，其中10例常规MRI未发现出血病灶。新生儿脑内出血包括小脑出血、大脑出血和生发基质-脑室内出血，其中实质出血以微出血（直径＜10 mm）为表现形式，SWI在检出数目上明显优于常规MRI，两者之间的差异有统计学意义（P<0.05）。SWI对生发基质-脑室内出血检出数目与常规MRI比较无明显差异（P>0.05）。⑤43例颅内出血病例SWI检出数目122个，包括室管膜下-脑室内出血19个（15.6%）、大脑实质内出血43个（35.2%）、小脑出血46个（37.7%）、硬膜下出血6个（4.9%）和蛛网膜下腔出血8个（6.6%）。常规MRI检出数目78个，两者比较有统计学意义（P<0.05）。⑥本研究中早产儿生发基质-脑室出血较足月儿多见，大脑实质出血和小脑出血早产儿和足月儿均可发生，硬膜下出血足月儿多见，蛛网膜下腔出血早产儿多见。结论：新生儿高胆红素血症颅内出血发病率较非胆红素血症新生儿高，早产儿发病率较足月儿高，对于这一类新生儿宜行SWI检查早期发现出血灶。SWI对新生儿颅内出血的检出阳性率较MRI高；对实质内出血灶的检出数目和显示清晰度方面均优于常规MRI。联合SWI和常规MRI序列能够提高新生儿颅内出血检出率。

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	郭莉莉1
	王德杭2
	张辉1
	陶维静1
	柏根基1

关键词 ：黄疸, 新生儿, 颅内出血, 磁共振成像

Abstract：Objective: To explore the value and limitation of SWI compared with conventional MRI in intracranial hemorrhage patients with neonatal hyperbilirubinemia. Materials and Methods: We conducted a study including 120 neonates. All 120 neonatal cases received MRI and SWI scanning, two radiologists who don’t know the history of subjects analyzed MRI and SWI images by double blind method. We recorded the detection of hemorrhagic cases and numbers in routine MRI and SWI and analyzed the performances of the intracranial hemorrhage in different locations. Results: ①The detection rates of neonatal intracranial hemorrhage between MRI and SWI were statistically significant(P<0.001), SWI is superior to conventional MRI. In the high blood bilirubin group, the detection positive rates of bleeding in routine MRI and SWI were statistically significant(P<0.05), and in the normal control group, the detection positive rate of bleeding in routine MRI and SWI were not statistically significant(P>0.05).②Among 120 neonates there were 43 cases with intraeranial hemorrhage detected on routine MRI sequences and/or SWI. Among neonates with intraeranial hemorrhage there were 27 preterm and 16 term neonates; 29 neonates with high bilirubin and 14 cases of normal control. The differences of incidences between preterm infants and full term were statistically significant(P<0.05). Incidences of neonatal intracranial hemorrhage between high blood bilirubin group and normal control group were compared, differences were significant(P<0.05). ③Among 43 neonates with intracranial hemorrhage, there were only 14 cases showed extracerebral hemorrhage(8 cases subarachnoid hemorrhage(SAH), 5 cases subdural hemorrhage(SDH), 1 SDH combined with cerebral hemorrhage). All 14 cases were found in both MRI and SWI. The detection positive rates of extracerebral hemorrhage between MRI and SWI were not statistically significant(P>0.05). ④Twenty-nine cases were detected with intracerebral hemorrhage on SWI, and among them 10 cases did not be detected on conventional MRI sequences. Neonatal intracerebral hemorrhage included subependymal hemorrhage/intraventricular hemorrhage(PVH-IVH), intraparenchymal hemorrhage(IPH) and cerebellar hemorrhage(CH). The detection positive rates of PVH-IVH between conventional MRI and SWI did not show obvious statistical significance(P>0.05). The parenchymal hemorrhage(including IPH and CH) always showed the form of microbleeds(foci<10 mm), the detection positive rates of SWI were superior to conventional MRI, the differences were considered as statistically significant(P<0.05). ⑤Among 43 cases with intracranial hemorrhage 122 foci were detected, including 19(15.2%) PVH-IVH, 43(35.2%) IPH, 46(37.7%) CH, 6(4.9%) SDH and 8(6.8%) SAH on SWI. On conventional MRI 78 foci were detected. The comparison was statistically significant(P<0.05). ⑥In our study, the PVH-IVH was detected more among premature than full term infants. The IPH and CH were detected among preterm and full term infants. The SDH was detected more among full term infants and SAH was detected more among premature infants. Conclusion: The incidence of intracranial hemorrhage in premature infants with high blood bilirubin level is higher than normal control infants. SWI is superior to conventional MRI in the detection positive rates and focus numbers of parenchymal hemorrhage and can be used as a powerful supplement to conventional MRI.

Key words： Jaundice, neonatal Intracranial, hemorrhage Magnetic resonance imaging

收稿日期: 2017-12-19

PACS:	Ｒ651.15
	R722.17
	Ｒ445.2

通讯作者: 柏根基，南京医科大学附属淮安第一医院影像科，223300。E-mail：hybgj0541@163.com

作者简介: 郭莉莉（1977-），女，江苏泗阳人，副主任医师。E-mail：guolili163@163.com

引用本文:

郭莉莉1，王德杭2，张辉1，陶维静1，柏根基1. 磁敏感加权成像在新生儿高胆红素血症颅内出血的应用研究[J]. 中国临床医学影像杂志, 2018, 29(11): 764-770.
GUO Li-li1, WANG De-hang2, ZHANG Hui1, TAO Wei-jing1, BO Gen-ji1. The application of MR SWI in intracranial hemorrhage of neonatal hyperbilirubinemia. JOURNAL OF CHINA MEDICAL IMAGING, 2018, 29(11): 764-770.

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http://www.jccmi.com.cn/CN/10.12117/jccmi.2018.11.002 或 http://www.jccmi.com.cn/CN/Y2018/V29/I11/764

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