CAJ | 학술논문

目的以磁共振成像(MRI)为依据,观察早产儿局灶性脑白质损伤(PWMD)的动态演变,并连续测定病灶及病灶周围区域的表观弥散系数(ADC)变化,探索其临床应用价值.方法 2010年10月至2011年6月中国医科大学附属盛京医院儿科收治的151例早产儿,全部在生后7d内完成MRI,依据扫描结果,随机选取24例PWMD患儿作为病例组(n=24),同时针对每一个病例随机选取同时期出生胎龄相同MRI正常的早产儿作为对照组(n=24),分别测量病例组病灶及病灶周围区域、对照组相应区域的ADC值,病例组在2～5周后复查MRI,并再次测量原病灶及病灶周围区域的ADC值,观察其变化.结果 (1)初次MRI扫描:24例PWMD患儿,全部(100％) DWI显示点簇状高信号,而常规MRI中19例(79.2％)T1加权高信号伴T2加权低信号,4例(16.6％)仅T1加权高信号不伴有T2加权低信号,1例(4.2％)未见异常.复查MRI扫描:全部(100％)DWI显示原病灶区域高信号消失,常规MRI中9例(39.1％)T1加权高信号完全消失,14例(60.9％)T1加权高信号未完全消失,但病灶面积较前缩小.(2)ADC值测定:初次MRI:PWMD病灶区域的平均ADC值为(942 ± 170)×10-3mm2/s,明显低于病灶周围区域(1 554±116)×10-3mm2/s及对照组相同区域(1 524 ±116) ×10-3mm2/s(P均＜0.05).复查MRI:原病灶区域的平均ADC值升至(1 468±195)×10-3 mm2/s,较前显著升高(P＜0.05),但依然低于病灶周围区域(1 586 ±97)×10-3mm2/s(P＜0.05).而病灶周围区域的平均ADC值较初次扫描差异无统计学意义(P=0.212).结论连续监测PWMD患儿病灶及病灶周围区域的ADC值变化,能更加准确且微观的描述其病理改变.
목적 이자공진성상(MRI)위의거,관찰조산인국조성뇌백질손상(PWMD)적동태연변,병련속측정병조급병조주위구역적표관미산계수(ADC)변화,탐색기림상응용개치.방법 2010년10월지2011년6월중국의과대학부속성경의원인과수치적151례조산인,전부재생후7d내완성MRI,의거소묘결과,수궤선취24례PWMD환인작위병례조(n=24),동시침대매일개병례수궤선취동시기출생태령상동MRI정상적조산인작위대조조(n=24),분별측량병례조병조급병조주위구역、대조조상응구역적ADC치,병례조재2～5주후복사MRI,병재차측량원병조급병조주위구역적ADC치,관찰기변화.결과 (1)초차MRI소묘:24례PWMD환인,전부(100％) DWI현시점족상고신호,이상규MRI중19례(79.2％)T1가권고신호반T2가권저신호,4례(16.6％)부T1가권고신호불반유T2가권저신호,1례(4.2％)미견이상.복사MRI소묘:전부(100％)DWI현시원병조구역고신호소실,상규MRI중9례(39.1％)T1가권고신호완전소실,14례(60.9％)T1가권고신호미완전소실,단병조면적교전축소.(2)ADC치측정:초차MRI:PWMD병조구역적평균ADC치위(942 ± 170)×10-3mm2/s,명현저우병조주위구역(1 554±116)×10-3mm2/s급대조조상동구역(1 524 ±116) ×10-3mm2/s(P균＜0.05).복사MRI:원병조구역적평균ADC치승지(1 468±195)×10-3 mm2/s,교전현저승고(P＜0.05),단의연저우병조주위구역(1 586 ±97)×10-3mm2/s(P＜0.05).이병조주위구역적평균ADC치교초차소묘차이무통계학의의(P=0.212).결론 련속감측PWMD환인병조급병조주위구역적ADC치변화,능경가준학차미관적묘술기병리개변.
Objective To observe the dynamic changes of MRI in the preterm infants with punctate white matter damage (PWMD),and to explore the clinical significance of apparent diffusion coefficient (ADC) values by continuously measuring the lesions and surrounding region by applying diffusion weighted imaging (DWI).Method MRI,using conventional and diffusion weighted imaging,was performed in 151 preterm infants within 7 days after birth between October 2010 to June 2011 in NICU.Twenty-four preterm infants with PWMD and 24 controls were obtained according to their MRI results.The control group infants were those with normal MRI results and at the same gestational age as those with PWMDs.The ADC value was measured for the lesions and their surrounding regions,and for the same sites of the controls.All the PWMD were followed up for 2-5 weeks,and apparent diffusion coefficients were measured at the same regions.The variation of magnetic resonance imaging was observed and the apparent diffusion coefficients were compared.Result The first MRI scanning:in the 24 cases with PWMD,high signals on DWI were seen in all patients (100％),increased signal intensity on T1-weighted images were seen in 19 (79.2％) patients,increased signal intensity on T1-weighted images and decreased signal intensity on T2-weighted images were seen in 4 (16.6％) patients.The second MRI scanning:in the 24 cases with PWMD,The high signal on DWI vanished in all patients (100％),the increased signal intensity on T1-weighted images vanished in 9 (39.1％) patients,the increased signal intensity on T1-weighted images did not vanish but was smaller than before in 14 (60.9％) patients.The measurement of ADC values:the mean ADC value of the lesions in the group of PWMD was (942 ± 170) × 10-3 mm2/s,significantly lower than the area surrounding (1 554 ± 116) × 10-3 mm2/s and the same area of the control group (1 524 ± 116) ×10-3mm2/s (P ＜ 0.05).The second MRI scanning:the mean ADC of the lesions in the PWMD group was up to (1 468 ± 195) × 10-3mm2/s,which is significantly higher than before,but still lower than the areas surrounding the lesion (1 586 ± 97) × 10-3 mm2/s (P ＜ 0.05).Conclusion Continuous measurement of ADC values in the lesions and surrounding areas is important to describe the micro-change of PWMD.