CAJ | 학술논문

目的探讨新生儿苍白球(GP)及下丘脑(STN)T1WI对称性高信号的危险因素.方法回顾性分析2008年8月-2014年6月在深圳市人民医院行头颅MRI检查,有完整临床资料的新生儿186例,确定GP及STN是否有T1WI对称性高信号,其中15例新生儿于首次MRI后1～5个月后行MRI复查.比较GP及STN有/无T1WI高信号的新生儿间胎龄、出生后年龄、性别、窒息史、高胆红素血症和经皮肤胆红素值(TCB)差异是否有统计学意义,采用Logistic回归分析比较在单因素分析中差异有统计学意义的因素与苍白球及下丘脑T1WI高信号的相关性,并采用ROC曲线确定危险因素的分界值.结果 186例新生儿中138例(74.2％)出现GP及STN出现对称性T1WI高信号.各观察指标中,TCB、胎龄和检查时年龄在GP及STN有无高信号的新生儿间差异有统计学意义[TCB:(132±62)比(91±55) μmol/L(t=3.935,P＜0.01);胎龄:(36.1±2.6)比(34.8±3.4)周(t =2.263,P=0.027);检查时年龄:(9±5)比(19±7)d(=8.992,P＜1.11)].15例有随访MRI的新生儿GP及STN均观察到对称性T1WI高信号,1～5个月复查头颅MRI时GP及STN的T1WI高信号消失,且体格检查均无异常.Logistic回归分析显示新生儿MR检查时年龄与GP及STN T1WI高信号呈负相关(OR=0.795,95％CI0.739 ～0.856,P＜0.01).ROC曲线确定年龄分界值为20 d.＞20d新生儿出现苍白球及下丘脑出现对称性T1WI高信号的发生率为16.1％,≤20 d为83.2％,(x2 =51.084,P＜0.01).结论新生儿颅脑MRI出现GP及STN对称性T1WI高信号与年龄呈负相关,为一过性改变,较常见于＜20 d的新生儿,并随着新生几年龄增加而消失,不能作为核黄疸和新生儿缺血缺氧性脑病的特异性征象.
목적 탐토신생인창백구(GP)급하구뇌(STN)T1WI대칭성고신호적위험인소.방법 회고성분석2008년8월-2014년6월재심수시인민의원행두로MRI검사,유완정림상자료적신생인186례,학정GP급STN시부유T1WI대칭성고신호,기중15례신생인우수차MRI후1～5개월후행MRI복사.비교GP급STN유/무T1WI고신호적신생인간태령、출생후년령、성별、질식사、고담홍소혈증화경피부담홍소치(TCB)차이시부유통계학의의,채용Logistic회귀분석비교재단인소분석중차이유통계학의의적인소여창백구급하구뇌T1WI고신호적상관성,병채용ROC곡선학정위험인소적분계치.결과 186례신생인중138례(74.2％)출현GP급STN출현대칭성T1WI고신호.각관찰지표중,TCB、태령화검사시년령재GP급STN유무고신호적신생인간차이유통계학의의[TCB:(132±62)비(91±55) μmol/L(t=3.935,P＜0.01);태령:(36.1±2.6)비(34.8±3.4)주(t =2.263,P=0.027);검사시년령:(9±5)비(19±7)d(=8.992,P＜1.11)].15례유수방MRI적신생인GP급STN균관찰도대칭성T1WI고신호,1～5개월복사두로MRI시GP급STN적T1WI고신호소실,차체격검사균무이상.Logistic회귀분석현시신생인MR검사시년령여GP급STN T1WI고신호정부상관(OR=0.795,95％CI0.739 ～0.856,P＜0.01).ROC곡선학정년령분계치위20 d.＞20d신생인출현창백구급하구뇌출현대칭성T1WI고신호적발생솔위16.1％,≤20 d위83.2％,(x2 =51.084,P＜0.01).결론 신생인로뇌MRI출현GP급STN대칭성T1WI고신호여년령정부상관,위일과성개변,교상견우＜20 d적신생인,병수착신생궤년령증가이소실,불능작위핵황달화신생인결혈결양성뇌병적특이성정상.
Objective To determine risk factors of T1 WI high signal intensity at globus pallidus and subthalamic nucleus (GP and STN) of neonates.Methods Brain MR images of 186 neonates with intact clinical files were retrospectively reviewed to identify whether there were T1WI high signal intensity at GP and STN.Among them,15 neonates received followed-up MR imaging in 1-5 months after first MR examination.Statistic comparison of clinical features between neonates with and without T1WI high signal intensity at GP and STN were performed using univariate analyses.Then,multiple Logistic regression analysis was used to identify the risk factors of T1WI high signal intensity at GP and STN among those factors which were statistical significant at univariate analyses.ROC curve was employed to determine the cut-off value of the risk factors.Results T1WI high signal intensity at GP and STN was identified in 74.2％ neonates (138/186).At univariate analyses,the following factors were found with statistical difference between neonates with and without T1 WI hyperintensity at GP and STN:transcutaneous bilirubin (TCB),(132 ±62) vs (91 ± 55) μmol/L (t =3.935,P ＜ 1.11);gestational age,36.0 ± 2.6 weeks vs 34.8 ± 3.4 weeks (t=2.263,P=0.027);age,9 ±5 days vs 19 ±7 days (t =8.992,P＜0.11).Multiple Logistic regression analysis revealed a significant negative contribution of age to T1WI hyperintensity at GP and STN (OR =0.795,95％ CI 1.739-0.856,P ＜ 0.01).T1 WI hyperintensity at GP and STN was seen in the fifteen neonates with followed-up MRI at the first MR imaging.It was disappeared in the followed-up MR imaging and all the neonates developed well without any remarkable abnormalities at physical examinations.ROC curve determined the cut-off value of age was 20 days (The incidence of T1 WI high signal intensity at GP and STN was 16.0％ in neonates ＞ 20 days and 83.2％ in those ≤ 20 days,respectively χ2 =51.084,P ＜ 0.01).Conclusions T1 WI high signal intensity at GP and STN of neonates'brain MR imaging is common,and is relatcd to their age at examination.It should be regarded as a transient phenomenon instead of a sign of kernicterus and asphyxia.