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目的探讨苍白球 MRI 信号改变与高胆红素血症的严重程度及其相关因素关系,为胆红素脑病诊断与预后判定提供客观依据。方法 36例高胆红素血症新生儿(TSB>342 μmol/L)在生后[10±6(2～34)]d 接受头部 MRI 检查。场强1.5～3.0 Tesla,扫描序列为 T1WI,T2WI 和 DWI。2名不知被检者病史的放射科医师分析 MRI 结果。结果首次 MRI 有20例苍白球 T1WI 呈对称性高信号。有苍白球信号改变组的 TSB、B/A 及 UCB 均显著高于无改变组[(605.28±89.19)μmoL/L vs.(438.19±67.89)μmol/L,(1.08±0.18)vs.(0.77±0.16),(555.49±92.3)μmol/L vs.(412.01±54.8)μmol/L,P=0.000],所有 MRI-DWI 均未见信号改变;TSB 在342.0～427.5 μmol/L 者9例,未见苍白球信号改变,427.5～513.0 μmol/L 者7例,有改变者3例,超过525.0 μmol/L 20例,有改变者17例,黄疸程度与苍白球信号改变有密切关系(χ~2=15.000,P=0.000);15例 ABE 苍白球 T1WI 均呈对称性的高信号(χ~2=17.601,P=0.000),同时3例 T2WI 苍白球也呈对称性稍高信号(TSB 分别为,745.3 μmol/L,735.7 μmol/L,707.6μmol/L)。7日内入院的25例中,16例苍白球有改变,平均入院时间显著晚于9例无改变者[(121.5±39.9)h vs.(68.9±35)h,P<0.03]。6例接受了第2次MRI,其中3例 ABE 有2例苍白球信号转为 T2WI 高信号,临床均表现脑瘫,另1例苍白球信号正常,但有听力异常;余3例非 ABE 患儿,2例苍白球信号转为正常,1例两次均无苍白球信号异常,目前发育正常。结论 MRI T1WI 苍白球对称性高信号,与高胆红素血症的严重程度及暴露时间密切关系,是新生儿 ABE 的重要表现特征。T1WI 高信号转变为 T2WI 高信号可能提示预后不良。
Objective To investigate the relationship between the change of MRI signal of globus pallidus and the severity of hyperbilirubinemia and its related factors so as to provide an objective basis for the diagnosis and prognosis of bilirubin encephalopathy. Methods Thirty-six neonates with hyperbilirubinaemia (TSB> 342 μmol / L) underwent MRI on the head [10 ± 6 (2 ~ 34)] days after birth. Field strength 1.5 ~ 3.0 Tesla, scan sequence T1WI, T2WI and DWI. Two radiologists, who did not know the subject’s medical history, analyzed MRI findings. Results The first MRI had 20 cases of globus pallidus T1WI symmetrical high signal. TSB, B / A and UCB in the group with pallidal signal were significantly higher than that in the group without changes [(605.28 ± 89.19) μmol / L vs. (438.19 ± 67.89) μmol / L, (1.08 ± 0.18) vs. There was no signal change in all MRI-DWIs. There were 9 cases of TSB between 342.0 and 427.5 μmol / L, There was no change in the signal of globus pallidus in 427.5 ~ 513.0 μmol / L in 7 cases. There were 3 cases in which there was a change, more than 525.0 μmol / L in 20 cases. There were 17 cases with changes. The degree of jaundice was closely related to the signal of globus pallidus (χ ~ 2 = 15.000, P = 0.000). Symmetric high signals were observed in 15 cases of ABE globus pallidus (χ ~ 2 = 17.601, P = 0.000) 745.3 μmol / L, 735.7 μmol / L, 707.6 μmol / L). Of the 25 patients admitted within 7 days, 16 had a change of pale globus pallidus, and the average admission time was significantly later than that of 9 patients without change [(121.5 ± 39.9) h vs. (68.9 ± 35) h, P <0.03). Six of the 6 patients underwent the second MRI. Three of the three ABE patients had the signal of the globus pallidus converted to T2WI high signal. All patients showed cerebral palsy and the other had normal globus pallidus, , Two cases of globus pallidus turned normal, and none of them had abnormalities of globus pallidus twice. Conclusion MRI T1WI globus pallidus high symmetry signal, and the severity of hyperbilirubinemia and exposure time is closely related to neonatal ABE is an important performance characteristics. The conversion of T1WI high signal into T2WI high signal may indicate poor prognosis.