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目的探索新生儿重度缺氧缺血性脑病(HIE)早期弥散加权成像(DWI)动态演变规律及其意义。方法对2006年1月至2007年2月收住我院14例重度 HIE 患儿,分别于生后72 h,7、14、21 d 及8个月行 DWI 及常规 MRI 扫描。结果 72 h内,常规 MRI 的 T_1加权(T_1WI)和 T_2加权(T_2WI)均未见异常,DWI 表现为双侧腹外侧丘脑对称性的高信号;7 d 常规 MRI 表现双侧腹外侧丘脑对称性 T_1WI 高信号,T_2WI 稍低信号,DWI 表现为双侧基底节高信号,而初期腹外侧丘脑高信号消失;14 d 常规 MRI 双侧丘脑、基底节对称性 T_1WI 高信号,T_2WI 低信号;21 d 常规 MRI 双侧丘脑及基底节 T_1WI 高信号,T_2WI 高信号,DWI 则未见明显异常;8个月常规 MRI 脑沟变深、脑室扩大及脑外间隙增宽,基底节 T_2WI 不规则的高信号。结论重度 HIE(主要因急性的完全性窒息所致)生后初期 DWI 显示相同的病变部位(腹外侧丘脑和基底节)和相似的病变程度,但其异常信号很快消失,而常规 MRI 可继之弥补 DWI 的不足。
Objective To explore the dynamic changes and significance of early diffusion-weighted imaging (DWI) in neonates with severe hypoxic-ischemic encephalopathy (HIE). Methods From January 2006 to February 2007, 14 children with severe HIE were admitted to our hospital. DWI and conventional MRI were performed at 72 h, 7, 14, 21 d and 8 months after birth respectively. Results There were no abnormalities in T 1 weighted (T 1 WI) and T 2 weighted (T 2 WI) images in routine MRI within 72 h. DWI showed high signal of bilateral ventromedial thalamus symmetry. The bilateral ventromedial thalamic symmetry T_1WI high signal, T_2WI slightly lower signal, DWI showed bilateral basal ganglia high signal, while the initial ventromedial thalamus high signal disappeared; 14d conventional MRI bilateral thalamus, basal ganglia symmetry T_1WI high signal, T_2WI low signal; 21 d There was no obvious abnormality of T_1WI high signal and T_2WI high signal in bilateral thalamic and basal ganglia in conventional MRI. The abnormal deep cerebral ventricle was enlarged in 8 months, . Conclusions Early onset DWI of severe HIE (mainly due to acute complete asphyxia) shows the same lesion (ventromedial thalamus and basal ganglia) and similar lesions, but the abnormal signal disappears quickly, whereas conventional MRI continues To make up for the lack of DWI.