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目的探讨DWI早期诊断早产儿脑白质损伤(WMD)及评估预后的价值。方法分析不同类型WMD患儿早期DWI和常规MRI特征性表现,随访观察病灶演变和患儿神经心理发育结果。结果首次检查:32例局灶性WMD中,24例DWI表现为半卵圆中心、侧脑室旁白质点簇状和线状或团片状高信号,常规MRI仅17例同时伴稍短T1信号,12例伴短T2信号;8例DWI均未见异常,常规MRI呈短T1伴或不伴短T2信号;11例弥漫性WMD则均表现为侧脑室周围大片状白质DWI高信号,但T1、T2均未见异常。复查:18例点簇状WMD患儿脑实质MRI均未见明显异常,其中6例伴单纯性脑外间隙增宽;14例线状或混合型WMD中,7例发展为PVL,5例发展为PVL后遗改变,2例仅表现为单纯性脑外间隙增宽而脑实质未见异常;11例弥漫性WMD中,4例发展为PVL,7例发展为PVL后遗改变。3种不同类型WMD患儿发育商差异均有统计学意义,而线状或混合型WMD与弥漫性WMD患儿发育商差异无统计学意义。结论 DWI可早期区分不同类型WMD并较好评价预后;点簇状WMD患儿预后较好,线状或混合型和弥漫性WMD患儿预后均较差。
Objective To investigate the value of DWI for the early diagnosis of white matter damage (WMD) in preterm infants and to evaluate the prognosis. Methods The characteristics of early DWI and routine MRI in children with different types of WMD were analyzed. The development of lesions and the neuropsychological development were observed. RESULTS: For the first time, DWI was found in 24 cases of focal WMD in 32 cases with semi-oval center. Clusters of paraventricular white matter and linear or cluster-like high signals were observed in 24 cases of DWI. Only 17 patients with conventional DWI accompanied with slightly shorter T1 signal, 12 cases with short T2 signal; 8 cases of DWI were no abnormalities, conventional MRI was short T1 or short T2 signal; 11 cases of diffuse WMD showed large periventricular white matter DWI high signal, but T1 , T2 were no abnormalities. Retrospectively, there were no significant abnormalities in brain parenchymal MRI in 18 cases of spotted WMD patients, of which 6 cases were complicated with simple extracerebral space. Among the 14 cases of linear or mixed WMD, 7 cases developed PVL and 5 cases developed In 2 cases, the simple extracerebral space was widened without abnormalities in brain parenchyma. Of 11 diffuse WMD cases, 4 cases developed PVL and 7 cases developed PVL. There were significant differences among the three kinds of developmental children with WMD, but there was no significant difference between the linear and mixed WMD children and those with diffuse WMD. Conclusion DWI can differentiate different types of WMD early and evaluate the prognosis better. The spotted WMD patients have a good prognosis, and the prognosis of both linear and mixed WMD patients is poor.