临床儿科杂志 ›› 2015, Vol. 33 ›› Issue (3): 205-.doi: 10.3969j.issn.1000-3606.2015.03.002

• 专家笔谈 • 上一篇    下一篇

早产儿脑白质损伤磁共振成像诊断基础与评价

毛健   

  1. 中国医科大学附属盛京医院儿科(辽宁沈阳 110004)
  • 收稿日期:2015-03-15 出版日期:2015-03-15 发布日期:2015-03-15

Diagnosis and evaluation on the MRI findings in the premature infants with white matter injury

 MAO Jian   

  1. Department of Pediatrics, Shengjing Hospital, China Medical University, Shenyang 110004, Liaoning, China
  • Received:2015-03-15 Online:2015-03-15 Published:2015-03-15

摘要: 随着新生儿重症监护病房(NICU)诊治技术的进步,降低了早产儿的死亡率,但是新生儿的神经发育异常发生率仍处于较高水平。人们越来越认识到,在早产的儿童中认知缺陷常可发生于没有显著损伤和脑性瘫痪时,其通常由于非严重的脑白质损伤(源于围生期)。微小囊性和弥漫性白质损伤常需要磁共振成像(MRI)才能发现,在早产儿脑损伤的构成中占据主导地位。早产儿脑白质损伤的靶细胞和组织不仅局限于前体少突胶质细胞和白质,也可以有神经元和灰质受累。实际上,脑白质损伤早产儿脑发育轨迹是破坏性损伤和异常发育过程的共同作用的结果。目前临床应用的MRI不仅能在损伤的早期发现微小性和弥漫性损伤,而且可以描述白质髓鞘化进程,纤维素发育及皮质成熟和脑的功能连接。但是,应用不同MRI技术在整个生命周期中准确反映脑发育上需要深入和长期的研究。

Abstract: Despite that improved neonatal intensive care unit therapies have reduced the mortality of preterm neonates, neonatal neurodevelopmental morbidity persists at high rates. There is increasing recognition that following perinatal brain injury, cognitive deficits in preterm neonates can often occur in the absence of significant impairment and cerebral palsy often due to non-severe white matter injury (WMI). Minicystic and diffusive white matter lesions that need MRI detecting make up the predominant role in the preterm brain injury. The target cells and tissue of WMI in the preterm infant not only focus to preoligodendrocytes and white matter, but also involve neurons and grey matter. In fact, brain developmental trajectory in the premature infant with WMI is a mixed disorder of destructive and dysmature processes. Current MRI applied with high resolution could detect the punctate and diffusive WMI at early stage, distinguish the hemorrhagic lesions from reactive gliosis, analyze cerebral metabolism, and even describe the developmental progresses of myelination, fiber tract, cortex and cerebral connectome. But the predictive value of different MRI techniques in brain development requires more and long-term research through the all life stages.