新生儿窒息CT还是核磁共振好
健康咨询描述：
朋友的女儿出生时，有轻度窒息，医生要求做脑部核磁共振，最后给出的诊断室:右侧基底节区点状异常信号灶符合轻度缺血缺氧改变，请结合临床密切随访复查。
想得到怎样的帮助：这到底严重么？需不需要治疗？（感谢医生为我快速解答——该。）
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时间： 13:48:09
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如果医生诊断为缺血缺氧脑病的话那么请你立即要提高警觉。 因为缺血缺氧脑病很有可能造成脑部的神经细胞永久性损伤。影响到小儿今后正常的神经运动发育。这样需要你时时保持对婴儿发育状态的关注。最好在小儿神经科门诊长期观察。1个月复查1次。做一次发育评价。跟踪婴儿最新情况。再有一个是治疗：如果我们诊断为缺血缺氧脑病的话。 先不要怕早期干预治疗最关键。
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方法二：点击浏览器上的收藏按钮收藏问题。The Value of MRI and CT in Diagnosis of Neonatal Hypoxic-ischemic Encephalopathy
作者中文名
新生儿,缺氧缺血性脑病,磁共振成像,CT
英文关键词
newborn,hypoxicschemicencephalopathy,MRI,CT
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目的：分析比较核磁共振(MRI)和电子计算机断层扫描(CT)在反映新生儿缺氧缺血性脑病(HIE)脑损伤情况及影像分度上的意义：探讨MRI加权弥散成像(DWI)、张量成像(DTI)在HIE的运用价值。
方法：40例HIE患儿(足月儿35例，早产儿5例)于生后11天内同步进行MRI及CT检查，并与临床分度进行比较。应用MRI主要观察T1WI、T2WI的异常信号灶并进行影像分度；DWI上测各脑叶表观弥散系数(ADC值)并定量分析：DTI上测白质纤维束各向异性分数(FA值)。CT主要观察CT值、低密度灶、形态学情况及出血区，并进行影像分度。
结果：35例足月HIE患儿MRI影像分度及CT旧法、新法影像分度与临床分度均有高度关连性(列联系数为0.725、0.731、0.723)；以HIE临床表现为诊断标准，CT检出率为91.4％，假阴性率为8.6％，而MRI检出率为100％。26例轻度HIE患儿中，临床和影像分度符合率为26.9％(CT旧法)、46.2％(CT新法)、61.5％(MRI)；8例中度HIE患儿中，MRI检出6例、CT检出5例。在34例轻、中度HIE中，MRI示2例基底节出血，发现率为5.9％，CT示9例蛛网膜下腔出血(1例合并脑室内出血)，发现率26.5％；1例重度HIE患儿MRI及CT均示多灶性出血。在足月HIE患儿中，各脑叶ADC值由高至低顺序依次为顶叶、额叶、枕叶和颞叶；中、重度HIE组双顶叶的ADC值小于轻度组，差异具有统计意义(P=0.004)；中、重度HIE组生后3～5天各脑叶的ADC值明显低于1～2及5天以上的ADC值(P=0.026、0.020)。在足月HIE患儿中，FA值由高至低依次为内囊后肢(0.467)、胼胝体压部(0.429)、胼胝体膝部(0.399)、内囊膝部(0.284)和内囊前肢(0.258)。5例轻度HIE早产儿的脑叶ADC值及白质纤维束FA值减低顺序同35例足月HIE患儿，早产儿的FA值与足月儿无统计学差异，但早产儿的各脑叶ADC值均大于足月儿，其中双枕叶有统计学意义(P=0.049)。
结论：国内众多影像分度法尚需进一步评估其准确性，诊断HIE应以临床表现为主，影像表现及分度可作为诊断参考指针之一。MRI异常检出率较CT高，能更早检测出基底节损伤；而CT更能发现蛛网膜下腔出血。MRI除常规T1WI、T2WI，尚可用DWI及ADC值定量分析病情、DTI及FA值了解脑髓鞘生长发育和病变情况。
OBJECTIVE: By comparing and analyzing the difference of image grade of using MRI and CT in response to brain-injured levels caused by hypoxic-ischemic encephalopathy(HIE) in neonates to discuss the utility of using diffusion weighted MR imaging and diffusion tensor imaging in HIE.METHODS: We have synchronously examined 40 HIE neonates (Including 35 full term infants and 5 preterm infants) using MRI and CT in 11 days after birth, and compared with clinical grade. MRI was used to observe abnormal signal of T1WI and T2WI and make image grades. DWI was used to measurement and quantitative analysis apparent diffusion coefficient(ADC) values in brain lobes, and DTI was used to measurement Fractional Anisotropy(FA) values in brain white matter fibre bundles. CT was applied to observe CT values, low density range, morphological condition and hemorrhage condition.RESULTS: There was highly correlation among MRI image grade, old and new CT image grade to compare with clinical grade in 35 full term HIE infants (contingency coefficient was 0.725, 0.731, and 0.723, respectively). HIE clinical diagnosis w therefore, CT scan had 91.4% detection rate and false negative rate was 8.6%. However, MRI had 100% detection rate. In 26 slight HIE infants (grade I ) that image grade appear equivalent and the coincident rate was 26.9%( CT old image grade)
46.2%( CT new image grade) and 61.5%( MRI image grade). In 8 medium HIE infants (grade ) that MRI and CT scan showed 6 and 5 infants have equal image grade. In 34 HIE infants with grade I and II that MRI showed 2 cases have basal ganglia hemorrhage(occur rate was 5.9%) and CT scan showed 9 HIE infants have subarachnoid hemorrhage(in which 1 case combine with intraventricular hemorrhage, occur rate was 26.5%). One serious HIE infant (grade) that MRI and CT scan show complex hemorrhage. In all full term HIE infants that brain lobes ADC values from the higher value to the grassroots were bilateral parietal lobes, frontal lobes, occipital lobes and temporal lobes, respectively. The infants with grade
and HIE group that bilateral parietal lobes ADC values were lower than the infants with grade I HIE group and have significantly different (P= 0.004). In addition, we detected that infants with grade II andlll HIE group have lower ADC value in 3~5d after birth than 1-2 days (P= 0.026) and lower than after 5 days, as well (P= 0.020). The FA values from the higher value to the grassroots were posterior limb of the internal capsule(0.467), splenium of corpus callosum(0.429), genu of corpus callosum(0.399), genu of the internal capsule(0.284) and anterior limb of the internal capsule (0.258), respectively. Five slight HIE preterm infants (grade ) had similar trend of brain lobes ADC value and myelination development FA value to the HIE term infants. Even there was no significantly different in the FA value between preterm infants and full term infants, the preterm infants had higherbrain lobes ADC value than full term infants especially on bilateral occipital lobes (P =0.049 ).CONCLUSION: Many image grage methods need further study to estimate their accuracy. When the pediatricians make HIE diagnosis who must first consider clinical manifestation then consulting with image manifestation and image grade. MRI is proved superior than CT scan in detecting brain hypoxic-ischemic injury, and MRI in detecting basal ganglia injury is earlier than CT scan. However, CT scan is more sensitive in detecting subarachnoid hemorrhage. In addition to T1WI and T2WI, we can use DWI and ADC value to quantitatively analyze HIE condition and use DTI and FA value to understand myelination development and pathological changes conditions.
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