Ment L R, Bada H S, Barnes P, Grant P E, Hirtz D, Papile L A, Pinto-Martin J, Rivkin M, Slovis T L
Department of Pediatrics, Yale University School of Medicine, New Haven, CT, USA.
Neurology. 2002 Jun 25;58(12):1726-38. doi: 10.1212/wnl.58.12.1726.
The authors reviewed available evidence on neonatal neuroimaging strategies for evaluating both very low birth weight preterm infants and encephalopathic term neonates.
Routine screening cranial ultrasonography (US) should be performed on all infants of <30 weeks' gestation once between 7 and 14 days of age and should be optimally repeated between 36 and 40 weeks' postmenstrual age. This strategy detects lesions such as intraventricular hemorrhage, which influences clinical care, and those such as periventricular leukomalacia and low-pressure ventriculomegaly, which provide information about long-term neurodevelopmental outcome. There is insufficient evidence for routine MRI of all very low birth weight preterm infants with abnormal results of cranial US.
Noncontrast CT should be performed to detect hemorrhagic lesions in the encephalopathic term infant with a history of birth trauma, low hematocrit, or coagulopathy. If CT findings are inconclusive, MRI should be performed between days 2 and 8 to assess the location and extent of injury. The pattern of injury identified with conventional MRI may provide diagnostic and prognostic information for term infants with evidence of encephalopathy. In particular, basal ganglia and thalamic lesions detected by conventional MRI are associated with poor neurodevelopmental outcome. Diffusion-weighted imaging may allow earlier detection of these cerebral injuries.
US plays an established role in the management of preterm neonates of <30 weeks' gestation. US also provides valuable prognostic information when the infant reaches 40 weeks' postmenstrual age. For encephalopathic term infants, early CT should be used to exclude hemorrhage; MRI should be performed later in the first postnatal week to establish the pattern of injury and predict neurologic outcome.
作者回顾了有关评估极低出生体重早产儿和脑病足月儿的新生儿神经影像学策略的现有证据。
所有孕周<30周的婴儿应在出生后7至14天进行一次常规头颅超声（US）筛查，并最好在孕龄36至40周时重复检查。该策略可检测到如脑室内出血等影响临床护理的病变，以及如脑室周围白质软化和低压性脑室扩大等提供长期神经发育结局信息的病变。对于头颅超声结果异常的所有极低出生体重早产儿进行常规MRI检查的证据不足。
对于有出生创伤史、血细胞比容低或凝血功能障碍的脑病足月儿，应进行非增强CT以检测出血性病变。如果CT结果不明确，应在出生后第2至8天进行MRI检查以评估损伤的位置和范围。传统MRI所确定的损伤模式可为有脑病证据的足月儿提供诊断和预后信息。特别是，传统MRI检测到的基底神经节和丘脑病变与不良神经发育结局相关。弥散加权成像可能有助于更早地检测这些脑损伤。
超声在孕周<30周的早产儿管理中发挥着既定作用。当婴儿达到孕龄40周时，超声也可提供有价值的预后信息。对于脑病足月儿，应早期使用CT排除出血；应在出生后第一周晚些时候进行MRI检查以确定损伤模式并预测神经学结局。
