Carson S C, Hertzberg B S, Bowie J D, Burger P C
Department of Pathology, Duke University Medical Center, Durham, NC 27710.
AJR Am J Roentgenol. 1990 Sep;155(3):595-601. doi: 10.2214/ajr.155.3.2117361.
Periventricular leukomalacia and germinal matrix hemorrhages are major causes of neurodevelopmental abnormalities in the premature neonate. Although sonography is widely used to detect these abnormalities and is thought to be sensitive for hemorrhages and the later cystic stages of periventricular leukomalacia, its sensitivity for the more acute phase of periventricular leukomalacia remains to be determined. It has been difficult to study this issue because periventricular leukomalacia often is not lethal, and in postmortem studies there is usually a considerable interval between the time of in vivo imaging, if any, and the death of the patient. A "prospective" autopsy study was performed on brain specimens from infants who died at less than 1 year of age during a 10-month period. Thirty-five formalin-fixed brains were studied and sonographic images of these specimens were compared with histologic findings in whole brain sections to determine the sensitivity and specificity of sonography for the detection of germinal matrix hemorrhage and periventricular leukomalacia. Sonography identified germinal matrix hemorrhages as small as 5 mm, although smaller lesions were not visualized. Postmortem sonography had a sensitivity of 27% and specificity of 88% for all germinal matrix hemorrhages, but a sensitivity of 100% and specificity of 91% for hemorrhages larger than 5 mm. Periventricular leukomalacia, seen as hyperechoic areas in the periventricular white matter, was not detected as readily. For periventricular leukomalacia, the overall sensitivity and specificity were 50% and 87%, respectively. We conclude that sonography is useful for detecting the larger germinal matrix hemorrhages, but has more limited sensitivity in the early diagnosis of periventricular leukomalacia.
脑室周围白质软化和生发基质出血是早产儿神经发育异常的主要原因。尽管超声检查被广泛用于检测这些异常，并且被认为对出血和脑室周围白质软化的后期囊性阶段敏感，但其对脑室周围白质软化更急性期的敏感性仍有待确定。由于脑室周围白质软化通常不会致命，并且在尸检研究中，在进行活体成像（如果有的话）和患者死亡之间通常有相当长的时间间隔，因此很难研究这个问题。对10个月内死亡年龄小于1岁的婴儿的脑标本进行了一项“前瞻性”尸检研究。研究了35个用福尔马林固定的大脑，并将这些标本的超声图像与全脑切片的组织学结果进行比较，以确定超声检查对检测生发基质出血和脑室周围白质软化的敏感性和特异性。超声检查可识别小至5毫米的生发基质出血，尽管较小的病变无法显示。尸检超声对所有生发基质出血的敏感性为27%，特异性为88%，但对大于5毫米的出血敏感性为100%，特异性为91%。脑室周围白质软化表现为脑室周围白质中的高回声区，不易被检测到。对于脑室周围白质软化，总体敏感性和特异性分别为50%和87%。我们得出结论，超声检查有助于检测较大的生发基质出血，但在脑室周围白质软化的早期诊断中敏感性有限。
