既往有脑出血的极低出生体重儿白质发育受损。
Impaired white matter development in extremely low-birth-weight infants with previous brain hemorrhage.
作者信息
Ou X, Glasier C M, Ramakrishnaiah R H, Mulkey S B, Ding Z, Angtuaco T L, Andres A, Kaiser J R
机构信息
From the Department of Radiology (X.O., C.M.G., R.H.R., T.L.A.), University of Arkansas for Medical Sciences, Little Rock, Arkansas Pediatric Radiology (X.O., C.M.G., R.H.R.), Arkansas Children's Hospital, Little Rock, Arkansas
From the Department of Radiology (X.O., C.M.G., R.H.R., T.L.A.), University of Arkansas for Medical Sciences, Little Rock, Arkansas Pediatric Radiology (X.O., C.M.G., R.H.R.), Arkansas Children's Hospital, Little Rock, Arkansas.
出版信息
AJNR Am J Neuroradiol. 2014 Oct;35(10):1983-9. doi: 10.3174/ajnr.A3988. Epub 2014 May 29.
BACKGROUND AND PURPOSE
Brain hemorrhage is common in premature infants. The purpose of the study is to evaluate white matter development in extremely low-birth-weight infants with or without previous brain hemorrhage.
MATERIALS AND METHODS
Thirty-three extremely low-birth-weight infants were prospectively enrolled and included in this institutional review board-approved study. Another 10 healthy term infants were included as controls. The medical records of the extremely low-birth-weight infants were reviewed for sonography diagnosis of intraventricular hemorrhage. All infants had an MR imaging examination at term-equivalent age for detection of previous hemorrhage, and their white matter was scored and compared among different groups. DTI measured fractional anisotropy values were also compared voxelwise by tract-based spatial statistics.
RESULTS
Compared with controls, the white matter score was not significantly different in extremely low-birth-weight infants without blood deposition on MR imaging (P = .17), but was significantly worse in extremely low-birth-weight infants with blood deposition on MR imaging but no intraventricular hemorrhage diagnosis by sonography (P = .02), in extremely low-birth-weight infants with grade 1 or 2 intraventricular hemorrhage on sonography (P = .003), and in extremely low-birth-weight infants with grade 3 or 4 intraventricular hemorrhage on sonography (P = .0001). Extremely low-birth-weight infants without blood deposition on MR imaging did not show any white matter regions with significantly lower fractional anisotropy values than controls. Extremely low-birth-weight infants with blood deposition on MR imaging, but no intraventricular hemorrhage diagnosis, did show white matter regions with significantly lower fractional anisotropy values, and extremely low-birth-weight infants with intraventricular hemorrhage diagnosis had widespread white matter regions with lower fractional anisotropy values.
CONCLUSIONS
Previous brain hemorrhage is associated with abnormal white matter in extremely low-birth-weight infants at term-equivalent age, and sonography is not sensitive to minor hemorrhages that are sufficient to cause white matter injury.
背景与目的
脑出血在早产儿中很常见。本研究的目的是评估有或无既往脑出血的极低出生体重儿的白质发育情况。
材料与方法
前瞻性纳入33例极低出生体重儿，并纳入本机构审查委员会批准的研究。另外10例健康足月儿作为对照。回顾极低出生体重儿的病历以进行脑室内出血的超声诊断。所有婴儿在足月等效年龄时均接受磁共振成像检查以检测既往出血情况，并对其白质进行评分并在不同组间进行比较。还通过基于体素的空间统计学逐体素比较弥散张量成像测量的分数各向异性值。
结果
与对照组相比，磁共振成像上无血液沉积的极低出生体重儿白质评分无显著差异（P = 0.17），但磁共振成像上有血液沉积但超声未诊断为脑室内出血的极低出生体重儿白质评分显著更差（P = 0.02），超声诊断为1级或2级脑室内出血的极低出生体重儿（P = 0.003），以及超声诊断为3级或4级脑室内出血的极低出生体重儿（P = 0.0001）。磁共振成像上无血液沉积的极低出生体重儿未显示任何白质区域的分数各向异性值明显低于对照组。磁共振成像上有血液沉积但未诊断为脑室内出血的极低出生体重儿确实显示白质区域的分数各向异性值明显较低，而诊断为脑室内出血的极低出生体重儿有广泛的白质区域分数各向异性值较低。
结论
既往脑出血与足月等效年龄的极低出生体重儿白质异常有关，且超声对足以导致白质损伤的微小出血不敏感。
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