Chakkarapani Elavazhagan, Poskitt Kenneth J, Miller Steven P, Zwicker Jill G, Xu Qi, Wong Darren S T, Roland Elke H, Hill Alan, Chau Vann
Department of Pediatrics (Neonatology), University of British Columbia and BC Children's Hospital, Vancouver, British Columbia, Canada Department of Pediatrics (Neurology), University of British Columbia and BC Children's Hospital, Vancouver, British Columbia, Canada School of Clinical Sciences, University of Bristol, St Michael's Hospital, Bristol, United Kingdom.
Department of Pediatrics (Neurology), University of British Columbia and BC Children's Hospital, Vancouver, British Columbia, Canada Department of Radiology, University of British Columbia and BC Children's Hospital, Vancouver, British Columbia, Canada.
J Child Neurol. 2016 Apr;31(5):553-9. doi: 10.1177/0883073815600865. Epub 2015 Aug 31.
In cooled newborns with encephalopathy, although late magnetic resonance imaging (MRI) scan (10-14 days of age) is reliable in predicting long-term outcome, it is unknown whether early scan (3-6 days of life) is. We compared the predominant pattern and extent of lesion between early and late MRI in 89 term neonates with neonatal encephalopathy. Forty-three neonates (48%) were cooled. The predominant pattern of lesions and the extent of lesion in the watershed region agreed near perfectly in noncooled (kappa = 0.94; k = 0.88) and cooled (k = 0.89; k = 0.87) infants respectively. There was perfect agreement in the extent of lesion in the basal nuclei in noncooled infants (k = 0.83) and excellent agreement in cooled infants (k = 0.67). Changes in extent of lesions on late MRI occurred in 19 of 89 infants, with higher risk in infants with hypoglycemia and moderate-severe lesions in basal nuclei. In most term neonates with neonatal encephalopathy, early MRI (relative to late scan) robustly predicts the predominant pattern and extent of injury.
在患有脑病的体温降低的新生儿中，尽管晚期磁共振成像（MRI）扫描（出生10 - 14天）在预测长期预后方面是可靠的，但早期扫描（出生3 - 6天）是否如此尚不清楚。我们比较了89例患有新生儿脑病的足月儿早期和晚期MRI的主要病变模式和病变范围。43例新生儿（48%）进行了体温降低治疗。在未进行体温降低治疗的婴儿（kappa = 0.94；k = 0.88）和进行了体温降低治疗的婴儿（k = 0.89；k = 0.87）中，分水岭区域的主要病变模式和病变范围分别几乎完全一致。在未进行体温降低治疗的婴儿中，基底核病变范围完全一致（k = 0.83），在进行了体温降低治疗的婴儿中一致性良好（k = 0.67）。89例婴儿中有19例晚期MRI显示病变范围发生变化，低血糖婴儿以及基底核中度至重度病变的婴儿风险更高。在大多数患有新生儿脑病的足月儿中，早期MRI（相对于晚期扫描）能够可靠地预测主要损伤模式和损伤范围。
