Parikh Nehal A, Pierson Christopher R, Rusin Jerome A
Cincinnati Children's Hospital, The Perinatal Institute, Cincinnati, Ohio; Department of Pediatrics, Ohio State University College of Medicine, Columbus, Ohio.
Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital, Columbus, Ohio; Department of Pathology, Division of Anatomy, The Ohio State University College of Medicine, Columbus, Ohio.
Pediatr Neurol. 2016 Dec;65:78-85. doi: 10.1016/j.pediatrneurol.2016.07.006. Epub 2016 Jul 21.
Diffuse excessive high signal intensity abnormality is the most common finding on term-equivalent age magnetic resonance imaging in extremely preterm infants. Yet its clinical significance remains a matter of debate, in part because of a lack of prior imaging-pathology correlational studies.
We present two 24-week-gestation infants with complicated clinical courses who died at 33 and 46 weeks postmenstrual age with magnetic resonance imaging evidence of diffuse excessive high signal intensity. Two patients with periventricular leukomalacia and two without injury were examined for comparison. Immunohistochemistry characterized the presence of reactive astrocytes, microglia, myelin, and axons. Infants with periventricular leukomalacia demonstrated the typical microscopic necrosis with spheroids, gliosis/microgliosis with reduction in stainable myelin and axons. Infants with diffuse excessive high signal intensity showed vacuolated regions with increased reactive astrocytes and microglia and fewer oligodendroglial cell bodies/processes and dramatic reduction in axon number.
These two individuals with diffuse excessive high signal intensity exhibited pathologic characteristics that were overlapping but distinct from those of periventricular leukomalacia.
弥漫性高信号强度异常是极早产儿在相当于足月年龄的磁共振成像中最常见的表现。然而，其临床意义仍存在争议，部分原因是缺乏先前的影像学-病理学相关性研究。
我们报告了两名孕24周的婴儿，他们临床病程复杂，分别在孕龄33周和46周时死亡，磁共振成像显示有弥漫性高信号强度。为作比较，还检查了两名脑室周围白质软化症患者和两名未受伤的患者。免疫组织化学鉴定了反应性星形胶质细胞、小胶质细胞、髓磷脂和轴突的存在。脑室周围白质软化症婴儿表现出典型的显微镜下坏死，有球状体、胶质增生/小胶质细胞增生，可染色的髓磷脂和轴突减少。弥漫性高信号强度婴儿显示有空泡化区域，反应性星形胶质细胞和小胶质细胞增多，少突胶质细胞体/突起减少，轴突数量显著减少。
这两名弥漫性高信号强度患者表现出的病理特征与脑室周围白质软化症有重叠但不同。
