UMC Utrecht: Universitair Medisch Centrum, Utrecht, Netherlands.
ZNA Middelheim, Antwerp, Belgium.
BMC Neurol. 2023 Mar 11;23(1):104. doi: 10.1186/s12883-023-03125-6.
Kernicterus in the acute phase is difficult to diagnose. It depends on a high signal on T1 at the globus pallidum and subthalamic nucleus level. Unfortunately, these areas also show a relatively high signal on T1 in neonates as an expression of early myelination. Therefore, a less myelin-dependent sequence, like SWI, may be more sensitive to detecting damage in the globus pallidum area.
A term baby developed jaundice on day three following an uncomplicated pregnancy and delivery. Total bilirubin peaked at 542 μmol/L on day four. Phototherapy was started, and an exchange transfusion was performed. ABR showed absent responses on day 10. MRI on day eight demonstrated abnormal high signal globus pallidus on T1w, isointense on T2w, without diffusion restriction, and high signal on SWI at globus pallidal and subthalamus level and phase image at globus pallidal level. These findings were consistent with the challenging diagnosis of kernicterus. On follow-up, the infant presented with sensorineural hearing loss and had a work-up for cochlear implant surgery. At 3 months of age, the follow-up MR shows normalization of the T1 and SWI signals and a high signal on T2.
SWI seems more sensitive to injury than the T1w and lacks the disadvantage of the T1w sequence, where early myelin confers a high signal.
急性期核黄疸较难诊断。其依赖于苍白球和丘脑水平的 T1 高信号。然而，这些区域在新生儿中 T1 也呈现相对高信号，这是早期髓鞘形成的表现。因此，像 SWI 这样较少依赖髓鞘的序列可能更敏感，能检测到苍白球区域的损伤。
足月新生儿，无并发症的妊娠和分娩，生后第 3 天出现黄疸，总胆红素在第 4 天达到 542μmol/L。开始光疗，进行换血治疗。第 10 天 ABR 显示无反应。第 8 天 MRI 显示 T1w 上苍白球高信号，T2w 上等信号，无弥散受限，SWI 上苍白球和丘脑水平高信号，相位图上苍白球高信号，这些发现与核黄疸的挑战性诊断一致。随诊中，婴儿出现感觉神经性听力损失，进行了人工耳蜗植入手术的检查。3 个月时，随访 MRI 显示 T1 和 SWI 信号正常，T2 信号高。
SWI 似乎比 T1w 序列更敏感，且没有 T1w 序列的缺点，即早期髓鞘形成导致高信号。
