Serial brain MRI and ultrasound findings: Relation to gestational age, bilirubin level, neonatal neurologic status and neurodevelopmental outcome in infants at risk of kernicterus
Serial brain MRI and ultrasound findings: Relation to gestational age, bilirubin level, neonatal neurologic status and neurodevelopmental outcome in infants at risk of kernicterus
复制标题
DOI：
10.1016/j.earlhumdev.2008.09.008
复制
发表时间：
2008-12-01
影响因子：
2.5
通讯作者：
Cowan, Frances
中科院分区：
文献类型：
--
作者：
Gkoltsiou, Konstantina;Tzoufi, Meropi;Cowan, Frances
目的：描述新生儿有核黄疸风险的颅超声（cUS）和磁共振成像（MRI）结果，与胎龄（CA）、血清总胆红素（TSB）、成像时年龄和神经发育结局的关系。患者和方法：TSB峰值> 400 μ mol/L和/或胆红素脑病体征的新生儿。回顾新生儿数据、cUS、早产儿、足月儿和后期MRI扫描和神经发育结局。两个< 31周，四个34-36周和五个37-40周CA。TSB水平：235-583 μ mol/L（早产）; 423-720 μ mol/L（足月）。新生儿神经系统检查8/10例异常。cUS显示4/9例婴儿基底神经节（BG）增加，5/9例婴儿出现白色回声（WM）、脑纹血管病（LSV）和尾丘脑强回声/囊肿（GLC）。1/2早产儿、819例足月儿和9/11例晚期MRI均显示苍白球（GP）内异常信号。2例早产儿、7例足月儿和10/11例晚期扫描中出现WM SI异常。7名婴儿出现手足徐动性/张力障碍性脑瘫（CP），6名婴儿出现听力损失（HL）。不良结局与cUS显示的BG异常（3/4 CP，4/4 HL）、晚期T2加权MRI（所有GA）和T1/T2加权足月MRI显示的CP高SI（7/9 CP，6/9 HL）相关，主要发生在足月婴儿中。WM异常，GLC和LSV没有相关outcome.Conclusions：严重CP发生在早产儿TSB水平相对较低，但只有在高水平的足月：HL是难以预测的。早期扫描并不能可靠地预测运动缺陷，而所有患有CP的儿童在后来的扫描中都有异常的中央灰质。早期发现异常WM提示原发性受累，而不是继发于灰质损伤的改变。为什么核黄疸的中央灰质MRI特征在早期没有被发现，仍然没有解释。(C)2008爱思唯尔爱尔兰有限公司保留所有权利。
Aims: To describe cranial ultrasound (cUS) and magnetic resonance imaging (MRI) findings in neonates at risk of kernicterus, in relation to gestational age (CA), total serum bilirubin (TSB), age at imaging and neurodevelopmental outcome.Patients and methods: Neonates with peak TSB > 400 mu mol/L and/or signs of bilirubin encephalopathy. Review of neonatal data, cUS, preterm, term and later MRI scans and neurodevelopmental outcome.Results: 11 infants were studied. two < 31, four 34-36 and five 37-40 weeks CA. TSB levels: 235-583 mu mol/L (preterms); 423-720 mu mol/L (terms). Neonatal neurological examination was abnormal in 8/10. cUS showed increased basal ganglia (BG) in 4/9 infants and white matter (WM) echogenicity, lenticulostriate vasculopathy (LSV) and caudothalamic hyperechogencity/cysts (GLCs) in 5/9 infants. MRI showed abnormal signal intensity (SI) in the globus pallidum (GP) in 1/2 preterm, 819 term and 9/11 later scans. Abnormal WM SI occurred in 2 preterm, 7 term and 10/11 later scans. Seven infants developed athetoid/dystonic cerebral palsy (CP) and 6 hearing loss (HL). Adverse outcome was associated with abnormal BG on cUS (3/4 CP, 4/4 HL), with high SI in CP (7/9 CP, 6/9 HL) on late T2-weighted MRI (all GA) and on T1/T2-weighted term MRI, mainly in term-born infants. WM abnormalities, GLCs and LSV did not correlate with outcome.Conclusions: Severe CP occurred with relatively low TSB levels in preterms but only at high levels in full-terms: HL was difficult to predict. Early scans did not reliably predict motor deficits whilst all children with CP had abnormal central grey matter on later scans. Abnormal WM was seen early suggesting primary involvement rather than change secondary to grey matter damage. Why characteristic central grey matter MRI features of kernicterus are not seen early remains unexplained. (C) 2008 Elsevier Ireland Ltd. All rights reserved.