Hypoxic-ischemic brain injury: Imaging findings from birth to adulthood
Hypoxic-ischemic brain injury: Imaging findings from birth to adulthood
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DOI：
10.1148/rg.282075066
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发表时间：
2008-03-01
期刊：
影响因子：
5.5
通讯作者：
Castillo, Mauricio
中科院分区：
文献类型：
--
作者：
Huang, Benjamin Y.;Castillo, Mauricio
大脑的全面缺氧缺血性损伤（HII）是死亡和严重神经功能障碍的重要原因。影像学在HII的诊断和治疗中起着重要作用，有助于指导急性环境中的病例管理，并提供有关长期预后的有价值信息。HII的正确影像学诊断需要熟悉该损伤的多种影像学表现。脑成熟度、损伤的持续时间和严重程度、影像学检查的类型和时间等因素都会影响HII的结果。早产儿和足月新生儿的严重缺氧缺血优先损害深部灰质，在后一年龄组中更常见的是周围区受累。不太严重的损伤导致早产儿脑室内出血和脑室周围白色物质损伤，足月儿脑旁分水岭区梗死。在出生后，严重的损伤会导致弥漫性灰质损伤，周围脑皮质和由后循环供应的结构相对较少。在年龄较大的儿童和成人中，严重的缺氧缺血会影响深部灰质核团、皮质、小脑和小脑。由于在常规成像的结果可能是微妙的，甚至没有在急性设置，特别是在新生儿，磁共振波谱可以帮助建立诊断HII。目前正在研究有希望的新的神经保护策略，旨在限制缺氧缺血引起的脑损伤的程度。(c)RSNA，2008年。
Global hypoxic-ischemic injury (HII) to the brain is a significant cause of mortality and severe neurologic disability. Imaging plays an important role in the diagnosis and treatment of HII, helping guide case management in the acute setting and providing valuable information about long-term prognosis. Appropriate radiologic diagnosis of HII requires familiarity with the many imaging manifestations of this injury. Factors such as brain maturity, duration and severity of insult, and type and timing of imaging studies all influence findings in HII. Severe hypoxia-ischemia in both preterm and term neonates preferentially damages the deep gray matter, with perirolandic involvement more frequently observed in the latter age group. Less profound insults result in intraventricular hemorrhages and periventricular white matter injury in preterm neonates and parasagittal watershed territory infarcts in term neonates. In the postnatal period, severe insults result in diffuse gray matter injury, with relative sparing of the perirolandic cortex and the structures supplied by the posterior circulation. Profound hypoxia-ischemia in older children and adults affects the deep gray matter nuclei, cortices, hippocampi, and cerebellum. Because findings at conventional imaging may be subtle or even absent in the acute setting, particularly in neonates, magnetic resonance spectroscopy can help establish the diagnosis of HII. Promising new neuroprotective strategies designed to limit the extent of brain injury caused by hypoxia-ischemia are currently under investigation. (c) RSNA, 2008.