MRI identification of early white matter injury in anoxic-ischemic encephalopathy
MRI identification of early white matter injury in anoxic-ischemic encephalopathy
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DOI：
10.1212/wnl.56.4.481
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发表时间：
2001-02-27
期刊：
影响因子：
9.9
通讯作者：
Kasner, SE
中科院分区：
文献类型：
--
作者：
Chalela, JA;Wolf, RL;Kasner, SE
背景：缺氧缺血性脑病（AIE）对灰质的影响大于白质。最近的动物实验表明，白质对缺血比以前认为的更敏感。作者描述了7例AIE患者的MRI结果，这些患者表现出早期白质优先受累。材料和方法：回顾性病例系列研究，包括7例AIE患者，他们在损伤后7天内接受了脑部MRI检查。人口统计信息，侮辱类型，临床。获得检查结果、脑电图结果和临床结果。回顾MRI研究，特别关注皮层、深部灰质和白质结构。计算小脑半球、壳核、丘脑、胼胝体脾、半叶中心体和内侧额叶皮质感兴趣区域的平均表观扩散系数（ADC）。结果：AIE的病因为心律失常2例，心肌梗死1例，药物过量2例，一氧化碳中毒1例，呼吸衰竭和败血症1例。到MRT的中位时间为2.5天。在脑室周围白质束（7/7例）、胼胝体（6/7例）、内囊（5/7例）和皮质下联合纤维（3/7例）均发现扩散受限的对称区。ADC图证实扩散受限。三例患者可见灰质受累，与弥散加权成像相比，在常规成像序列上更为突出。皮层平均ADC略有下降。结论：AIE后早期白质可出现明显的对称限制性弥散，而灰质受累可能不太明显。需要进一步的研究，包括更大的样本和连续成像来证实这些初步发现。
Background: Anoxic-ischemic encephalopathy (AIE) affects the gray matter more than the white matter. Recent animal experiments suggest that the white matter is more sensitive to ischemia than previously thought. The authors describe the MRI findings in seven patients with AIE who demonstrate early preferential involvement of the white matter. Materials and methods: A retrospective case series study was performed, including seven patients with AIE who underwent MRI of the brain within 7 days of insult. Demographic information, type of insult, clinical. examination findings, EEG findings, and clinical outcome were obtained. MRI studies were reviewed with specific attention to the cortex, deep gray matter, and the white matter structures. Mean apparent diffusion coefficient (ADC) was calculated in regions of interest placed in the cerebellar hemispheres, putamen, thalamus, splenium of corpus callosum, centrum semiovale, and medial frontal cortex. Results: The causes of AIE were cardiac arrhythmias in two patients, myocardial infarction in one, drug overdose in two, carbon monoxide poisoning in one, and respiratory failure and sepsis in one. The median time to MRT was 2.5 days. Symmetric areas of restricted diffusion were found in the periventricular white matter tracts (7/7 patients), the corpus callosum (6/7 patients), internal capsule (5/7 patients), and the subcortical association fibers (3/7 patients). ADC maps confirmed the restricted diffusion. Gray matter involvement was seen in three patients, and was more prominent on conventional imaging sequences compared with diffusion-weighted imaging. A subtle decrease in mean ADC was seen in cortex. Conclusions: Prominent, symmetric restricted diffusion can occur early after AIE in white matter, whereas gray matter involvement may be less prominent. Further studies involving a larger sample and serial imaging are required to confirm these preliminary findings.