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新生儿缺氧缺血性脑病(HIE)有比较统一的临床诊断与分度标准,但是符合相同诊断标准的窒息所致HIE的临床表现、神经病理损伤类型有很大差异。磁共振成像(MRI)能很好地呈现HIE损伤类型、损伤进程,且与其远期神经发育结局密切相关,但不同MRI检查序列所反映的损伤表现可能不尽相同。弥散加权序列适宜的检查时间为出生后2~4 d,常规序列为出生后的4~8 d。HIE的MRI主要损伤类型有丘脑基底节+内囊后肢损伤、分水岭样损伤累及皮层和皮层下白质、局灶-多灶性微小性白质损伤,以及广泛全脑性损伤。严重的急性产时窒息易导致深部灰质损伤(丘脑基底节),也可累及脑干,锥体束是最易受累的白质纤维束,而反复间断性缺氧缺血以及伴有感染、低血糖等易导致分水岭区和深部白质损伤。但上述损伤类型有时很难明确区分,而是以某一类型为主,并非所有HIE都有特征性的MRI表现。
Neonatal hypoxic-ischemic encephalopathy (HIE) has a more uniform clinical diagnosis and classification criteria, but in line with the same diagnostic criteria of HIE caused by asphyxia clinical manifestations, neuropathic injury types are very different. Magnetic resonance imaging (MRI) can well present the type of HIE injury, the process of injury, and its long-term neurodevelopmental outcome is closely related, but different MRI examination sequence may reflect the performance of different lesions. Diffusion-weighted sequence appropriate examination time after birth 2 ~ 4 d, the conventional sequence of 4 to 8 d after birth. HIE MRI main injury types are the thalamus basal ganglia + hind limb injury, watershed lesions involving the cortex and subcortical white matter, focal - multifocal small white matter damage, and extensive global brain injury. Severe acute aspartate asphyxia can easily lead to deep gray damage (thalamus basal ganglia), but also to the brain stem, pyramidal tract is the most vulnerable white matter fiber bundle, and repeated intermittent hypoxic-ischemic and associated with infection, hypoglycemia Easily lead to watershed and deep white matter damage. However, it is sometimes difficult to clearly distinguish the types of injuries described above, but based on a certain type. Not all HIEs have characteristic MRI manifestations.