颅脑超声对宫内窘迫新生儿脑损伤的早期诊断价值OACSTPCD

Objective To investigate the diagnostic value of cranial ultrasound for brain injury in neonates with intrauterine distress.Methods Totally 146 neonates with intrauterine distress were examined by cranial ultrasound and conventional MRI,and the results of ultrasound and MRI were compared and analyzed.According to the degree of brain injury,the neonates were divided into the brain injury group(n=46)and the non-brain injury group(n=100).The hemodynamic parameters(peak systolic velocity(PSV),end diastolic velocity(EDV)and resistance index(RI))of the middle cerebral artery and anterior artery were compared between the two groups.Receiver operating characteristic(ROC)curve was used to analyze its diagnostic value in brain injury.Results Among 146 neonates with intrauterine distress,46 cases had abnormal imaging signs,and the positive detection rate was 31.74%(46/146).The detection rate of MRI was 91.30%(42/46),which was significantly higher than that of cranial ultrasound was 65.22%(30/46,χ2=9.200,P=0.002).The detection rate of MRI in patients with hypoxic ischemic encephalopathy(12.33%vs 5.48%,χ 2=4.222,P=0.040)and dural or subarachnoid hemorrhage(2.74%vs 0,χ 2=4.056,P=0.044)was significantly higher than that of cranial ultrasound(P<0.05),while the detection rate of periventricular intraventricular hemorrhage by cranial ultrasound was significantly higher than that of MRI(11.64%vs 4.79%,χ 2=4.540,P=0.033).The PSV and EDV of the middle cerebral artery and anterior cerebral artery in the brain injury group were smaller than those in the non-brain injury group,while RI was larger than that in the non-brain injury group(P<0.05).ROC curve showed that the areas under the curve of PSV,EDV and RI in the middle and anterior cerebral arteries for diagnosing brain injury were 0.710,0.786,0.625,and 0.740,0.819,0.613,respectively.Conclusion Craniocerebral ultrasound can early detect the changes in brain tissue structure and hemodynamics in neonates with intrauterine distress,and the detection rate of periventricular-intraventricular hemorrhage is better than MRI,but the diagnosis effect of brain injury is not as good as MRI.The appropriate examination scheme can be selected according to the clinical situation of the children.