미숙아에서 뇌 MRI와 뇌 초음파 검사의 결과 비교
Neuroimaging in Preterm Infants: Comparison between Magnetic Resonance Imaging and Ultrasonography
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목적: 미숙아에서 뇌 자기공명영상(magnetic resonance imaging,MRI) 검사는 신경발달의 결과를 예측하는 방법으로서 점차 많이사용되고 있지만, 정기적 뇌 초음파 검사는 여전히 신생아 뇌 검사방법의 기준으로 남아있다. 미숙아에서 퇴원 무렵에 시행된 뇌 자기공명영상과 입원기간 중 연속적으로 시행된 뇌 초음파영상을 비교하여 뇌 자기공명영상이 추가적인 정보를 줄 수 있는지 알아보았다. 방법: 2006년 1월부터 2011년 6월까지 임신나이 32주 미만의 미숙아로 분당 서울대병원 신생아 중환자실에 입원한 환아들 중 퇴원무렵에 뇌 MRI 검사를 받은 225명을 대상으로 하였으며, 이들 환아중 염색체 이상 또는 중추신경계 기형이 있는 28명 환아를 제외한197명의 뇌 MRI와 입원기간 중 뇌 초음파 소견을 비교하였다. 결과: 대상 환아들 중 퇴원 무렵 뇌 MRI 검사 결과가 정상인 환아는 142명(124/197, 72%) 이었고, 양성 소견(positive finding)을 보인환아는 55명(55/197, 28%) 이었다. 뇌 초음파에서 미숙아의 주요 뇌병변에 대해 기술된 경우는 뇌실 내 출혈 82명, 뇌실 주위 백질연화증 90명, 뇌실질의 출혈 7명 및 허혈성 병변 3명 이였고, 뇌 MRI에서는 각 질환 별로 30명, 10명, 12명, 3명 이었다. 뇌실 확장은 주로 뇌 초음파에서 발견되었고, 뇌 초음파에서 발견되지 않았던 뇌실 내 출혈5건, 뇌실 주변 백질연화증 1건, 뇌실질 출혈 11명, 소뇌 병변 9명은뇌 MRI에서만 발견되었다. 교정나이 만삭아 시기에 촬영한 뇌 MRI 에서 입원기간 마지막으로 시행한 뇌 초음파에서 발견되지 않았던뇌실 내 출혈(Grade 1 or 2)이 발견되기도 하였다. 결론: 뇌 초음파 검사와 비교할 때, 미숙아들에게 퇴원 전 뇌 MRI 검사는 뇌 초음파 검사에서 발견하기 어려운 뇌 실질의 출혈, 소뇌병변의 발견 및 뇌실 내 출혈 정도를 명확히 확인하는 데 있어서도도움이 될 것으로 생각된다
Abstract
Purpose : Brain magnetic resonance imaging (MRI) scans have become increasingly popular as a predictive tool for neurodevelopmental outcome in preterm infants, while serial brain ultrasonograms remain as a standard evaluation modality for neonatal brain. The aim of this study was to determine whether brain MRI taken at term-equivalent age could give us further information over serial brain ultrasonograms taken during admission. Methods : We analyzed 225 preterm infant (<32 weeks gestational age) who were admitted to NICU at Seoul National University Bundang Hospital from January 2006 to June 2011. The 28 infants with chromosomal abnormalities or major congenital anomalies were excluded. We compared abnormal findings between brain MRI scan taken at term-equivalent age and serial brain ultrasonograms taken during admission in 197 preterm infants. Results : The brain MRI scans taken at term-equivalent age showed normal findings in 142 out of 197 (72%) infants and abnormal findings in 55 out of 197 (28%) infants. The brain ultrasonograms during admission revealed 82 intraventricular hemorrhages, 90periventricular leukomalacias, 7 brain parenchymal lesions, 3 ischemic lesions. Brain MRI scans discovered 30 intraventricular hemorrhages, 10 periventricular leukomalacias, 12 brain parenchymal lesions, 3 ischemic lesions. Ventriculomegaly was discovered only by the brain ultrasonography. Five brain parenchymal lesions and 9 cerebellar lesions were appeared only on the brain MRI scans. Brain MRI scans taken at term-equivalent age detected grade 1 or 2 intraventricular hemorrhages which were not discovered by last brain ultrasonograms. Conclusion : In compare to the serial brain ultrasonograms, the brain MRI scan taken at term-equivalent age is advantageous in discovering brain parenchymal lesions and cerebellar lesions and precise grading of intraventricular hemorrhage in preterm infants.
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