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교정 주령 만삭 주변에 촬영한 뇌 자기 공명 영상의 백질에서 미만 성 과잉 고신호 강도(diffuse excessive high signal intensity, DEHSI) 소견을 보이는 극소 저체중 출생아의 신경발달

Neurodevelopmental Outcomes of VLBW Infants with Diffuse Excessive High Signal Intensity (DEHSI) in the White Matter of the Brain MR Imaging around a Near Termequivalent Age

장영표|오종석|성인창
대한신생아학회 (THE KOREAN SOCIETY OF NEONATOLOGY)|2012.11|Neonatal medicine|제19권 제4호|pp. 212-220

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키워드

Cerebral palsyVery low birth weightDevelopmental delayMagnetic resonance imagingWhite matter disease

초록

목적: 극소 저체중 출생아에서 뇌 MRI의 백질에서 미만성 과잉 고신호 강도(diffuse excessive high signal intensity, DEHSI) 소견과신경 발달 장애의 연관성을 연구하고자 하였다. 방법: 교정 주령 만삭 근처에 뇌 MRI를 촬영하였던 167명의 극소저체중 출생아를 대상으로 T1-과 T2-가중 영상에서 뇌 백질 병변에 대하여 판독하였다. DEHSI의 존재를 결정하고 그 확장 정도에 따라4단계로 분류하였다. 교정 연령 18-24개월에 신경학적 진찰과 신경발달 평가(BSID-II)를 받은 94명에서 DEHSI와 신경 발달 장애의 연관성을 조사하였다. 결과: 뇌 MRI에서 DEHSI는 가장 흔히 관찰되는 백질 소견이었다(68.3%). 재태 주령과 출생 체중은 DEHSI의 확장 정도가 증가함에따라 증가하는 경향을 보였다(각각 P=0.060, P=0.001). DEHSI의 확장 정도와 교정 연령 18-24개월의 뇌신경 발달 결과는 의미 있는 연관성이 없었다(P>0.05). 뇌 MRI의 측뇌실 백질 낭성 소견과 뇌실 확장이 신경 발달 장애의 의미 있는 위험인자였다(P<0.05). 결론: DEHSI는 극소 저체중 출생아에서 교정 주령 만삭 근처에촬영한 뇌 MRI의 백질에서 가장 흔히 보이는 소견인데, 교정 연령18-24개월의 뇌신경 발달 장애와는 연관이 없는 것으로 여겨졌다.

Abstract

Purpose: The aim of this study was to investigate the relationship between diffuse excessive high signal intensity (DEHSI) in the white matter of the brain MRI and neurodevelopmental abnormalities in VLBW infants. Methods: The T1- and T2-weighted MR images of the brain around a near term-equivalent age in 167 VLBW infants were evaluated for the white matter lesions. The presence of DEHSI was determined and classified into four grades on the extent of DEHSI. The relationship between the grade of DEHSI and neurodevelopmental abnormalities was investigated in 94 infants who were assessed for neurodevelopmental outcomes by using a neurologic examination and neurodevelopmental assessment (BSID-II) at 18-24 months of corrected age. Results: DEHSI was the most commonly observed white matter lesion (68.3%) in the MR imaging of the brain around a near term-equivalent age. Gestational age and birth weight tended to increase with increasing grade of DEHSI (P=0.060, P=0.001, respectively). There was no significant relationship between the grade of DEHSI and neurodevelopmental outcomes at 18–24 months of corrected age (P>0.05). Periventricular cysts and ventriculomegaly in the brain MRI were significant risk factors for neurodevelopmental abnormalities (P<0.05). Conclusion: DEHSI, most commonly seen in the white matter of the brain MRI around a near term-equivalent age in VLBW infants,did not seem to be related to the neurodevelopmental abnormalities at 18-24 months of corrected age.

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