新生儿颅脑磁共振检查临床实践的专家共识

Expert consensus on the clinical practice of neonatal brain magnetic resonance imaging

摘要:

颅脑磁共振成像（magnetic resonance imaging，MRI）技术的迅速发展为新生儿脑发育评估、脑损伤诊断和预后判断提供了客观依据，临床应用日益广泛。中国医师协会新生儿科医师分会基于国内外现有研究证据，结合临床实践经验，为新生儿颅脑MRI的适应证和临床实践规范制定专家共识，主要内容包括：（1）疑似新生儿缺氧缺血性脑病、颅内感染、脑卒中，以及原因不明惊厥者应行颅脑MRI；颅脑MRI不纳入早产儿常规脑损伤筛查管理，当颅脑超声筛查有明确损伤证据时应行颅脑MRI进一步评估；对于颅脑超声未见异常的超早产儿和超低出生体重儿，建议在纠正胎龄足月时行颅脑MRI；（2）新生儿颅脑MRI应尽量在非镇静状态下完成；（3）过程中需密切监测生命体征，优化检查条件，保障安全，危重患儿检查需严格评估检查的必要性，可应用磁共振兼容的转运培养箱和呼吸机；（4）目前新生儿颅脑MRI检查可选1.5 T或3.0 T设备，应用新生儿颅脑专用线圈以提高信噪比；常规扫描序列选择应遵循：至少包含轴位T1加权像、轴位T2加权像、弥散加权成像，以及矢状位T1加权像或T2加权像；（5）建议采用结构化或分级报告系统，通过双人审签报告、多中心协作等方式提高报告可靠性。

Abstract:

In recent years, magnetic resonance imaging (MRI) has been widely used in evaluating neonatal brain development, diagnosing neonatal brain injury, and predicting neurodevelopmental prognosis. Based on current research evidence and clinical experience in China and overseas, the Neonatologist Society of Chinese Medical Doctor Association has developed a consensus on the indications and standardized clinical process of neonatal brain MRI. The consensus has the following main points. (1) Brain MRI should be performed for neonates suspected of hypoxic-ischemic encephalopathy, intracranial infection, stroke and unexplained convulsions; brain MRI is not considered a routine in the management of preterm infants, but it should be performed for further evaluation when cranial ultrasound finds evidence of brain injury; as for extremely preterm or extremely low birth weight infants without abnormal ultrasound findings, it is recommended that they should undergo MRI examination at term equivalent age once. (2) Neonates should undergo MRI examination in a non-sedated state if possible. (3) During MRI examination, vital signs should be closely monitored to ensure safety; the necessity of MRI examination should be strictly evaluated for critically ill neonates, and magnetic resonance compatible incubator and ventilator can be used. (4) At present, 1.5 T or 3.0 T equipment can be used for neonatal brain MRI examination, and the special coil for the neonatal head should be used to improve signal-to-noise ratio; routine neonatal brain MRI sequences should at least include axial T1 weighted image (T1WI), axial T2 weighted imaging (T2WI), diffusion-weighted imaging, and sagittal T1WI or T2WI. (5) It is recommended to use a structured and graded reporting system, and reports by at least two reviewers and multi-center collaboration are recommended to increase the reliability of the report.