극소 저체중 출생아에서 뇌백질 병변의 MRI 소견 = Magnetic resonance imagining findings of the white matter abnormalities in the brain of very-low-birth-weight infants

다국어 초록 (Multilingual Abstract)

Purpose:To observe the abnormal white matter findings on the magnetic resonance imaging (MRI) scans of very-low- birth-weight (VLBW) infant brains at term-equivalent age and to determine the clinical risk factors for the development of periventricular leukomalacia (PVL).
Methods:In all, MRI was performed in 98 VLBW infants and the white matter abnormalities were observed. Clinical risk factors for cystic and noncystic PVL were determined.
Results:MRI scans of 74 infants (75.5%) showed diffuse excessive high signal intensity (DEHSI) in the periventricular white matter, 17 (17.3%) lateral ventricle dilation, 5 (5.1%) and 11 (11.2%) focal punctate lesions and cystic changes in the periventricular white matter, respectively, 9 (9.1%), germinal layer hemorrhage (GLH) or subependymal cysts 3 (3.1%) intraventricular hemorrhage (>grade 2) 2 (2.0%) posthemorrhagic hydrocephalus and 2 (2.0%) periventricular hemorrhagic infarct. Gestational age (GA), 1-minute Apgar score, Clinical Risk Index for Babies-II (CRIB-II) score, and inotrope use, and GA, CRIB-II score, postnatal steroid administration, inotrope use, and abnormal white blood cell (WBC) count at admission were related to cystic PVL and noncystic PVL development, respectively (P<0.05). However, in logistic regression analysis, CRIB-II (odds ratio, 1.63, 295% confidence interval, 1.15–2.30 P=0.006) for cystic PVL, and GA (odds ratio 0.90, 95% confidence interval, 0.82–0.99 P=0.036) for noncystic PVL were only significant independently.
Conclusion:White matter abnormalities could be observed on MRI scans of the VLBW infant brains at term-equivalent age, and CRIB-II and GA were only independently significant for cystic and noncystic PVL development, respectively.

국문 초록 (Abstract)

목적:극소 저체중 출생아에서 교정 주수 만삭(40주) 근처에 시행한 뇌 MRI 소견에서 뇌백질 이상 소견을 관찰하고 측뇌실 부위 백질연화증 발생과 관련 있는 임상 위험 인자를 관찰하고자 하였다.
방법:교정 주수 만삭(40주) 근처에 뇌 MRI를 시행한 극소 저체중 출생아 98명을 대상으로 뇌 MRI의 뇌백질 이상 소견을 관찰하였다. 뇌백질 이상 소견 중 낭성 또는 비낭성 측뇌실 부위 백질 연화증 환아들의 임상 소견을 관찰하여 측뇌실 부위 백질연화증의 발생과 관련된 임상 위험 인자를 관찰하고자 하였다.
결과:1) 98명의 환아 중 DEHSI가 74명(75.5%), 뇌실 확장은 17명(17.3%), 국소 백질 음영 증가는 5명(5.1%), 측뇌실 부위 낭성 소견은 11명(11.2%), 종자층 출혈 또는 상의 하 낭종이 9명(9.1%), 뇌실 내 출혈이 3명(3.1%), 출혈 후 뇌수종이 2명(2.0 %), 측뇌실 부위 출혈성 경색이 2명(2.0%) 관찰되었다. 2) 측뇌실 부위 백질연화증 발생과 관련된 임상 위험 인자로는 낭성 측뇌실 부위 백질연화증에서는 재태 기간, 1분 Apgar 점수, CRIB-II 점수, 혈압 상승제 투여가, 비낭성 측뇌실 부위 백질연화증에서는 재태 기간, CRIB-II 점수, 출생 후 스테로이드 투여, 혈압 상승제 투여, 출생 시 비정상적인 백혈구 수치 등이 통계적으로 의미 있었다(P<0.05). 로지스틱 회귀분석에서는 낭성 측뇌실 부위 백질연화증에서는 CRIB-II 점수(odd ratio, 1.63, 95% confidence interval, 1.15, 2.30, P=0.006)가 비낭성 측뇌실 부위 백질연화증에서는 재태 기간(odd ratio 0.90, 95% confidence interval, 0.82, 0.99, P=0.036)이 독립적인 위험 인자였다.
결론:교정 주수 만삭 근처에 시행한 극소 저체중 출생아의 뇌 MRI는 다양한 뇌백질 이상 소견을 보였고, 측뇌실 부위 백질연화증 발생과 연관된 임상 위험 인자로는 CRIB-II 점수와 재태 기간이 의미 있었다.

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