弥散加权成像早期预测新生儿缺氧缺血性脑损伤区域及其表观弥散系数值改变  

Early prediction of the injuried regions in neonatal brain with hypoxic-ischemic encephalopathy by diffusion weighted imaging and measuring their apparent diffusion coefficient

作　　者：蔡清[1] 薛辛东[1] 富建华[1] 刘春丽[1] 轩哲[1] 张磊[1] 

机构地区：[1]中国医科大学盛京医院儿科,沈阳110004

出　　处：《中华儿科杂志》2011年第5期351-355,共5页Chinese Journal of Pediatrics

摘　　要：目的 阐明弥散加权成像（diffusion weighted imaging,DWI）可于生后早期预测HIE患儿的损伤区域,并且评估不同区域的ADC值变化情况.方法 研究对象为2006年7月至2009年7月,我院新生儿病房收治26例HIE患儿,其临床分度为重度19例和中度7例,均于生后72 h内完成常规MRI和DWI扫描.其中,10例重度HIE患儿（ADC值组）行8个感兴趣区的ADC值测量,以同期住院的12例无神经系统疾病的足月儿为对照.8个感兴趣区分别为内囊后肢（PLIC）、腹外侧丘脑、基底节、中央沟周围皮层、枕叶皮层、半卵圆中心、脑干、额叶白质.结果 生后72 h内,26例HIE患儿的常规MRI示5例蛛网膜下腔出血、2例硬膜下出血,仅1例患儿的T2WI可见部分皮层稍高信号,此外未见其他异常.但26例HIE患儿的DWI均可见异常高信号.在19例重度HIE患儿中,17例（89%）表现为双侧腹外侧丘脑和中央沟周围皮层的异常高信号（其中6例伴有双侧基底节区异常高信号）,仅2例（11%）表现为皮层及皮层下白质的异常高信号.7例中度HIE中,4例表现为皮层及皮层下自质的异常高信号,2例表现为脑室周围白质的异常高信号,仅1例表现为双侧腹外侧丘脑和中央沟周围皮层的异常高信号.ADC值组内囊后肢（PLIC）、腹外侧丘脑、基底节、中央沟周围皮层、枕叶皮层、半卵圆中心、脑干、额叶白质的平均ADC值依次为0.68（0.56～0.88）,0.73±0.13,0.67±0.11,0.78±0.22,0.90±0.16,0.87±0.21,0.73±0.19,1.32±0.22×10-3 mm2/S.对照组内囊后肢（PLIC）、腹外侧丘脑、基底节、中央沟周围皮层、枕叶皮层、半卵圆中心、脑干、额叶白质的平均ADC值依次为0.96（0.95～1.02）,1.02±0.90,1.15±0.99,1.08±0.07,1.09±0.08,1.39±0.20,0.96±0.05,1.58±0.18×10-3 mm2/S.与对照组相比,ADC值组8个感兴趣区的平均表观弥散系数（apparent difusion coefficient,ADC）值明显降低（P＜0.01）.结论 在生后早期,重度HIE患儿的损伤�Objective To elucidate that diffusion weighted imaging （DWI） can be used to predict the injured regions of neonatal brain with hypoxic-ischemic encephalopathy （HIE） in the early phase of injury, and to measure the apparent diffusion coefficient （ADC） values in the multiple regions of the brain.Method The participants in this study were twenty-six infants with HIE from neonatology ward hospitalized between July 2006 and July 2009.Nineteen patients had severe HIE, and seven had moderate HIE.DWI and conventional magnetic resonance imaging （MRI） were performed for each case within the first 72 hrs.The ADC values of eight regions of interest （ROIs） were measured in ten cases with severe HIE （ ADC values group）. ROIs included posterior limb of internal capsule （PLIC）, ventrolateral thalami, basal ganglia, perirolandic cortex, occipital cortex, centrum semiovale, brainstem, and frontal white matter.Twelve neonates were enrolled as the control subjects.Results During the first 72 hfs, the conventional MR1 of 26 patients showed subarachnoid hemorrhage in 5, subdural hemorrhage in 2, and mild high signal intensity in the cortex of only one patient.In the 19 cases with severe HIE, abnormal signal intensities were seen in ventrolateral thalami and perirolandie cortex of 17 patients （ 89% ）, and the remaining 2 infants showed abnormal cortex and subcortical white matter.In 7 cases with moderate HIE, 4 had abnormal signal intensity in the cortex and subcortical white matter, 2 had abnormal periventricular white matter, and only one showed abnormal signal intensity in the ventrolateral thalami and perirolandic cortex.In the ADC values group, the average ADC values of posterior limb of internal capsule （ PLIC ）, ventrolateral thalami, basal ganglia, perirolandic cortex, occipital cortex, centrum semiovale, brainstem, and frontal white matterrespectively were 0.68（0.56-0.88） ,0.73 ±0.13,0.67 ±0.11,0.78 ±0.22,0.90 ±0.16,0.87 ±0.21,0.73 ±0.19,1.32 ±0.22 × 10-3 mm2/S.In the control gro

关 键 词：缺氧缺血 婴儿 新生 磁共振成像 弥散 

分 类 号：R445.2[医药卫生—影像医学与核医学]