磁共振成像及氢质子磁共振波谱在新生儿缺氧缺血性脑病中的应用价值  

Application value of MRI and H1-MRS for the neonates with hypoxic-ischemic encephalopathy

作　　者：王瑞珠[1] 邹月芬[2] 唐文伟[1] 管红梅[1] 

机构地区：[1]南京医科大学附属南京儿童医院放射科,江苏南京210008 [2]南京医科大学第一附属医院放射科

出　　处：《实用放射学杂志》2014年第8期1358-1362,共5页Journal of Practical Radiology

摘　　要：目的：探讨 MRI 平扫及氢质子波谱磁共振成像（H 1-MRS）在足月新生儿缺氧缺血性脑病（HIE）中的应用价值。方法30例足月 HIE 患儿和同期10例正常新生儿生后15 d 内行头颅 MRI 及 H 1-MRS 扫描，记录病变区域各代谢产物波峰下面积比值，并进行比较。结果 MRI 平扫能显示 HIE 患儿存在的多种异常征象，当出现弥漫性脑水肿、基底节和脑干损伤、T1内囊后肢高信号消失、脑回征、脑实质广泛出血、广泛白质损伤等是脑损伤严重的表现。H 1-MRS 扫描 HIE 组乳酸/肌酸比值（Lac/Cr）较对照组升高，差异有统计学意义，比值随病情加重程度呈逐渐升高趋势。N-乙酰天门冬氨酸/肌酸比值（NAA/Cr）及 N-乙酰天门冬氨酸/胆碱（NAA/Cho）比值 HIE 组较对照组降低，差异有统计学意义（P 〈0.05），且比值随病情加重程度呈逐渐降低趋势。谷氨酸复合物-α/肌酸（Glx-α/Cr）在对照组与 HIE 组有显著性差异，在中重度组明显高于轻度组及对照组（P 〈0.05）。胆碱/肌酸（Cho/Cr）比值在4组中差异无显著性。结论 H 1-MRS 与 MRI 平扫相结合可客观反映 HIE 患儿脑形态及代谢变化，更好地评价脑损伤的严重程度，为临床诊治提供有效依据。Objective To study the value of MRI and proton magnetic resonance spectroscopy（H 1-MRS）for neonatal hypoxic-ischemic encephalopathy（HIE）.Methods Magnetic resonance imaging （MRI）and proton magnetic resonance spectroscopy （H 1-MRS）were performed in 30 cases of full-term neonates with HIE,and 10 infant control group without evidence of birth asphyxia. Cerebral MRI and H 1-MRS were performed within 1 5 days after birth.The results of H 1-MRS such as subwave crest values of metabolites in lesion areas were recorded.The data were analyzed statistically.Results （1）MRI showed abnormal fetures of HIE such as diffuse cerebral edema,loss of hyperintensity in the posterior limb of the internal capsule on T1 WI,gyrus sign,diffuse parenchymal hemorrhage,which could predict the severity of brain damage.（2）On H 1-MRS,the ratio of Lac/Cr in HIE group was much higer than that in control group,which was statistically significant （P 〈0.05）.The ratio of Lac/Cr showed a rising trend with clini-cal grading of HIE.The ratio of NAA/Cr and NAA/Cho were lower in HIE group than that in control group （P 〈0.05）,which showed a trend of gradually reduce with clinical grading of HIE.The difference between ratio of Glx-α/Cr in HIE group and control group was also significantly,the moderate-severe group was much higher than the mild group and control group.There was no sig-nificant difference in the ratio of Cho/Cr between the 4 groups.Conclusion The combination of MRI and H 1-MRS can objectively re-flect brain morphology and metabolic changes of HIE,and evaluate the severity of the brain injury,and provide an effective evidence for clinical diagnosis and treatment.

关 键 词：磁共振成像 磁共振波谱 新生儿缺氧缺血性脑病 

分 类 号：R445.2[医药卫生—影像医学与核医学] R722.1[医药卫生—诊断学]