扩散张量成像各向异性分数在足月新生儿缺氧缺血性脑病中的应用  

Fractional Anisotropy of Diffusion Tensor Imaging in Evaluating Neonatal Hypoxic-ischemic Encephalopathy

作　　者：向葵[1] 干芸根[1] 王宏伟[1] 杜牧[2] 

机构地区：[1]深圳市儿童医院放射科,广东深圳518038 [2]深圳市妇幼保健院,广东深圳518028

出　　处：《中国医学影像学杂志》2016年第4期248-252,共5页Chinese Journal of Medical Imaging

基　　金：深圳市科创委基础研究项目(JCYJ20140416141331480;JCYJ20140414144755473)

摘　　要：目的探讨磁共振扩散张量成像(DTI)的各向异性分数(FA)值在足月新生儿缺氧缺血性脑病(HIE)早期诊断及病情评估中的应用,为临床治疗提供依据。资料与方法收集58例临床确诊的足月HIE患儿,其中轻度HIE 28例,中度HIE19例,重度HIE 11例,并选取20例正常足月新生儿为对照组,行颅脑常规MRI及DTI扫描,测量内囊前肢、内囊后肢、豆状核、胼胝体膝部及胼胝体压部的FA值,比较各组不同部位的FA值。结果对照组内囊前后肢、胼胝体膝部和压部的FA值均高于中度HIE组和重度HIE组,对照组胼胝体膝部的FA值高于轻度HIE组,轻度HIE组和中度HIE组内囊前后肢、胼胝体膝部和压部的FA值高于重度HIE组,轻度HIE组内囊后肢FA值高于中度HIE组,差异均有统计学意义(P<0.05);各组豆状核的FA值差异均无统计学意义(P>0.05)。在各部位中,内囊后肢FA值诊断HIE的准确度最高,曲线下面积为0.802,当内囊后肢FA值的截断点取0.543时,诊断灵敏度为61.2%,特异度为85.0%,Youden指数为0.462。结论 DTI FA值可以早期、定量评价HIE新生儿脑损伤的程度,为HIE的早期诊断及病情评估提供客观依据。Purpose To investigate the feasibility of fractional anisotropy（FA） in the evaluation of neonatal hypoxic ischemic encephalopathy（HIE） using magnetic resonance diffusion tensor imaging（DTI）. Materials and Methods Fifty-eight neonates with HIE confirmed clinically（28 mild, 19 moderate and 11 severe HIE neonates, respectively） and twenty age-matched controls were recruited to have conventional brain MRI and DTI scans. FA values at anterior and posterior limbs of internal capsule, lenticular nucleus, and genu and splenium of corpus callosum were measured respectively. FA values among different groups were compared. Results FA values at anterior and posterior limbs of internal capsule, and genu and splenium of corpus callosum in the control group were higher than those of the moderate and the severe HIE groups. FA value at genu of corpus callosum was exhibited greater in the controls than that in the mild HIE group. Higher FA values were found at anterior and posterior limbs of internal capsule, and genu and splenium of corpus callosum in the mild and moderate groups compared to the severe group. FA value at posterior limb of internal capsule in the mild HIE group was found to be greater than that of the moderate group（P〈0.05）. No significant difference of FA value at lenticular nucleus was observed among different groups（P〈0.05）. Specially, FA value at posterior limb of internal capsule proved to be superior in diagnosis of HIE with area under the curve of 0.802. When FA threshold at posterior limb of internal capsule was set to be 0.543, the diagnosis susceptibility and specificity were 61.2% and 85.0%, respectively, with the Youden index of 0.462. Conclusion The index of FA can facilitate the quantitative evaluation of neonatal brain injury with HIE, which may provide important information for early diagnosis and disease assessment.

关 键 词：缺氧缺血 脑 磁共振成像 扩散张量成像 各向异性分数 婴儿 新生 足月分娩 

分 类 号：R722.1[医药卫生—儿科] R445.2[医药卫生—临床医学]